Where to Buy CPAP (should I go off insurance?)

[geekinchief]

So, honestly, I haven't been having that bad of a time but I went to the ENT a few months ago for wax in my ear and he convinced me to take a home sleep study. After like 3 weeks, he calls me back and says "you need a machine. someone will call you." Six weeks go by and today someone called me saying "A dude named Larry will you call you to rent you a machine." I looked up Larry's company on Google and it gets one star for doing things like not shipping things, hanging up on people when they call and sending people to bill collections for no reason. I don't want to deal with 'Larry' so I asked for a prescription and my doctor's office somewhat reluctantly sent it to me, for a Resmed Airsense S10 Auto specifically.

I've read on a lot of forums that I'm better off paying out of pocket and not dealing with my insurance company at all, because it allegedly costs more money and the insurance company then gets a load of medical data on you (the idea of the insurance company spying on me is terrifying TBH). So I googled around and it seems like CPAP.com has a good reputation and they seem to have my device in stock. Their site says that it's even possible I could get some kind of reimbursement from my insurance company for out-of-network purchases. CPAP.com specifically says to ask about insurance reimbursements on this forum.

So I am going to ask: A.) Is CPAP.com a good place to buy my stuff? B.) What kind of stuff do I need to buy and how much will it cost if I don't use insurance and C.) Do you recommend I avoid 'Larry' and dealing with my insurance company?

[Pugsy]

cpap.com is a good place to purchase cpap supplies from...they pay the bills for this forum

What kind of insurance do you have? Does it have a high deductible? Is there a co pay involved? Have you met max out of pocket expenses for this year. Does your insurance want to do the rent to own thing or just purchase outright? Lots of questions that your own insurance will need to answer.
Read this
https://maskarrayed.wordpress.com/what- ... me-part-i/

Will your insurance reimburse for out of network purchases? You need to ask them. Some will and some won't.

For some people it is more cost effective to bypass insurance and just go out of pocket but for some people...depending on the insurance....using insurance saves them money.

Oh....just because you don't buy a machine from a local DME doesn't mean you can't use them for masks and other accessories.

So we need a lot more details about your insurance before we can really offer opinions.

And finally...check with your insurance company as to possibility of there being another DME equipment supplier in your area that they have contracts with besides "Larry".

[geekinchief]

I currently have Cigna PPO and not filled my deductible for the year.

[chunkyfrog]

I purchased my first Autoset from www.cpap.com.
I saved several hundred dollars over local clip joint prices.
Each insurance company has different policies for different clients.
You need to ask them for a statement of what is covered in YOUR policy.
And then do the math.

[Pugsy]

Ahhhh...a PPO...extra restrictions. Cigna (I think) typically uses CareCentrix to handle cpap stuff and that's typically Apria which we commonly call Crapia for good reason. I doubt they will reimburse out of network expenses or even allow those to apply towards the deductible.

Call them (your insurance) up and ask them all the particulars about reimbursement and expected expenses on a claim for the E0601 cpap machine. They may or may not mimic Medicare's way of reimbursement and protocols.
We have no way to know because each insurance plan can be different.

If you have a big deductible and a lot left to meet ....most likely out of pocket purchase will be a more cost effective option...and remember the deductible will start all over on Jan 1.

You have to do the math though.
You have some homework to do. Read the link I posted above.

[Miss Emerita]

The ResMed Airsense 10 Autoset is currently going for $598 at cpap.com -- a good price, I believe. I use them for masks and such, and the customer service is excellent. You will need to scan your prescription and send it to them; after that, they will keep it on file.

"ResMed Airsense 10 Autoset" -- be aware that every word counts.

[Pugsy]

Also bear in mind at cpap.com your machine RX lets you get masks which also require a prescription.

And at cpap.com all masks come with free 30 day return insurance (be sure to read up on what all is involved) so if you try a mask and hate it...you aren't stuck with it and flushed money down the toilet.

The mask part of cpap therapy is IMHO the most difficult part of the cpap journey. Finding the right mask for your face and your own personal preferences, wants and needs can be a challenge when first starting therapy because you have nothing to base your needs on.

[Okie bipap]

The mask part of cpap therapy is IMHO the most difficult part of the cpap journey. Finding the right mask for your face and your own personal preferences, wants and needs can be a challenge when first starting therapy because you have nothing to base your needs on.

This is so true. I tried 15 or 16 masks before I found one I can use every night. I have returned several masks to cpap.com and passed on others I got from other places. I am still looking for that "perfect" mask, but I doubt I will ever find it. Most of us have to settle for what works without causing other problems such as sore nose, too many leaks, etc.

[Pugsy]

I am still looking for that "perfect" mask, but I doubt I will ever find it. Most of us have to settle for what works without causing other problems such as sore nose, too many leaks, etc.

Nothing is ever 100% "perfect" 100% of the time...even within one person much less all the people out there.
Our own personal preferences, wants and needs can change over time as well. Something that didn't bug me 3 years ago might bug the heck out of me today.

We pick the one that seems to fit our own needs today as best as it can today....now tomorrow it can be a whole different ball game in terms of our own needs and new masks as they get released and what is available on the market.

[Janknitz]

Some day I'm going to create a spreadsheet to help people determine if they are better off buying their own machine or using insurance to obtain one. It will compare out of pocket costs like deductibles, co-payments, and a special box for aggravation potential.

Some day . . .

[zonker]

and a special box for aggravation potential.

be sure to leave a BIG space for that!

[geekinchief]

So I ordered and just received my ResMed S10 from thecpapshop.com. I would have ordered from cpap.com and maybe I will in the future for supplies, but I found a special deal where they sold me the machine and a free mask for $599. So I saved like $100 on a mask over what other sites were offering. It's a full face mask and I'll see how I like it.

The whole having my insurance company get my sleep data thing makes me uncomfortable. Especially in this environment where pre-existing conditions may no longer be protected soon, I don't want the insurance company to have data it can use against me in the future. I have $1K left on my deductible for the year so I'm going to assume I probably wouldn't have saved much by going with the DME my doctor wanted me to use. And that DME had an F rating from the BBB and numerous online complaints about not shipping product and then sending people to billing collections months later.

[chunkyfrog]

www.Cpap.com will match prices . . .