Amount Paid by Insurance for Items Purchased at Cpap.com

[Lugus]

Just wanted to post my EOB for a claim I submitted to the insurance company myself for items purchased from cpap.com The rates paid are based on out of network at 50% and $1000 deductible. Did not think they would pay so I am very happy to have received something.

https://www.amazon.com/clouddrive/share ... TqZ9yKmdZI

Sorry I posted a url and not the image.

[jdm2857]

I would have thought that the insurance allowed amounts would be much closer to the cpap.com prices.

But, as you said, at least you got something.

[Lugus]

I think the allowed amounts are low because cpap.com is out of network and has no relationship with the insurance company. If I had used the DME's connected with the insurance company the amount quoted by DME and Insurance was close to $1700 and that was renting the machine not purchasing it. By going solo I saved a lot of money and removed the smirk from the DME who claimed they could not be beaten elsewhere.

[jdm2857]

The insurance companies get you every way they can.

You find lower prices, they reduce both the percentage coverage and the amount allowed.

[Wulfman...]

Looking that form, the thing I wasn't sure about was the "Deductible".
If that amount wouldn't have been a factor, I'm thinking the percentage would have been quite a bit higher......like maybe 80%.


Den

.

[jdm2857]

If the deductible was not a factor the insurance company would have paid about $125 more, as the deductible amount
would have been allowed and the insurance company pays 50% of the allowed amount.

That makes the insurance company's share about $300, or 36% of the $840 total.

[Lugus]

Unfortunately my insurance has separate deductibles for in network and out of network. I had already blown through my in network deductible but my sleep study and cpap equipment was all out of network hence an extra $1000 out of my own pocket to clear the out of network deductible. The insurance company also changed rules this year and does not count my deductible payments towards my out of pocket max. So $1500 out of pocket before I make a dent in the out of pocket max and doctors visits do not count towards it either.