insurance only paying part of supplies

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blueeyes
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insurance only paying part of supplies

Post by blueeyes » Tue Jan 06, 2015 11:04 am

My insurance will not pay for all of my supplies anymore. They want you to replace them regularly but I cannot order everything I need because of costs. Is there anything out there that can help with the costs?

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Sleeprider
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Re: insurance only paying part of supplies

Post by Sleeprider » Tue Jan 06, 2015 11:16 am

Can you be more specific what is being denied, and why? What supplies do you need/want? I notice you have a S6 CPAP which has to be at least 8 years old. Almost any insurance policy would replace that antique brick. Why have you been denied an upgrade/replacement?

Lots of us are in the same boat and we source less expensive materials from online providers like CPAP.com, Craigslist, Ebay, Amazon and swaps and exchanges through this forum. For me, that approach is often less expensive than buying with insurance assistance that forces you to use high-cost, inconvenient DMEs and imposes conditions.

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Wulfman...
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Re: insurance only paying part of supplies

Post by Wulfman... » Tue Jan 06, 2015 12:38 pm

blueeyes wrote:My insurance will not pay for all of my supplies anymore. They want you to replace them regularly but I cannot order everything I need because of costs. Is there anything out there that can help with the costs?
Who is "they"? And, what type of supplies do you need so often?
For almost 10 years, other than the initial equipment purchase, all of my supplies and extra machines have been purchased out-of-pocket with no assistance from insurance. I could buy all of my supplies from places like CPAP.COM for much less than what my deductible was (which I never met, anyway). It made no sense to me to buy at over-inflated prices from a brick and mortar place just to use up my deductible.


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englandsf
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Re: insurance only paying part of supplies

Post by englandsf » Tue Jan 06, 2015 12:59 pm

Does your prescription specify what and how often you can replace mask, pillows, tank etc?

That should be what insurance goes by minus deductibles of course.

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blueeyes
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Re: insurance only paying part of supplies

Post by blueeyes » Tue Jan 06, 2015 2:23 pm

I have a respironics remstar pro system one with humidifier.

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palerider
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Re: insurance only paying part of supplies

Post by palerider » Tue Jan 06, 2015 2:36 pm

blueeyes wrote:I have a respironics remstar pro system one with humidifier.
if you update your profile to show correct things, people will not be confused when trying to help you.

replace your stuff as it wears out, not the ridiculously fast rate that people trying to pad their profit margins want to sell you things. buy from amazon or ebay for best prices in most cases.

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rtrtrt

Re: insurance only paying part of supplies

Post by rtrtrt » Tue Jan 06, 2015 4:47 pm

Just because an prescription has something written on it, such as allowables, does not mean the insurance will cover the items. The insurance company is the "dictator" by the allowables they set.

The 2 most important pieces to change are the cushion and the disposable filter. The frame is the most expensive part, I keep a back up on hand and only replace the frame when I go to my back up because the something broke.

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Re: insurance only paying part of supplies

Post by Bobby120446 » Tue Jan 06, 2015 7:42 pm

rtrtrt wrote:The 2 most important pieces to change are the cushion and the disposable filter.
My disposable filter is a little block of foam no more than an inch on a side. When I saw the cost of new filters, I bought a simple kitchen stainless steel mesh strainer. The filter goes in the strainer, I hit it with the vacuum cleaner crevice tool from the other side, and it's clean in a couple seconds. It can't get sucked through the mesh and disappear into the machine. Sometimes I have to move the filter around a little so the mesh doesn't block parts of it.

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OkyDoky
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Re: insurance only paying part of supplies

Post by OkyDoky » Tue Jan 06, 2015 7:48 pm

The black foam filter can be washed. I wash with baby shampoo and rinse then dry.
Last edited by OkyDoky on Tue Jan 06, 2015 7:52 pm, edited 1 time in total.
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Re: insurance only paying part of supplies

Post by Rtrtrt » Tue Jan 06, 2015 7:48 pm

The black filter is a reusable filter, washable. No need to replace unless it gets a hole, torn or you lose it.

The disposable filters are white.

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palerider
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Re: insurance only paying part of supplies

Post by palerider » Tue Jan 06, 2015 8:01 pm

Bobby120446 wrote:
rtrtrt wrote:The 2 most important pieces to change are the cushion and the disposable filter.
My disposable filter is a little block of foam no more than an inch on a side. When I saw the cost of new filters, I bought a simple kitchen stainless steel mesh strainer. The filter goes in the strainer, I hit it with the vacuum cleaner crevice tool from the other side, and it's clean in a couple seconds. It can't get sucked through the mesh and disappear into the machine. Sometimes I have to move the filter around a little so the mesh doesn't block parts of it.
the DISPOSABLE filter is a flat white fuzzy on one side mesh... the washable, reusable filter is a dark gray foam.

both are VERY cheap http://smile.amazon.com/s?ie=UTF8&field ... oniccom-20

even less on ebay

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Wulfman...
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Re: insurance only paying part of supplies

Post by Wulfman... » Tue Jan 06, 2015 9:21 pm

blueeyes wrote:I have a respironics remstar pro system one with humidifier.
Still waiting to hear what type of "supplies" you need on a regular basis.

You've been a member of this forum for over 10 years. You should know by now that there are folks who can try to help you out.


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blueeyes
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Re: insurance only paying part of supplies

Post by blueeyes » Wed Jan 07, 2015 11:38 am

I guess I will not be replacing my supplies as often as I have. I was going by what came with my supplies. It says once a month replace full face cushions. Every 3 months you replace mask and tubing. Every 6 months replace reusable filters and headgear. I do have the reusable black filter that I wash and let it dry. Thanks for the link palerider on amazon did not know that had cpap supplies.

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palerider
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Re: insurance only paying part of supplies

Post by palerider » Wed Jan 07, 2015 12:09 pm

blueeyes wrote:Thanks for the link palerider on amazon did not know that had cpap supplies.
yeah, I was surprised how much was on there now when I looked a few months ago, before that, I'd mainly been getting filters and mask parts off ebay... now I compare prices

it's best to replace things *as needed* not on a schedule. replacing perfectly good parts on a schedule benefits the DME and their profits, not you.

I've gotten *years* of use out of a full face cushion... I had a spare, kept waiting for the first one to fail... it never did, got it in 2009 and used it until I switched to a pillow mask a few months ago. still have the spare mirage quattro cushion.

replacing them monthly is just a huge drain on money. same for hoses, as long as pets don't eat them, they're good until the ends get too soft to hold onto the connections, and even then, I just wrapped some thread tightly around the end of mine, (it was easier and quicker than getting another hose, even though they're only a few bucks on amazon or ebay, or from cpap.com.

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blueeyes
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Re: insurance only paying part of supplies

Post by blueeyes » Wed Jan 07, 2015 3:14 pm

I totally agree palerider. The DME really are making the money on supplies telling people you have to replace your supplies so often.
Have a good one!!

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