Buying online or use a DME – help me make a decision please

[PetrusKy]

I had my sleep study done and will see the doctor for results and prescription next week. I anticipate to be prescribed a CPAP for which I will try to convince the doc to write the script for an APAP. Specifically, I want the S9 Autoset. Presuming there’s no problem with that and I have a prescription in hand, my next battle is how to go about buying.

I have BCBS for insurance and talking to them, here’s the break down:

1) If I use a preferred DME like Pacific Pulmonary, my deductible is $300 and they cover 85%.

2) If I buy it myself, my deductible is $300 and they cover %65.

I haven’t been down this path before and all I know is what I read on this forum. Here are some of my thoughts.

Buying Online:

Pro:
. Get exactly the equipment I want
. Speed of delivery

Con:
. Out of pocket expense is more (although I don’t know how much)
. Hassle of sending in claim forms
. Can’t try masks without buying them first
. Future supplies and masks require more claim forms


Use a DME:

Pro:
. Out of pocket is less (although I don’t know how much)
. No insurance paperwork
. Can try on various masks at no extra expense
. Future supplies and masks require no more paper paperwork

Con:
. May have to “negotiate” for the desired equipment which may take several iterations
. May take longer to take delivery
. May have billing issues

[Jersey Girl]

Hi!

You may want to call a few "preferred" DME providers that BCBS lists. You can ask them if they have an s9 autoset in stock. Also, make sure that your doctor writes down Resmed s9 autoset. I always try to get something covered as much as possible by insurance first.

My DME gave me exactly what the doctor ordered and I did not have to pay out of pocket. (Although, I have heard horror stories here on the forum about DME's.) Still, we are not made of money, are we? Just stick to your guns and demand the machine your doctor has ordered.

Regards,

Jersey Girl

[PetrusKy]

Hi Jersey Girl,
I do have a deductible and a copay, so it won't be free with the DME route.

[jules]

call BC/BS and ask them what they pay allow a DME in your area to bill them for a CPAP

you can call DME's but they might not give it out to you or even know it

[kevincoop]

I work for a DME and I think you can get exactly what you want from one. Just do your research because as your research on here shows they are not all created equal.
Good luck,
Kevin

[GumbyCT]

I have BCBS for insurance and talking to them, here’s the break down:

1) If I use a preferred DME like Pacific Pulmonary, my deductible is $300 and they cover 85%.

2) If I buy it myself, my deductible is $300 and they cover %65.

I haven’t been down this path before and all I know is what I read on this forum. Here are some of my thoughts.

Buying Online:

Pro:
. Get exactly the equipment I want
. Speed of delivery

Con:
. Out of pocket expense is more (although I don’t know how much)

Use a DME:

Pro:
. Out of pocket is less (although I don’t know how much)

. May have billing issues

NOT so fast here Petrusky - DME and online prices won't be the same. So how would you know which will be more? You got that crystal ball out again?

Billing Issues? Just go the DME route then get back to us....lmao.

[PetrusKy]

NOT so fast here Petrusky - DME and online prices won't be the same. So how would you know which will be more? You got that crystal ball out again?
.

I didn't say they were the same. I really don't know that's why I'm asking you guys for your experience in this stuff.

If anyone don't mind sharing, I'd love to know how much you paid for the equipment you got when it's all said and done, DME or Online/Insurance. Thanks.

[jules]

your insurance contracts with their network DME's - you got to ask them how much as I said above

as far as reimbursement for online purchase, carefully check it out - get it in WRITING in TRIPLICATE they will actually give you anything in advance - experiences for ppl with vary on this too

you got some calls to make on Monday

[mattman]

Speaking as someone who has spent a long time as a DME provider and also as a proponent of buying online if someone should choose to, here's my take on it:

DME companies are best suited for patients who need or want a local partner in their treatment.

Online proviers are best suited for patients who know want to be driving their treatment. People who have the time and/or inclination to do the research and either do not want or do not need anyone getting involved in their treatment.

Aside from that, you've already outlined many of the pros and cons. I would however argue that delivery wouldn't be different between a local provider and online. Several places I've worked at we've had a maximum 24 hour turnaround before we've got someones butt planted in a patients living room setting them up. Same day if it's severe.

mattman

[GumbyCT]

If anyone don't mind sharing, I'd love to know how much you paid for the equipment you got when it's all said and done, DME or Online/Insurance. Thanks.

I didn't pay anything for mine. But I think each plan is different even within the same Ins. Co.

So without knowing your plan specifics it will just be a WAG (wild azz guess) without talking to your Ins.Co.

I could assume yours will be like mine - but I didn't.

Modified-

Con:
. Out of pocket expense is ( I don’t know how much)

Pro:
. Out of pocket is (I don’t know how much)

To me - the best advantage of going thru the DME hassle is using the mask fit. Tho you can get a mask fitting at most sleep centers too and Ins. will pay. The MAJOR diff there is you can get a 30 day mask exchange IF you buy at DME. CPAP.com offers that too for a fee.

There is much discussion already posted regarding the Pro and Cons. It always starts and ends the same - with the Ins. Co. Something you haven't yet shared.

- Ins. Co. and City/State can make many, many changes to the WAG's.

[PetrusKy]

Thanks for all the responses guys. I'm a little closer to finalize which path I'll take.

[Komodo]

If anyone don't mind sharing, I'd love to know how much you paid for the equipment you got when it's all said and done, DME or Online/Insurance. Thanks.

My DME billed my insurance $1200 for my S8 Elite 2 Cpap. My insurance payed them $400, which was the negoticated price, and I had zero co-pay. BUT.... the DME also charged $400 per month, for another 12 months, of which my insurance payed $56, and I had to pay $7 until my "insurance year" started over, and then I had to pay the full $63 per month.

Initial cost: $400

12 month rental @ $63 per month: $756

Total to DME: $1156

MY total out-of-pocket: @ $225

After only 9 months of Cpap therapy, I switched over to Vpap therapy, with a different insurance company, where I have ~ZERO~ co-pay. You REALLY NEED to talk to your insurance and find out EXACTLY HOW MUCH you're going to have to pay out-of-pocket before you make your decision of going with them, or an on-line dealer. Also, don't forget to fnd out when your "insurance year" ends and your yearly deductable starts all over again!!! (Mine started in July, and really screwed me, I thought it went from Jan-Dec!)

[PetrusKy]

Thanks Komodo, your info is really helpful.

[sleepycarol]

Even with a doctor's script written for specific model and brand it can be difficult to get what you want from a DME. You may have to fight them, and still not win. We have limited choices in our area of DMEs and they know that.

[rtsteve]

HI, i am a RT from Canada so it works a bit different up here. but if you are first starting out on therapy i think it is very important that you start with a live person that you can work with on your therapy. After you are set up and doing well on your therapy i think further purchases on line are fine but sometimes you can run into issues that require some one on one. In saying that if your vendor sucks and doesn't give good follow up or knows you well , then that isn't good either.. Bottom line if the cost is close and you can find someone(vendor) who cares about their patients and does good follow up(ie mask fittings,strategies if issues) then go with them . This forum is great as well you can get a lot of good stuff. mask fitting in my ;mind is the most important thing , machines do the job. but you dont wear the machine on your face,,, thats what i tell my patients... gets a laugh sometimes. Good luck.. Steve