American Home Patient & Cigna - no prices?

[Chilehead]

I started CPAP about 3 months ago. I got my machine and mask through American Home Patient, no problems so far to speak of.

I ordered another mask and replacement pillow through cpap.com figuring it would be a lot cheaper.

I got a call today from American Home Patient saying it's time to replace my mask and tubing. So I ask for a price, and she said they aren't allowed to give that out. Really? WTF? I'm supposed to order blind and home they don't take me to the cleaner? She said I'd have to call cigna to get the price, which seems odd - they should know based on my insurance.

Too much hassle - masks and supplies aren't that much to have to deal with multiple phone calls to incompetent people, so I'll just get supplies through cpap.com and in 5 years when it's time to get a new machine I'll have to figure out if it makes sense based on whether I've met or am near my high deductible.

[Cardsfan]

Call your insurance co. and ask how much the DME is allowed to charge for the item you need. Your insurance co has set prices with the DME that they are allowed to charge you. It's pretty simple. If you have a deductible, you have to meet it first. Then whatever co pay or percentage of the ALLOWABLE CHARGES, you are responsible for.
And it may be cheaper than going thur an online vendor.

[Wulfman...]

I started CPAP about 3 months ago. I got my machine and mask through American Home Patient, no problems so far to speak of.

I ordered another mask and replacement pillow through cpap.com figuring it would be a lot cheaper.

I got a call today from American Home Patient saying it's time to replace my mask and tubing. So I ask for a price, and she said they aren't allowed to give that out. Really? WTF? I'm supposed to order blind and home they don't take me to the cleaner? She said I'd have to call cigna to get the price, which seems odd - they should know based on my insurance.

Too much hassle - masks and supplies aren't that much to have to deal with multiple phone calls to incompetent people, so I'll just get supplies through cpap.com and in 5 years when it's time to get a new machine I'll have to figure out if it makes sense based on whether I've met or am near my high deductible.

Yeah, it's a big "secret" between the DMEs and insurance providers.
But, if you inquire into it, it may be that if your new year's deductible is just restarting (and it's a sizable amount), those supplies could be very expensive.

Other than 2005 when I met my deductible with my sleep study, etc., I purchased all of my additional supplies over the years out-of-pocket.......I didn't even ask. I never met a deductible again until 2011 and was already pretty well stocked up by then. I also never went through a brick and mortar DME.......other than what I purchased from individual sellers, I ordered all of my equipment and supplies through online sellers like CPAP.COM.

But, since most insurance guidelines are different, your mileage may vary.


Den

.

[Chilehead]

I started CPAP about 3 months ago. I got my machine and mask through American Home Patient, no problems so far to speak of.

I ordered another mask and replacement pillow through cpap.com figuring it would be a lot cheaper.

I got a call today from American Home Patient saying it's time to replace my mask and tubing. So I ask for a price, and she said they aren't allowed to give that out. Really? WTF? I'm supposed to order blind and home they don't take me to the cleaner? She said I'd have to call cigna to get the price, which seems odd - they should know based on my insurance.

Too much hassle - masks and supplies aren't that much to have to deal with multiple phone calls to incompetent people, so I'll just get supplies through cpap.com and in 5 years when it's time to get a new machine I'll have to figure out if it makes sense based on whether I've met or am near my high deductible.

Yeah, it's a big "secret" between the DMEs and insurance providers.
But, if you inquire into it, it may be that if your new year's deductible is just restarting (and it's a sizable amount), those supplies could be very expensive.

Other than 2005 when I met my deductible with my sleep study, etc., I purchased all of my additional supplies over the years out-of-pocket.......I didn't even ask. I never met a deductible again until 2011 and was already pretty well stocked up by then. I also never went through a brick and mortar DME.......other than what I purchased from individual sellers, I ordered all of my equipment and supplies through online sellers like CPAP.COM.

But, since most insurance guidelines are different, your mileage may vary.


Den

.

I'm on a high deductible, that I usually don't meet. Last year I did because of the sleep doctor visits, the cpap machine and supplies, and a few other things with the family, so it made sense to go through the DME.

I don't expect to meet the deductible this year - hopefully! - so it makes sense to check prices via cpap.com and through the DME. I did call cigna, who had to call carecentrix, to figure out what american home patient would be allowed to bill.

Looks like the costs through the DME to get a new mask and headgear (which is stupid to be billed separately), hose and filters would be about $40 more than cpap.com. Though if I order through them the cost gets applied to my deductible, while ordering through cpap.com does not, at least not all of it. So it's a small gamble to go one way or another, based on whether I think it makes sense to pay more now to apply to my deductible.

[ChicagoGranny]

So I ask for a price, and she said they aren't allowed to give that out.

They have had too many people who did not understand their insurance plan and did not contact their insurance company. Then these people paid more than they expected and complained to the DME. So, the DME implemented a policy to encourage these people to understand their policy.

[LSAT]

I started CPAP about 3 months ago. I got my machine and mask through American Home Patient, no problems so far to speak of.

I ordered another mask and replacement pillow through cpap.com figuring it would be a lot cheaper.

I got a call today from American Home Patient saying it's time to replace my mask and tubing. So I ask for a price, and she said they aren't allowed to give that out. Really? WTF? I'm supposed to order blind and home they don't take me to the cleaner? She said I'd have to call cigna to get the price, which seems odd - they should know based on my insurance.

Too much hassle - masks and supplies aren't that much to have to deal with multiple phone calls to incompetent people, so I'll just get supplies through cpap.com and in 5 years when it's time to get a new machine I'll have to figure out if it makes sense based on whether I've met or am near my high deductible.

The allowable amount is different by insurance company...there is no set amount except for Medicare. The DME may not know specifically what your insurance amount is.

