Need clarification on renting equipment

[ColoradoDreamer]

Hi All,
I’ve been following the forum since I completed my sleep study a couple weeks ago. This is a new world to me and I feel like I’m taking the first steps on a long journey. I just received my sleep study results. I want to be in control of what equipment I get especially after reading of the horrors some of you have had with ENTs, DMEs and insurance companies. ENT recommended that I rent for a couple months to see if I can get use to it (I told him I don’t want to go the surgery route and he admits that dental devices are not always successful). My report stated that I did not tolerate the nasal mask (for a first time user I thought I did very well, woke up feeling good and said to myself that I am sold on this CPAP) [Report said my sleep efficiency was w/ CPAP 53% and 56% w/o CPAP].

When he said he would make arrangements for a rental I did not know what to do. If he said let’s fill out a prescription I was ready. I was prepared to give him the model number of an APAP with smart card (Report called for “close clinical follow-up to ensure treatment compliance and remission” which translates to me to mean another $3K sleep study and $300 out of my pocket that I could put towards the purchase), humidifier (dry climate here) and a full face mask because of my allergies.

On the way home, it dawned on me that rental or not I should have told him what I wanted. Yesterday and today’s posts on rentals and rent-to-buy have me more concerned. I feel that I can put up with a rental for a month or two but not making co-pays for 10 months (I told him I have to buy a machine this year because I don’t want to have to cough up another $250 deductible next year).

So, here are my questions to you all…

1. When I get a rental, is it implied that it is a rent-to-own appliance? I rent it I buy it? Is it nonbinding? Am I able to tell them what I want? Can I change my mind with my ENT in 2 months w/out penalty?

2. Should I have told the ENT exactly what I want so he can put it on the prescription for a rental? (my 20/20 hindsight says yes)

3. Would an ENT accept printouts from a smart card instead of another sleep study (save me and insurance company some $$$)? [another question to ask him I guess.]

4. Anyone have BCBS federal health plan? Says I pay 10% for medical equipment but do not know what limitations they have on the type of equip. I would like to get what I want but am concerned about the battles ahead based on posts with insurer problems. I thought about calling them but from what I hear in the posts they tend to be clueless.

BTW, here is some info for those interested. I spent about an hour putting the text results of my sleep study report into a spreadsheet so I could see what was really happening (don’t know why they didn’t do it. the text reads like some Dr. or engineer wrote it and I found a minor error which does not change the outcome.). The important item they said is my REM sleep AHI is 80.

TNX

[lfranek]

Hi there...I am in Colorado too, Littleton actually. Where my sleep study was done I was told the first three months were rental payments-4th month you buy it, so to me that means if I dont like it or want another within the first 3 months I can return it-I didnt ask if the money you paid for "rental" would go towards a three month rental on another cpap though. Also, my general practioner dr obviously wrote the prescript but I dont think he specified a machine-I'm pretty sure the sleep center set me up with what they thought was best. Probably wasnt much help but good luck!

[tomjax]

One thing you can do is to go back and look at all the previous postings from newbies,
Lots of info there.

[Guest]

I don't expect there is a magic answer. Each insurance and the contract they have with a particular DME will be different.

My cpap was rent to own - got my insurance to buy it out during 3rd month at my insistance - thought it would be fewer headaches - that was last Dec - the bills are still not fixed right as the rental was to go towards purchase price and the paper trail on that is unreal. Both the DME and insurance agree about the rental toward purchase price but getting them to fix is - well -- I gave up on getting them to do it fast - guess it has only been 9 months of being screwed up.

I paid my part back in Jan and kept getting bills to pay more until I finally called corporate HQ for the DME and got them to stop sending them and asked them to get the account fixed.

They owe me money back (not big bucks but still - they would have threatened collection for my not paying them the money) and maybe before I die I will get it.

[Krelvin]

3. Would an ENT accept printouts from a smart card instead of another sleep study (save me and insurance company some $$$)? [another question to ask him I guess.]

What they will accept really depends on what they want.

A sleep study provides more info than a normal machine can give. They also monitor heart rates, respiration from nose and mouth etc...

However, I think having good info from the machine you are using will give you and them an idea how you are doing with the process. It also can act as an encouragement if you are progressing and can see the results first hand.

[Patrick A]

No matter what Ins. you have they will stick you with the Deducatable again in January. I have been fighting with APRIA since last Jan. I think they finally got their heads out where the sun don't shine on my deductable and that I was also being charged rent for a DME that was paid for in Full by the DOL.

[Patrick A]

I wopuld say that you should just buy the machine you want out right from cpap.copm and then bill your insurance. You will get it for a lot less trhan they will pay for rental.

Call Claudia at bill my insurance and ask her to help you. She did all kinds of foot work to get my ins. paperwork correct and she is great
Also talk to Adam at Cpap.com he helped me with getting my Remstar pro-2 w CFlex.
Good luck

[snoregirl]

For franek, Your DME stuck you with the cheapest Respironics machine they make, not "what they thought was best"

For the original poster.

