Insurance or not???

[Jcoyne97222]

I thought at some point I saw a sticky regarding dealing with insurance but don't seem to see anything right now. If I am missing it let me know.

I am on a 3 month rental because I was unsure if I could get used to CPAP. I have now gotten used to it mainly do to this forum so thanks!

Now I am working to get my own machine instead of the rental.

My DME just got info back from my insurance and my machine cost is out of pocket because I haven't met my deductible.

The quote from my DME is just under $1,032 for a resmed 11 airsense with humidifier and heated hose. When I look on CPAP.com the price is within dollars just to buy from them and not involve my insurance. It also states on my quote it is for a 10 month rental. I questioned the DME about the rental and they said that is just for insurance purposes. That after the 10 months the machine would be mine. I explained I could buy a machine myself for the same costs and then she offered to price it not going through insurance. For the hell of it I said sure, go ahead.

She came back with $750 if I just buy it outright. I asked why the price difference and she said something about that's their contracted price with the insurance company....

I usually don't meet my annual insurance deductible so I ask is there any reason I shouldn't just buy the machine outright? Basically it will cost me $282 more out of pocket for it to only apply towards my deducible.

Let me know if I am missing something or any experiences any of you might have had.

[ChicagoGranny]

Firstly, don't trust the DME. Ask your insurance company. Also, ask the insurance company if durable medical equipment is subject to the deductible.

She came back with $750 if I just buy it outright. I asked why the price difference and she said something about that's their contracted price with the insurance company....

It is standard insurance company practice to negotiate lower prices with their in-network providers.

[ChicagoGranny]

resmed 11 airsense

Please specify ResMed AirSense 11 AutoSet.

[Jcoyne97222]

Firstly, don't trust the DME. Ask your insurance company. Also, ask the insurance company if durable medical equipment is subject to the deductible.

She came back with $750 if I just buy it outright. I asked why the price difference and she said something about that's their contracted price with the insurance company....

It is standard insurance company practice to negotiate lower prices with their in-network providers.

Then why is my price cheaper than the insurance company price?

[Jcoyne97222]

resmed 11 airsense

Please specify ResMed AirSense 11 AutoSet.

The resmed AirSense 11 Autoset is what was originally quoted. I just sent a message to the DME to verify the price they quoted me was for the same machine.

[Pugsy]

Then why is my price cheaper than the insurance company price?

When you buy up front and without insurance involvement the DME gets all his money up front at one time.
When insurance is using the 10 month rent to own thing they get the insurance approved amount divided up in 10 different monthly payments.

[Janknitz]

Then why is my price cheaper than the insurance company price?

In addition to what Pugsy said, the DME may be on the hook as long as 5 years to repair or replace the machine if you to it through an insurance covered rental process, especially if you are on Medicare. Medicare (and you with your deductibles and copayments) pays higher than the retail price because of the documentation, repair and replacement requirements they put on DME's.

If you had a crystal ball to know if meeting that deductible is important it would help, but owning the machine outright has both perks and problems.

Perks--it's yours and you don't have to worry about proving your compliance (you SHOULD be 100% compliant, but that's your business, not anyone else's).
Problem--if it needs repairs or replacement even during the warranty period, you'll have to wait, and it could be out of pocket outside the warranty period. OTOH, they rarely break down.

[Jcoyne97222]

Then why is my price cheaper than the insurance company price?

In addition to what Pugsy said, the DME may be on the hook as long as 5 years to repair or replace the machine if you to it through an insurance covered rental process, especially if you are on Medicare. Medicare (and you with your deductibles and copayments) pays higher than the retail price because of the documentation, repair and replacement requirements they put on DME's.

If you had a crystal ball to know if meeting that deductible is important it would help, but owning the machine outright has both perks and problems.

Perks--it's yours and you don't have to worry about proving your compliance (you SHOULD be 100% compliant, but that's your business, not anyone else's).
Problem--if it needs repairs or replacement even during the warranty period, you'll have to wait, and it could be out of pocket outside the warranty period. OTOH, they rarely break down.

I will ask about the warranty and length of term. They stated after the 10 months I would own the machine. No Medicare. I am sure they probably have to report compliance to the insurance company which has cost for the DME. I am just really frustrated with the DME and feel like I don't get straight answers. It seems like their game is sell you tons of stuff and bill the insurance company but then I end up paying anyways.

Compliance isn't an issue either, I am averaging about 8 hours use a night.

[chunkyfrog]

I suspect paperwork is a significant part of the price.
Also, the machine you are using is "used".
(Unless it was used when YOU got it--what are the run hours?)
The DME should not be able to sell it as new--
but some will try anyway.

[jtravel]

Save yourself some money and consider buying from Cpap.com without insurance, they sell the Airsense 10 auto at a huge bargain price of 499
The Airsense 10 is a high quality work horse of a machine with many years of proven design function and reliability. The Airsense 11 is a new design using the smaller Blower motor from the Resmed mini.

[amenite]

Save yourself some money and consider buying from Cpap.com without insurance, they sell the Airsense 10 auto at a huge bargain price of 499
...

Maybe three years ago a new Airsense 10 was $499. Not today.

[jtravel]

Save yourself some money and consider buying from Cpap.com without insurance, they sell the Airsense 10 auto at a huge bargain price of 499
...

Maybe three years ago a new Airsense 10 was $499. Not today.

Actually they have been selling it for $499 for several months now. It was even lower on black friday and Cyber monday sale. right now at Cpap.com with their current promotion code RESMED25 from the email they sent me it is $499. Add to cart and apply promo code to get the $499 price. I know others have called in the past and asked for the promo if they had any problem applying it.
https://www.cpap.com/productpage/resmed ... t-humidair

[amenite]

Save yourself some money and consider buying from Cpap.com without insurance, they sell the Airsense 10 auto at a huge bargain price of 499
...

Maybe three years ago a new Airsense 10 was $499. Not today.

Actually they have been selling it for $499 for several months now. It was even lower on black friday and Cyber monday sale. right now at Cpap.com with their current promotion from the email they sent me it is $499. I know others have had to call and ask for the promo in the past if you don't have the email link to follow.

Back in the old deleted email folder I do see another bulk mail - Code SLEEP25
I guess this the last gasp for the Airsense 10, $499 is pretty darn low for this machine.
If they would just send me fewer junk mails I might actually read one now and then

[chunkyfrog]

. . .
If they would just send me fewer junk mails I might actually read one now and then

My emails are almost all JUNK.
I only check when I am hoping for something real . . .

[ChicagoGranny]

Then why is my price cheaper than the insurance company price?

You are comparing apples and oranges. One is a rental that you could back away from and leave the DME with little revenue and a used machine. The other gives the DME full revenue upfront.