DME vs. Online Provider Costs

[apneaheadaches]

So I've been lurking around theses forums since being diagnosed with SA about 4 weeks ago. After going through the game of trying to determine whether it would be more economic to go through a local DME vs online, it seems the local DME is a better bet (or I have simply given up due to fatigue.) In the interest of providing information to others who may have similar experiences, the breakdown went something like this for me (ymmv): I have BCBSFL with $0 of $500 deductible met and BCBSFL pays 80% thereafter.

The local DME charges one price for retail but is limited by an agreed contract price for patients coming through BCBSFL (insurance did something good for us ???). BCBSFL pays by renting the equipment for 10 months and then you own it. Basically my 1st payment will be ~$475 and this pays for everything (humidifier purchased in one payment) except for the remainder of the cpap machine. The remaining 9 payments are ~$63 (of which I pay 20%) except payment #2 which will be slightly more to meet the $500 deductible.

If I order online (and out of network) and all the equipment adds to ~$1200 I pay this full amount and submit bill to BCBSFL. Rather than the (out of network $1000) deductible being met and then BCBSFL covering 50% (out of network percentage coverage) of the remaining $200, my met deductible will only rise by what BCBSFL considers "allowable" which ends up being about the same amount as going through the local DME. So we can see I save in the hundreds by going local DME.

To find out this information I had to call BCBSFL and the local DME multiple times but eventually it came together.

Now the good stuff, it seems that even though my Rx states CPAP the local DME will be giving me a DS550S (PR System One Remstar Auto w/A-Flex) so that makes me happy. I was leaning toward a S9 Autoset for the purported better data availability via on board screen but can live with having to download from the card (as long as I can get comparable data that way). I have read that the System One uses standard data cards so that just leaves getting the software.

I would greatly appreciate any information on where this might be available to me since it appears hard to come by (from reading the posts).

In any event, I'm looking forward to getting rid of all the headaches (which I think are from constant arousal events) and will try to help out with answers to other questions from people going through the very beginning stages of trying to find the best deal for them (not that I'm an expert).

Btw, they say I'm about 28 events per hour but they divided the total events (168) by 6 hours (total time I was there) rather than the 4 I actually slept! Minimum O2 was 94% but I have done NO research on this aspect so I have no idea what is normal there yet.

[Janknitz]

Good research on the costs--always good to see a careful consumer

Encore Viewer software is available from online suppliers like our hosts for about $100.

[apneaheadaches]

Does anyone know if the memory card for the PR S1 Auto is a normal SD card (like from Best Buy) in case they don't give that to me?

[Pugsy]

Does anyone know if the memory card for the PR S1 Auto is a normal SD card (like from Best Buy) in case they don't give that to me?

I believe that it is a normal SD card. Someone can correct me if I am wrong but I just imagine it will come with a SD card because for insurance purposes the DME will likely need to check for compliance so that the insurance company will pay their portion.

[msradar65]

I would call and ask your BCBSFL if you can do an outright purchase. I had BCBSLA and they allowed me to chose purchase or rental. Since I had met my deductible and I was near the end of year I chose purchase.

[cpapcharge]

I would call and ask your BCBSFL if you can do an outright purchase. I had BCBSLA and they allowed me to chose purchase or rental. Since I had met my deductible and I was near the end of year I chose purchase.

I know some times the insurance company wants to make sure you're compliant before they will pay for a purchase but I would do this if you can. You will have to pay the $500 up front but overall it will be less expensive for you because you won't have the 9 months of extra payments at 20%.

[apneaheadaches]

I would call and ask your BCBSFL if you can do an outright purchase. I had BCBSLA and they allowed me to chose purchase or rental. Since I had met my deductible and I was near the end of year I chose purchase.

I know some times the insurance company wants to make sure you're compliant before they will pay for a purchase but I would do this if you can. You will have to pay the $500 up front but overall it will be less expensive for you because you won't have the 9 months of extra payments at 20%.

I don't think it would make much of a difference except the one possible payment (10th one) after my deductible resets at beginning of new year. Rather than 20% of 9 payments over time it would just be 20% of all 9 payments at once since after I meet my deductible (1st payment and a fraction of 2nd payment) BCBSFL only pays 80% of anything further for the year. If my last (10th) payment does occur on the next year, it will just be ~$63 rather than 20% of ~$63 since the price of cpap machine is split into 10 payments of ~$63.

[msradar65]

I would call and ask your BCBSFL if you can do an outright purchase. I had BCBSLA and they allowed me to chose purchase or rental. Since I had met my deductible and I was near the end of year I chose purchase.

