CPAPtalk.com

GoofyUT wrote:Really??? Does it have protected deep-water anchorage or beach rights????
Chuck

YOU BETCHA!!!

Den

[quote="MaskedMechanic"]Don't worry. Resmed is working right now to fix this problem. It is not the doctor that is at fault. It is cpap.com and all the other internet sellers. They are selling products and services at prices that are lower that your doctor offers. Resmed will STOP this unfair pricing on September 4, 2006. Then all will be well.

minerva wrote:I'm pretty sure this is meant to be tongue-in-cheek humor...

M.

I know.......just couldn't pass it up.

Den

AMEN........I just dumped my DME (Apria) who was gouging me and the insurance I had (charged $750 for a $100 mask). I lost my job and insurance and just hand delivered that overpriced rental back to them. I ordered a REMstar Auto with humidifier from CPAP.COM today ($709.00 for the whole deal). Apria would have charged $2400.00 for it, and that's assuming they wouldn't get their 90 days of rental before cashing out of it. It is a racket indeed. We need to take charge and rally the troops against these thieves. I did.........

The doctor and/or DME isn't at fault when s/he marks up a piece of hardware to four times cost? Give me a break, bonehead. You must think that folks reading this thread just came into town on a turnip truck.

Masked Mechanic, the trouble with you and the DME folks is that while you folks have a public posture favoring a free market, you don't really believe in it or want it that way. You want a monopolistic position so that you can sell products at above a market-clearing price. If Milton Friedman were to read your comments about unfair pricing, he would laugh himself silly.

I used to work for a boss who said he loved to be criticized for saving the company money. That's the way I feel about my insurance carrier paying over four times cost for a CPAP machine.

This OSA thing is the first time in my life that I have run head-on into the health care mafia and I am not liking what I am seeing. Sleep docs who don't even examine you and won't answer questions and refuse to prescribe an automatic CPAP, sleep labs who don't tell you that you should sleep on your back during the polysomnogram and titration study and recommend a pressure based on 30 minutes of sleep, and DME personnel who think CFlex is the ramp-up function and tell me that only they can adjust the CFlex setting. I could go on, but won't.

Masked man, If your comment was tongue-in-cheek, I owe you a HUGE apology. I am on bended knee begging forgiveness.

Thought I would jump in here with a bit of clarification on the equipment pricing and insurance contracted rates as well as direct purchase opportunities since my work world is insurance billing. If our insurance covers the treatment of sleep apnea, we want to use it to receive our equipment. Only natural. That is why we have insurance.

Insurance companies have billing relationships with providers of services. When a provider of services [be it a Medical Lab, Dentist or Durable Medical Equipment Company (DME)] has a contract with an insurance company it makes that provider "In Network". Generally, but not always, a policy holder (all of us medical consumers) will receive a higher level of reimbursement if we are using an in network provider than by using a provider that is Out Of Network for our plan.

For instance, when using a DME that is in network with your insurance you may have a 20% copay and a $200.00 yearly deductible, which is likely met by this time of year. I know BMI is in network for many PPO insurance plans and Medicare through their contracts with insurance companies. BMI does offer great service and selection of equipment. Keep in mind, the rates billed to the insurance company by the DME are set by the insurance company itself, or by Medicare.

However, if you elect to use an "Out of Network Provider" your benefits may be 50% copay with a $1000.00 yearly deductible that has to be met prior to the insurance company's consideration of payment at 50%.
cpap.com is out of network for all insurance companies, they do not have billing relationships with any insurance companies. You would file your own claim. cpap.com does have fabulous, low direct purchase pricing.

In order to successfully submit claims to an insurance company, the provider must build a file that meets the insurance company guidelines for that particular service, or in this case, equipment. Generally, for the treatment of sleep apnea to be covered by insurance, a copy of the diagnostic sleep study establishing the presence of sleep apnea is needed, as well as a titration study showing the successful use of a CPAP machine, along with a letter of medical necessity. Those documents would be sent to the insurance company along with the claim at the time of submission.

