RENT vs BUY

[11cdubyah]]]

Hi,

I am not really a newbie at this. I have had some experience using different types of masks and machines but it’s been awhile but I have almost no experience with the decision I have to make now. I have United Healthcare insurance. UHC uses Apria Healthcare to administer their respiratory DME in my area. I went to Apria last week to get fitted for a mask and look at a PAP machine. The sales woman at Apria, fitted me with a mask (which felt extremely comfortable) and demonstrated the APAP machine, did an excellent job of presenting this product. However, she didn’t seem prepared when I refused to sign the agreement when she tried to close the deal. I told her that I wanted to take the contract home to read it before I signed it. She said if I wanted to do that then I couldn’t take the machine home. I said no problem. She told me she wasn’t even sure I could “take home a contract,” so she went and got her insurance “person.” When the claims processor came into the room she too looked at me a bit puzzled. She had that, “why would you ask to take the contract home to read it before you sign it” look on her face. Apparently this doesn’t happen much ‘round there. Well, short story is… they let me have a copy of the agreement to take home.

Basically, according to the Apria presentation, the choice I have is to rent this machine; pay some “up front costs” for some of the hardware and then pay a monthly rental fee of $35.00. I’m supposed to do this until it is determined, by my compliance, that this mask and machine are a successful fit. At that point, UHC pays for a portion and I pay for a portion. If the mask and machine “don’t work” for me then it’s on to the next mask and/or machine.

My question is... I’m wondering if wouldn’t be cheaper just to buy a mask and machine? What are my options here? I have read some posts on this but am not sure where to begin in terms of questions to ask; information I need to be gathering and numbers I should be crunching.

Thank you,

Chuck

[RandyJ]

Basically, you can do the math. Most of the rent-to-own contracts through insurance are 10 months. Find out what your total cost will be. $35 x 10 = $350 plus whatever upfront costs there might be. Find out what they are. Make sure one of the "upfront costs" is not an upcharge. (See Janknitz's blog: "Do not pay that upcharge..." http://maskarrayed.wordpress.com/dont-p ... -upcharge/

Often insurance will only do rental. That way if you do not use the machine at least the minimum for compliance, they can terminate the contract and you have to return the machine. If you want to buy, you may be on your own. I had United Healthcare this year and my only option was to rent-to-own for 10 months. Buying outright wasn't an option unless I did it on my own, without insurance.

If you go the purchase out of pocket route, you can find gently used machines at http://www.secondwindcpap.com or new machines at https://www.cpap.com. Craigslist is an option for used machines as well but it is definitely "buyer beware."

You might find this recent thread interesting: viewtopic/t70967/DME-antics.html

Good luck.

[chunkyfrog]

UHC runs a variety of plans--if it's an HMO, rental may be your only option.

[Janknitz]

CALL your insurance company and find out EXACTLY what your options are (if any). Be sure to figure in the annual deductible and how many deductibles you may have to pay over the rental period (which may be as long as 15 months). NEVER rely on a DME to tell you what's covered--they are often wrong.

Then price machines online and see which is a better deal.

$35 per month is pretty reasonable. For Medicare it could be 2 or 3 times that amount monthly for just the blower. The humidifier is a one time purchase in almost every case.

[Perrybucsdad]

I think you have some good advice above, but one other thing to look into is this. If the machine doesn't work for you than what? Let's say you were prescribed an APAP and it turns out that you have to have very high pressures and are having a hard time being compliant with the APAP due to the high pressures and are now being recommended a BiPAP. If you buy it (or rent it) will your insurance allow you to swap it out? My insurance would only allow that if I was renting to own. In my case, the rent to own didn't cost me a dime extra, so I don't have a problem with it. For me it was my money staying in the bank a little longer and a little insurance that if I need a different machine (Philips vs ResMed or APAP vs BiPap).

John

[LSAT]

Often you rent the machine, but buy the humidifier and mask. The upfront charges might be paying for the humidifier.

[Perrybucsdad]

Often you rent the machine, but buy the humidifier and mask. The upfront charges might be paying for the humidifier.

... and mask and hose, etc.

[archangle]

What you end up paying after the insurance company processes the claim will often bear no resemblance to what the DME tells you.