Buying directly... your experience?

[Mikosiko]

Time to renew my mask and filters have come and I just found out that my insurance (AVMED) has a new DME provider... I've been trying to work with them for 3 days to get my mask and filters... no luck... what a bunch of inept!!

so... I called my insurance and according to them I CANNOT buy anything directly because they will no reimburse anything .... in your experience is that true? or the CS rep. just gave me s$$$&&&**t ?

your opinions? ...

thanks
Miko

[roster]

When the insurance company is paying, they have the right to select the supplier(s).

Unfortunately, it is not so easy for you to change insurance companies, because government has taken actions that severely limit competition among insurance companies.

[6PtStar]

Most insurance companies (including mine) I have had any contact with will not reimburse for anything not bought from the company's they have contracts with. A few people have reported that their insurance company would but it is generally at a much lower rate even if you are saving them lots of money.

Jerry

[Janknitz]

The rep was probably telling you the truth, but the only way to be sure is to request a copy of your insurance company's "Evidence of Coverage" (EOC) booklet. You will have to specifically request this from the insurance company--it is not sent to you as a matter of course. The EOC is the fine print of the contract you have with your insurance company (that you knew nothing about until now!). There should be a section in there about how they reimburse for DME and supplies.

I hate the only provider my insurance company will cover, so if at all possible I pay out of pocket. I have used the auction site with good success to get items I wanted that I couldn't get at all from my insurance company or items that cost me less to buy online than the co-pay.

OTOH, it's a judgment call for you. Your insurance company has contracted to provide this to you, that's part of what you pay for. Paying for CPAP supplies should save the insurance company money in the long run by not paying for the illnesses that lack of treatment could cause. So it is their obligation, but they do make it difficult (on purpose, hoping you'll go away).

[Mikosiko]

Thank you all for the answers....

Miko

[jweeks]

Time to renew my mask and filters have come and I just found out that my insurance (AVMED) has a new DME provider... I've been trying to work with them for 3 days to get my mask and filters... no luck... what a bunch of inept!!

so... I called my insurance and according to them I CANNOT buy anything directly because they will no reimburse anything .... in your experience is that true?

Miko,

What are you buying, and what kind of co-pay do you have? I found that my insurance co-pays were often higher than what I could buy the stuff for directly from a place like cpap.com. As a result, I buy everything myself. That lets me pick what I want, when I want, without having to beg. And for me, it is cheaper in the long run. My insurance is great at paying for clinic visits and sleep clinic bills, and that is wonderful.

-john-

[LoQ]

Ask if they will consider buying direct to be an out-of-network service. With my insurance, my copay is 30% in-network and I think it might be 50% out-of-network. I have not asked them if cpap.com counts as out-of-network, but it might be a thing to do.

[Mikosiko]

John: I'm buying a new mask and a few filters... my co-pay is around 10%.

LoQ: what amazed me is that my insurance doesn't allow out-of-network for this kind of items... I have to buy only for their selected DME or pay myself in full without refunds...

[Hospiceangel]

My insurance is Aetna,
They are now paying 100% up to 2500. per year for CPAP and supplies. I had also met my out of Network deductible so I bought an S9 from CPAP.com which they will reimburse me 70%. I was pleased with CPAP.com, helpful people and quick shipping.
Shar:)