Still wicked confused!! (and without machine)

Sleeper · Post by **Sleeper** » Wed Sep 21, 2005 8:16 pm

Let's see, well, to recap; I've got my Rx for a CPAP machine, pressure set to 8. The doc recommends a Swift Mirage and a machine w/C-Flex, but he was dismissive of the Auto-Pap idea. So here I am, about a month out from my last sleep study, and still with no machine and no treatment.

I started reading this board and began thinking an auto machine would be great because at least I would have the feature if I need it. I really don't want to have to go back in for repeat studies if I don't have to. I also want to get a card reader and software. So I got the ball rolling with billmyinsurance.com and it sounds like they're "in-network" for insurance. I still would need to talk with my doctor about the auto versus the standard cpap machine, and that makes me a little nervous.

So I got the estimated copay for billmyinsurance and for comparison sake, I went to LINCARE today...

Well, I've got to say, I was pleasantly surprised and disappointed at the same time. I *finally* got the chance to actually see these different machines, look at the masks, and just generally get a better sense of this stuff. According to the RT, they don't carry the Remstar auto. She showed me the Remstar Pro2, plus, and the tiny little S8 escape. I liked the RT, and I got the impression that she would be very helpful and accommodating. I can also kind of see the logic in the insurance company renting the machine for a 3-month trial.

BUT, nobody at the Lincare office was able to quote me a single price. They had no idea. They wrote the Lincare 800 # on a post-it note and told me to call billing.

Even if Lincare is lots more expensive, I'm now thinking my copay will be roughly the same. I have a $500 annual out-of-pocket limit.

So the dilemma is, do I go with the local DME where I can get my hands on things and say, return a mask if I don't like it? Or do go where I can get it the cheapest, *make sure* I get my manuals, and where I can get the auto machine.

The RT also mentioned that my doctor regularly adjusts patients' pressures without having them repeat sleep studies, so that was a relief if I *do* go with a straight CPAP.

Another question, while I'm at it: Does anyone know if Lincare can *lock* certain settings on the Remstar Pro2's?

Okay, that's all for now!! Eventually I hope to actually have one of these machines here at home. Thanks for all the help!

wading thru the muck! · Post by **wading thru the muck!** » Wed Sep 21, 2005 8:57 pm

Sleeper,

Don't get sucked in by the evil DME propaganda. They are worse than used car salesmen. The reason they don't carry the autos is because they can't bill any more for them. As far a getting a price...why would they not be able to tell you a price unless they practice a "make it up as we go" policy. You don't need a special prescription from your Doc to get an auto from cpap.com. You may have gotten lucky and found a good RT, but many on the forums have been wowed by the initial visit and then banished to unanswered voicemail purgetory. I can't count the number of posts from people who wait several WEEKS for a call back. There is a reason that they have earned the nickname Lin-don't-Care.

capt · Post by **capt** » Wed Sep 21, 2005 9:05 pm

A Remstar auto with cflex and humidifier is $760 delivered to your door from cpap.com. A Remstar pro with humidifier is $499 delivered. If I had the prescription for a cpap, and for $760 I could get an auto with humidifier, I know what I would be doing. Now, if my doctor was paying for my machine out of his pocket, I might get the machine he wanted, otherwise I am buying the machine I want. I can understand your wanting to try various masks and then buying them locally from them, since they are providing you with that service.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): humidifier, cpap.com, cflex, CPAP, Prescription, auto

snork1 · Post by **snork1** » Wed Sep 21, 2005 11:08 pm

and never EVER believe a DME that says "We'll call YOU."
Just keep calling them until they get so tired of your calls that they finally deal with you....eventually....

Patrick A · Post by **Patrick A** » Wed Sep 21, 2005 11:17 pm

Sounds like APRIA Healthcare

Sleeper · Post by **Sleeper** » Thu Sep 22, 2005 8:02 am

Boy oh boy, EVERYBODY you talk to at Lincare tells you something different! I called the billing office and they told me their contracted rate for a generic CPAP is $1200. The RT in the local office tells me they're all different prices, yet the woman at the desk says that a "cpap is a cpap is a cpap" to the carrier. Oh man...

Patrick A · Post by **Patrick A** » Thu Sep 22, 2005 6:37 pm

ARE you SURE YOU ARE NOT TALKING TO APRIA HEALTHCARE IN SAN DIEGO ???

