Insurance denies new machine

Check out craigslist.com for cpap, Today I bought a ResMed AirSense 10 AutoSet with heated hose for 295.00. It has 113 hours on it. It makes a great backup. The one I'm using now is the ResMed S9 Auto. It came with a heated hose. It cost me 350.00 on craigslist and had 0 hours. It was still in the shipping box. I know with Medicare, you're allowed to get one every five years.

ErnieH wrote: ↑

Thu Oct 11, 2018 3:53 pm

I know with Medicare, you're allowed to get one every five years.

That is not correct. https://www.resmed.com/us/dam/documents ... achine.pdf

ChicagoGranny wrote: ↑

Thu Oct 11, 2018 1:23 pm

dreamingofdreaming wrote: ↑

Thu Oct 11, 2018 12:08 pm

I have United Healthcare and used this to purchase my machine this year. The cost for the machine, humidifier and tubing was very close to what they charge on cpap.com. They bill the insurance for all of these separately.

Do you have your EOB yet? What was the amount you had to pay? What was the amount UHC allowed (paid to the DME)?

I have a high deductible, so I had to pay for everything. The allowed charges after it went through my insurance came out to just under $700 for the matching, humidifier and tubing. The machine was billed monthly for 11 months. It saved a little, but I don't know if it was worth the headache. I go through Rotech and have to call EVERY month because my bill is wrong. Every month. At this point it's just the monthly machine fee and they screw that up. I wonder if it's done on purpose. Unless someone matches up their EOB, they might just pay what is being billed. It's either that or they are really incompetent.

dreamingofdreaming wrote: ↑

Thu Oct 11, 2018 7:06 pm

I have a high deductible, so I had to pay for everything. The allowed charges after it went through my insurance came out to just under $700 for the matching, humidifier and tubing. The machine was billed monthly for 11 months. It saved a little, but I don't know if it was worth the headache. I go through Rotech and have to call EVERY month because my bill is wrong. Every month. At this point it's just the monthly machine fee and they screw that up. I wonder if it's done on purpose. Unless someone matches up their EOB, they might just pay what is being billed. It's either that or they are really incompetent.

Thanks for the numbers. Makes me feel like I did ok.

We have a high (or medium I guess) deductible. However we have an employer funded HRA that helps. Rotech was one of the 3 DME's they mentioned as being in network. Apria and another I can't remember were the 3 names I got when I called. I disliked the DME I dealt with on the original machine and wasn't looking forward to that.

If my machine was covered by United Healthcare/Oxford I might have been able to get a bit back as I met my deductible for 2018. But not my out of pocket max. Not sure if they would have reimbursed it or not under the HRA. Need an EOB to even attempt.


Set up the machine this morning and found another P10 mask I had. Thought I had thrown it out and kept a different mask as a backup. Really happy to have two P10 masks after I clean it up and put it in the bag with my old machine. I have a new nasal pillow for it and will wash the strap in the wash.

dreamingofdreaming wrote: ↑

Thu Oct 11, 2018 7:06 pm

have to call EVERY month because my bill is wrong. Every month.

Don't feel alone. I just received an order of supplies from my DME, and it contained the wrong parts. They sent me a return label, and I am waiting on the correct parts.

I told my sleep doc that I wasn't happy with the DME they recommended. She said, "I am not happy with any of them."

ChicagoGranny wrote: ↑

Fri Oct 12, 2018 7:34 am

dreamingofdreaming wrote: ↑

Thu Oct 11, 2018 7:06 pm

have to call EVERY month because my bill is wrong. Every month.

Don't feel alone. I just received an order of supplies from my DME, and it contained the wrong parts. They sent me a return label, and I am waiting on the correct parts.

I told my sleep doc that I wasn't happy with the DME they recommended. She said, "I am not happy with any of them."

They did that to me too. Waited 2 weeks for the supply to come in and it wasn't my supply.

In my case , it is correct.

ErnieH