Trying to get supplies from HMO nightmare

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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chunkyfrog
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Re: Trying to get supplies from HMO nightmare

Post by chunkyfrog » Tue Jun 21, 2022 7:48 pm

Crunch your own numbers--then you can make your own best choice.
The best deal for the right machine could easily be a used machine.
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dream321
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Re: Trying to get supplies from HMO nightmare

Post by dream321 » Wed Jun 22, 2022 9:12 am

I recently spoke to some America based people who work for the DME. Much more helpful, and my order is getting processed. I was apparently dealing with a overseas call center, where the workers didn't know what they were doing (or care). Ill also be receiving my order from cpap.com, so it will be good to have backup supplies.

dream321
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Re: Trying to get supplies from HMO nightmare

Post by dream321 » Wed Jun 22, 2022 9:21 am

Janknitz wrote:
Tue Jun 21, 2022 7:28 pm


Be aware that since Oscar is an HMO, they don't have to do the 13 month capped rental. They can charge you a rental fee for the rest of your life (or theirs). Under that scheme, you may end up paying many times over the retail value of your machine. I never intend to give Crapria my money every month for the rest of my life.

My insurance contract just says it's 20% copay, but nothing about whether I'd own a new machine after a rental period. Right now, with the cpap machine shortage, the higher prices, and the Resmed machines without the cellular capability, I'll use my 5 year old machine until the supply gets back to normal.

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Pugsy
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Re: Trying to get supplies from HMO nightmare

Post by Pugsy » Wed Jun 22, 2022 9:38 am

dream321 wrote:
Wed Jun 22, 2022 9:21 am
My insurance contract just says it's 20% copay, but nothing about whether I'd own a new machine after a rental period. Right now, with the cpap machine shortage, the higher prices, and the Resmed machines without the cellular capability, I'll use my 5 year old machine until the supply gets back to normal.
At some point in the future you might want to clarify exactly what the coverage for the machine is and is there a time limit on your copays. Typically if they don't tell you a time limit...there isn't one.
Since you aren't trying to get a new machine right now....you have some time to clarify coverage and be aware that coverage can change every year. I have a Medicare Advantage plan and when I first got it they had the usual 13 month time limit for the 20% copay....and then the next year...it had no time limit and became a perpetual rental. They can change things each year as to how they cover goods and services. They do it every year.
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Janknitz
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Re: Trying to get supplies from HMO nightmare

Post by Janknitz » Wed Jun 22, 2022 3:30 pm

Pugsy wrote:
Wed Jun 22, 2022 9:38 am
dream321 wrote:
Wed Jun 22, 2022 9:21 am
My insurance contract just says it's 20% copay, but nothing about whether I'd own a new machine after a rental period. Right now, with the cpap machine shortage, the higher prices, and the Resmed machines without the cellular capability, I'll use my 5 year old machine until the supply gets back to normal.
At some point in the future you might want to clarify exactly what the coverage for the machine is and is there a time limit on your copays. Typically if they don't tell you a time limit...there isn't one.
Since you aren't trying to get a new machine right now....you have some time to clarify coverage and be aware that coverage can change every year. I have a Medicare Advantage plan and when I first got it they had the usual 13 month time limit for the 20% copay....and then the next year...it had no time limit and became a perpetual rental. They can change things each year as to how they cover goods and services. They do it every year.
You can easily find out by requesting the "Evidence of Coverage" (EOC). That's the actual contract between you and your insurer, and you've never seen it unless you knew to ask (Contracts require a "meeting of the minds" and I never understood how medical insurers get away with binding you to a contract you've never seen and you don't know what's in it).

The EOC will tell you exactly if it's a capped rental or a perpetual rental. And, as Pugsy points out, they can change the contract every year without giving you any input or explaining the changes. So you make payments and pay two deductibles thinking you're about to own the machine, and nope--now you rent it for life. The Kaiser EOC's specify if you die or stop using the machine, then it belongs to Kaiser. So people who stop using their machines and decide to sell them on Craigslist or whatever may be in for a nasty surprise if they haven't paid attention to that particular detail in the EOC.
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