Insurance DME or web supplier

Hello all,

I am a newly diagnoised paitent and am awating the insurance company DME company to contact me. My question is that my share of the co-pay is $600. I am trying to find out what kind of machine I will be receiving. Looking at the cost of various machines on the web, I am wondering how many people buy their own, or pay the deductable with the insurance recommended DME.

We have HAP HMO in the Detroit area. Does anyone use this HMO and know what machines are "recommended" by them?

I am sure I will be posting many questions in the future and would appreciate any thoughts a newby may need to know.

gotta go

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Thanks!

Dave

emailman wrote:Hello all,

I am a newly diagnoised paitent and am awating the insurance company DME company to contact me. My question is that my share of the co-pay is $600. I am trying to find out what kind of machine I will be receiving. Looking at the cost of various machines on the web, I am wondering how many people buy their own, or pay the deductable with the insurance recommended DME.

We have HAP HMO in the Detroit area. Does anyone use this HMO and know what machines are "recommended" by them?

I am sure I will be posting many questions in the future and would appreciate any thoughts a newby may need to know.

gotta go

zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

Thanks!


Dave

Dear Dave,

Have you called your HMO to ask your questions? Although conceptually all HMO's are fairly standard with respect to having a "gatekeeper" and the need to have a referral for any services not rendered by your primary care physician, there may be some variances in the way each HMO manages xPAP. You may be able to find out some basic information by going online to your HMO's member section and doing a search on DME/CPAP.

Otherwise, I would suggest calling your HMO on Monday to find out exactly what your options are. I would want to know things such as, what DME's are within network, is the machine rented or purchased, is the choice of machine per your doctor's Rx, can your doctor get a "prior authorization" (yes, usually) for a machine that is not listed due to your medical needs, do you have a co-pay for DME, if so how much, etc.

I do not recommend that you leave this information gathering up to your "in network" DME provider. That's a very quick way trip to getting a machine that you may not like.

Most importantly, know exactly what machine you want before venturing out to your DME. Particularly in an HMO setting, your doctor's recommendation (with your prompting) and willingness to seek a "prior auth" is your ticket to getting what you need.

i hope this helps. Good Luck! Laurie

HMO's are notorious for only allowing the cheapest brick around, but you might luck out. I have BCBS of FL HMO and they would not approve any type of data capable or auto machine for me. I did my research, and for $449 I got my Intellipap Auto Adjust w/Smartflex and humidifier paid out of pocket. If you have to pay $600 and then be monitored for compliance, you might want to get your own machine as I did. My HMO does still provide me my supplies.... mask, filters, hose, but I didn't have a co-pay. If you have a deductible and co-pay to meet, and if you don't have many other types of medical expenses throughout the year, it might be cheaper to just buy those items online as well.

You MUST do the math, ask lots of questions of the insurance company and DME, and don't get snookered! One of our forum members has a wonderful blog on which she posts this advice BEFORE you see your DME: http://maskarrayed.wordpress.com/what-y ... me-part-i/

I doubt if you will want any machine recommended by HMO or their DME supplier. Do some research and decide what you want, then be ready to beat them into submission . Seriously, I'm in your area, send me a PM if you want to know the name of a particularly slimy DME that tried to pull a fast one on me. Good luck, you will find all sorts of good advice here.