Hi jeepdoctor. I was just kidding. I had a good laugh when I saw your first post. I appreciated your views and energy. It is very sad to say that the internet providers are being attacked because they are providing a light in the sleep treatment darkness.

Guest 2 needs to wake up. You say that you may have an in-network $200 deductable which is likely to be met by now.

I don't know about the rest of you but my in network deductable is $618 and on any year except one where I have an overpriced sleep study I never meet it by Dec 31.

You also speak of an out of network deductable $1000. Sorry mine is over $3000 and I will be a lot of forum members are in the same boat.

I believe that these types of deductables are pretty common these days.

So this basically amouts to no choice. Either you can buy overpriced supplies $30 hoses etc from the local DME and try to make the deductable in hopes that you will get enough coverage after that to make up the overpricing, or you can just forget you have insurance and buy straight from cpap.com. Basically it is a no brainer. After the initial machine, buy supplies from CPAP.com cash and be ticked off that you are paying for useless insurance that doesn't cover anything you need.

Snoregirl sounds quite angry about her coverge. Maybe she is not getting enough rest!
My plan has a $250.00 yearly deductilbe with a 20% copay for in network services. I guess I am a lucky one.

Mine has a zero dollar deductible and zero copay as long as I am in network!

Another thing to consider. Apria may charge me $350 for a mask I can pay online for $125, but my insurance will only pay them the "contract rate" - in this case $100 and I don't pay only the 20% and not the difference! So I get the mask at less than I'd pay for it online.

I was also upset when I saw what my insurance was being billed but Apria is "in network" and must take the price they have contracted with my insurer. So, you don't always pay it all and your insurance company may not either.

That said, I don't like price gouging either. I keep track of cost and my insurer will authorize me to purchase out of network if I can show them it saves both of us money. Works for me but I had to spend some time working with my insurer - who contracts for coverage.

Wulfman wrote:

MaskedMechanic wrote:Don't worry. Resmed is working right now to fix this problem. It is not the doctor that is at fault. It is cpap.com and all the other internet sellers. They are selling products and services at prices that are lower that your doctor offers. Resmed will STOP this unfair pricing on September 4, 2006. Then all will be well.

And if you believe THAT, I've got some ocean-front property for sale in Wyoming......

Den

NO KIDDING ! Hey Wolf, I also have the Encore Pro software but do you have the upgrade or know where to get the upgrade to stop the 3 hour difference on time and other issues? I can only see it on the Resp. site and you have to have an account number. The person I dealt with at the DME left before I could get it......

Yes I am angry about my coverage. No kidding.

I am also angry that they don't care at all about saving money -- mine or theirs.

Very arrogant about it too.

Wish I could change but it is a major, major manufacturing company, and not only do I have to watch them waste money, but I have to listen to them tell me about how great their benefits are compared to the industry standard which is a major pile of you know what.

ve6cry wrote:NO KIDDING ! Hey Wolf, I also have the Encore Pro software but do you have the upgrade or know where to get the upgrade to stop the 3 hour difference on time and other issues? I can only see it on the Resp. site and you have to have an account number. The person I dealt with at the DME left before I could get it......

You didn't say what version you have, but if you're not using the Bi-PAP Auto, or an "M Series" machine, the older version (prior to 1.5) will work just fine. I'm using 1.4.99. The 1.5i version was for their new Bi-PAP and the 1.6 version was for the new "M" series.
These XPAP machines have an internal clock on the motherboard that is set at the factory to GMT. The times recorded on your reports are "adjusted" to your time zone when you download the data to the database.....to the time in the computer. If the time on your reports is "OFF" by some amount of time and the time is correct in your computer, then your machine has been losing time and would have to be sent in to the factory to be fixed. I've had this same problem with my Pro 2 since I got it.....it was 7 minutes slow when I got it and it's a half-hour slow now. I'm going to be sending it in before the 2-year warranty runs out.

Hope this answered your questions.

Den