DME coverage is 50%

So do you think I'll do better getting something on line? I expect to get my Rx tomorrow. (Thanks for advice to call insurance co ahead of time!)

depends on what you buy.
ask for the price and check it against cpap.com's

Also, you can buy the machine and still use the DME for supplies or vice-versa.

I have 50% reimbursement for IN-PLAN DME. I have ZERO for out-of-plan DME.

If you have the same then it's often times only just a little cheaper to buy online. It depends on what you're buying. I recently made a purchase that, because of some things my insurance won't pay for at all.... software and card reader... it would have cost me over $900 out of pocket using an in-plan DME, but I got everything for $599 from cpap.com. So it really depends what you're buying.

If you have 50% copay for BOTH in-plan and out-of-plan DME, then definitely buy online, no contest there. The local DME jacks prices up a LOT because that's what insurance allows them to do.

My recent purchase... forget about copays... here's what the local DME would have charged: $1583

Here's what I bought if for online at cpap.com.. all the exact same stuff: $599

AND I got all the manuals and spare parts. The DME doesn't give you clinician's manual AND they often keep parts that you should be getting by default (extra mask parts in different sizes, etc)

Thanks, Yardbird. Good to hear your experience -- helps me to know what questions to ask. I guess it will stil be approx 10 days before I get the results from titration and my Rx for the cpap. I plan to do a lot of research until then.

no problem.

It's pretty common I think for most insurance companies to NOT pay for card readers, data modules, data reading software, because they call it "not medically necessary"

Questions for your insurance company

I have 50% copay on durable medical equipment. Is that for in-plan DME only? Or is it also for out of plan DME.
-- if they cover out-of-plan DME purchases also ask if there is a deductible to be met. I've seen that before; "yes we cover out-of-plan DME purchases at 50% copay but there is also a $500 deductible on out-of-plan" ... watch out for that one. It can bite you.

What are my choices for in-plan DME purchases? Who can I purchase from?
-- to see if you have a couple of choices in your area. Some DME suppliers are better than others.

Then it comes down to doing the math and figuring out exactly what you're getting for your money whether in-plan or out-of-plan. And what are you missing and what's it worth to you? If a mask comes boxed from the manufacturer with 3 different pillow sizes, for example, (small, medium, large) will the local DME give you all sizes? Or will they give you ONE size and keep the other 2? (and SELL them to you later when you decide the LARGE size is too big and want to try a medium!!!). If you get a fully data capable machine... do you get the clinician's manual from the local DME? (probably not... I haven't seen a local DME include the manual yet)

So... do your homework. It's YOUR therapy... and your money. Get the best you can get for yourself.

yardbird wrote:no problem.

It's pretty common I think for most insurance companies to NOT pay for card readers, data modules, data reading software, because they call it "not medically necessary"

Questions for your insurance company

I have 50% copay on durable medical equipment. Is that for in-plan DME only? Or is it also for out of plan DME.
-- if they cover out-of-plan DME purchases also ask if there is a deductible to be met. I've seen that before; "yes we cover out-of-plan DME purchases at 50% copay but there is also a $500 deductible on out-of-plan" ... watch out for that one. It can bite you.

What are my choices for in-plan DME purchases? Who can I purchase from?
-- to see if you have a couple of choices in your area. Some DME suppliers are better than others.

Then it comes down to doing the math and figuring out exactly what you're getting for your money whether in-plan or out-of-plan. And what are you missing and what's it worth to you? If a mask comes boxed from the manufacturer with 3 different pillow sizes, for example, (small, medium, large) will the local DME give you all sizes? Or will they give you ONE size and keep the other 2? (and SELL them to you later when you decide the LARGE size is too big and want to try a medium!!!). If you get a fully data capable machine... do you get the clinician's manual from the local DME? (probably not... I haven't seen a local DME include the manual yet)

So... do your homework. It's YOUR therapy... and your money. Get the best you can get for yourself.

Mke sure that you know what your copay will be. They may have a "street price" that is higher than what your insurance company has contracted for. For example list price might be $1500 dollars. However insurance may be contracted at $750. That means you should only pay $375. You may have to be persistent and go through a couple of people to get answers. Also be ssure to check whether the insurance will reimburse for purchase or just monthly rental to purchase.