What is customary equipment when you have a new CPAP script?

[Rexlan]

I just received a CPAP prescription after a sleep study that prescribed an APAP machine with the settings and a flex value. Who decides what machine I will receive and if it is used or new?

I'm in Alabama and have BC/BS Advantage (age 73). None of the DME's in my area sell equipment - rental only. Reading the "literature" which is as clear as mud, it implies that the rental is owned after 13 months. No so according to the DME. They intend to bill monthly for the rental and turn a $700 investment into $6,000.

My question is what's normal practice. I was offered a brand I didn't care for that was used and told to take it or leave it so I bought my own Dream Station.

If rented from a DME do you own the rental after 13 months and can stop paying ? Is the DME to provide a new unit (not necessarily of your choice) or can they give you a working unit that is well used?

Finally, is there any chance insurance will reimburse me the equivalent amount thy would pay the DME as a private claim? My hunch is no chance.

The code for the machine is E0601 and only says 1 every 5 years. That implies ownership and not rental. I can not find one for rental and another for purchase like they have for oxygen concentrators. And, most of the folks here seem to use the DME's for equipment.

[Pugsy]

If you had traditional Medicare then there is a 13 month capped rental.

But you have a Medicare Advantage plan and it seems to be more and more common for those plans to do the perpetual for life rental per month. I have a Medicare Advantage plan and I see that wording in my own explanation of coverage. Sometimes they will do a capped rental if the person requests it but there is nothing to force them to do it.

You did the best you could in this situation and it is what I would do if I were new to cpap with my existing Medicare Advantage plan.

There's nothing stopping you from using the DME for masks and other supplies though....that's what I do with my DME. I get my mask allowance and sometimes incidental supplies from the DME using my insurance.

[Rexlan]

That is an excellent idea I had not considered at all. I will see if they have the proper mask. Thank you for the tip.

I got the Dream Station auto machine w/heated humidifier and hose, some filters, a complete DreamWear mask kit and 3 extra hoses for $699. I think that was a decent price and about $200 - $300 less than most places.

I did the same thing with the oxygen concentrator. Bought the identical unit they wanted to rent for $594 - Invacare Perfecto 2. The DME bills and gets from BC/BS 136/month for it ... lol. That is almost $5,000 when the warranty is up in 3 years - what a racket.

Thanks again for the tip.

[bwexler]

You need to request the "Evidence of Insurance" from your Advantage plan and READ the portion about DME.
I have learned the hard way that no one knows or cares about DME and how it actually works.
When I read mine it was very clear that I would never own any equipment that the insurance helped to pay for. That is why I paid out of pocket for my oxygen concentrator and my new ASV machine.

[prodigyplace]

You do not need nearly as many CPAP supplies as Medicare allows. DMEs use those numbers to oversell supplies, increasing their profit.

Many DMEs try to place you on an automatic supply program to maximize their profit too.

[LSAT]

As indicated above...with Medicare you rent for 13 months and then own the equipment. I have been told that my Medicare Advantage Plan follows Medicare Guidelines. The monthly rental the DME charges is fictitious...Medicare allowable amount is about $75 monthly. You pay 20% or about $15-16. After 13 months you will have paid about $200 for the machine. On my last machine (4 years ago) my payment was $16 monthly for 13 months.

[lukerolin]

hi!
i wanted to throw in my info here in case it may help. i have been in sleep and DME for almost 20 years now and was most recently the operations manager at a mid size DME in Texas.

more and more insurance companies are requiring a rental period now. the insurance decides how long that rental period is, could be 3 months, or 13 months but almost NEVER longer than that. If your DME says the rental continues, that's just false. it is not.
But yes, after those rental months, you absolutely own that machine. you own the supplies immediately.

they are also requiring compliance, meaning if you don't wear it, they do not pay the DME for it.

personally, i absolutely hate insurance companies. i believe their business practices are criminal. that's why i started my own cpap company that deals in cash.

on the DME side, it's becoming impossible to run a successful business because of these changes. and i believe that's why the quality of DME has suffered so greatly.

[prodigyplace]

hi!
i wanted to throw in my info here in case it may help. i have been in sleep and DME for almost 20 years now and was most recently the operations manager at a mid size DME in Texas.

more and more insurance companies are requiring a rental period now. the insurance decides how long that rental period is, could be 3 months, or 13 months but almost NEVER longer than that. If your DME says the rental continues, that's just false. it is not.
But yes, after those rental months, you absolutely own that machine. you own the supplies immediately.

they are also requiring compliance, meaning if you don't wear it, they do not pay the DME for it.

personally, i absolutely hate insurance companies. i believe their business practices are criminal. that's why i started my own cpap company that deals in cash.

on the DME side, it's becoming impossible to run a successful business because of these changes. and i believe that's why the quality of DME has suffered so greatly.

And be sure the DME does not try to bill you for more months.

My rental was 10 months, rent to own (Anthem Medical). I kept track & complained when I saw a bill for the 11th month. They quickly reversed that because they got caught..

[ChicagoGranny]

I don't understand why people don't pick up the phone and call their Advantage plan CSR. Mine is perfectly helpful and even offered to have a supervisor call my lying DME and straighten them out.

[babydinosnoreless]

I don't understand why people don't pick up the phone and call their Advantage plan CSR. Mine is perfectly helpful and even offered to have a supervisor call my lying DME and straighten them out.

I called Bc/bs with issues about my dme, they shrugged and said well you can switch to someone else then gave me a list made up of dmes that I see complained about most on here like apria and linecare.

[chunkyfrog]

Customary is whatever they can get away with.

[LSAT]

hi!
i wanted to throw in my info here in case it may help. i have been in sleep and DME for almost 20 years now and was most recently the operations manager at a mid size DME in Texas.

more and more insurance companies are requiring a rental period now. the insurance decides how long that rental period is, could be 3 months, or 13 months but almost NEVER longer than that. If your DME says the rental continues, that's just false. it is not.
But yes, after those rental months, you absolutely own that machine. you own the supplies immediately.

they are also requiring compliance, meaning if you don't wear it, they do not pay the DME for it.

personally, i absolutely hate insurance companies. i believe their business practices are criminal. that's why i started my own cpap company that deals in cash.

on the DME side, it's becoming impossible to run a successful business because of these changes. and i believe that's why the quality of DME has suffered so greatly.

Very interesting...many of us feel the same way about DMEs