Should I buy from DME or CPAP.com?? Please help

[WalkingZombie]

I am thinking about purchasing the Resmed S9 Auto For Her. But I'm debating on whether or not to go with my DME which insurance will pay 80% of the cost. Or get my machine from CPAP.com and let the insurance reimburse me for 60%. The DME tells me that all cpap/apap machines are $1500, heated humidifiers are $370 and their masks run anywhere from $200-$375. So I'm looking at around $2095 if I go with the DME. After talking with CPAP.com, the Resmed S9 for her, with the Respironics True Blue mask (that I was titrated with) total cost would be $1168.19 that also includes the $7.19 extra for return insurance on the mask. The heated hose would be an extra $51 bringing my total to $1218.19, which insurance would reimburse me 60% of. So if I figure this correctly, going with the DME, my cost would be $419 and if I get it online, my cost would be around $467.
If I use the DME, I would also have to travel 45 minutes to get to them, so figure in gasoline. I'm torn as what to do. What do y'all think? Is there any benefit with going with the DME?
How important is the heated hose? Is it worth $51 extra dollars? The cpap I've been using is a Resmed one I think, that my husband uses for travel, and it doesn't even have a humidifier. The doctor is precscibing a heated humidifier for me. Hubby thinks it is not necessary.

[WalkingZombie]

Also, this is a machine that records full data, I know that, how can I access that data? It has some onscreen data, but not sure what exactly.

[apneawho]

I need the humidity and I have the climate line hose. I like the climate line. No rain out. I would not consider the humidity a luxury, but that is my opinion.
There hasn't been any advantage to going with traditional DME for me. On the other hand, I have ordered and communicated many times over the phone with cpap.com and they are great.

[jabman]

Thought I have not (yet) used cpap.com to purchase anything, I think it would be your best bet. It seems that alot of DME's don't like to play fair and you end up fighting with them. so your 45 minnute drive might turn out to be more if lets say they give you the wrong machine, whick they like to do. By the way when you ask for your S( make sure you are stating AUTOSET because I beleave there is now a S9 escape Auto which is not data capable.

[BlackSpinner]

Also, this is a machine that records full data, I know that, how can I access that data? It has some onscreen data, but not sure what exactly.

There is free downloadable software from Resmed.

[jules]

get it in writing the insurance will actually pay for a cpap.com purchase - don't just assume they are out of network provider

[moresleep]

Sounds like the difference is the travel time. I've gotten machines and lots of masks from Cpap.com, and have never had a problem. They will also match prices, if you can find a cheaper price for the S9 Autoset somewhere. However, if you go with them, make sure you are right about your insurance paying 60%.

I would definitely get the humidifier. I've done it both ways, but have found that just a little humidification (not too much), keeps my nose less stuffy. The heated hose is worth trying, especially if the room in which you sleep sometimes gets cold.

My two cents.

[WalkingZombie]

get it in writing the insurance will actually pay for a cpap.com purchase - don't just assume they are out of network provider

I checked with my insurance earlier today and told them I was thinking about using cpap.com to purchase and they are sending me the claim form to fill out just in case I go that way.

Also, this is a machine that records full data, I know that, how can I access that data? It has some onscreen data, but not sure what exactly.

There is free downloadable software from Resmed.

Thanks so much! That is what I was wondering. Of course, you ask them about it and they say there is no way to access that info, that only the doctor can read the card.

Thought I have not (yet) used cpap.com to purchase anything, I think it would be your best bet. It seems that alot of DME's don't like to play fair and you end up fighting with them. so your 45 minnute drive might turn out to be more if lets say they give you the wrong machine, whick they like to do. By the way when you ask for your S( make sure you are stating AUTOSET because I beleave there is now a S9 escape Auto which is not data capable.

Yes, not only would I have to drive, but have to get off of work. I am sure this is the Resmed SP Autoset...it's the pink one for her, so it'll be pretty! lol

I need the humidity and I have the climate line hose. I like the climate line. No rain out. I would not consider the humidity a luxury, but that is my opinion.
There hasn't been any advantage to going with traditional DME for me. On the other hand, I have ordered and communicated many times over the phone with cpap.com and they are great.

That's what I thought. I think I may as well go ahead and get it.

[Janknitz]

The DME tells me that all cpap/apap machines are $1500, heated humidifiers are $370 and their masks run anywhere from $200-$375.

