Local DME: What's the Benefit?

More surprises. Equip in, but local DME had said they'd "wave my co-pay". Great. That was before I insisted on "M Series Pro". Not sure if that's a factor, but I'm now in for $300 plus 10% of an undetermined amount. I'll investigate amount, which I guess isn't "technically" a co-pay, but disappointing.

My insurance docs say durable med equip deduct is $900 for the family plan, not $300. Will there be more surprises in the next phone call or bill? It's possible.

I don't mind paying a bit more since I'm getting the equipment I want, but damn, I've become a private eye trying to anticipate surprises and what known stuff will actually cost ME. And it's all just word of mouth anyway, and may not match what comes on the bill, which will be "my problem" after accepting the equip. I wouldn't have known about the "deduct" amount if I hadn't asked out of paranoia. What else haven't I asked?

And... Initially, the sleep lab said the machine would only be "rented" for the first few months, for insurance to verify compliance. Am I paying $300 plus 10% of ?$? just to rent a machine? I know, call the DME... again...

Conflicting info all around! I'll keep plugging away, but the bigger question may be, should I give up on my local DME, or will they likely provide better assistance via "hands on" access to me with mask fittings, etc., than say, just buying stuff online and hoping I can handle potentialities?

To further complicate, I have a 2nd sleep study in 2 months, I may then be placed on bi-pap, then a 3rd sleep study, and if my central apneas persist, I may be placed on a HIGH DOLLAR adaptive servo ventilation machine. If each of those acquisitions is like this one, I may take up sky diving and hope for the worst.

In a nutshell: Do you think my local DME is likely worth this hassle? Am I taking a long walk with a known pick-pocket who will at least see me all the way to my destination for a bit of extra pocket change, or am I simply swimming naked in a shark tank?

You need to weight the cost of buying whaat you want online from https://www.cpap.com/, even if you have to pay out of pocket, all you need it the script. Jim

The benifit of a local DME, you don't have to drive far to be screwed, saves gas.

I don't know how long you have been on xPAP, but I just got on it and tried to buy from my local DME. They also wanted something like $350 for the machine then another $250 for the humidifier plus copay and rental. I was like "HOLY CRAP"! So I submitted my claim to billmyinsurance.com to see what it would cost through them, and it dropped to less than $150 with humidifier and 7 months rent at less than $100. I understand the insurance wants to rent it to make sure I'm compliant, then I have to pay up to my yearly deductible which starts over in Jan. But they (cpap.com)had to save me upwards of $800 in cost and difference in rental amounts.

It was all the difference between very basic cookie cutter machine and getting what I wanted.

Not saying that is the best route for you, but it worked for me and I adjusted very naturally to treatment and my mask without any more help than I found in this forum. 7 days on treatment. 7 days compliant.

Also, my father just got diagnosed as well. He went with DME because his Medicare picked up the difference for the same equipment where my insurance fell short. He has received more help from me because of my participation on this forum and what I have read on cpap.com than he gets from the DME who does not even know how to operate his equipment.

I hear that not all DMEs are bad, but my local one did nothing but provide me with an overpriced quote.

Although, if you get on the more expensive equipment that you mentioned, you may not have a choice.
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I'd venture to say that most insurances insist on a "capped rental" type of arrangement similar to Medicare but not necessarily w/the copays and not necessarily for as long. 3 months is not an unusual rental period before the xPAP is then purchased outright. Now is JUST for the xPAP machine itself. All the other equipment is an outright purchase at the time you start xPAP therapy.

My understanding is also that most insurances, including Medicare, will NOT purchase a bi-level for patient until they "fail" straight CPAP therapy. It sounds like your sleep doctor expects you will fail straight CPAP therapy and NEED a bi-level or higher level xPAP and is only complying w/insurance requirements.

That being the case, the DME supplier most likely is NOT going to be willing to provide more than a basic, bare-bones, compliance data only xPAP in anticipation that they might get in back and have to exhange it for a bi-level or higher level xPAP.

