Don't need to be in compliance

[ozzyluvshockey21]

The only thing that annoys me is I am having to go through compliance because I have a new insurance and got a new machine, but I have been on cpap therapy for years and years...so it isn’t like I am new to the game. I am not going to pay out of pocket, I pay for insurance for a reason, but it does annoy me still.


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[Cubbiebear]

I'm going to say ONE THING in defense of Crapria and LinDon'tCare (probably for the first time ever!) and that is that IF you have Medicare or a contracted insurance company they are correct that it may be illegal (Medicare) or a violation of their contracts with your insurer to sell a CPAP machine to you directly and bypass your insurance. This is to prevent these DME's from scalping people who don't know how their insurance works. But I'm not sure you'd want to buy through them anyway because their prices are ridiculous fantasies.

Its never illegal to by pass your insurance in lieu of cash. I found and bought from a place that doe not accept insurance or bother with it in any way. cpap.com. For me this was perfect after what I had been through.

It is possible that in order to be "in network" for an insurance provider, the DME has contractually agreed not to sell devices directly to a covered customer. If I were an insurance provider, that is what I would require, to "stay in control".

However, if the insured person revoked consent to use their insurance they are then a self pay customer, not insured. It is illegal to bill someone’s insurance without their consent.


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Thank you, you are correct. I called my insurance today and read a few comments on here. No one EVER is to be forced for any reason to use insurance if they choose not to, that is illegal.

[D.H.]

Its never illegal to by pass your insurance in lieu of cash. I found and bought from a place that doe not accept insurance or bother with it in any way. cpap.com. For me this was perfect after what I had been through.

It's not illegal for YOU to pay cash in lieu of using your insurance but it is ILLEGAL for a certified Medicare provider to accept your direct payment instead of going through Medicare. That's called Medicare fraud if they sell to a Medicare recipient directly. Non-Medicare providers like most online sellers can do it, but Medicare providers cannot.

Certainly, it's fraud if they bill you as an "out of pocket" sale and also bill Medicare. If they don't bill Medicare it's in a muddy area. However, they are well advised to avoid this situation. You'll need to buy from a provider that does not accept insurance, or at least not medicare.

[greatunclebill]

I went to a couple different medicare authorized suppliers and paid cash for things that i could have got thru medicare with a prescription. There was nothing muddy about it. They knew i was on medicare and we even discussed which way to go.

[Okie bipap]

When I was using my original DME supplier, I purchased several items in addition to what I got through Medicare. If I offered to pay without mentioning Medicare, they took my credit card, rang it up, and it never showed up on my Medicare charges. I think they preferred my paying with the card since they actually got more money that way. They weren't restricted to Medicare reimbursement rates.

[bwexler]

I am 8 years in new and I expect to need a new ASV machine in the next year or two. Since they tend to be expensive I would like to use my Medicare advantage insurance. However all the companies I have checked with are requiring perpetual rental, never own.
This is different from when I acquired my current machine and my first APAP.
I do not plan on renting forever, but haven't determined a good plan of action yet.

[Okie bipap]

If you have basic Medicare, you rent for 13 months, then the machine is yours. If you have a Medicare advantage plan, you must go by their rules. Medicare advantage plans have good things and bad things about them. You must decide if the good out weighs the bad. If you have to rent for ever, it may be cheaper to purchase out right using your own funds.

[bwexler]

Yes I am well aware.
Now if someone could tell me the exact date my current ASV will die, I can prepare a logical plan.
While your at it, let me know what all my other medical expenses will be for the next 3 years and I can formulate the ideal plan of action.

[palerider]

Yes I am well aware.
Now if someone could tell me the exact date my current ASV will die, I can prepare a logical plan.
While your at it, let me know what all my other medical expenses will be for the next 3 years and I can formulate the ideal plan of action.

2018-11-16, 04:23

$14,743.27

Anything else?

Why don't you start keeping your eye out *now* for a used machine... it's always good to have a spare.

[Pugsy]

Call up your Medicare Advantage insurance company and ask them if there is an option to convert the perpetual rental option to a purchase at the end of 13 months. I know of one person who got them to agree to go the other way and not do the perpetual rental. You have to ask though.

You don't want perpetual rental for sure...20% of the approved ASV rental costs is quite pricey. Not cheap like the 20% for cpap machines.

If they won't do it...start shopping at secondwindcpap.com and watch the forum.

[trekwars2000]

Call up your Medicare Advantage insurance company and ask them if there is an option to convert the perpetual rental option to a purchase at the end of 13 months. I know of one person who got them to agree to go the other way and not do the perpetual rental. You have to ask though.

You don't want perpetual rental for sure...20% of the approved ASV rental costs is quite pricey. Not cheap like the 20% for cpap machines.

If they won't do it...start shopping at secondwindcpap.com and watch the forum.

Just curious about how much are the CPAP or APAP machines to rent per month?

[bwexler]

Call up your Medicare Advantage insurance company and ask them if there is an option to convert the perpetual rental option to a purchase at the end of 13 months. I know of one person who got them to agree to go the other way and not do the perpetual rental. You have to ask though.

You don't want perpetual rental for sure...20% of the approved ASV rental costs is quite pricey. Not cheap like the 20% for cpap machines.

If they won't do it...start shopping at secondwindcpap.com and watch the forum.

Yes I know. I went through this a year ago when I had to replace my oxygen concentrator. I went all the way through the formal appeals process, and then went and bought a machine for cash.
The O2 was cheap compared to ASV.
I am hoping to wait for the next round of new ASV to come available used.

[Pugsy]

Just curious about how much are the CPAP or APAP machines to rent per month?

You wanting to rent just to try something or rent to own?
I have no idea about rental fees with no plans to purchase. It's not done very much here in the US.
Now other parts of the world yeah, but I have no idea as to fees.

Now rent to own after whatever months...that's up to the insurance company and what the allowed amount is.
Some years ago I put a pencil to what Medicare out of pocket expenses would be (assuming no supplemental coverage to pick up the 20% copay)...and roughly the 20% co pay for 13 months was around $33 a month. That was machine/blower only.
Humidifier was a separate and one time full approved amount purchase. No monthly fees with the humidifier...bought and paid for up front.
That was some years ago and I am sure allowable amounts have changed.

[trekwars2000]

Just curious about how much are the CPAP or APAP machines to rent per month?

You wanting to rent just to try something or rent to own?
I have no idea about rental fees with no plans to purchase. It's not done very much here in the US.
Now other parts of the world yeah, but I have no idea as to fees.

Now rent to own after whatever months...that's up to the insurance company and what the allowed amount is.
Some years ago I put a pencil to what Medicare out of pocket expenses would be (assuming no supplemental coverage to pick up the 20% copay)...and roughly the 20% co pay for 13 months was around $33 a month. That was machine/blower only.
Humidifier was a separate and one time full approved amount purchase. No monthly fees with the humidifier...bought and paid for up front.
That was some years ago and I am sure allowable amounts have changed.

I'm just trying to get a feel for the overall cost for the rented machine vs buying outright on cpap.com or where ever. Your saying it was $33 month but on a 20% copay. So that actually meant it was $165/month for 13 months? That seems high, but of course, what doesn't...

I am going to visit with a DME next week to see what the deal is with my insurance even though I should have my machine delivered today.

[Cubbiebear]

[/quote]

I am going to visit with a DME next week to see what the deal is with my insurance even though I should have my machine delivered today.
[/quote]

You might do better just calling your insurance company for answers. That is way to much if it comes to $165 monthly..way more then the cost of one. Good luck.