New machine and Lincare questions

I know there's probably lots of info out there on this subject, but I do better with direct answers, so please bare with me.
I've been using my present cpap for about 6 years (Resmed Autoset Vantage . I'm going to ask the doctor soon, for an Rx for a new machine.
I really don't want to go through Lincare, but I'm thinking that my insurance (BCBS anthem), probably will give me the best discount if I go through them. What I did the last time was pay a certain amount every month, until it was paid off. (the only way they will do it).

If I call my insurance company (which I don't want to do 'cause I'm on hold forever).......will they tell me how much they would pay if I buy it online and then submit it myself?
Routinely, do people get a better deal by going through a DME and getting a discount (if they have a contract with them)? If I buy it online, then I have to continue to buy all my supplies online (and file my own insurance), right?

Since I've never gotten a 2nd machine, I'm just not sure of the procedure.

Also.......while I have you here..........is there any reason for me to get an APAP machine, if I've been on straight cpap for most of my time using cpap?
When I go to the doc's, does he have to write an Rx for the exact model I want?

Thanks for your help!

Whether or not it will be in your best interest to go through a DME or purchase online depends mostly on your deductible. Though replacment machines through BCBS can now be purchased, rather than the long time capped rental, as long as your deductible is low or has been met, an in network provider should be a good way to go.

As far as an insurance company reimbursing you after an online purchase, that I have not heard of. At least not yet. I have had clients get money back after paying cash up front, so I suppose it will only be a matter of time before online purchases will be treated the same way. Depending on the deductible once again, as long as it is low (zero to $200), people do routinely get a better deal going through a DME. Regardless of where you buy your replacement machine, you should still have the option of continuing with your current DME, or if it's most cost effective for you purchasing your supplies online.

Regarding APAP, though the reason to get one now may not be apparent, I would advise going ahead and replacing it with another APAP. If you have difficulty in obtaining satisfactory results from your equipment, at least you could try APAP and see if your pressure requirement has changed.

On the last issue, I would highly recommend you find out exactly what you are wanting, and asking the doctor to write precisely for that including the model and add the letters DAW (dispense as written). Good luck with your replacement machine. If you go the DME route, be sure to ask them to bill it as a purchase. I was just recently informed of this optional cap rental/purchase change on replacements about a month ago.

SleepWellCPAP wrote:If you go the DME route, be sure to ask them to bill it as a purchase. I was just recently informed of this optional cap rental/purchase change on replacements about a month ago.

Yes, I do realize that insurance policies may vary significantly even with the same company (especially BC/BS & especially BC/BS in different areas).

I am on my 3rd machine in 16 years.
All 3 were purchased through the same BC/BS plan.
BC/BS purchased all 3 outright - no lease whatsoever.
And BC/BS has never required any proof of compliance.

You really just need to call them (or maybe email) to find out.

My insurance of last year (and 20 years previously -- which was cancelled directly due to Obama care) would have happily paid their portion for an online purchase. Symettra didn't care HOW I got my treatment as long as it was covered they paid.

I don't know about the new company yet (Aetna) but so far they have not been nearly as much of a pain as I expected. One issue is with 80/20 IN NETWORK they only pay 60/40 OUT of network (and the yearly max doubles for out of network).

Paying 40% doubles medical costs over %20 which is obvious when we look at it that way, but not so obvious when just reading 80/20, 60/40 where the focus is on the insurance portion going down by 20%.