Doctor Giveth / Insurance taketh away . Forgive my Rant.

[papdaddy]

Just got a call yesterday from my DME saying my insurance was not going to cover my CPAP purchase. The reason they gave them is "patient already has a CPAP machine, doesn,t matter how old or that it has no COMFORT features". So I call my third party insurer that covers DME for my Insurance carrier.(too many middle men) I try to explain to them that I just recenty had a sleep study and titration done and the findings were that I needed a pressure of 18 when laying on my back and a pressure of 16 any other position and that I was recomeded the Auto Titrating machine with AFLEX ,as 18 was too uncomfortable to exhale. (My original machine REMSTAR Pro with NO Cflex or pressure relief. 6 1/2 years old) I was told by Insurance overseer that they would not cover an new cpap machine due to" PATIENT COMFORT REASONS" I told them that I did not know exhaling was a patient comfort feature. I have been doing it all my life, Go figure! I call my DME back to tell him I had no luck with the insurance provider. To my suprise ,they recomended that I do something. I called my doctor to tell her that I had problems with insurance and DME suggested that they change perscription to a Bi Pap Auto and put failed Cpap on script. LOW AND Behold, the insurance company will cover the new BiPap as persrcibed???? So the insurance company didn't pay for the Cpap(which worked well with AFlex), But they paid almost 3 times as much for a New BiPap. Though I am not complaining, How did this so called 3 party save my Insurance company any money???? What a Joke. I am just so glad that I have a very good doctor and finally a great DME .(yes I said it ) Now I am very very happy with my Resmstar M series BiPap Auto with Bi Flex. Please forgive my Rant. Rich

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap machine, bipap, cflex, Titration, CPAP, DME, auto

[Slinky]

I LOVE it!!! A GOOD DME, a GOOD sleep doctor and some idiot at the insurance company screws the insurance company and the patient benefits w/a great machine that costs so much, much more. HURRAY!!

Thanks for making my day w/this information!!! I wish we could have more rants like yours. So many of us would be so much better off.

[Guest]

Ahem, I advised my neighbor to call her dme and tell them that her machine was making a funny noise. They said do you want to pick up a new one or have us deliver and set a new one up.I guess it all depends on what your definition of "funny noise" is.

[papdaddy]

[quote="Slinky"] I LOVE it!!! A GOOD DME, a GOOD sleep doctor and some idiot at the insurance company screws the insurance company and the patient benefits w/a great machine that costs so much, much more. HURRAY!!

Thanks for making my day w/this information!!! I wish we could have more rants like yours. So many of us would be so much better off.

[papdaddy]

Oceanpearl, that UHUM funny noise wouldn't be from falling off the Uhum roof , would it.

[Highnote]

This is my insurance company's policy also. I downloaded their coverage guideline off their website. It says c-flex = not medically necessary, failed cpap = you qualify for bipap and we'll pay.

Their explanation is that there is only one small, flawed study showing c-flex is better than straight cpap. Until somebody does a better study, they won't cover it.

[Snoredog]

yep, Insurance is the reason we have to pay what we do for most medical, the medical establishment charges us more for Insurance company stupidity.

The Bipap Auto is a better machine anyway for your high pressure, you get all the features of Aflex in Bflex and more.

This is exactly why our medical costs have risen 16% in 2006 when inflation never went over 6%.

[goose]

What cracks me up is that the Insurance companies are the first ones to whine about the "cost of medical care" and they are part and partial to the exorbitant costs -- so they do it to themselves!!!

cheers
goose

[geoDoug]

I was told by Insurance overseer that they would not cover an new cpap machine due to" PATIENT COMFORT REASONS" I told them that I did not know exhaling was a patient comfort feature. I have been doing it all my life, Go figure!

I dunno. I can see the insurance company's logic. After all, not breathing is uncomfortable. The short period between when I put my mask on and when I actually hook up to the machine so I can get some oxygen in me is uncomfortable...

That's probably not what they meant, is it?

Doug.