A $2500 Auto CPAP???

dllfo · Post by **dllfo** » Wed May 10, 2006 4:26 am

My insurance is with Tricare, retired military. Congress mandates all this junk
and they are stuck..no....we are stuck paying for it. It is not cheap either.

Apria told me they charge a lot more because they demo everything.
Now I hear they bill separately for the labor. My Apria bill, in my hand...well,
no, I scanned it and can magnify it...it says continued on page two, but I did
not get a page two. I just found that. I certainly am not accusing anyone of
anything crooked, just curious as to how they can play the game and the
insurance companies (yours anyway) don't howl.

I just called Apria's "hot line" and told them I couldn't use the full face mask. I tried again tonight and the asthma just won't let me use the full
face mask right now. Sooooooo I called the hotline and told them their
DME guy talked me into the wrong mask, I want a nose mask. I will get
one...except I now have to read a hundred of these posts until I find a post
that lists why people like their nose masks. I would like two things on mine.

One: I need one that allows me to scratch or at least rub my nose while it
is on. I don't know why (yet), but my nose itches when I have the FF mask
on.

Two: No hot spots please. I have the Flexifit HC431A mask. If I am sitting
up it is fine. When I lay down, it is not. The asthma causes other problems.
My HC431A has a hot spot, but that is my fault. If I could keep it, I would
learn how to adjust it and get rid of the hot spot.

Any other things you consider important on a "nose mask" - -please let me
know because I will probably be invited to their offices tomorrow to pick one
out.

Thanks, Dave

Guest · Post by **Guest** » Wed May 10, 2006 6:03 am

How can you really tell if the machine the DME brings out is used? I would think that the can wipe off the hours used somehow?

I bought a used Remstar Pro privately and can't find a date of manufacture or serial number on it.

Normally I would look for a date of manufacture to get an idea of how long the machine has been around but if it isn't there? Maybe it is inside the machine or something? Anyone know?

Maybe DME guy?

DME_Guy · Post by **DME_Guy** » Wed May 10, 2006 9:31 pm

If there is a way to clear the hours, I don't know about it. My guess is you bought a stolen CPAP and the took the serial # and date of manufacture off so it couldn't be traced. I wonder if the serial # is also stored on the hardware of the machine. I'll try to find out.

[quote="Anonymous"]How can you really tell if the machine the DME brings out is used? I would think that the can wipe off the hours used somehow?

I bought a used Remstar Pro privately and can't find a date of manufacture or serial number on it.

Normally I would look for a date of manufacture to get an idea of how long the machine has been around but if it isn't there? Maybe it is inside the machine or something? Anyone know?

Maybe DME guy?

Wulfman · Post by **Wulfman** » Wed May 10, 2006 9:35 pm

There's actually two sets of "use time". One is the compliance hours, which CAN be cleared. The other is the hours of use.....which CANNOT be cleared.

Den

Linda3032 · Post by **Linda3032** » Wed May 10, 2006 9:37 pm

Dave, I got my equipment through Tricare "standard". I purchased my own equipment out of pocket and Tricare reimbursed me 75%. I bought a Remstar Auto, humidifier, bag, hose, Nasalaire mask, everything I needed for around $1000 (this was before I found cpap.com).

I had no problem getting reimbursed via Tricare - I just filed a normal claim form. I never went through a DME.

DME_Guy · Post by **DME_Guy** » Wed May 10, 2006 9:40 pm

Wulfman wrote:There's actually two sets of "use time". One is the compliance hours, which CAN be cleared. The other is the hours of use.....which CANNOT be cleared.

Den

Yes, thanks for clarifying.

Wulfman · Post by **Wulfman** » Wed May 10, 2006 9:48 pm

I'm sorry, I don't have an answer for the serial number question. (at the moment)

Den

cmsmws · Post by **cmsmws** » Thu May 11, 2006 1:27 pm

Tell me about it. My provider will not pay for my BPAP unless it comes from a DME. So they initially charge $4000, adjust it down to $3000 to hit the limit of my insurance carrier and then I get to pay the 20% of the cost of durable medical equipment. LAST time for that, I have a DME appointment in July and I will have a few things to show them....none in their favor. I will be working with my insurance on items from CPAP.com and go from there. I finally figured out what DME really stands for: D****d Medical Extortionists.

Wulfman · Post by **Wulfman** » Thu May 11, 2006 1:33 pm

cmsmws wrote:Tell me about it. My provider will not pay for my BPAP unless it comes from a DME. So they initially charge $4000, adjust it down to $3000 to hit the limit of my insurance carrier and then I get to pay the 20% of the cost of durable medical equipment. LAST time for that, I have a DME appointment in July and I will have a few things to show them....none in their favor. I will be working with my insurance on items from CPAP.com and go from there. I finally figured out what DME really stands for: D****d Medical Extortionists.

