DME/insurance or buy online? Same price, what do I do?

[YawnGone]

So paying through a DME and using my insurance is roughly the same price as buying machine and masks online. My deductable is $1500, so that may figure in just this year since I'm buying the machine, but probably not in following years. I own the machine outright through insurance and I believe my insurance doesn't even require compliance data. Online I would obviously own it outright as well.

With the costs being roughly the same and deductable not likely to factor in in the future, which route would you pick and why?

[palerider]

So paying through a DME and using my insurance is roughly the same price as buying machine and masks online. My deductable is $1500, so that may figure in just this year since I'm buying the machine, but probably not in following years.
With the costs being roughly the same and deductable not likely to factor in in the future, which route would you pick and why?

If you buy the machine online, it's yours, done and done.
If you use insurance, you have to jump through whatever hoops they want, and have to play their game.

[YawnGone]

So paying through a DME and using my insurance is roughly the same price as buying machine and masks online. My deductable is $1500, so that may figure in just this year since I'm buying the machine, but probably not in following years.
With the costs being roughly the same and deductable not likely to factor in in the future, which route would you pick and why?

If you buy the machine online, it's yours, done and done.
If you use insurance, you have to jump through whatever hoops they want, and have to play their game.

I added this to my initial question above. I would own the machine outright through my insurance and from what I'm told it doesn't even require compliance information.

[chunkyfrog]

But if the online dealer is not in your insurance network, it will not count towards your deductible.

[harrywr2]

It's only the 5th of January. Plenty of time to blow through that $1500 deductible.
Now that you will be wearing a mask every night nasal congestion might be an issue that needs addressing. Sinus CT Scan + consult with and Ear Nose Throat specialist will be at least $500.
You are probably going to have a few hundred dollars in consumables during the year as well. Masks, mask pillows, hoses don't last forever.
I'd go thought the insurance unless the insurance will count your online purchase towards your deductible.

If it was October or the deductible was higher than I'd go online. (or as was the case with me the DME misquoted me how much I would have to pay..never trust a DME..some have small print that says the amount in the sales/rental agreement is only an 'estimate'...the actual price may be different).

[palerider]

I would own the machine outright through my insurance and from what I'm told it doesn't even require compliance information.

While that's not totally unprecedented, it's very rare.

[D.H.]

I think that the question is that since you don't expect to meet the deductible, you don't see any benefit to going through a DME. I also understand that the on-plan DME price is roughly the same as the off-plan DME.

Assuming that this is correct, the downside is that if the unexpected happens during the year, you might meet the deductible (or might have met it had the CPAP been included).

BTW, I had a similar dilemma in 2005. I need a new CPAP machine. The DME supplier wanted approx $1500 for which the insurance would cover 90%, while an off-plan provider wanted approx $500, for which the insurance would have paid 70%. As you can see, this was a break-even deal. I chose the off-plan provider, as I got much better service. However, the deductible back them was quite low, and I don't think any plan you get now would cover a out-of-network DME this generously (if at all).

[Cruiser1234]

You also need to compare it to what either a used machine or what a new one would be from one of the discount suppliers. You may find you can get the machine for $400-600 from them...so then the whole $1500 conundrum becomes a very different discussion.

Many people think they want new until they hear of VAutos with <40 hours selling for $550. 40 hours is five nights. Heck, I even know of some with 15hours on them and this really changes the value proposition. Just make sure you have a new mask, filter, hose and humidifier and it's as good as new for literally half the price. This way you own everything and do not have to worry about all of the insurance hassles. Supplies can also be had very cheap from CPAP.com and others.

[Cardsfan]

If it is the same price buying it through insurance, I would want it to apply to my deductible. I went through my insurance and never had to prove compliance. My insurance paid the 80%.

[Janknitz]

You need to talk to your insurance company. Most insurance companies have contracts with DME's, and though the DME may CHARGE $1500 for a machine, the negotiated contract price with the insurer is only a fraction of that amount, and you only have to pay the insurance company's contracted price toward your deductible. So going through insurance may not actually cost you as much as you think. This is important to clarify before you make your decision. I would be very surprised if your insurer has contracted to pay $1,500 for a machine that retails for less than $1000 including hose, filter and mask.

Understand that DME's play a "fantasy billing game". They charge the amount they WISH they could get, but nobody but clueless suckers that walk in off the street ever pay. Insurers negotiate the prices down and in most cases (by contract or state law) "balance billing" (that is charging you the difference between what your insurance pays and the fantasy billing price) is ILLEGAL.

On the other hand, buying your own machine has its advantages. You don't have to hassle and dicker with a DME (NEVER, NEVER PAY $1500 for a machine!!!!), you get exactly what you want, when you want it. There are used machines in great condition from secondwind.com, from CAREFUL Craigslist shopping (we have a member who can help find you a great machine for a reasonable price), or buy brand new from cpap.com for much less than that.

