CPAP rental- fair price?

I just got diagnosed with sleep apnea by my physician and he sent me to get a machine through his hospital supply store. I got a DS560S Remstar with a humidifier DS6H. I'm renting the machine for $138 a month and the humidifier for $45 a month. On the rental agreement the machine is $1651 and the humidifier is $380. Is that reasonable? Seems really high to me. I went online and checked prices and the machine is only $639 and the humidifier is $189 to purchase outright. I'm paying for this out of my pocket as my insurance has a $7500 deductible. I had the machine for a week now, will I be able to return it? I'm also worried the doctor won't give me a prescription because he wants me to use his supply house (maybe he gets a kickback?). I had an argument with him on the sleep study... he wouldn't let me use a home study and instead made me pay $2000 for a sleep study at his hospital. I also paid $275 for the mask and headgear (mirage quattro full) and $50 for the tubing which I understand I can't return since I used them. Am I right to feel rip off? Thanks.

If your insce. co will let you buy outright from online (e.g. from Cpap.com) and invoice them for reimbursement, then do it. It's very likely your MD's getting something from the deal, but don't rush to judgment til you know more. However, I think you're entitled to a prescription by law, but someone from the U.S. would know that for sure and I'm in Canada.

Please take a look at my blogpost What you need to know BEFORE you meet your DME.

With a high deductible, particularly this time of year (your deductible will reset in January!) you are better off returning the rental and buying your own from and online supplier like our host. Keep the humidifier, hose, and mask and buy the same main unit so you can use the humidifier you already bought outright--only the blower is rented. [ETA--I see you say you are renting the humidifier, but that's highly unusual. Be sure to double check].

Your doctor is required to provide you with a written RX on request, and it's none of his business where you choose to buy your equipment and supplies. If he has a problem with that he has a conflict of interest and you need a better doctor. He is supposed to work for you, not the other way around.

Price out masks and replacement supplies before you buy online. If you can get an insurance discounted price from the DME you would be better off. But if you paid $50 for a standard, non-heated hose you WERE ripped off. They cost about $10 online.

Even if you had met the deductible this year the monthly rent to own capped rental would start all over in January so all it would do is be applied to your deductible. Unless you routinely meet your annual deductible there's not going to be much benefit to reaching it so that insurance will pay anything.

Do the math...which way ends up with you forking over the most cash outlay.

You can't be forced to use the supplier the doctor sent you to. There's nothing stopping you from buying from anyone you want.

For insurance to cover it (even though they won't pay anything but at least let the amount go towards your deductible) your insurance would probably want you to use whomever they deem as in network....so check with your insurance company to find out who they would deem "in network".

If you don't care about insurance at all and simply want to spend the least amount as possible...buy online.
You are probably stuck with the mask and hose. $50 for the standard generic hose... they are $6 online all over the place. You shouldn't owe more than what your insurance would allow for these items though....Most insurance won't allow $50 for a hose. Your charges for items that your insurance would have paid for if your deductible had been met...should still only be what your insurance would have allowed and not the pie in the sky amount they billed for.
The doc may not be happy with the choice but he can't force you to do anything or buy from someone that you don't want to.

If you buy online it's unlikely that your insurance will consider an online supplier as part of your network and will probably disallow any submitted charges...they won't pay anything (they wouldn't anyway with your deductible if it hasn't been met) but neither will they likely allow anything you might pay online go towards any deductible....but even if they did...in January it starts all over again.

holy crap?? If you're paying through the nose like that, they should offer up a drum of Vaseline, IMO...If compliance is the main thing to the doc, try and return the machine now, use CPAP.com, craigslist, or word of mouth to find a machine and buy it out of pocket. You'll be paying like 3 times the cost of one anyhow...because your deductible is so high. So you may as well save some money...
The trucking company I work for has me and many other drivers who are required to get a machine. It does NOT have to be through them, but if it is, the total package cost is around $1350, I believe...they pay around $600 of this, leaving us with $750-ish of our own money. This included (for me) the PRS1 560 with humidifier, basic hose, AC power supply AND DC power supply, a wireless modem that plugs into the back, SD card, and I got the Resmed Swift FX mask. Earlier drivers were through a different DME and had the Resmed S9. I believe their cost was the same. The HUGE benefits to going through my company for the purchase were that a) we got to pay off units a little at a time instead of all up front, b) we got data capable machines and don't have to worry over getting compliance info to them. c) we were supplied with EVERYTHING REQUIRED for using them in our trucks AND homes...good, solid units. Some drivers come to the company with older units that need updating, some come with everything working and recent and don't need the new stuff yet.