[Janknitz]

This is why I laugh when some politician gets on his high horse and says that the problem with medical costs is that we aren't being good consumers. According to these hot air bags, we should comparison shop for all of our medical care. HOW???

And imagine having a heart attack but turning away ambulance #1 because they charge more than ambulance #2, and insisting that Ambulance take you to a hospital 10 minutes farther away because they charge less than the closest hospital.

Then there's "consumers should know the real cost of their medical care"--like when the DME charges my insurer $2,400 for a CPAP machine the insurer will pay $1,200 for and I can buy online for $800. What exactly is the "real" cost of my medical care???

[Wulfman...]

This is why I laugh when some politician gets on his high horse and says that the problem with medical costs is that we aren't being good consumers. According to these hot air bags, we should comparison shop for all of our medical care. HOW???

And imagine having a heart attack but turning away ambulance #1 because they charge more than ambulance #2, and insisting that Ambulance take you to a hospital 10 minutes farther away because they charge less than the closest hospital.

Then there's "consumers should know the real cost of their medical care"--like when the DME charges my insurer $2,400 for a CPAP machine the insurer will pay $1,200 for and I can buy online for $800. What exactly is the "real" cost of my medical care???

Here's a true story. And, it wasn't something to laugh about.
About a dozen years or so ago, one of my co-workers had a heart attack and needed to be life-flighted to another hospital. In the (out of state) city they life-flighted her to, there were two hospitals......one was "in-network" and the other was not. Guess which one they took her to.......the one which was NOT "in-network". Her bills were astronomical and our insurance provider would only cover "part" of it.

In subsequent years, they finally got that other hospital included in the "in-network" category, but for that woman it was too late. She had been horrifically, monetarily impacted by someone else's decision.


Den

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[Sleeprider]

If buying without insurance through the online sites, be sure to call for a quote. They will often give a lower price on the phone as the sites are limited by the manufacturer minimum advertised price policy.

[curems]

More absurdities about how the insurance companies actually pay out more than they should because their policies serve to screw them:

1) I was prescribed a medication that the formulary required I try a different med first. We had tried that previously and it didn't work but still had to go through the motions again. The pharmacist explained the situation to me, called my doc for approval, dispensed the one medication and then immediately went back and dispensed the one I actually needed while I waited.

2) My primary ordered an MRA because I was diagnosed with HBP and my mother had controlled HBP and still had an aneurysm in her brain that blew itself out. The insurance company denied the request saying I didn't meet the criteria and listed the exact same criteria on the back of the page. I had to go to the neuro (and the same insurance co. had to pay the neuro to say what he knew they wanted to hear) in order to get the pre-cert.

[palerider]

I'm on a high deductible, that I usually don't meet. Last year I did because of the sleep doctor visits, the cpap machine and supplies, and a few other things with the family, so it made sense to go through the DME..

also ebay and amazon, usually the best prices for mask parts and other supplies. sometimes you even find they've snuck in whole masks, even though they're not supposed to.

[klv329]

A whole mask? Haven't used Cigna for cpap in awhile, but if I recall it was always a mask up front if I met the criteria for whole mask, then parts of masks like nasal pillows then head gear, or something like that alternating along. I had trouble keeping track of what the prices were because the online detail wasn't sufficient to figure out what I paid for over a period of time, and I had to keep track of the dates of what was ordered and write it down to match it to a price online. If I recall, the water tubs were more expensive than online sellers and weren't the heavier duty re-washables.

[flightco]

I started CPAP about 3 months ago. I got my machine and mask through American Home Patient, no problems so far to speak of.

I ordered another mask and replacement pillow through cpap.com figuring it would be a lot cheaper.

I got a call today from American Home Patient saying it's time to replace my mask and tubing. So I ask for a price, and she said they aren't allowed to give that out. Really? WTF? I'm supposed to order blind and home they don't take me to the cleaner? She said I'd have to call cigna to get the price, which seems odd - they should know based on my insurance.

Too much hassle - masks and supplies aren't that much to have to deal with multiple phone calls to incompetent people, so I'll just get supplies through cpap.com and in 5 years when it's time to get a new machine I'll have to figure out if it makes sense based on whether I've met or am near my high deductible.

Question for the more knowledgeable here; If you have a High Deductible plan, chances are good you also have a Health Savings Account (assuming you are still working). HSA gives you a debit card to spend your money with, I am wondering if you can use the debit card (legally) to purchase from Cpap.com

Yeah, it's a big "secret" between the DMEs and insurance providers.
But, if you inquire into it, it may be that if your new year's deductible is just restarting (and it's a sizable amount), those supplies could be very expensive.

Other than 2005 when I met my deductible with my sleep study, etc., I purchased all of my additional supplies over the years out-of-pocket.......I didn't even ask. I never met a deductible again until 2011 and was already pretty well stocked up by then. I also never went through a brick and mortar DME.......other than what I purchased from individual sellers, I ordered all of my equipment and supplies through online sellers like CPAP.COM.

But, since most insurance guidelines are different, your mileage may vary.


Den

.

I'm on a high deductible, that I usually don't meet. Last year I did because of the sleep doctor visits, the cpap machine and supplies, and a few other things with the family, so it made sense to go through the DME.

I don't expect to meet the deductible this year - hopefully! - so it makes sense to check prices via cpap.com and through the DME. I did call cigna, who had to call carecentrix, to figure out what american home patient would be allowed to bill.

Looks like the costs through the DME to get a new mask and headgear (which is stupid to be billed separately), hose and filters would be about $40 more than cpap.com. Though if I order through them the cost gets applied to my deductible, while ordering through cpap.com does not, at least not all of it. So it's a small gamble to go one way or another, based on whether I think it makes sense to pay more now to apply to my deductible.