Renting vs. Purchasing CPAP

[heavybreathing]

I got my authorization for my CPAP. According to the insurance, they want me to rent the CPAP and Heated Humidifier, and buy the mask, hose, and filter.

Is there any successful way to convince an HMO to buy the equipment instead of doing a rental?

I don't want to feel like I can't change HMO's without having to go through this whole uncomfortable DME negotiation process again, so I would prefer to have them just buy it. I also want to know that my CPAP equipment won't be changing if I change insurance providers. And in the long term, if I stick with this HMO, it will probably be much less expensive for them to just buy the equipment instead of renting it.

[LSAT]

Most insurance and Medicare require you to rent...usually after 12-13 months rental the CPAP belongs to you
They require the DME to check your compliance at 30 days to be sure that you are using the machine for at least 4 hours a night.

[sleepyb]

Actually it can be helpful to rent for a few months. If you hate the machine (like I did) you can return it and go somewhere else. Some insurances just have the rental for a couple months where some have it for over a year. I'd check if I were you because depending on the copay of the rental charge, it might be cheaper to just by one online. Of course then you miss the wonderful experience of negotiating with a DME.

[jules]

actually in a HMO all conventional rules can be discarded

they pick - they choose - they dictate it all

if you want other, you pay OUT OF POCKET

[msradar65]

I think there are some factors that play a part in this. What equipment you are issued to begin with? How well you adjust to the new equipment?

I chose to make a purchase and not a rental. But I got the equipment I wanted and the mask I wanted. So I am completely happy with my purchase. I also have a high deductible...and renting would have cost me most of the machine out of pocket. So a purchase was best for me from a financial standpoint.

Now my DME did not bill my insurance until I was past about 30 days into having the equipment. So I guess they could show compliance and of course they let me know about changing masks within the 30day window.

[jmelby]

The only way to find out is to call your insurance... the way it worked for me was a 3-month rent-to-own... the first 3 months, it was a rental. Then, it converted to a purchase after my DME certified I was using it (from the data card). But, the rental amount already paid went toward the purchase price. I doubt the insurance company would make any changes to the way they handle it (i.e., there is no way to "convince" them), but you would do well to call and find out how it works.

Most insurance companies require the rental first to ensure compliance... a large percentage of people who try CPAP fail to use it regularly, so they don't want to shell out the purchase price (their portion anyway) until they are certain you will follow through with using it.

[mayondair]

I changed from a CPAP to an Auto about 2 weeks into therapy, was glad I insisted on a rental, unless you are sure about the machine a rental may be a good idea, less trouble to switch to an auto or BIPAP if that is what you end up needing.

[Janknitz]

Your insurance company dictates whether or not you can purchase rather than rent. The only way to know for sure is to contact your insurer.

If you have traditional Medicare Parts A and B with a supplement/Medi-gap policy, you MUST do it on a capped rental basis. Other insurers have their own policies, so you need to check with the individual insurer. Many follow the same terms as Medicare, but not all.

HMO's don't have to follow the standard rules, even if you have an HMO plan through Medicare Part C (also known as Medicare Advantage). And in most cases, with an HMO, it's "their way or the highway". If you don't like the terms, the items covered, or the DME, you'll have to pay out of pocket to buy your own (which, incidentally, MAY be cheaper out of pocket in the long run--always check on what your total out-of-pocket expenses will be for YOUR share of the equipment--monthly rental co-pays plus any annual deductible periods which you might pass).

Finally, a word of caution: NEVER, NEVER, NEVER, NEVER take a DME's word for what is covered by YOUR insurance company. Always double-check by contacting your insurer. DME's lie or make mistakes since they can't memorize every insurance plan. Don't get stuck because you didn't double check their word. The CPAP user is always the loser.

[heavybreathing]

I got a good laugh. (Well, not really.) I called my insurance and asked. They said hold on and we'll call the DME company to find out. You have to be kidding. I told them not to bother, as of course I had already talked to the DME company and the DME company said it is all up to the insurance company.

[jlk]

I requested an outright purchase for my first machine and got it, it was the Escape model, didn't know better back then, I really didn't win, did I?. I went online to purchase my S-9 and submitted the bill to my insurance. I was reimbursed at the non-preferred provider rate at 75%. It was far cheaper than renting as my $1000 deductible was met for the year and was about to start over. I would have paid more than the unit cost online to go thru the local dme rental. Get out your calculator and check that option also. Call your insurance and find out the non-preferred rate. john

[jweeks]

Is there any successful way to convince an HMO to buy the equipment instead of doing a rental?

Hi,

How much do they want you to pay? I see used S8 auto machines that are like new selling for under $300. I'd suggest taking a look at a used machine now, and then after 3 months, once you know for sure what you need and what you like, then buy a new machine for long term use. That leaves you with a spare machine, and a machine to use for travel. I have seen co-pays and rentals that were far more than $300, so you might be able to do it on your own much cheaper. When I first got started, I picked up a used M-Series BiPAP Auto for $400. The DME cost on this was over $3000. Even if I would have had insurance, it would have cost me more than the used machine.

-john-

[jtoast]

I'm in the same discussion with my insurance company now. Before I got the machine I talked to several reps and was told a straight purchase would be no problem. Same when I spoke with the DME (Lincare).

Unfortuantely Lincare billed me for both a rental and a purchase. The purchase got declined as a duplicate and now I'm fighting to get it fixed. Wouldn't be a big issue normally but I actually covered my deductable last year and a rental will cost me much more money if it has to come out of this years deductable. (I'm on an HDHP).

An HMO is a whole different ball game. About all you can do is follow their appeals process. Usually less stress to just accept the rental.