So...FWIW, my above ramble is based on NEVER HAVING RENTED A xPAP MACHINE. But I would have to assume that they're definitely making money on the deal.

What is a DME? Durable medical equipment? I'm pretty sure I'm renting the humidifier, it says $45 a month on the contract. I will go there tomorrow to see what the rental return policy is since it only says there is a minimum rental period but doesn't exactly so how long this period is.

DME is indeed Durable Medical Equipment and when we use it here we are generally referring to the brick and mortar store where you are purchasing the equipment from. The place where you got the equipment from.

Yes, DME is the supplier for the equipment, but can also mean the equipment itself.

I'm confused how you appear to be paying the list price even though you have insurance. Although they are not covering anything as you haven't met your deductible, if it is run through insurance, you would still get a lower price. As long as it is an in-network provider and they ran it through your insurance, you should only pay the insurance-negotiated amount for each component. Often that amount isn't known until the claim goes through and you and the DME get the Explanation of Benefits. That would say the list price, the negotiated amount, the balance between the two (written off by the DME), and that you owe the negotiated amount as your deductible hasn't been met.

The insurance negotiated amount is typically closer to online DME prices than brick & mortar DME list prices, but can vary greatly based on your insurance's buying power. Typically bigger insurance companies negotiate lower prices. There is a set price for each code, so the DME gets the same payment for a brick and a data capable CPAP (same code). Definitely question what is going on with the pricing (if they are even in-network for you and if they ran it through your insurance). Ask what is the list price vs. the insurance negotiated amount. Make them let you return the rented components so you can buy online on your own. If they try to argue you haven't yet met the minimum rental period, bring up that they didn't give you the proper information regarding the list price vs. insurance negotiated amount (or if applicable, didn't tell you that they weren't even running it through your insurance). Its weird the humidifier would be a rental, but I guess it could be given to another patient, unlike a mask or hose. Best wishes.

alphastar wrote:I just got diagnosed with sleep apnea by my physician and he sent me to get a machine through his hospital supply store. I got a DS560S Remstar with a humidifier DS6H. I'm renting the machine for $138 a month and the humidifier for $45 a month. On the rental agreement the machine is $1651 and the humidifier is $380. Is that reasonable? Seems really high to me. I went online and checked prices and the machine is only $639 and the humidifier is $189 to purchase outright.

you answered your own question, correctly.

you're being screwed

This current wave of exorbitant CPAP rentals from DMEs makes me want to scream. But then I usually feel that way when I think about DMEs in general, not to mention lots of other medical hijinks I've come across over the years. Don't get me started

Whatever happened to journalistic conscience?
Somebody needs to get busted!
Inside Edition: tonight--ripping off the sick. Be appalled!

Where the equipment is concerned, had I known in the beginning what I know now I would have just handled it on my own and submitted to my insurance for direct reimbursement. My DME provider has already made a "mistake" monthly supplies that necessitated me calling them up to point it out, then weeks or months to sort it out. Their billing practices are a bit shady IMO also - invoices that show several months worth of claims with no invoice date on them, but a huge "LATE AFTER" date. I'll be firing them soon, probably in December just before my coverage changes. The amounts that are submitted in these claims are made up numbers that have no relation to the actual cost of things (like most medical billing seems to be in the US - that is - pull a number out of your arse and see if you can get it through the system and paid without someone calling BS).

the real poor part of it is that the cost of machine and supplies initially may or may not even knock out your deductible. And after you have the machine at home...supplies can be relatively cheap, depending how often you plan to replace parts. Example: Nasal pillows are supposed to be replaced every what...2 weeks? I started therapy in May, and have roughly 6 pillows of the correct size that I've rotated through...none are junk yet. I've read on this forum that SOME people have made pillows last many months. While it never hurts to have spares on hand, headgear, hoses and masks will hardly make you go broke, if you take care of them.

I'm glad you've found this site so early in your therapy to hopefully take advantage of the knowledge contained herein. (sounds purty, don't it?) Feel free to pick brains, but realize that SOME of us (myself included on certain days) can be more a mental train wreck than medical guru.

chunkyfrog wrote:Whatever happened to journalistic conscience?
Somebody needs to get busted!
Inside Edition: tonight--ripping off the sick. Be appalled!

the whole cpap "industry" seems to be targeted to ripping off the sick.

if you look at the little bits of plastic and silicone and spandex that are in a mask, and and they charge HOW EFFING MUCH for that?

or the filters, or the hoses, or .... well, every single bit of it. *sigh* I need to go take some deep breaths now.

pr go attache the hose and relax