Company A or Company B -- Please help

[HealthyandHopeful]

Hi,
Some of you have read my posts about the frustrations I have had using Company A for my CPAP machine:

1-I decided to pay for my CPAP machine rather than use insurance because I thought I was going to switch to a dental appliance later on and use insurance for that. Since I was paying for it myself, the lady at Company A offered me a new machine as an "under the table deal" (her words) from a friend of hers who has her own DME company and said she had an over abundance of machines. I would have to meet the lady at my home or a parking lot and pay cash. I didn't not take this deal, it did not seem honest to me.

2- The lady at Company A said I could buy a "lightly used machine" from them and I bought it. I got home and saw that the machine had actually been used for 206 days and over 1550 hours. I called back and she said they considered that "lightly used". I kept the machine and have been using it. Bought it on May 21.

3-I changed my mind and decided to go with insurance for my CPAP and return this machine (I found out it was not high efficacy data machine, although she gave me a data card and an instruction manual to another machine -- possibly accidental -- with instruction on getting the data).

4-Yesterday I told her the machine I wanted (S9 autoset) and she acted like I shouldn't get that machine. Said that it would be a whole 'nother prescription. I did get the prescription from my doctor and she still acted like that isn't what I would want. After my saying "isn't this one that can be used as both CPAP and APAP and wouldn't that be better", she finally said yes. She said they had the Resmed 460.... (I later found out on these forums that the 460 isn't a fully capable APAP, only serves as APAP for a short time).

5-I did return the machine today. She had told me it would cost me $12 for the two weeks I have had it and then $6 per day if I keep it the next two weeks while waiting for the new machine and that I could apply what I have paid to the new machine. Today when I returned it she was not there, and I was charged $6 per day for the entire time I have had the machine. She later told me that the $12 was only if I applied my balance towards the new machine, but I did not. I got it credited back to my credit card.

6-I called insurance today and was told my preapproval the lady from Company A sent in was approved for out of network benefits, which means $1000 deductible then I would pay 30%. I was told that this company is not in network. The lady from Company A called me today (I wondered what she would have to say) ... to tell me it was preapproved and that yes they are in network and my charge would be a total of $431 for the S9 autoset. I had to drag out of her the exact machine that it is. She first said "for the Resmed". Then I asked is it the S9 and she said yes. Then she agreed it's an auto pap. I asked is it the autoset and she said yes. I had to drag each part out of her. When I returned the machine today I was glad to "be done with them". I didn't expect her to call with this price for the machine that I want.

In the mean time, I found another Sleep place (Company B) with good reviews and made an appointment with a doctor there for June 24th. I was SO thankful to have found them!! I have been searching for an in network place in my area. At the time I called them, I thought I was finished with Company A. Even the insurance said the doctor with Company B had a Premium rating. I made an appointment to see the doctor, emailed my sleep studies (I emailed my prescription too, even though he would probably give me the prescription he thinks I need). With this doctor, I may or may not get the S9 Autoset. Depends on what he thinks I need.

My questions are: Should I just go with Company A since I finally have approval to get the machine that I want? Should I wait about making that decision until I see the doctor at Company B? I can probably get the S9 autoset from Company A on June 17th. I would have to wait until June 24th to see the doctor at Company B and then possibly have to wait to have the machine ordered. I could just wait to see what Company B doctor says and then make the decision about who to go with for the machine. I did call Company A back and asked the lady to hold off on ordering this for me, but she said they were also ordering it for other patients at the same time and not to worry about that.

I would prefer not to give business to Company A but I want the machine that they are finally offering. I don't know why the price is $431 when my insurance company told me it was approved but with a $1000 deductible. Is there any way that I may be getting a less quality machine, even though she says it is a Resmed S9 autoset? My dealings with them have been less than desirable but the sign on their door says they are affiliated with a hospital in the area. Could it just be that the one lady is the problem and that dealing with the company is okay? I am just not sure what to do!

What I am leaning towards doing is to wait until June 24th and see the doctor with Company B, see what he has to say and what machine he would order. If it is the same, just wait and let Company B order it and only deal with them from then on. If he wouldn't prescribe the machine that I want, I could always go back to Company A. It would just mean an extra week of going without the machine. Perhaps knowing that my insurance has already preapproved me for this machine might help sway him. ??

I was starting to feel better after getting better sleep but will now be without any machine for the next two weeks at least, possibly a month. But I've been without all these years and didn't know, so I want to do what's best even if it takes a bit longer.

Thank you for hanging in there and reading this whole thing. I appreciate any responses. This has been such a roller coaster ride! I guess Company A didn't expect me to know as much as I do about all of this -- and it's all thanks to you on here!!