You, on the other hand, don't want to be stuck w/a bare-bone CPAP if it turns out you DON'T qualify for a bi-level or better. I would suspect in this type of situation that you might be better off going w/a local DME supplier. There are no returns of used xPAPs w/online DME suppliers. And I don't know that your insurance is going to pay for a straight CPAP and then turn around and pay for a bi-level or better as well. Perhaps the insurance person at your sleep lab can give you some idea of how this works.

OR - you might be able to get a straight answer from billmyinsurance.com It would be worth at least calling and talking to them about the situation. They may or may not be able to advise you but nothing ventured, nothing gained.

Looks like I may have complicated my situation, or made it more expensive, by asking for better equipment.

I called billmyinsurance. They only work with BC/BS and I have diff insur. So no help there.

I'll call the insurance person at the sleep lab tomorrow, but I'm not sure they'll know the hardware side of things. They only bill Dr. fees and sleep studies.

I guess I'll call the DME again tomorrow, too. And try to find out if I'm renting, if I'll be able to turn in the 1st xPAP for a biPAP if needed, and the biPAP for an ASV if needed, and how much I'll be expected to pay for each of these. Maybe I should go back to the bare bones "M Plus" if they'll eliminate the out of pocket costs (I could start CPAP sooner that way), but the "M Pro" has already arrived, even though I canceled my appt to pick it up since I have no idea how much it's going to cost me. Good grief!

This is ridiculously complicated with zero pricing visibility, and little other info coming my way. I'm expected to surrender to this whole process and pay whatever gets billed. All merchants would LIKE to operate this way, but only the health care industry manages to pull it off.

I may wait until the New Year since it's only 3 wks away. That will put the first $500, or so, of deductibles in the same year as two more possible xPAP deductibles, presumably at similar amounts, plus co-pays, plus 10%, etc. This could get really expensive.

On the brighter side, I've lost another 5 lbs and my BMI is at 27, down from 32 about 6 months ago. I think I'm breathing better at night, although I know I still need the therapy. The wife hasn't noticed (m)any "episodes" lately. I know that isn't a reliable indicator, but it's better than the alternative, which was what sent me to the sleep doctor. God knows how long I've had OSA/CSA/CSDB, so another 3 wks shouldn't be life altering. No lectures, please.

This whole thing is bumming me out, and I was bummed out to begin with.

Oh, and Freelancer, I've never been on xPAP. This is all new, a big headache, and I'm not even out of the gate.

Thanks, if you made it this far...

Like Jim said, you really need to do the math. If they're going to ding you for an extra $300 and 10%, you could probably buy out-of-pocket and get what you want.....cheaper.
Did you ever ask your insurance provider if they'll reimburse you for out-of-pocket purchases? That's what I did. I never used a local DME.....purchased all my stuff from CPAP.COM and billed my insurance provider and they reimbursed me for 80% of the cost.

There's more than one way to do this. I've never figured out why I'd need a local DME, anyway......I can read the instruction manuals and have the Internet for resource information.

Den

In my case.. the local DME is more of a liability than an asset.

I've been waiting over 2 months for a new cushion for my Quattro mask.

I called today and was told, "oops. we never ordered it"

Yeahhhh, nice.

When I picked up my equipment, the nice lady told me to be careful with my air hose, because a replacement hose costs like 60 or 70 dollars.

Check the price on cpap.com about 1 tenth of that.

There are only 2 advantages that I can think of. First is if your machine ever breaks, you can usually get a loaner right away, it will take a day or 2 if you rent one from cpap.com while you are getting yours repaired. Of course, total cpap failure is not a common thing.

The other thing is the ability to try on masks at pressure, and that is IF you have a good DME. I was able to try on just about every mask made, and I walked away a happy customer because I knew which masks wouldn't work for me.

[quote="Sleepy Dog Lover"]There are only 2 advantages that I can think of. First is if your machine ever breaks, you can usually get a loaner right away, it will take a day or 2 if you rent one from cpap.com while you are getting yours repaired. Of course, total cpap failure is not a common thing.
The other thing is the ability to try on masks at pressure, and that is IF you have a good DME. I was able to try on just about every mask made, and I walked away a happy customer because I knew which masks wouldn't work for me.