is it too late??

pharmwoman · Post by **pharmwoman** » Wed May 17, 2006 4:17 pm

I have had my cpap since February, and really wish I could have an S-8--I just found out form my insurance company about this whole rental thing and I can only get a new machine every few years--is it too late for me to bring the machine back to my DME and get a scrip and get an S-8 from cpap.com--do they take insurance?? Thanks:)

Guest · Post by **Guest** » Wed May 17, 2006 4:51 pm

Here is the link to find out if cpap.com takes your insurance.

http://www.billmyinsurance.com

Sleepy-in-AL · Post by **Sleepy-in-AL** » Wed May 17, 2006 5:18 pm

http://www.billmyinsurance.com is the sister site to cpap.com.

Unfortunately, the way most insurance companies seem to work this is that you are renting against the purchase price. Assuming you remain compliant, you would own the machine after some period of time. This rental price comes out of the total amount they will pay for the equipment. So for instance, if the unit you are using costs $1000 to purchase, they will pay their allowable rental charges against the $1000 cost. If you have rented the unit for say 4 months and they are paying $100 per month (these figures are completely out of the air), most companies will reduce your remaining benefit by that amount.

Theres another dirty little secret. The first DME to bill apparently has priority. Once they have the billing in place, it can be difficult to "get rid" of them. Your mileage may vary, but this has been my experience.

Depending on your coverage, you might be able to purchase a unit from cpap.com and submit a claim yourself. But be sure to verify with your insurace carrier exactly what they will pay given your circumstances.

Good luck!

pharmwoman · Post by **pharmwoman** » Wed May 17, 2006 5:39 pm

ok, now if my insurance is refused, can I buy a machine and be reimbursed for part of it??or of billmyinsurance says my insurance isnt accepted is there nothing back to me?? thanks:)

Guest · Post by **Guest** » Wed May 17, 2006 6:15 pm

I spoke on the phone to bill-my-insurance a couple months ago and if your insurance company doesn't work with them (mine doesn't), you can't use them unless you want to foot the whole bill (which is much greater than buying cash from CPAP.com).

I received an estimate of about $1800 if I recall correctly for an APAP (Remstar auto with heated humidifier...might have had a mask in there too but I don't remember). This was my number based on my insurance not being usable. I assume that this is what they would charge my insurance if my insurance could be used, but I don't know for sure since it made no sense to continue. Maybe there are negotiated contracts in place with insurance companies that they do deal with that are lower, no way for me to to find out and irrelevant for me.

So, the only good reason to go with Bill my insurance is if your insurance will pay, otherwise go with cash to cpap.com.

I can't say if the total price (insurance plus your copay) is better or not than your local DME, just easier to get exactly what you want with less hassle).

Sleepy-in-AL · Post by **Sleepy-in-AL** » Wed May 17, 2006 6:40 pm

It depends on your insurance. Some insurance companies will let you purchase it and submit a claim yourself. You would purchase it through cpap.com and then complete all the paperwork your insuarnce company requires.

Several things to be aware of though. First as I said before, your benefits will almost certainly be reduced based on what has already been billed. Second, if you are in a PPO or an HMO it is likely that this will be considered an out of network expense and reimbursed at a lower rate than an in network provider.

Bottom line, contact your insurance company and ask specifically, preferably in writing, what your benefits are and how they handle your situation.

sthnreb · Post by **sthnreb** » Thu May 18, 2006 3:32 pm

And don't forget to get a copy of your prescription. It is required (copy) to purchase a machine. A Rx for a Cpap will let you purchase any of them and the same for Bipap.

roadwarrior · Post by **roadwarrior** » Thu May 18, 2006 5:03 pm

Having dealt with this exact same scenario lately I found out that standard procedure for most insurance providers is that when you start your therapy with a new machine there is a billing period of 90 days in which it is billed as a "Rental". Then after that billing period it is converted over to a "Purchase". I was fortunate to have been under the wire as the original provider of my first machine only billed once so far and the 2nd is coming soon. Since that magical 3rd one hasn't happened they are getting this maching (a Invacare Polaris) back and I have ordered another machine (the new smaller Respironics RemStar Plus "M" with humidifier). It is on order and as soon as it arrives that other uncooperative DME is getting this other machine back and I'm done with them. They would not order the RemStar M for me with a lot of excuses why. My doctor just faxed in the new order to Apria and it's DONE.......

