No DME for Walk in CPAP???

Hi all! Just signed up and hoping I can get some help from the forum.

Used a CPAP around 2015…an old Phillips One I think. I started using the machine again religiously about a month ago and I’m now realizing there is a recall and the machine is over seven years old so under my insurance I more than qualify for a new one. I called my doctor and she faxed over a script but the company doesn’t show it in their system yet and said it could take to the middle of next week! What??? Isn’t it possible to walk into a DME, hand then the prescription, they punch it into their computer linked up with the insurance, they tell me the deductible, I pay it and walk out of the store with the machine and supplies? There doesn’t seem to be one that either has machines or works in this way. Heck… I live in Jersey just across the river from Philly. I would think somewhere I could walk in and just get one. No?

Is there a particular online store that is liked by the form where I could purchase and get reimbursed from insurance?

Skyking wrote: ↑

Fri Sep 09, 2022 4:31 pm

Isn’t it possible to walk into a DME, hand then the prescription, they punch it into their computer linked up with the insurance, they tell me the deductible, I pay it and walk out of the store with the machine and supplies?

Skyking wrote: ↑

Fri Sep 09, 2022 4:31 pm

Hi all! Just signed up and hoping I can get some help from the forum.

Welcome to the forum. Someone will be along to help you shortly.

Ok…thanks. I thought if one could walk in a medical supply store, hand them a scrip and walk out with canes, walkers, wheel chairs and the like, just paying the deductible, why not a CPAP but I appreciated the humor and have my answer.

Skyking wrote: ↑

Fri Sep 09, 2022 4:31 pm

Is there a particular online store that is liked by the form where I could purchase and get reimbursed from insurance?

You would have to ask your insurance about that.

Skyking wrote: ↑

Fri Sep 09, 2022 4:31 pm

but the company doesn’t show it in their system

You never mention what DME that is, so let's start there.

btw Welcome to this zoo.

Skyking wrote: ↑

Fri Sep 09, 2022 5:57 pm

Ok…thanks. I thought if one could walk in a medical supply store, hand them a scrip and walk out with canes, walkers, wheel chairs and the like, just paying the deductible, why not a CPAP but I appreciated the humor and have my answer.

Apparently they think a cpap contains some opiates or something. I always encourage folks to get a copy of their sleep study and their equipment order to help when getting supplies. Not sure if its required by the insurance to get it directly from the Dr. but I have walked in before and handed them a valid order and I think they use that so they know who to contact and how to reach them. Cuz I did have to wait, too.

But these days with the recall and backlog it can be a while.

You should contact your insurance directly to ask if there is another DME in their network. So you know where to go if/when this place gives you a hard time or drags their feet.

It took me a year to get a machine before the pandemic and before the recalls. The insurance hoops are crazy. I don't know anywhere you can walk in and get one if you are expecting insurance to pay. Now if you want to pay out of pocket there are places you can order online.

babydinosnoreless wrote: ↑

Fri Sep 09, 2022 6:28 pm

It took me a year to get a machine before the pandemic and before the recalls. The insurance hoops are crazy. I don't know anywhere you can walk in and get one if you are expecting insurance to pay. Now if you want to pay out of pocket there are places you can order online.

OK… I know many are resentful but the wife was a government attorney for decades and the insurance is pretty awesome. It plainly states in network I pay only 15%. I honestly don’t remember the cost on this old system one in 2014 because it was New Years Eve and I just signed paperwork, grabbed the stuff and left.

So…why did you have to wait a year, when I see you can go online and there appears to be a large selection to choose from? Is there a particular website that is most reliable\honest that members of the forum use? I’m thinking I may call BCBS Fed and ask if I can order one and have them reimburse me their part??? I gather these websites are not in networks so reimbursement will be slightly less.

Skyking wrote: ↑

Sat Sep 10, 2022 8:01 am

I’m thinking I may call BCBS Fed and ask if I can order one and have them reimburse me their part??? I gather these websites are not in networks so reimbursement will be slightly less.

Aware of the market shortage, some health insurance companies have flexed their rules to benefit the insured.

