Insurance vs self pay

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Pugsy
Posts: 59237
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Insurance vs self pay

Post by Pugsy » Fri Oct 08, 2021 1:53 pm

Janknitz wrote:
Fri Oct 08, 2021 1:32 pm
DME's lie like snakes anyway. So I would never, EVER, trust a DME who tells me what the out of pocket cost is going to be, if they ever would. ALWAYS check with your insurer.
Totally agree but to my thinking if I go to a DME that my insurance recommends they damn well should at least make an attempt to answer my questions (which I would then of course verify with the insurance company) and make a damn phone call if they can't answer the question.
If they aren't willing to make a simple phone call....pretty sorry DME and like I said...run don't walk away from that sort of service.
There's someone in their billing department whose job it is to figure this stuff out....and if there isn't...another reason to go elsewhere.

I would also report to the insurance company the level of non service I got from someone they recommended I go to and maybe they should reconsider recommending them.

When I get on my high horse for the principal of the thing I can ride it a long way. :lol: Will it make any difference??? Probably not but I would sleep better knowing I ratted on the crappy DME.

I can understand not knowing....but what is unforgivable to me is lack of trying to find out whatever it is they don't know.
Obviously a don't give a crap mentality there....would make me wonder what else they don't give a crap about.
I wouldn't buy so much as a filter from a place like that.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

TheWalkman
Posts: 7
Joined: Thu Oct 13, 2011 8:50 pm

Re: Insurance vs self pay

Post by TheWalkman » Mon Oct 11, 2021 9:05 am

My old CPAP is 10 years old and having finally reached my insurance deductible for 2021, I thought this would be a good time to get a new CPAP. Wrong!

The insurance company (Cigna) makes you jump through so many hoops (and requires you to rent the machine for six months, have a new sleep study, visit your doc for another check-up, etc.) it would likely cost more for me to have them pay for a new machine than if I paid for it out of pocket.

(From what little I can tell, they would reimburse me around $100 before my deductible gets reset on December 31, making the insurance claim a real joke.)

This assumes I could even buy a new machine before the end of the year which seems impossible due to the Philips fiasco.

I did my homework and it appears that the new ResMed 11 is a nice machine but I can't get a straight answer from any DME on what the cash price would be.

Has anyone gotten a cash price for the new ResMed 11?

I've never seen an industry where no one seems to have a clue about anything. Very frustrating.

GrumpyHere
Posts: 246
Joined: Sat Feb 13, 2021 2:40 am

Re: Insurance vs self pay

Post by GrumpyHere » Mon Oct 11, 2021 8:32 pm

TheWalkman wrote:
Mon Oct 11, 2021 9:05 am
Has anyone gotten a cash price for the new ResMed 11?
$1000 per garagelogician
garagelogician wrote:
Wed Oct 06, 2021 8:26 am

Two weeks ago I found a DME that was selling the AS11 online for preorder, and the website said that the units would start shipping at the end of September. I placed an order, and they notified me that the order was processed and they attached my prescription to my reserved unit, and that they would ship it out once ResMed approved them for online sale. Later that day, the preorder page was updated to say that they would not ship until Jan 2022, and by the end of the day the preorder listing had been removed entirely. I've contacted the DME regarding this and they didn't have any firm date on when ResMed would allow my unit to be shipped...they only assured me that it would be sent out as soon as possible (and they did offer to sell me an AS10 instead).
garagelogician wrote:
Thu Oct 07, 2021 12:36 pm
chunkyfrog wrote:
Wed Oct 06, 2021 11:06 pm
Did they get your money?
Yeah, I paid $999 for it. They've been super responsive, so I'm not worried about it at all. At least I know the unit has been reserved for me and will be shipped out as soon as ResMed gives them the OK. I'm not going to go through insurance and all that BS in order to get one sooner.

If my AS10 dies before I get the AS11...I guess I'll break out the tools and yank the foam out of the Dreamstation.
But there is a much better deal via a new Aircurve 10 VAutos in black (rather than the usual white/silver) for $950 from a seller on DotMed if "For Her" algorithm doesn't matter for you.

https://www.dotmed.com/listing/bi-level ... ew/3650482

https://www.dotmed.com/listing/bi-level ... ew/3650483
ResMed S9 VPAP Adapt, p10 mask

Janknitz
Posts: 7745
Joined: Sat Mar 20, 2010 1:05 pm

Re: Insurance vs self pay

Post by Janknitz » Wed Oct 13, 2021 2:09 pm

I did my homework and it appears that the new ResMed 11 is a nice machine but I can't get a straight answer from any DME on what the cash price would be.

Has anyone gotten a cash price for the new ResMed 11?

I've never seen an industry where no one seems to have a clue about anything. Very frustrating.
IF you intend to pay out of pocket, don't expect a fair price from a DME. And they may not have 11's yet. They don't seem to be in wide circulation in the US right now.

If you can "make do" with a ResMed 10 Autoset, our hosts at cpap.com have them ready to ship and the price is published right there $1099.99. If you join their newsletter you get 15% off, around $935. And used ones in great condition abound, some aren't even really "used". This is an excellent machine and will be a significant upgrade from a 10 year old anything.

You may have to wait a bit for online suppliers to start carrying ResMed 11's.
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