CPAPtalk.com

LoBattery wrote:I may be stupid, but I'm not dumb enough to pay some of those prices, which are twice what I can buy them for. I figured there had to be an insurance price. This will be my first time ever ordering so I have lots of questions regarding insurance.

From the Cpap.com website,

"Purchasing through CPAP.com is often cheaper than your copay and deductible through insurance. CPAP.com is a cash only medical distributor that does not accept insurance assignment, does not have an NPI number, and is not a participating provider with any insurance companies. A pre-populated example insurance form is available for all CPAP.com orders. To view and print the form, log into your CPAP.com account. The pre-populated form may be used to seek reimbursement from your insurance company. CPAP.com is out of network for private insurance companies. Check with your private insurer to see if they will reimburse your purchase. Medicare, Medicaid and other government run healthcare programs will not reimburse CPAP.com purchases."

LoBattery wrote:I may be stupid,

no argument there.

anything you buy at 99% of the online suppliers is not going to be automagically covered by your insurance. you might be able to work with your insurance to get reimbursed, but that's between you and your insurance company. don't ask here.

I wasn't asking here, that was what I asked them. It is the dream of everyone to get ahead somehow with insurance. Like leaving the porch light on for Jimmy Hoffa. Just took back the rental brick. They let me keep the heated hose, that was nice. I'm not even going try getting anything more with insurance now. I'm canceling my next sleep appointment too. It was only with a nurse and they haven't been helpful at all with anything.

With insurance, it's like Vegas.
The rules almost always favor the house--a LOT!
The only difference is you don't have to go to Vegas.

palerider wrote:

LoBattery wrote:
I may be stupid,

no argument there.

I hope he figures it out before he bankrupts himself buying machine filters.

linuxman wrote:

Costs who four times as much??

The patient or the insurance company, or both, depending on the situation.

There are no insurance companies that pay four times as much. Some of the customer service reps may be that dumb, but the people who negotiate the contracts with the suppliers are sharp.

Hang Fire wrote:

linuxman wrote:

Costs who four times as much??

The patient or the insurance company, or both, depending on the situation.

There are no insurance companies that pay four times as much. Some of the customer service reps may be that dumb, but the people who negotiate the contracts with the suppliers are sharp.

Sorry, I didn't make myself clear there. I wasn't agreeing that anything costs four times as much. Indeed, insurance companies generally negotiate very good prices for things (as compared to what the providers claim is the "standard" price). I was just speaking to the direct question of "who pays for what" in general when dealing with insurance.

Even if you're still paying deductible, it makes sense to go through the DME for it, IMO. First, as mentioned it counts towards your deductible. Second, the allowable insurance prices are CHEAPER than those on cpap.com from what I've seen. I got an invoice with my Simplus FFM that said insurance allowed $75.76 for it, while cpap.com sells it for $88. For some unexplained reason, they also included a replacement cushion for it, which is listed at $28.02 and cpap.com sells for $32. I'd rather pay less AND have that money count towards my deductible. Now, if you were to pay what they CHARGED insurance, then those prices are highway robbery - but you don't.

That being said, I'm new to all of this. Maybe I'm missing something?

I'm the fool that payed out my nose for equipment when I first got it a few years ago. When I went in for my sleep study it was the first time I had ever dealt with insurance. I was completely ignorant. I have a $2000 deductible to meet and my insurance company only negotiates the price done 10% on equipment other than the machine itself. I had no idea what insurance was like, what apnea is, what a cpap is or that you can actually buy them from a lot of places with a prescription. Took me many months, even years to learn this stuff and I'm still learning every time I have to see a doc.

These are some of the prices I payed when I walked out the door of the sleep center/dme with my machine that they prescribed. $219 per month rental of Remstar S1 Auto cpap machine for several months. Insurance would not pay for anything until I had at least a few months use and data for them to look at, so I had to rent. At least I thought I had to at the time. I had to buy the humidifier right away for $449, full face mask and head gear cost me $416. Insurance payed for the hose for some reason at $106. Several months later when it came time to settle up on the cpap machine the supplier wanted $2441 for the machine I had been renting. I had racked up a whole bunch of medical bills so my $2000 deductible had been met and the insurance company payed $1200 for just the cpap without humidifier. So they negotiated that one down by 50%.

Just this fall I got an Airfit N10 nasal mask with head gear from the same Allina sleep center/dme in town. They charge $470 and the insurance company negotiated it down to $460. I had already met my $2000 deductible for the year the the insurance company payed for that one.

The whole medical/insurance industry is ridiculous from my experience. It's a full time job studying everything so you don't end up broke.

Anyway, please don't comment on this stuff since I already know I was a fool and know what to do now. This is not my thread. We need to help the original poster so they can get some cpap equipment at a reasonable price.

Thanks, everyone!
Clearly busying online is the way to go!

jds2001 wrote:That being said, I'm new to all of this. Maybe I'm missing something?

Yes, what you are missing is that every insurance policy is different. What applies in your insurance policy is likely different in other people's policies. Example, Gramps and I each have insurance policies with the same insurance company. Deductibles, copays, networks and a lot more are different in our policies.