Technically, CPAP.COM IS a DME provider.... (The GOOD kind)

Den

cmsmws · Post by **cmsmws** » Thu May 11, 2006 1:43 pm

My apologies, I was referring to the one my Fr. so happily provided righ in his office. I did not mean to imply that CPAP.com was included in my definition. If I had known about this site before I would have found a way to get it through here.

Wulfman wrote:
cmsmws wrote:Tell me about it. My provider will not pay for my BPAP unless it comes from a DME. So they initially charge $4000, adjust it down to $3000 to hit the limit of my insurance carrier and then I get to pay the 20% of the cost of durable medical equipment. LAST time for that, I have a DME appointment in July and I will have a few things to show them....none in their favor. I will be working with my insurance on items from CPAP.com and go from there. I finally figured out what DME really stands for: D****d Medical Extortionists.

Technically, CPAP.COM IS a DME provider.... (The GOOD kind)

Den

cmsmws · Post by **cmsmws** » Thu May 11, 2006 1:46 pm

I am retired military also and is there a way to get it yourself and then file with Tricare Prime/Humana? If I have to keep paying these prices I am going to explode.

[quote="dllfo"]My insurance is with Tricare, retired military. Congress mandates all this junk
and they are stuck..no....we are stuck paying for it. It is not cheap either.

Apria told me they charge a lot more because they demo everything.
Now I hear they bill separately for the labor. My Apria bill, in my hand...well,
no, I scanned it and can magnify it...it says continued on page two, but I did
not get a page two. I just found that. I certainly am not accusing anyone of
anything crooked, just curious as to how they can play the game and the
insurance companies (yours anyway) don't howl.

I just called Apria's "hot line" and told them I couldn't use the full face mask. I tried again tonight and the asthma just won't let me use the full
face mask right now. Sooooooo I called the hotline and told them their
DME guy talked me into the wrong mask, I want a nose mask. I will get
one...except I now have to read a hundred of these posts until I find a post
that lists why people like their nose masks. I would like two things on mine.

One: I need one that allows me to scratch or at least rub my nose while it
is on. I don't know why (yet), but my nose itches when I have the FF mask
on.

Two: No hot spots please. I have the Flexifit HC431A mask. If I am sitting
up it is fine. When I lay down, it is not. The asthma causes other problems.
My HC431A has a hot spot, but that is my fault. If I could keep it, I would
learn how to adjust it and get rid of the hot spot.

Any other things you consider important on a "nose mask" - -please let me
know because I will probably be invited to their offices tomorrow to pick one
out.

Thanks, Dave

Wulfman · Post by **Wulfman** » Thu May 11, 2006 1:49 pm

My provider will not pay for my BPAP unless it comes from a DME.

I understood you.....I was trying to make the "connection" because of the stipulation by your insurance provider. I'm not sure if you can argue that point with them, though.

Den

Handgunner45 · Post by **Handgunner45** » Thu May 11, 2006 1:58 pm

cmsmws and dllfo,

Have you guys tried to go through your local VA Healthcare system. I was discharged on a medical disability and am able to get everything done through the VA. No charge and they have been really nice to work with abeit a little slow at times. As Retires you should be eligible for the same benefits!!!!

Linda3032 · Post by **Linda3032** » Thu May 11, 2006 4:25 pm

cmsmws wrote:I am retired military also and is there a way to get it yourself and then file with Tricare Prime/Humana? If I have to keep paying these prices I am going to explode

I don't know how Prime works - call your area representative with Humana. They were very helpful with me when I bypassed my DME. I've been doing this for 3 years now, buying everying myself and filing claims. I get a new mask every 6 months, and in fact, I just got another new machine.

But, I have "standard", so the rules might be different with Prime. If you don't know how to contact your local Humana rep, look in your Tricare book, or contact me with what state you live in. I can look it up for you.

Guest 12 · Post by **Guest 12** » Thu May 11, 2006 5:01 pm

Everyone likes to complain allot on this site, but the truth of the matter is that if it was you making the money you wouldn't be complaining. First for most insurances they will cover 80-100% of the cost. If the DME is good they will waive the remaining 20% and then you will pay 0.00$ out of pocket. Also allot of the DME providers have a customer service departments and techs who service the machines. Who do you think pays them? Finally if your company is trying to raise prices by 300% it's as simple as calling another DME provider and telling them to beat the prices. If you have insurance you might as well use it.

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