[Janknitz]

The person at company A is a liar and a thief.

First, don't believe for a NY minute that they are going to provide a brand new ResMed Autoset without a fight. She's counting on you 1) not knowing the difference, 2) not understanding how your insurance works--she'll tell you when you come to pick up that your insurance did not authorize an Autoset for you.

I'm positive the $431 quoted is NOT what you will end up paying for a brand new ResMed Autoset. That is probably the with insurance price for the humidifier, mask, and I'm strongly suspecting it's only the first month's RENTAL for the machine. They don't seem to realize you have not met your deductible. So this is what will happen: You will be billed more than $431 for the mask, hose, filters, humidifier and first months rental because your insurance will pay nothing. Once your deductible is met, you will have monthly rental fees until next year, when you are out of pocket ANOTHER $1000 for that deductible, as the machine won't be paid off at that point.

Run, as fast as you can from Company A. When you meet your new sleep doctor, tell him/her it's important that you be very involved in your treatment, and you want a machine with full efficacy data. Ask him to specify the ResMed Autoset in the prescription. Take that prescription to Company B and see if they can fill it.

If not, since you have a $1000 deductible anyway, you may want to consider buying your machine online from our hosts, and getting your mask through Company B since they are an in network provider. You don't have to buy a machine from them to get masks. Unfortunately, this still leaves you to meet your deductible for other medical care, but at least you won't be handing it over to Company A.

P.S. Didn't your initial sleep study and first sleep doctor count against your deductible?

[HealthyandHopeful]

The person at company A is a liar and a thief.

First, don't believe for a NY minute that they are going to provide a brand new ResMed Autoset without a fight. She's counting on you 1) not knowing the difference, 2) not understanding how your insurance works--she'll tell you when you come to pick up that your insurance did not authorize an Autoset for you.

I'm positive the $431 quoted is NOT what you will end up paying for a brand new ResMed Autoset. That is probably the with insurance price for the humidifier, mask, and I'm strongly suspecting it's only the first month's RENTAL for the machine. They don't seem to realize you have not met your deductible. So this is what will happen: You will be billed more than $431 for the mask, hose, filters, humidifier and first months rental because your insurance will pay nothing. Once your deductible is met, you will have monthly rental fees until next year, when you are out of pocket ANOTHER $1000 for that deductible, as the machine won't be paid off at that point.

Run, as fast as you can from Company A. When you meet your new sleep doctor, tell him/her it's important that you be very involved in your treatment, and you want a machine with full efficacy data. Ask him to specify the ResMed Autoset in the prescription. Take that prescription to Company B and see if they can fill it.

If not, since you have a $1000 deductible anyway, you may want to consider buying your machine online from our hosts, and getting your mask through Company B since they are an in network provider. You don't have to buy a machine from them to get masks. Unfortunately, this still leaves you to meet your deductible for other medical care, but at least you won't be handing it over to Company A.

P.S. Didn't your initial sleep study and first sleep doctor count against your deductible?

The funny / strange thing (well one of them) is that I didn't pay anything out of pocket for my sleep studies. Doesn't make any sense! Also, my in network deductible is $325 and I have not met it. I wondered if they were going to just have me pay what I would pay at an in network provider.

Also, I had to keep the make and hose that I have used for the past two weeks. They would not let me return it. In all it cost me almost $185 for the rental for 2 weeks and the mask. They were supposed to have charged me what it would have cost if I had used insurance (although I didn't) and I paid about $90 for the mask and hose. Later I thought about this and if insurance would have charged me 20% that seems like a high price!

In network my cost will be $325 deductible plus 20%. Out of network is $1000 deductible and 30%. I just called back and asked -- she said the price includes the heated humidifier and the hose (not a heated hose).

Thank you!

[sc0ttt]

2- The lady at Company A said I could buy a "lightly used machine" from them and I bought it. I got home and saw that the machine had actually been used for 206 days and over 1550 hours. I called back and she said they considered that "lightly used". I kept the machine and have been using it. Bought it on May 21.

I don't think that's disingenuous... probably represents 10% usable life.

And it seems like you can get this equipment on-line for less than you think you'll have to pay in deductible... why are you doing this? Can you use the humidifier with your used machine with a new blower half upgraded to AUTO? That would save even more money.

[HealthyandHopeful]

2- The lady at Company A said I could buy a "lightly used machine" from them and I bought it. I got home and saw that the machine had actually been used for 206 days and over 1550 hours. I called back and she said they considered that "lightly used". I kept the machine and have been using it. Bought it on May 21.