Any individual has to look at his own policy or speak to his own insurance company to understand what is best for himself.

jds2001 wrote:Even if you're still paying deductible, it makes sense to go through the DME for it, IMO. First, as mentioned it counts towards your deductible. Second, the allowable insurance prices are CHEAPER than those on cpap.com from what I've seen. I got an invoice with my Simplus FFM that said insurance allowed $75.76 for it, while cpap.com sells it for $88. For some unexplained reason, they also included a replacement cushion for it, which is listed at $28.02 and cpap.com sells for $32. I'd rather pay less AND have that money count towards my deductible. Now, if you were to pay what they CHARGED insurance, then those prices are highway robbery - but you don't.

That being said, I'm new to all of this. Maybe I'm missing something?

I strongly disagree.
But, it depends on the insurance plan and the deductible.
If you have a relatively high deductible and believe you have to pay many times more than what the online price is just to meet your deductible, that doesn't make sense. You could buy LOTS of "stuff" (online) before you meet your deductible.

So......"DO THE MATH"........and use a little common sense.


Den

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Many who are diagnosed with Sleep Apnea don't have any idea how the system put in place by their insurance company works and what is covered and what is not.
Calling the insurance Company and asking questions is a good Idea but beware that does not always help.
I was given completely different conflicting information each time I called Cigna.
I started trying to get treatment in May 2016 and Cigna ran the clock out on my health plan year so that I would have to pay a whole new yearly deductible starting in Oct 2016
I had purchased a used Apap machine back in May 2017 so my issue was treated. I did get a at home sleep study performed and a Prescription from my Doctor during that period so I could purchase equipment from online stores on my own.
Then they wanted to do a 10 month rental first but I had to purchase the humidifier and Mask upfront. I would have to pay the full cost because my deductible of $1000 and still was only renting the main unit.
Cpap.com had a sale and was selling New System one 560 Auto apaps with heated hose humidifier for $335 shipped in Late Nov 2016 so I purchased that on my Own.
I purchased Dreamware and P10 Masks from Amazon.com for around $55 each on my own.
Picked up a few others to try from forum members selling them here.
Greyghost on this fourm often has new or very low hour Resmed or PR autos for sale at around $400

Hindyg wrote:Are there physical retail stores that sell CPAPs and CPAP supplies or are they mostly just available online?

Unless I missed it, no one answered the OP's original question, which is odd in that the folks that provide this forum "CPAPtalk.com" do own a brick and mortar store of the same name (without the "talk" in the store's name). It is located in Stafford,TX, which is a suburb of Houston. Since I also live if the greater Houston area, and have visited CPAP.com's store (and bough hardware), I just wanted to mention it. It was very helpful to see a variety of competitive CPAP products sitting side-by-side. Made the buying decision much easier. (I realize that there are very few users of this Board that could ever have the opportunity to visit their store, but if you are ever in Houston it may be worth a trip to Stafford.)

Yes, you missed it. The first post by Pugsy after the OP's first post.

sptrout wrote:

Hindyg wrote:Are there physical retail stores that sell CPAPs and CPAP supplies or are they mostly just available online?

Unless I missed it, no one answered the OP's original question, which is odd in that the folks that provide this forum "CPAPtalk.com" do own a brick and mortar store of the same name (without the "talk" in the store's name). It is located in Stafford,TX, which is a suburb of Houston. Since I also live if the greater Houston area, and have visited CPAP.com's store (and bough hardware), I just wanted to mention it. It was very helpful to see a variety of competitive CPAP products sitting side-by-side. Made the buying decision much easier. (I realize that there are very few users of this Board that could ever have the opportunity to visit their store, but if you are ever in Houston it may be worth a trip to Stafford.)

Pugsy wrote:Are you in the USA or somewhere else?

In the USA there are what we call brick and mortar stores that sell cpap stuff.
Some are Home Health aid stores that deal mainly with various home health needs but sometimes some cpap stuff can be found in little mom and pop pharmacies. I live near a small town...5,000 population and there is a mom and pop pharmacy that offers some home health aids and cpap masks are shown on their shelves on little mannequins. I don't know how much inventory they actually stock but I assume it is going to be limited and they are likely still going to require a prescription for the items packaged with the RX sticker.

So yes...there are retail stores out there depending on where you live. In the big city with population over 100k about an hour from me there are dozens of such home health aid stores. Some will stock cpap stuff and some don't.

Online is often cheaper though...less overhead costs lets them sell cheaper.

Den

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jds2001 wrote:Even if you're still paying deductible, it makes sense to go through the DME for it, IMO. First, as mentioned it counts towards your deductible. Second, the allowable insurance prices are CHEAPER than those on cpap.com from what I've seen. I got an invoice with my Simplus FFM that said insurance allowed $75.76 for it, while cpap.com sells it for $88. For some unexplained reason, they also included a replacement cushion for it, which is listed at $28.02 and cpap.com sells for $32. I'd rather pay less AND have that money count towards my deductible. Now, if you were to pay what they CHARGED insurance, then those prices are highway robbery - but you don't.

That being said, I'm new to all of this. Maybe I'm missing something?

One problem is that new folks don't even know all the stuff they'll be needing, so it's hard to do the math when you don't have all the figures.

I did my math after I bought from DME without knowing what I was doing, but I have good insurance and a good DME and didn't get ripped off.