Got a call from my DME

[craftyncrazy]

and he was all ready to set up an appoitnment to come out to my house and set it up, but I have to wait till I have the money to cover the Co-pay. $361.21.

Hope it will only be about another week.

I am so tired of being tired!

[nanwilson]

Crafty
Please make sure its a fully data capable machine. Call and ask them what it is and then let us know and we can make sure you are getting what you need. The codes for a plain jane machine and a fully automated one are the same, so don't let them tell you any different.

[xenablue]

Ditto what nanwilson said.

Also, I think it's Janknitz who has a great blog on DMEs and what you should know BEFORE their visit. Please don't let them talk you into a machine or mask you're not happy with.

You came here for information, which means you're interested in taking control of your own health - don't settle for anything less than a fully data-capable machine.

When I was given my machine - fortunately it's a good one - I asked about accessing the detailed data so I could track my therapy and was told "you don't need to know any of that".

Read up as much as you can here before your visit so you'll be well-informed before the day.

Cheers,
xena

[archangle]

Crafty
Please make sure its a fully data capable machine. Call and ask them what it is and then let us know and we can make sure you are getting what you need. The codes for a plain jane machine and a fully automated one are the same, so don't let them tell you any different.

Don't ask the DME if it's fully data capable. Get the EXACT machine model. For instance, "ResMed S9 AutoSet" and post it here. When you get it, check that it actually IS that model. DMEs have been known to tell you it's one model and deliver another.

Many DME's will call non data capable machines "data capable" because they have an SD card, but they'll try to sell you a cheap one that only records how long you have it turned on.

Q: What's the difference between a DME and a used car salesman?
A: The used car salesman KNOWS he's lying to you.

[archangle]

Also be sure you understand whether it's $361 total, or $361 now, and $xx a month for the next 13 months.

[ameriken]

You have to pay them that full amount on the day they bring it? They won't bill you or give you some other choices?

[Pugsy]

What is your insurance?

That co pay amount is real close to Medicare's first month co pay because the humidifier is usually billed out in full the first month plus the monthly rental co pay on the cpap machine itself. Find out what your monthly co pays are after this initial bill and for how long you can expect them. January is just around the corner and a new deductible may rear its ugly face.

[Alshain]

Wow, I don't feel so bad now. My co-pay was only $90 + $30/mo-10mo. That just seems like an awful lot, pretty much the whole cost of the machine if you were paying 20% and getting the highest level machine. They aren't going to have you do a rent-to-own? Most insurance companies require this.

[Pugsy]

Wow, I don't feel so bad now. My co-pay was only $90 + $30/mo-10mo. That just seems like an awful lot, pretty much the whole cost of the machine if you were paying 20% and getting the highest level machine. They aren't going to have you do a rent-to-own? Most insurance companies require this.

You are lucky. Most people pay more. I would bet that the OP here in this thread also will have an additional monthly rental for a set period of time. If she has Medicare.. for sure.. 13 months. Other insurance maybe not so long.

[Alshain]

Wow, I don't feel so bad now. My co-pay was only $90 + $30/mo-10mo. That just seems like an awful lot, pretty much the whole cost of the machine if you were paying 20% and getting the highest level machine. They aren't going to have you do a rent-to-own? Most insurance companies require this.

You are lucky. Most people pay more. I would bet that the OP here in this thread also will have an additional monthly rental for a set period of time. If she has Medicare.. for sure.. 13 months. Other insurance maybe not so long.

How do they get away with that? It's almost like not having insurance. The machine is $1000 tops. if your co-pay 40%, that is $400. How could it be more than that?

EDIT: Actually I forgot about the humidifer. I guess it could be a little more.

[Pugsy]

How do they get away with that? It's almost like not having insurance. The machine is $1000 tops. if your co-pay 40%, that is $400. How could it be more than that?

Because the DMEs bill twice that $1000 ( and more ) then the insurance pays on the allowed amount which is often much less. Then the co pay kicks in on the allowed amount. Besides... who often has $1000 sitting in the drawer.. with rent to own they get to pay it out.

Medicare co pay is 20 % of the allowed amount after an annual deductible. Insurance out side of Medicare will vary and I have no idea how much is allowed. It will vary with insurance companies though. I think Robysue pays 50% co pay. A while back I saw what Medicare allows and thus was able to figure up what the patient pays total and what the DME will get in the total payments. I will see if I can find it again. Out of pocket for a Medicare cpap user ends up being not too far off from what your totals will end up being. The worst is the first month because the humidifier is not rent to own but a one time purchase as it is normally not considered a returnable item. After that I want to think the co pay was around $20 but I have slept since then and don't remember. Also it changes every year. I can only speak about Medicare. Don't know much about all the others. My insurance mimics Medicare in everything, replacements and co pays.

Edit: Forgot to mention Medicare's allowable amounts aren't the same for the whole country. They can vary by state and even by city or area within a state. I am in SW Missouri and allowable amounts are lower here than in say St Louis or Kansas City.

[craftyncrazy]

I have insurance through my employer. I haven't met my deductible yet for this year so I really do need to find out what the $361.21 is for.

I need to find a time to call the guy when I have my head on staight. Yesterday he called while I was in my boss' office and I had to run out and catch my cellphone ringing like mad on my desk.

I need to complie a list of what to ask him so I dont let my sleepieness and lack of concentration get in my way.

[Pugsy]

I have insurance through my employer. I haven't met my deductible yet for this year so I really do need to find out what the $361.21 is for.

For sure find out what for..what to expect next month and the following and does the January new deductible come into play again. Find out exactly what machine this money buys. Full data as opposed to hours of use.

Do the math..if you haven't met deductible and depending on how much is left to be met and what subsequent co pays might be.. it might be much less out of pocket to purchase online. My machine shown in my profile is full data capable, is Auto (APAP) and can be used in cpap mode. Has multiple easy to obtain software choices and it can be purchase from cpap.com with the humidifier for $635 total.

And you don't have to fight with DME to get a full data machine. You could still use DME for masks. If $635 out of the question because of lump sum.. the cpapauction often has same machine new or gently used for $250 to $300 including humidifier. Just another option to consider.

Edit.. Also check with your insurance company to see if online seller can be a provider.. even if out of network, it might then count towards your deductible.

[chunkyfrog]

I wish flex funds were an option under Medicare.
Those of us who choose to manage our own therapy would have the option;
AND save money for ourselves as well as the system.
I am planning to use my post employment healthcare fund to cover dental care (insurance sucks)
and continued quality apnea therapy beyond what Medicare will cover.
--(plus hearing aids and quality eyeglasses -not covered).
Not everyone has this--retirement flex funds might be a solution,
by putting durable equipment sales into an open, competitive market.
Ah, in a perfect world. . .
--I know, I'm ranting --my bad.

[Bons]

Flex for medical care drops to $2500 max for next year.... I went through my $5000 already for this calendar year so I am not happy about that.