Bill my insurance

NyNurse33 · Post by **NyNurse33** » Fri Sep 15, 2006 12:14 pm

I submitted info to this site and this is the response I received. Can I just return the machine and then try again, what is the solution other than paying out of pocket for the entire cost?

Your form indicates you are a current CPAP user with
the CPAP machine being rented through another durable
medical equipment provider.

The rental of the CPAP unit prior to purchase is a
condition of your insurance coverage. Most often the
process is as such: after a rental period determined
by your insurance company, the CPAP unit will reach
purchase price, and with the last claim submission by
your durable medical equipment company,it will become
your property.

Because this rental process is on going with another
provider of equipment, we will not be able to interupt
the process. We will not be able to provide you with
CPAP equipment and bill it to your insurance company.

If you are considering purchasing the equipment
outside of your insurance coverage, visit
https://www.cpap.com/

DreamStalker · Post by **DreamStalker** » Fri Sep 15, 2006 12:18 pm

Call your insurance and ask them how long you have to rent before they will cover the cost of buying a machine. For BC/BS TX it is one month rental.

- roberto

cpapjack · Post by **cpapjack** » Fri Sep 15, 2006 12:44 pm

Melissa,

I'm not sure how billymyinsurance works, but I do know that they aren't any less expensive if at all than a local DME. (I might be wrong on this, but I thought I read this in a post before)

I was afraid of this exact thing when I switched machines. When I was initially diagnosed with OSA in May, the DME I went to gave me a CPAP machine without giving me any options. Of course, like so many others, I was not educated in the least bit before going in there. Once I was about 1.5 months into my treatment, after learning so much information from all of the wonderful people on this forum, I decided to pursue an APAP machine, just like you are. I started off by doing a 1 week trial with my original DME. I had a follow up appt. with my Sleep Dr. after and he wrote me a script for an APAP. I took this to my original DME and they wanted to charge me $395 (even though I'm covered 100% for DME) for an APAP because the insurance company wouldn't cover the cost of an APAP, even though I was told numerous times from different people at my insurance company that they would cover it, as long as the Dr. deemed it necessary, hence the script. (the precsription is key) So I took my CPAP machine back to the DME and told them I was done with it. No questions asked. I then took my new APAP script to another DME and within two days, I had the APAP of my choice. No issues with the insurance company.

I know this isn't an answer to your problem, but maybe this will give you some ideas on what step to take next in your pursuit of an APAP machine. Good luck and keep us posted. Happy xPAP'ing !!!

Jack

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap machine, DME, APAP

NyNurse33 · Post by **NyNurse33** » Fri Sep 15, 2006 4:20 pm

Roberto

That would be a bad thing if my insurance already bought my machine, wouldn't it? That would mean that I'm stuck and can't use my insurance to buy another one for a couple of years. I think my DMEs told me it's a 3 month rental, but I'm going to check with my insurance on Monday. I guess my question was, that if its still in its rental stage, I could return it to the DMEs, get the script for apap from my MD or even just the original one for cpap is she won't give me one for apap and submit it to billmyinsurance.com? Did I get that right? This however seems like the longer process, b/c I can't tell what my co-pay will be from them until I'm not in an agreement with another DMEs. I would have to return one machine, submit it to here and then wait. Maybe the quicker way would be just to switch DMEs like cpapjack. I was only trying to use this site to get an apap, b/c I thought that was the only place I could if all I had was a cpap script. Will a local DMEs give me an apap, if the script says cpap....I don't think so. I am only hoping to get the MD on the same page as me.

DreamStalker · Post by **DreamStalker** » Fri Sep 15, 2006 7:32 pm

NyNurse33 wrote:Roberto

That would be a bad thing if my insurance already bought my machine, wouldn't it? That would mean that I'm stuck and can't use my insurance to buy another one for a couple of years. I think my DMEs told me it's a 3 month rental, but I'm going to check with my insurance on Monday. I guess my question was, that if its still in its rental stage, I could return it to the DMEs, get the script for apap from my MD or even just the original one for cpap is she won't give me one for apap and submit it to billmyinsurance.com? Did I get that right? This however seems like the longer process, b/c I can't tell what my co-pay will be from them until I'm not in an agreement with another DMEs. I would have to return one machine, submit it to here and then wait. Maybe the quicker way would be just to switch DMEs like cpapjack. I was only trying to use this site to get an apap, b/c I thought that was the only place I could if all I had was a cpap script. Will a local DMEs give me an apap, if the script says cpap....I don't think so. I am only hoping to get the MD on the same page as me.

That is correct. If you are still renting, you should be able to take it back. If you have Rx in hand you can then ask current DME to give up the APAP or let them know that you will find another DME to take your business to. I'm sure your insurance has a list of network DME s for you to choose from.

If you are not renting and your insurance has indeed payed for the machine, you are stuck with it. You can then take Snoredog's advice and keep it as a back-up or try and recover some of its value by selling to off-set the purchase of one you want from cpap.com.

Hope it all works out well for you ... best of luck.

- roberto

Guest · Post by **Guest** » Fri Sep 15, 2006 8:15 pm

I think it will be the norm for most DME companies to not be legally allowed to provide an APAP if the script is only for a CPAP.

However, it should not be much of an ordeal to just call your doctor and ask him to write out an Rx for an autopap. You could have it faxed straight to a willing DME or have it mailed/picked up yourself.

GoofyUT · Post by **GoofyUT** » Fri Sep 15, 2006 8:22 pm

APAPs are auto-titrating CPAPs and therefore, a script for a CPAP can legally be filled with an APAP unless it is written for CPAP ONLY.