Offerocker · Post by **Offerocker** » Fri May 19, 2006 4:05 am

WOW I didn't know ANY of this! It was NOT explained to me that way at all.
I have 'just' ordered thru CPAP.COM directly an AUTO CPAP W/CFLEX.

I have not quite had a CPAP for 6 months. A CFLEX was ordered for me (rental also) less than a month ago, So, does that mean that I'll be out 'only' one month's rent deducted from my out-of-pocket expense?

Why in hades are things so complicated. Did Congress have their hands in all of this? Never mind that question - I've learned that there usually isn't an answer to those 'Why' questions, ha ha.

I hope that I won't be stuck, though. Well, just 2-3 hours before I can make the phone call to Insurance. Didn't ask them first because I wasn't aware of this, and I would have purchased the dream machine setup anyway and just bit the bullet. With my Bruxism though, it would have gone off in my mouth!!!!!

sleepylady · Post by **sleepylady** » Fri May 19, 2006 6:36 am

Pharwoman,

I had a similar experience. My insurance is a 10 month rental. I was originally on a ResMed S7 CPAP, but after 2 monthes found it wasn't working well for me. I requested from my dr. a new script for a P&B 420e APAP. My DME didn't carry that brand and after lots of wrangling, I did get this from them. Also, I didn't have to start over in my rental period. I did call first billmyinsurance.com and then my insurance about purchasing from cpap.com. I found that my insurance doesn't care for online providers. If I had gone through one, it would have been considered out of network. Since I hadn't had any in the out of network deductable...I would have had to pay the first $500 and then I would have been reimbured for 50% of the balance. I found it was better to keep with my pesky DME.

If your insurance doesn't deal with online dealers, you may want to consider staying with your DME, depending on how your insurance is set up. I would first find out how they view online suppliers. Next you'll want to know how the rental period is set up.

Good luck,

Melinda

pratzert · Post by **pratzert** » Fri May 19, 2006 6:55 am

I have CIGNA insurance who has a National Contract with the Worst DME ever created by the Devil ! A P R I A !!! Remember that name, avoid them like the plague....

After fighting with them for a month and getting nowhere, I ordered my RemStar Auto w/ Htd Hum. from cpap.com. I paid out of pocket for the machine, but CIGNA said they will consider it a DME purchase from an "Out of Network" provider and I will be reimbursed at 60% of the remaining "Allowable" cost MINUS my deductable. So maybe I'll end up getting a couple hundred back.

It's STILL better than dealing with APRIA.

It's a darn shame that if I used Apria, CIGNA would supposedly cover 100% with NO deductable, but I just could not do it anymore.... If I had to have ONE MORE conversation with anyone from APRIA, I would have stroked out.

Inept... incompetent... uncaring... unknowledgable... uncooperative = APRIA

This is too serious of a condition to have to argue for a month to get the proper equipment, to get the proper therapy that my DOCTOR prescribed.

But Apria assumes that the untrained idiots who answer the phone in their Sales department have a much deeper understanding of my Therapy requirements that my Doctor.

Yep... the entire Insurance Carrier and "EVIL" DME business SUCKS !

To them, it's all about the money.... and it shows.

Tim

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap.com, DME, auto

Guest · Post by **Guest** » Fri May 19, 2006 7:55 am

It just goes to show you how different separate offices can be. I had the Apria experience you had except with Med One. Now I've switched over to Apria and they have been great! I'm beginning to think it is more of a local rather than general or national issue. In general it is probably wise to go and interview your DME before buying.

Machine

Additional Comments: Resmed AirCurve 10 VAuto BiLevel with HumidAir

Mask

Additional Comments: Pressure MinE 11 MaxI 17.5

Mask

Additional Comments: Pressure MinE 11 MaxI 17.5