WHOA!!!! Hold it. Before you make your decision, you need to know from your insurance what their allowable fee is for this equipment. The DME may charge $1500 for the machine, $370 for the the humidifier, and up to $375 for the mask, but the DME may have a contractual obligation to accept whatever the insurance company allows for these items. In other words, the insurance company may say that the allowable fee for the CPAP is only $1000 and then you only have to pay your 20% share on $1000, not on $1500. State laws sometimes allow DME's to not "accept assignment" which means that they can charge you the difference, but if that's the case, you should shop around for a DME that will.

You need to know whether or not this is the case, to factor it into your calculations. The prices DME's charge are pure fiction. It's what they'd like to get paid, but rarely do except for the poor suckers without insurance who don't know better that they could save a bundle online. The insurer sets the price, and most of the time state law and contracts with insurers prohibit DME's from doing something called "balance billing" which is charging you the difference between the DME's asking price and the allowed amount under your insurance.

Distance to the DME should not be an issue--most will Fed-Ex the equipment to you on request. Crapria prefers to do it that way so they don't have to interact with you.

[Uncle_Bob]

Yes, not only would I have to drive, but have to get off of work. I am sure this is the Resmed SP Autoset...it's the pink one for her, so it'll be pretty! lol

Pink maybe pretty to you now but maybe not to a guy when you want to sell it used

You need to get a list of the common equipment codes and find out from your insurance company the replacement schedule and maximum allowable cost for each item. Then you can compare apples with apples.
If the DME takes your insurance they have agreed to accept the maximum allowable and then you only have to pay your co-pay percentage on that amount. Your task regarding the DME is limited to finding an honest one who will give you exactly what you want (product number) without any up charges or gimmicks.

My DME is minutes from my home. So if a machine breaks I get replacement delivered to my home the same day while my machine is taken for repair. I get free shipping on supplies or free delivery to my door if required. They have all the masks and bed for me to try them out. They handle the insurance billing and any rework billing. If i don't like a mask i take it back within 30 days and try a different one, no return insurance required.

I have used cpap.com and the service is excellent. But they are limited by being an internet business. They don't handle insurance and I had lots of hassle with my BCBS insurance messing up claims and not paying them, it was so much hassle. But i still use cpap.com for out of pocket purchases.

The links to download the software and clinicians manual (the manual you won't get with the machine) are below this post over to the left.

Good luck with whatever you decide and i hope you like the S9 in pink as much as i like mine in silver

[msradar65]

I would confirm the payment arrangement with your insurance company. If you can do better financially with online I would go with online.

Definately get the humidifier and climate line hose. I love mine. It will save you a lot of hassle as the weather is getting cooler now. When I don't need humidification I turn if off and just go with passover.

[70sSanO]

This is a tough decision. 10 years ago my insurance didn't care if I went to a brick and mortar DME or bought online. For me it was better to go online. The positives were a little less cost and I got to pick what I wanted... and I didn't have to argue with the DME on what machine I had to get.

Just recently I moved form the stone age into a new data machine and my insurance would not cover an online purchase. That kind of forced me go to a DME. It has been okay so far. The biggest benefit is that I get a new mask every 3 months at a much reduced cost instead of buying one every few years and limping the old ones along. I think I'll save a little on the machine in the long run. But, I don't like the rent-to-buy process and I'm waiting for the other shoe to drop, so I would rather deal online.

But here is the real kicker... if you don't know what mask to get or how to set anything up and you don't want to spend the time trying to understand all the Xpap stuff, a "good" DME can really help. You can go in and see the different masks and try a few out in the process. In that respect my DME does nothing for me because I already knew all the basics and what I didn't know I found out on this forum.

John

[ronbien]

Janknitz is correct, at least in my case. The DME is billing total list price but the insurance is only allowing so much. It is not as cheap as CPAP.Com but a lot better than list. That would change your calculations. Also, I like the fact that it is "yours" much quicker if you were to purchase outright.
Good luck in your decision.

[Riorican]

Have you checked the deductible for out-of-network if you go with an on-line purchase? My deductible in-network is $600 but $1,000 for out-of-network. If it's different for you, make sure you've already met the necessary deductible (higher) before you purchase on-line.

[archangle]

Apart from the ResMed software, there is a free, open source program called SleepyHead. It's still in development, but works really well. It works for the S9 Autoset.