However Melissa, others have posted about this here, and in my recolelction, no one has been successful with BillMyInsurance,com once they have received a machine from a local DME. BillMyInsurance typicaly won't touch them.

Sorry,

Chuck

Snoredog · Post by **Snoredog** » Fri Sep 15, 2006 8:41 pm

you need to read your insurance policy carefully as it relates to cpap and any recommendations suggested by the sleep lab/doctor such as: "trial on cpap is recommended".

If a "trial" is indicated, it means they give you a machine for 30-90 days as a "trial" on a month to month rental. If you are unhappy with the treatment/machine you can give it back and go elsewhere or seek alternative treatments (such as dental or surgery).

If the 30-90 day trial elapses it automatically turns into a rent to own. Usually after 10 months rent, the insurance company will purchase the machine outright.

You are then STUCK with that machine for a period of 5 years before insurance will pay for another machine.

So it is best to get the machine upfront that you want.

Loss of job/insurance: Keep in mind if they go to a rental and should you lose your job or medical coverage, you will be stuck with paying that monthly rental. Not uncommon for them to charge $280 month for machine/mask supplies.

And if you suspect your job/insurance coverage may be going away at anytime during that period you would be wiser purchasing your machine outright on-line such as from cpap.com. Let the DME supply you with masks and pay for the doctor visits.

Wulfman · Post by **Wulfman** » Fri Sep 15, 2006 8:52 pm

Melissa/Squidworth,

Will your insurance provider reimburse you for out-of-pocket purchases?
If they will, get your prescription (which you need to get anyway), buy the XPAP you want from CPAP.COM, return your other machine to DME, submit an invoice to your insurance provider.

Best wishes,

Den

Offerocker · Post by **Offerocker** » Fri Sep 15, 2006 10:54 pm

Melissa,

I interpreted your question to mean: Can I switch DME's after one has charged my insurance company, and expect the 2nd DME to put a claim to my insurance company.

Yes and No. If you were the 2nd DME, and the 1st one had already retrieved half of their usual selling price for that item, the 2nd one would not want to rent/sell you their machine for half price (all of this via Insurance company).

It's best to take actions of this type as soon as possible, so that the next person you deal with will have incentive to deal with you.

You MAY be able to get a statement of relinquishment from 1st DME, so that you can proceed with renting from another.

I may be all wet on this, but that's what I've found. Everyone wants to get as big a piece of the pie as they can. Unfortunately, it's usually the first one, who doesn't provide the best service.

I would clarify with billmyinsurance exactly what your options are with them.

NyNurse33 · Post by **NyNurse33** » Sat Sep 16, 2006 7:58 am

If I get my MD to write a script for a apap, the current DMEs I'm using will have to take back my current machine (provided I'm still renting it, which I think I am) and honor the new script, right?

If I want the remstar M series with c-flex, does the MD have to write anything special on the script? Or just apap?

snoregirl · Post by **snoregirl** » Sat Sep 16, 2006 8:24 am

If I were going that direction I would have the MD write exactly the machine I wanted. Barring that APAP with cflex would get you either the old apap that I have or the M series as RemStar units are the only ones with CFLEX.

As to the DME having to provide it. Mine tried not to. They claimed my insurance co didn't cover it. In actuality my insurance themselves claimed that I didn't need it (their MD reviewing my stuff) and that APAP was deluxe equiptment which they don't cover and don't even contribute what they would have contributed for regular equiptment towards deluxe. Amazing but I saw it in writing. I persisted with the DME that I wanted what was on my script and they finally gave it to me. Billed e0601 (cpap which an auto is) and the insurance co was none the wiser as they paid the rental and approved and paid the purchase.

So do they "have to give it to you" Yes and no. Yes in terms of selling it to you, possibly no if your insurance won't support it and you expect the DME to collect insurance. It is a very grey area in my opinion. Worth the try and be strong with the DME. You are gold if your insurance doesn't have an issue with you having APAP, you have to be tough if the insurance is not supportive.

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CPAPopedia Keywords Contained In This Post (Click For Definition): cflex, DME, auto, APAP

bellasmiles · Post by **bellasmiles** » Sat Sep 16, 2006 9:39 am

Here is my experience. I went to the DME after having Cpap prescribed. They provided me with a new cpap machine with cflex. It worked, but after learning more here, I decided I wanted the Autopap....I just like the idea of being able to monitor my results. I called the DME and they said I would have to get a new script....called my doc and they faxed one to the DME requesting the Apap. The DME, turns out, didn't like that, for whatever reason, but I went back to them and they provided me with an Apap...the one I requested. Unfortunately, I've noticed that it was a used machine...should it be?? (it smells like tobacco when turned on). My insurance buys the machine outright for me. Soo, I have the apap, just doesn't appear to be a new one.

Good luck in getting what you want. I think satisfaction with equipment will go a long way to ease of use and compliance.

snoregirl · Post by **snoregirl** » Sat Sep 16, 2006 10:57 am

No it shouldn't be used if it is an outright purchase and certainly not smelling like anything.

Take it back now and demand a new one that your insurance paid for and if you get any trouble call your insurance and find out what to do to file a complaint and switch to another DME.

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CPAPopedia Keywords Contained In This Post (Click For Definition): DME

NyNurse33 · Post by **NyNurse33** » Sat Sep 16, 2006 12:35 pm

Billed e0601 (cpap which an auto is) and the insurance co was none the wiser as they paid the rental and approved and paid the purchase.

Chances are that the DMEs won't get as much reimbursed on the apap w/ cflex, b/c its being billed as a plain cpap, right? I'm guessing this would make them hesitant to even go this route.

Mask