Either your doc wants to you to use CPAP or not. It is not his business whether you rent or own. Your insurance co on the other hand may not pay for a "rental prescription" as a purchase. It is just not his (the doctor's) concern where you obtain the machine or how much you pay.....

On the other hand, if you rent witih a DME you may not be able to change DME's later for insurance purposes. And you may find getting them to change machines to be a hassle.

My bottom line advice, given you are determined to make CPAP work, is get the doc to give you a prescription (for what you want or generic Apap which should keep you away from expensive future sleep studies at least for a while), and go buy what you want.

Check with insurance company yourself and determine if you can purchase online and get reimbursed. Good comments on end of year and getting stuck with another deductable. It is all well and good if you only pay 10% but if you have a large copay... Check with Bill-my-insurance also.

May want to buy outright cash online. You may want to do the cash online thing and then if you meet the annual deductable next year for some other reason go to an in network DME -- if you can't get reimbursed for the original cash purchase -- and get your back up machine for 10% copay (they don't need to know you are already on CPAP).

But whatever you do, do go back to your doc and get the prescription for what you want. Do call insurance and see if there is a compliance rental period (you may be able to get it in since Oct hasn't ended yet if it is 3 months rent to buy but maybe not too. And do understand all the implications of renting from a local DME -- both financial and machine choice/swap.

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, CPAP, DME, Prescription, APAP

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, CPAP, DME, Prescription, APAP

[snoregirl]

For franek, Your DME stuck you with the cheapest Respironics machine they make, not "what they thought was best"

For the original poster.

Either your doc wants to you to use CPAP or not. It is not his business whether you rent or own. Your insurance co on the other hand may not pay for a "rental prescription" as a purchase. It is just not your doc's concern.

On the other hand, if you rent witih a DME you may not be able to change DME's later for insurance purposes. And you may find getting them to change machines to be a hassle.

My bottom line advice, given you are determined to make CPAP work, is get the doc to give you a prescription (for what you want or generic APAP), and go buy what you want.

Check with insurance yourself and determine if you can purchase outright and submit for reimbursement. Good comments on end of year and getting stuck with another deductable Patrick. It is all well and good if you only pay 10% but if you have a large copay in January there may be no point in playing the local DME game...

May want to buy outright cash online. You may want to do the cash online thing and if you meet the deductable sometime next year go to the DME and get your back up machine for 10% with insurance (they don't need to know you are already on CPAP).

But do go back to your doc and get the prescription for what you want. Do call insurance yourself and see if there is a compliance rental period (you may be able to get it in since Oct hasn't ended yet if it is 3 months rent to buy but maybe not too.

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, CPAP, DME, Prescription, APAP

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, CPAP, DME, Prescription, APAP

[Guest]

Hi All,
So, here are my questions to you all…

1. When I get a rental, is it implied that it is a rent-to-own appliance? I rent it I buy it? Is it nonbinding? Am I able to tell them what I want? Can I change my mind with my ENT in 2 months w/out penalty?

Hiya Back ColoradoDreamer and welcome to the site! FYI, I've always thought Colorado looked like an awesome place and I've always always wanted to go visit there! I guess I dream of it too.

9 times out of 10 yes the rental is a rent to own arrangement. What typically occurs is your insurance will rent for 3 months then convert to a purchase. This is to help shave off some cost for the people for whom CPAP therapy doesn't work. No sense in buying equipment for people who can't use it and all.
Once it's converted to a purchase it is yours, just like anything else you buy, so yes it would be binding. That's another reason for the 3 month rental - to help figure out if you need a different setup.
Generally speaking you can change machines without any difficulty during that initial period.
There are some plans where the rental period may go 12-15 months. There are a few rare cases where Insurance will rent indefinately - though those are the exception rather than the norm.
I also have BCBS on a plan that is very similar to Federal and it was a rental for 3 months then converted to purchase.

2. Should I have told the ENT exactly what I want so he can put it on the prescription for a rental? (my 20/20 hindsight says yes)

You could have though I doubt it's that big a deal. Plus, every doctor is different. Some want every patient on the same machine to help higlight anomolies (easier to see if something is wrong when everyone uses the same item), some providers may not carry all different types of equipment, and some insurance plans are harder than others to get specific equipment billed.
However, there is also nothing that says you cannot still get exactly what you want. Talk with your DME company about your needs and wants and they may well be able to work with you to get exactly that.

3. Would an ENT accept printouts from a smart card instead of another sleep study (save me and insurance company some $$$)? [another question to ask him I guess.]

Oh absolutely. By the way, in your message you posted this:
"(Report called for “close clinical follow-up to ensure treatment compliance and remission” which translates to me to mean another $3K sleep study...."

The "close clinical followup" in this case is generally just referring to the DME company keeping up with you and also exactly what you asked about - the smart card. The only times the doc usually would order another sleep study is if after several months you weren't responding to treatment.

4. Anyone have BCBS federal health plan? Says I pay 10% for medical equipment but do not know what limitations they have on the type of equip. I would like to get what I want but am concerned about the battles ahead based on posts with insurer problems. I thought about calling them but from what I hear in the posts they tend to be clueless.

