getting a cpap

[678]

I'm looking for a cpap machine for my husband. I've read to get all the bells and whistle to start with but money is an issue right now. I'm wondering if I should get a lesser unit to start with so he can have something to use and keep looking for a better one. His doctor has suggested Resmed for ease of use and ability to get products for and has also suggested by passing Medicare and buying outright. Any suggestions? Thanks

[Slinky]

Whoa! What an elightened doctor! I'm impressed. IF you are in Michigan PM me your doctor's name and phone number, please!!! He sounds like a real keeper!

I can't tell you today's Medicare reimbursements but I can give you some ideas from 2006 Medicare reimbursements.

Medicare will reimburse for all accessories as an outright sale. Bear in mind that the Billable amount is the local DME supplier's pipedream so to speak. Actual monies are the Allowed, Paid and Patient CoPay amounts.

Total Accessories Billed: $548.00 - Medicare Allowed $499.63 - Medicare Paid $399.70 - Patient CoPay $99.93
a7037 - tubing used with positive airway pressure device - Allowed $48.00 - Paid $32.82
a7034 - nasal interface (mask or cannula type) used with positive airway pressure device, with or wi - Allowed $130.00 - Paid $94.11
a7035 - headgear used with positive airway pressure device - Allowed $45.00 - Paid $31.80
e0562 - humidifier, heated, used with positive airway pressure device - Allowed $325.00 - Paid $240.97

Medicare requires a 13 month Capped Rental after which time the CPAP becomes your sole property. So for 13 months:
Billed $135.00 - Allowed $99.95 - Medicare Paid $79.96 - Patient CoPay $19.99

By 2007 Medicare Allowances and Reimbursement amounts had dropped to monthly amounts of:
Billed $135.00 - Allowed $74.96 - Medicare Paid $59.97 - Patient CoPay $14.99

The amounts were again dropped in 2008 but by that time my CPAP capped rental had ended and I don't know the amounts.

Now shop around for the various CPAPs via online DME suppliers such as cpap.com and compare your costs. Just keep in mind that Resmed, Respironics and Fisher & Paykel have instituted MAP (minimum advertised pricing) policies against the online DME suppliers so at some online sites you have to call their toll-free number to ask if they have an "unadvertised sale price" for an item you are interested in, at other online sites you can just "add the time to our shopping cart" to find out the true sale price. Don't just accept the advertised price as necessarily being the actual price you might have to pay, you may be able to get the item for less. These MAPs make things a bit more difficult to comparison shop but the savings can be worth it.

Once you have an idea of prices, before you make your final decision check out the CPAPs and accessories at cpapauction.com If you see an item that interests you decide the maximum amount you are willing to pay and bid only that amount, (keep shipping charges in mind when placing your bid). You may get it for less once the bidding is done, or you either won't win the item or won't pay more.

If feasible I would recommend the Resmed S8 Elite w/EPR or the Resmed S8 II Elite w/EPR.

Good luck!

[Guest]

Wow.... the medicare thing is complicated. Our doctor tends to be very practical and I wish I could tell you he's in Michigan but alas... he's in GA (thank goodness for us). I'll keep looking at sites for machines. Thanks for your quick rely. 678

[RipVW]

Check out the cpapauction.com as well--sometimes we get great prices there. Good luck!

[Slinky]

Wow.... the medicare thing is complicated. Our doctor tends to be very practical and I wish I could tell you he's in Michigan but alas... he's in GA (thank goodness for us). I'll keep looking at sites for machines. Thanks for your quick rely. 678

Rats. Some people have all the luck! I suppose you are having warmer weather in GA than we are in MI too.

Ah well, to make it easier for you. Let's assume the 2006 rates still applied (your costs would be lower in 2009): You would have to pay $119.92 up front when you take delivery of your equipment from the local DME supplier plus $19.99 a month for 13 months (and we know from the 2007 amount that you would be paying $14.99 or less a month now). HOWEVER, you might have one devil of a time getting more than a bare-bone, compliance data only CPAP from the local DME supplier. Why use insurance to buy the cheapest CPAP and then at a later date pay considerably more out of pocket for a better CPAP?

$15 a month for 13 months is $195 plus the $99.93 up front. Your total cost via Medicare: $294.93 for CPAP "and" accessories.

Try this: most all local DME suppliers accept Medicare. Visit the various local DME suppliers in your area and tell them you have Medicare and want a Resmed S8 Elite w/EPR or a Resmed S8 II Elite w/EPR and see if one of them will supply you w/either of those Elites and what your total costs would be. Its really no different than shopping for a car. Don't let them hand you any BS that you would have to pay extra for the Elite. Medicare pays by HCPCS code, NOT by brand and model, and the Elite is the exact same HCPCS code as any of the bare bones, compliance data only CPAPs.

You and your doctor DESERVE a fully data capable CPAP such as the Elite to monitor your husband's therapy and not have to make any necessary adjustments by guess and by gosh.

[cflame1]

If you're going with Resmed... a machine that you don't want... is an Escape/Compact.
If you're going with Respironics... a machine that you don't want... is anything labelled Plus or DS100.

These 2 machines will give you no usable data other than compliance (if that when it comes to the DS100).

[boston]

you can also check craigslist

[Slinky]

Check out going the Medicare route first w/the various local DME suppliers, then compare w/your other options. Keep the figures I've given you in mind as you shop the locals. Their quote should be less and certainly no more than those I've given you.

[Guest]

Okay I want to make sure I'm clear before I go into the real world of DME. I should tell I want a Resmed S8 Elite or Elite II with EPR and that I have Medicare. I want to see what they'd sell them to me for and I'm using the Medicare as price cap, so to say, but I'm not filing it through Medicare. Is that right?

[678]

Okay I want to make sure I'm clear before I go into the real world of DME. I should tell I want a Resmed S8 Elite or Elite II with EPR and that I have Medicare. I want to see what they'd sell them to me for and I'm using the Medicare as price cap, so to say, but I'm not filing it through Medicare. Is that right

[Georgio]

Check this one out at CPAPAUCTION.COM that is mentioned above:

http://www.cpapauction.com/listingPage. ... ngId=37736

[Slinky]

I'm just giving somewhat outdated Medicare figures so you have something to compare to. That's all. It will probably be cheaper for you to go w/a local DME supplier using your Medicare benefits.

[678]

Gotcha! Thanks for all the info. I'm also looking at cpap auction but I have to get the cpap prescription first so..... I'll let you know how it goes.

[Slinky]

Good luck. That's a darling dog!

[678]

Why thank you. She's a sweety. Just an update on the Cpap> I talked to a DME who is really helping me get through the system. She says she can use the initial sleep study but to get the second one done and make sure the results are sent to her. She will set us up with the Resmed S8 Elite with EPR and humidair 4, that medicare will pay 80% we'll be responsible for 20% but she may be able to get that written off. Can this be happening? I've got the sleep study set up so we're getting somewhere. I'll gladly pay 20%. We'll see what happens.