Skyking wrote: ↑

Sat Sep 10, 2022 8:01 am

Is there a particular website that is most reliable\honest that members of the forum use?

cpap.com Sponsor this forum.

Skyking wrote: ↑

Sat Sep 10, 2022 8:01 am

babydinosnoreless wrote: ↑

Fri Sep 09, 2022 6:28 pm

It took me a year to get a machine before the pandemic and before the recalls. The insurance hoops are crazy. I don't know anywhere you can walk in and get one if you are expecting insurance to pay. Now if you want to pay out of pocket there are places you can order online.

OK… I know many are resentful but the wife was a government attorney for decades and the insurance is pretty awesome. It plainly states in network I pay only 15%. I honestly don’t remember the cost on this old system one in 2014 because it was New Years Eve and I just signed paperwork, grabbed the stuff and left.

So…why did you have to wait a year, when I see you can go online and there appears to be a large selection to choose from? Is there a particular website that is most reliable\honest that members of the forum use? I’m thinking I may call BCBS Fed and ask if I can order one and have them reimburse me their part??? I gather these websites are not in networks so reimbursement will be slightly less.

My insurance did not let me order from online. I was diagnosed at the end of the year. Had I got the machine at that point I would have had to pay my deductible twice. So would have paid out of pocket more than the machine would have cost without insurance. In that years end my insurance changed, and was in the process of trying to get approved when we moved and were once again on a new insurance. Then the process started over again. As I was now in a different state I had to go get a prescription from a new doctor and start the process over with a new dme. Dx'd 10/2018 got my machine 9/2019. Still got screwed over by the double deductible.

Discovered Lsat, bought my back up machine here on the forum for less than one of my deductibles and will never go back. Easier and cheeper to buy out of pocket & I don't have to deal with compliance /deductibles and extra doctors. Did I mention less expensive than with the insurance ?

Wow…just wow.

Insurance person was very nice but said once they get the prescription it will take up to a week for approval. She said THEN the hard part starts of finding a supplier who has a machine. I said that’s interesting…I can call cpap.com by 4PM CDT today and it will be on my doorstep TOMORROW. When I did the search saying in stock only, there were 12 to choose from. How is that?

Edit…said F it and called cpap.com. They got me an airsense 10 for 599 and it will be delivered tomorrow. I told the woman cpaptalk referred.

Skyking wrote: ↑

Tue Sep 13, 2022 12:23 pm

She said THEN the hard part starts of finding a supplier who has a machine. I said that’s interesting.

It is my understanding that DMEs do NOT stock equipment. Unless and until your insurance approves the transaction they just will not order anything. So they will blame your insurance for the delay. All this takes place electronically? In a week? Amazing.

BEWARE of this when you think that when you have a problem with your cpap and can't sleep w/o it that this same supplier will provide you with a loaner. This I why I always tell people to get a spare of each piece of equipment.

SleepGeek wrote: ↑

Tue Sep 13, 2022 1:18 pm

Skyking wrote: ↑

Tue Sep 13, 2022 12:23 pm

She said THEN the hard part starts of finding a supplier who has a machine. I said that’s interesting.

It is my understanding that DMEs do NOT stock equipment. Unless and until your insurance approves the transaction they just will not order anything. So they will blame your insurance for the delay. All this takes place electronically? In a week? Amazing.

BEWARE of this when you think that when you have a problem with your cpap and can't sleep w/o it that this same supplier will provide you with a loaner. This I why I always tell people to get a spare of each piece of equipment.

Ah…gotcha. I can’t tell you how nice that young lady was at cpap.com. Within reason I will order my supplies from them in the future. My old CPAP machine is part of the recall so yes… I will have a spare eventually. That is an excellent point because I was going to give it to someone.

Now I completely understand why you can’t just walk in with a prescription and walk out with the machine and supplies.

Skyking wrote: ↑

Tue Sep 13, 2022 2:13 pm

Now I completely understand why you can’t just walk in with a prescription and walk out with the machine and supplies.

It's ALL about the money.