Sleeper · Post by **Sleeper** » Thu Sep 22, 2005 7:04 pm

Patrick A wrote:ARE you SURE YOU ARE NOT TALKING TO APRIA HEALTHCARE IN SAN DIEGO ???

Are they pretty BAD ??!

Man, what is with these fools, right?

Patrick A · Post by **Patrick A** » Thu Sep 22, 2005 7:15 pm

If I could get rid of them I would but they do stand behind your product, but don't try to call them for customer service and or try to pay your co-pay, just go online with a CC and pay them.

RAMBLINMAN · Post by **RAMBLINMAN** » Fri Sep 23, 2005 6:17 pm

Hey Sleeper,

I know exactly how your feeling I had went for my sleep study in July/Aug. and saw my Dr. and got my RX for a cpap devive on Aug. 18th,

It is now the 23rd. Of Sept. and so far I've been thru 2 DME's and submitting my information to billmyinsurance.com

Like yourself I also been reading the post and alot of good information from the people on here and I also went with a few suggestion on wanting a Remstar Auto w/Cflex and the accompaning software/ reader.

It's been now over a month and with all the headaces I've had with DME's I really don't know what to do if billmyinsurance doesn't work....

With my insurance both DME's got aproval for renting a machine but just refuse to get me an Auto....aleast the 2nd one came close with a remStar Pro2...( like the DME quoted how I wanted a macahine that uses software ).

The really bad thing is that the 2nd DME was one reconmended from my insurance I wasn't going to have to pay a dime.

I just don't understand how everyone else on here ( unless they pay with their own money) able to get a RemStar Auto with no problem with or without insurance. Not to mention unlike you and myself people on here got there setup less than a week after they got their RX....!!

yawn · Post by **yawn** » Fri Sep 23, 2005 6:58 pm

Sleeper,
I sent you a PM with actual Lincare costs for Remstar Pro2 with C-flex and a Humidifier...also cost of a swift mask.

Amy

WAFlowers · Post by **WAFlowers** » Sat Sep 24, 2005 2:02 pm

I bought my auto out of my own pocket for about the same price as my deductible.

Actually, I might have saved $$$ given the high markup that a DME has.

In network my deductible was $500 plus 20% of the balance.

4Katie · Post by **4Katie** » Sat Sep 24, 2005 7:20 pm

I can't count the number of posts from people who wait several WEEKS for a call back. There is a reason that they have earned the nickname Lin-don't-Care.

Gee, I called twice and got return calls the same day!

Of course, both times their answer to my problem was 'keep trying for a few weeks, and call back if you're still having trouble.' Thanks a lot.

Needless to say, that's the last time they heard from me. I get all the help I need right here.

Incidently, those were the only two conversations I've had with any medical peeps since getting my machine.

Sleeper · Post by **Sleeper** » Sat Sep 24, 2005 7:53 pm

One of the other DMEs, Keene Medical Products, told me that BCBS sets *one* rate for CPAP machines and that as long as it's billed to insurance, all the DMEs charge that same rate to that particular company. Not sure if that's true or not, but I did get a quote from BillMyInsurance which seemed to be about the same as what Lincare said they would charge. It wasn't quite apples to apples, tho, it was more like Remstar Autos to Pro/2s w and w/o humidifiers. I guess a lot of it depends on how high your deductible and copay is. I seem to be in a pretty good plan. It's a $250 deductible, followed by an 80/20 copay till the $500 annual out-of-pocket limit, and then they cover 100%. Of course, when I look at my paychecks every 2 weeks it's pretty obvious where the money's coming from!!

I'm still trying to figure all this out, but it's been so great to be able to come to this board and ask questions and blow off a little steam!

mommaw · Post by **mommaw** » Sat Sep 24, 2005 10:13 pm

sleeper,

Go with billmyinsurance.com. You will be glad you did. Whild I have not used them, they are part of cpap.com and I have been very pleased with all my purchases from them. I have set up my insurance account with billmyinsurance.com, but since I am not due any mask upgrades at this time, I have not ordered thru them. Get an auto with heated humidifier, you will be glad you did.

Good luck
Gilda

Mask	Humidifier

Additional Comments: Pur~Sleep Oils (Love Them) Aussie Heated Hose, Encore Analyzer, Pad-A-Cheek Guards (Work Great!)