The downside of buying your own is that if your machine breaks down you won't have a DME to repair or give you a loaner (but from what I understand, most DME's no longer give loaners in any case), and you won't be paying against your deductible.

Make sure you have all the fact when making your decision.

[JayDee]

So paying through a DME and using my insurance is roughly the same price as buying machine and masks online. My deductable is $1500, so that may figure in just this year since I'm buying the machine, but probably not in following years. I own the machine outright through insurance and I believe my insurance doesn't even require compliance data. Online I would obviously own it outright as well.

With the costs being roughly the same and deductable not likely to factor in in the future, which route would you pick and why?

Are you going to follow through with PAP therapy either way? If so...

Do you expect or can you schedule other large, covered medical bills this year? If so, then it's to your benefit to try and burn through your deductible. And even if you don't have or can't schedule any other planned medical procedures, considering insurance will cover CPAP stuff, then it still might be to your benefit to make sure it counts towards your deductible in case of any *unplanned* (no jinx!) medical issues that may arise tomorrow.

Another consideration - Does the DME you are working with not have, or won't issue, the machine or mask you want? In that case you may want to get a copy of your prescription from the Doc and buy on your own then. You could also go DME shopping. You don't have to use the DME the Doc's office points you to. The Doc generally just issues the prescription. It should work with any CPAP DME/vendor. In which case I would go with the DME that suits me and still use insurance.

Another way to look at it... Since you have insurance, you are paying those premiums anyway. It really is in your interest to chip away at the deductible every chance you get if you know you can get past the deductible this year. Since you have these CPAP expenses, I would try to cram as much medical stuff into this year as I could. Especially something like a colonoscopy that you won't have to repeat for 3 to 5 years. To beat the insurance companies at their own game, it's best to schedule big medical bills for the same year if/when you can. Though they're sort of like a casino where, "the house never loses".

Good luck with it!
-JD

[YawnGone]

Thanks for all the feedback! I found this DME by shopping around (avoided the one my doc had originally provided). They gave me an estimate of $950 for a Resmed AirSense 10 Auto with first mask included. So it sounded like a fair amount to me. I don't know that I will have alot of medical expenses later in the year, but may as well go thru DME and have it apply to my deductable either way.

[palerider]

Understand that DME's play a "fantasy billing game". They charge the amount they WISH they could get, but nobody but clueless suckers that walk in off the street ever pay.

It's not just DMEs it's everything and everyone even remotely connected with anything medical in this country.

It's no secret that I'm on dialysis. I had a procedure done at a new place, they wheeled me down a corridor into another company's dialysis center. hooked me up for a couple hours to make sure things were working... not even a full session.

The bill? *SIXTY SIX HUNDRED DOLLARS*.

Medicare says "How about you take $350 instead".

So, it's not just DMEs

I've seen bills from the regular dialysis center where they're wanting to charge $200 FOR A SYRINGE. The same one I can buy on amazon for TWENTY CENTS.

It's insane.
.

[ChicagoGranny]

Now that you will be wearing a mask every night nasal congestion might be an issue that needs addressing. Sinus CT Scan + consult with and Ear Nose Throat specialist will be at least $500.

If that is needed, then it is already needed before you ever touch a CPAP mask. The need might become more apparent while adapting to CPAP.

And, BTW, the pressure from CPAP eliminated nightly congestion for many of us. When in use, CPAP opens up the nasal passages.

[Janknitz]

Understand that DME's play a "fantasy billing game". They charge the amount they WISH they could get, but nobody but clueless suckers that walk in off the street ever pay.

It's not just DMEs it's everything and everyone even remotely connected with anything medical in this country.

It's no secret that I'm on dialysis. I had a procedure done at a new place, they wheeled me down a corridor into another company's dialysis center. hooked me up for a couple hours to make sure things were working... not even a full session.

The bill? *SIXTY SIX HUNDRED DOLLARS*.

Medicare says "How about you take $350 instead".

So, it's not just DMEs

So true. It IS insane. It's a game. The providers jack up the prices because Medicare conducts an audit every year to determine what the Medicare price will be. The providers think the more it's jacked up, the more Medicare will give them. Clearly NOT true, Medicare is on to that game, but the providers play it anyway. I don't know what would possibly happen to a provider who gave an honest and reasonable price. I wonder if these jacked up prices allow providers to claim losses for income tax purposes???

I've seen bills from the regular dialysis center where they're wanting to charge $200 FOR A SYRINGE. The same one I can buy on amazon for TWENTY CENTS.

It's insane.
.