Help estimating costs

purple22 wrote: ↑

Wed Dec 26, 2018 12:35 pm

Any company that hires people for low wages has a lot of personnel who might not be helpful.

And, the further up the pay scale you go, the worse it gets.

purple22 wrote: ↑

Wed Dec 26, 2018 12:35 pm

The first person to answer the phone is usually not an expert on anything, unless they are subbing for the receptionist. The feelings some have here about DME's is both about expectation, and how they treat the DME Personnel. At least my experience has always been like I described here. DME's are competent and professional and caring. I do believe that many of you have had different experiences. Any company that hires people for low wages has a lot of personnel who might not be helpful.

Maybe you're simply not competent at recognizing incompetence? Either that, or you found a unicorn... whichever, go with what pleases you.

purple22 wrote: ↑

Wed Dec 26, 2018 12:35 pm

The first person to answer the phone is usually not an expert on anything, unless they are subbing for the receptionist. The feelings some have here about DME's is both about expectation, and how they treat the DME Personnel. At least my experience has always been like I described here. DME's are competent and professional and caring. I do believe that many of you have had different experiences. Any company that hires people for low wages has a lot of personnel who might not be helpful.

I got my first machine and first two masks via a local DME. They seemed nice, but they never told me the prices of anything (not their prices or the negotiated prices). Nothing in the paper that I signed when I picked it up. I did call my insurance company first and got a general idea - once past deductible, they cover 85%. Also, they do a 2-3 month rental. If I make compliance, they finish off the purchase. If not, it goes back. That's it. Personally, I think that is way better than the rentals, especially the 13 month rental. At 5 weeks, the DME mailed me a new card with an envelope to send in the first card. I made compliance, so a couple weeks later, I got the insurance statement which showed what they paid and what my part would be.

I think about 3 weeks in, I called and asked about a different mask. They provided that one.

Later, I learned about the smaller headgear for the first mask, which I liked better. I emailed them, and they said it did not exist. I sent them a link to the cpap.com website with that headgear, and they replied that they could not order it. I never contacted them again. I got another DME to order it for me.

Once, I tried to order from an online company that accepts insurance. Unfortunately, they are out of network, and I have a separate deductible for that. So the purchase would have been paid me anyway and wasn't cheaper than cpap.com. So, I never contacted them again either. I just buy what I need via cpap.com, amazon, craigslist, and ebay.

This requires some homework.

1. Take the list of equipment HCPCs codes an earlier poster provided and call your insurance company. Ask the following questions:
a. Does my insurance cover CPAP equipment and supplies under the DME provisions?
b. Do I have a deductible and how much will I have met when the purchase is made (remember, many--but not all--insurers start the deductible counting again in January)?
c. Does the insurer pay by HCPCS (billing codes)?
d. Do I have to rent the equipment or can I buy it? If I must rent first, for how long?
e. What will my out of pocket costs be for these items.

NEVER, NEVER, NEVER, EVER, EVER, EVER trust a DME to tell you what the costs will be and what your insurer will or will not cover--especially Lincare.

Keep in mind that if your insurer requires a 13 month of longer rental, you are going to hit another deductible period.

Now calculate your costs. Are you better off using insurance or not, keeping in mind that if you meet your deductible other expenses during the year may have little or no out-of-pocket costs?

Then and only then can you decide if you would really save any money buying out of pocket. You will definitely save hassle buying elsewhere in most cases if your only DME choice is Lincare. What's that worth to you?

BTW, if you are Medicare, there are online vendors that will bill Medicare and some other insurers. But they typically have very limited options.