I know some times the insurance company wants to make sure you're compliant before they will pay for a purchase but I would do this if you can. You will have to pay the $500 up front but overall it will be less expensive for you because you won't have the 9 months of extra payments at 20%.

You are correct it was not until my DME has all the compliance data that they billed BCBS of LA. I did pay $154 copay out my pocket. I am still waiting for them to bill my secondary insurance. I will probably owe nothing.

But still I didn't want to mess with rental. The BCBS plan I was on was COBRA plan and with a $4k deductible that I had met I knew I was not going to continue the insurance at the start of the new year. My new job had BSBS anthem last year and this year it switched to CIGNA.

So when looking at cost..it was better for me to go ahead and make a purchase, and BCBSLA was ok with a purchase over rental.

[chrisp]

It's good that your insurance is picking up most of the tab on this. Is the PR system what you asked for or is that what the DME sells?
FWIT I can buy a Devilbis intellipap w/ humidifier and software for $590 and I own it. Throw in $100 for the mask. And I help keep insurance rates down. Yes its a lower priced unit and seems to not be the fancy unit that many posters have but it seems like a well made unit. They seem to be a patient friendly and want OUR input. This is the unit I am considering.

Is your BCBS a group plan, govt, private pay. It does seem like a good deal. Can you try it for a while and trade for another if you don't like it?

I just got the bill for my sleep study....$2800. And I didn't even sleep. They should call it a well make sure you don't sleep study

Thanks for the info.

[LarryD]

"chrisp" hit the nail on the head. My DME was insistent on the PR System One. I didn't want that machine. I finally got them to order the Intellipap Auto with Smart Flex and integrated humidifier. They agreed simply because I was in a position to buy the machine myself out of pocket and they decided they wanted the business. Amazing how felxible they become when you have done your homework.

I will pay $19 per month for 13 months.

[Wulfman]

"chrisp" hit the nail on the head. My DME was insistent on the PR System One. I didn't want that machine. I finally got them to order the Intellipap Auto with Smart Flex and integrated humidifier. They agreed simply because I was in a position to buy the machine myself out of pocket and they decided they wanted the business. Amazing how felxible they become when you have done your homework.

I will pay $19 per month for 13 months.

Not if you have a deductible and it resets somewhere in those 13 months.


Den

[apneaheadaches]

It's good that your insurance is picking up most of the tab on this. Is the PR system what you asked for or is that what the DME sells?
FWIT I can buy a Devilbis intellipap w/ humidifier and software for $590 and I own it. Throw in $100 for the mask. And I help keep insurance rates down. Yes its a lower priced unit and seems to not be the fancy unit that many posters have but it seems like a well made unit. They seem to be a patient friendly and want OUR input. This is the unit I am considering.

Is your BCBS a group plan, govt, private pay. It does seem like a good deal. Can you try it for a while and trade for another if you don't like it?

I just got the bill for my sleep study....$2800. And I didn't even sleep. They should call it a well make sure you don't sleep study

Thanks for the info.

The PR S1 is the only one they said they have. Since the memory card is non-proprietray and software is available, I can live with the subpar info display screen.
I called multiple DME's and others had different machines (such as the S9 Elite) but no other DME was offering an AUTO machine like the original DME was (the PR S1 Auto w/A-Flex).
My plan is Blue Options through my employment (group plan).
My sleep study was roughly the same and I got a bill for $50. I barely slept in the 1st one but got a little more in the 2nd one.

[Pugsy]

Sounds like you have done your home work and your math to figure out which is best for you. The PR S1 Auto w/AFlex should serve you well. I have the older M Series Auto w/AFlex. On screen data is pretty useless on it also. Since I have the software, I never bother with the on screen data. I have never regretted my decision to get it.

[StevenXXXX]

Apneaheadaches said: The PR S1 is the only one they said they have.


Most DMEs can get exactly what you want pretty much overnight if they order it for you.

I am not pushing you towards one or another, but don't let them tell you that the PR S1 is the only one they have.
They are telling you that just to steer you towards that one.

If that is what you want, then OK, but get what you want.

[apneaheadaches]

Apneaheadaches said: The PR S1 is the only one they said they have.


Most DMEs can get exactly what you want pretty much overnight if they order it for you.

I am not pushing you towards one or another, but don't let them tell you that the PR S1 is the only one they have.
They are telling you that just to steer you towards that one.

If that is what you want, then OK, but get what you want.

Actually, to clarify, they said they don't carry Resmed products.