Getting the equipment's convoluted!

[sifr]

I was referred from a specialist in my HMO to the facility's associate sleep center. After my sleep study results were analyzed, my doctor had to send a recommendation for prescription (not an actual prescription) to a department in the HMO. That department then reviewed it, approved it, and sent it to a DME supplier (Sleep Med of California, supposedly very good customer service). Apparently the DME supplier now has to get in touch with my doctor at the sleep center, get the actual equipment recommendation along with a copy of the sleep study, and my insurance information.

Then, they'll call me and supposedly set me up with my equipment.


And, strangely, I have to rent the APAP machine for 10 months (with a 20% co-pay...I'm already armed with the price I can buy the unit for outright, from online sources), and then insurance will purchase it, BUT I have to buy the humidifier outright.

If their contracted rates are ridiculous, I'm going to be annoyed.


At least the DME now has a "give this guy something" order, finally. So hopefully I'll have it by the end of next week, unless they're so backed up that they can't even schedule time for me with a tech next week.


Sheesh. I swear, with a copy of the sleep study, I could set the silly thing up myself. Is all this really necessary?

I really hate the idea of having to rent the machine for 10 months. I mean, the only change they could make is moving me to a full biPAP unit, which the doctor already said I don't need.


I hate bureaucracies.

[Sleeprider]

I think equipment "rent to own" is the standard for insurance. Before you will own the equipment, you will be scheduled for a follow-up with your doctor. At that time, your compliance and tolerance for CPAP will be evaluated and obviously, if you don't use the equipment, you lose it. Many people are dispensed CPAP equipment and quit using it in the first few weeks. Support groups like this forum can really help some people stick with it and overcome some difficulties. Anyway, the DME provider will usually have a pretty significant price difference from online, and that is because they will help to fit and support the equipment. If I didn't have 100% coverage, I would have considered just buying outright and getting what I want.

If you have a specific type of equipment you want to receive (APAP with data and humidifier), you should talk to your primary physician and explain your preference. It will be written as a prescription, and if APAP is not specified, you could be dispensed the least expensive CPAP alternative.

[BlueSky72]

It's only necessary if you want to go through your HMO and insurance etc etc. I live in a country where no insurance covers equipment, period. A basic CPAP machine (compared to an ASV machine for central sleep apnea) is relatively affordable if bought online. You can either continue with the bureaucracy and all its immutable problems, or just go ahead and buy a reasonably priced machine online. Yes, you can set it up yourself. Just choose carefully first by checking with knowledgeable fellow patients that you are getting the right machine as per your study and prescription. Good luck.

[sifr]

The doctor -- and I -- wants me to have a ResMed S8 AutoSet II with an integrated heated humidifier and a Swift II or Swift LT mask. Supposedly that's what I'll be getting. If I don't, I'll raise all kinds of stink. (not to mention that I already have a card reader and software on the way. ).

[BlueSky72]

Good to hear you are going to be fully data capable. I didn't mean reasonably priced as in a cheap model - I meant the same model as prescribed, without the huge DME/insurance scam markups. A lot of people find that keeping it simple and buying direct is cheaper in the long run. And when I mentioned about getting the right mahcine, I meant don't get a CPAP if you need an APAP or a VPAP, as you'll end up buying twice.

[GumbyCT]

Not ALL Ins. Co use the "rent-to-own" price mark-up scam. Just make sure YOU read any paperwork thoroughly before signing. In many cases the burden shifts from Ins. to the patient for non-compliance.

You can either buy online or use craigslist and/or cpapauction dot com
You need to spend some time reading and searching this forum. Run the numbers for your cost both ways.

Good Luck

[plr66]

I'm one who returned the rental/insurance-involved machine after the first 30 days, when it dawned on me that I'd be paying double or triple the cost of just purchasing out of pocket from cpap.com. (My sleep-deprived brain never could run the numbers exactly, but I knew it was going to be a huge difference!). I did buy my mask from the DME, simply because they allowed me to do trials on about 6-7 different ones over that month, to get the right one.

Be sure to keep in mind that this is nearly September, and most insurance deductibles start over in January. This can make using your insurance counter-productive and much more costly in the long-run if you have as high a deductible as I have.

[windsurfertx]

I have a high deductible on my insurance so purchasing on line is what I'll probably do.

I've found there are 4 prices for this equipment. This is a basic machine w/no humidifier mask or head gear.

DME - $1300
using insurance $700+??
cash price - $750
on line - $400

+?? This price is a guestimate because none of the DMEs will tell me what the charge would be using insurance. It seems you have to purchase it first.
and may involve renting for 8 months at a cost of $94 per month.
Does this seem to be in line with what ya'll are finding?

Perhaps this is what should be discussed in the all this health care debate.

windsurfer