I don't think that's disingenuous... probably represents 10% usable life.

And it seems like you can get this equipment on-line for less than you think you'll have to pay in deductible... why are you doing this? Can you use the humidifier with your used machine with a new blower half upgraded to AUTO? That would save even more money.

My deductible is $325. I'm so new at this I don't even know what you mean in this question: "Can you use the humidifier with your used machine with a new blower half upgraded to AUTO? That would save even more money."

And, maybe so about the machine being lightly used. She just represented it differently to me. She said sometimes Medicare patients get them and hardly use them, that she didn't know if that was the case with this machine or not. I found the usage as soon as I got it home and I have never seen a CPAP machine before.

Anyway I have returned the machine and am starting over now.

[jencat824]

I would just put company A waaaay behind me.

Starting over with Company B, you know you want the ResMed S9Autoset, so make sure you get it. Let company B know up front that is the machine you wish to purchase. If they hesitate or talk 'around' the issue, run again. If they deal fairly, you are probably OK, but be sure its the Autoset before you leave there with it. If you have questions, post them here before you sign anything or take anything home. Excuse to use is the plain truth "I'm sorry, I need to think this over' and that is true, you will be thinking with some help from your friends here at the forum.

Good luck & ask any questions you have,
Jen

[Bama Rambler]

I think company "B" would be the one I'd go with.

There IS an S9 Auto that's not an AutoSet. It's the Escape Auto. My bet is that they might be trying to pass one of those off on you. It sounds like something Co "A" would do.

[sc0ttt]

My deductible is $325.

Anyway I have returned the machine and am starting over now.

OK, I got it now. When I got my machine, the DME told me how much it would be and that's how much they charged me, but after they settled up with the insurance company I got another bill for $317... so no, you won't know for sure until it's been through the system how much you're going to pay. But do check on-line to see what it would cost you out of pocket to just personal buy. In my case, the insurance adjusted price was almost exactly what CPAP.com would've charged me for a cash purchase... my insurance paid about a third of it.

[robysue]

HealthyandHopeful,

First, about the deductible. You need to clarify this with your insurance. You may have two separate deductibles: One for medical care and drugs and a separate one for durable medical equipment. Only your insurance company can clarify this and only your insurance company can clarify exactly how your equipment will be paid for if you have not yet met your durable medical equipment deductible.

Next: I'm inclined to agree with JanKnitz concerning Company A. Trust your instincts and take your business elsewhere. Think of it this way: You're likely going to be sleeping with this machine for the next 5 years and you are going to need to replace the "consumable" CPAP supplies on a regular basis, and for most people, the easiest way of doing that is to continue working with the place that sold you the machine in the first place. In other words, you're at the start of a 5+ year relationship with the DME that you will buy the machine from. You don't want to have to deal with Company A's shenanigans for the next 5 years.

So give Company B a chance to earn your business.

Or, if you have the script in hand that says "efficacy data machine set to 7-12cm" on it, continue calling DMEs until you find one that's willing to take the script you already have and sell you an S9 AutoSet or a PR System One Series 60 Auto CPAP (model 560) machine.

If it takes a few more weeks before you can get started on therapy with the kind of machine you want and need, think of it this way: You've been sleeping with the untreated OSA for a long time, and another few weeks to line up the proper machine is not likely to affect things in the very long term sense.

[Kiralynx]

Well, everyone else as said what I would say -- I just got out of a 5.5 year nightmare with a bad DME, and believe me, you do NOT want to do that to your blood pressure.

I vowed I would NOT give the sale of my new machine to the DME who treated me so shabbily. You sound like a person of honor.

Give Company B the chance to deal honorably with you, and put the slimeballs of Company A (who have already cheated you once, and will certainly try to cheat you again) behind you!

I agree -- they'll probably try to pass an Escape off on you!

[library lady]

My deductible is $325.

Anyway I have returned the machine and am starting over now.

OK, I got it now. When I got my machine, the DME told me how much it would be and that's how much they charged me, but after they settled up with the insurance company I got another bill for $317... so no, you won't know for sure until it's been through the system how much you're going to pay. But do check on-line to see what it would cost you out of pocket to just personal buy. In my case, the insurance adjusted price was almost exactly what CPAP.com would've charged me for a cash purchase... my insurance paid about a third of it.

@Sc0tt: They charged for a Download Device? There's no such thing on my statement, and I have the same machine you have. I do have an SD card but there's no mention of that either. When I got the machine the RT showed me where it was, took it out and put it back in. She said it comes with the machine. Or, it just occurred to me they attached a modem so they could wirelessly monitor your complance... is that what the charge is? Just curious.