Your doctors office will most likely know someone who is in-network for your particular plan and can refer you to them. You will generally get much better answers from your DME than from your Insurance since the DME company will have all your specific information in front of them and be used to dealing with your specific plan.

Now yeah, it does get kind of ugly at the end of a calendar year since you may have deductibles and whatnot that you have to meet again at the beginning of the year. However, depending on your health you may very well have to pay them sooner or later so paying them at the start of the year off a CPAP claim may be just as well. That's a question only you can really answer though.

You had a concern about masks. Most DME companies will have a selection of masks you can try on and see if one works best for you. It sounds like you may well want to look into doing just that.

Oh, and as an FYI - they do put the information into a spreadsheet. And a graph, and a pie chart too! You just usually will only see the summary and the diagnostic information. A full sleep study is usually around 50 pages long!

Hope that helps you out some, and good luck!

Mattman

[Patrick A]

ColoradoDreamer
4. Anyone have BCBS federal health plan? Says I pay 10% for medical equipment but do not know what limitations they have on the type of equip. I would like to get what I want but am concerned about the battles ahead based on posts with insurer problems. I thought about calling them but from what I hear in the posts they tend to be clueless.


I have BCBS FEHB They paid Apria $1057.00 in rental for my machine.
I paid Apria $105.70 when I got my machine I June of 2005. Then I paid 10.50 co-pay from July 05 In January they billed BCBS 105.70 monthly rental, I was told by Apria I owed them the deductable. I refused to pay them because I already paid a deductable on the equipment. Apria was also billing me for a Tens unit, (which was dol owcp) They were also billing me and BCBS for a Walker $867.00 They finally got their heads out of their ... and decided I owed them nothing. When they put me on Medicare Apria tried to bill Medicare for all of the DME I have.
Stay on top of it. Also Bill my insurance will bill BCBS for you, but my suggestion is buy your equipment ouit right and then send the bill to BCBS for reimbursment. I know they will give you 90% but In the long run it will cost you less by buying it out right.
Good Luck

[ColoradoDreamer]

Thanks all for the feed back. I will keep an eye on the insurance billing. Thanks for the info on BCBC Patrick A. That helps me feel better having to pay 10%. I have a good idea of what I should be charged for the sleep study and the rental of the equip.

The ENT was quick for the prescription was sent to the DME later the same day as my appt w/ him and the DME was calling first thing in the AM. Not use to having DRs responding this quick. I quizzed DME on what she was bringing. She explained the equipment and I tried several masks and practiced fitting them (found out that fitting a mask sitting up is not the same as lying down). As I mentioned I wanted smart card capability and this model does have it. I will stop by the DME in 2 weeks to download the card on their computer for the printout. When I go to the ENT in Dec I will take this info w/ me. Hopefully that will be enough to convince him to purchase the equipment. Renting through DME is expensive. In 3 months of renting, all the equip would have been fully purchased!

Here is what I have:
Respironics M Series Pro C-Flex (would have liked APAP)
Respironics ComfortFull 2 Full Face CPAP Mask with Headgear (I get to try out a full face at no charge. DME says these are not moving well)
Resmed Ultra Mirage II Nasal Mask with Headgear
(Plan to purchase Resmed Ultra Mirage Full Face Mask in three months through Ins.).

Gone through 2 nights and, so far, am adapting well.

Patrick A.: I’m W0UZ.

Thanks again for your help.

[snoregirl]

You mention that in three months the machine would have been paid for with the rental. Find out how long you have to rent and if you are better off buying online.

Somone above said that you get better information from the DME than your insurance. I disagree. Watch out for the DME. They don't always tell the truth.

You say you would have preferred an APAP. GET THAT prescription, since if you decide later that you want to purchase an APAP for yourself that prescription is good for another machine online. CPAP prescription is good for APAP online.

[KimberlyinMN]

One good thing about renting for a few months through your DME is that you have the opportunity to see if the CPAP machine is what you actually need. I started out with a CPAP (with C-FLEX) but found I had too much pressure in my chest all day. Thanks to renting first, I was able to switch over to a Bi-PAP machine. If I had outright purchased the CPAP machine, I'd be "stuck" with it - regardless of where I bought it. I think my rental amount is something like $30/month and BCBS has me renting for 3 months with the rental amount being put towards the purchase of the unit.

Kimberly

[ColoradoDreamer]

Snoregirl,
The ENT wanted me to rent for a couple months to see how it works out, based on the sleep lab’s report that said I did not receive CPAP well. I will be seeing him 1.5 months into this rental to determine how I get along with CPAP. I fully intend to get the prescription w/ the info you mention at that time. I should be able to convince him that I should get APAP. I’ll see what my options are with terminating the rental and purchasing the APAP.

I like the idea of being able to monitor my progress and be able to provide the ENT info on my status and any changes. Being new to this, I don't knw if the APAP will show upward or downward trends that would justify it needing to be brought to the ENT's attention to change perscription or seek additional medical attention. I assume that it would. Sounds like from the posts that with APAP one might be able to better understand what their body is doing and even make minor adjustments. One night in a sleep lab may not accurately reflect one's average requirement (may be low or may be high that night). Wonder if there is any info on this.

TNX