[sc0ttt]

@Sc0tt: They charged for a Download Device? There's no such thing on my statement, and I have the same machine you have. I do have an SD card but there's no mention of that either. When I got the machine the RT showed me where it was, took it out and put it back in. She said it comes with the machine. Or, it just occurred to me they attached a modem so they could wirelessly monitor your complance... is that what the charge is? Just curious.

Yup, those nine line items are right off my invoice. The whole line item says "DATA MANAGEMENT / DOWNLOAD DEVICE / DATA". I don't have a wifi or bluetooth or anything on my machine so it must be the SD card and drive that the machine comes with anyway. No way for remote monitoring, I just take my card in to the doctor when I have an appointment.

They estimated my share of the costs based on my insurance and I paid $150 to take it home, but then they underestimated and sent me the bill for another $317 which agreed with what the insurance company said was my share... if I'd known the true price, I may have shopped around a little bit, but I'm not unhappy with the result.

[HealthyandHopeful]

Thanks to all of you for the insight! I know in my gut I should not work with Company A any more. But then the possibility of quickly getting a good machine clouded my judgment. Yes, Company B would be much better to work with long term and they are also much closer to me! I plan on writing a letter to the director of Company A once this all is complete and I have what I need. I'm thinking / hoping that surely Company B will let me get the machine that I want, especially since insurance has already preapproved it. I will have to get it preapproved again though, at an in network rate. And then, I still have the prescription from my doctor to fall back on if Company B doctor does not agree to order this machine. I hope that's not the case but if it is you all will be hearing again from me for more advice!

So for now, until June 24th I will wait. That is when I have an appointment with Company B. I will definitely keep you updated!

[HealthyandHopeful]

Company B it is!! I had to wait for an appointment but it was well worth the wait! I had an appointment for the 24th but they had an opening today. Now I have an appointment on the 24th to go back and get my machine!!

The doctor was very thorough with me about what the dangers of living with sleep apnea are. Wow, I am glad to have caught it because I never thought I had OSA! No one had gone over all of this info with me before now!

Now to the machine choices. He did have a copy of my other prescription from my PCP and knew it was for an APAP. After he went over everything with me, he told me I could have the Cadillac of machines. I had told him I want to be able to see the info. He recommended and probably thought he would be providing me today with the S9 Elite. I asked about the APAP. He said that if I want it, he will let me get that one, because my insurance doesn't care which machine I get, that it is up to me and what I want. He didn't really see a need for the APAP and said they don't give them out that often unless there is a denial of titration study by insurance (I think he said. I may have that wrong). But I said don't these also work as a CPAP machine? He was never defensive and said if that is what I want, then I can get that machine (the Resmed S9 Autoset). They didn't have one in that office today and would need to get it from their other office, thus the appointment on Tuesday to come back.

My choices are:
1-A used S9 Autoset that they do have there at the office with only 300 hours used. They need to check on price, if insurance would cover a used machine, and if it would come with a warranty.
2-A new S9 Autoset -- will check on price.
3-A new S9 Elite -- will check on price.
They will let me know the price of each on Monday and I will decide by Tuesday.

I am happy that I waited and went to this doctor. I did pay a $50 copay here, which I didn't pay before, but then, I saw a doctor who specializes in sleep problems. This office was actually given a high rating, my insurance company told me, that not all doctors have. (the rating was actually for the doctor who started this practice and not the doctor I saw, but I figure the doctor in charge probably would only work with someone he completely trusts).

So, that is where I am right now. I am so excited. I have been without my machine for 2 weeks now, so I can wait another 4 days!

As far as masks, I have the P-10 nasal pillow for women. He suggested I use it another month (save my insurance eligibility) and see if I still like it and if so, use my insurance to get a full face mask to use as backup for when I have problems breathing through my mouth. I have only used it 2 weeks so far with the machine that I returned. He said since the full face mask is a back up, don't use my insurance right away for something that will be a back up. I guess he meant in case I don't end up liking the nasal pillow and want to use my insurance sooner for something I would use all the time.

I am so thankful that this is working out and that I found out I even have this problem. It would be great if this helps my teeth grinding and TMJ! I would not have known to do any differently than go with Company A, or even get the regular CPAP machine, if not for the help I have found here. THANK YOU!!

[KCDC]

Wow, I'm sorry the hell you've been through!! Like I've said so many times, I was armed with machine guns and ak-47s from this website before I saw anyone. I was actually slightly secretly excited to fight.

But I didn't use any of my arsenal at all. It was the easiest transaction made, compared to all the stories I've read on here.

I got lucky!!