am i getting ripped off?

Wulfman · Post by **Wulfman** » Thu Jan 10, 2008 8:58 pm

heckler wrote:ahhhhh I gotcha. Is this something I should get an approval for beforehand or just give it a shot after the fact?

Since cpap.com will not be submitting any claims I will have to do that myself after ordering anyhow.

NOW you got the picture!

See if this link helps answer any question you may have about how it works.

https://www.cpap.com/cpap-faq/Insurance.html#104

They didn't have this stuff when I did it 3 years ago.....I had to figure this out on my own.

Den

Guest · Post by **Guest** » Thu Jan 10, 2008 9:42 pm

Alright, I got a plan of the attack it seams.

Tomorrow I am calling the DME first to ask them for a firm out of pocket cost and cancel the appointment for now.

Then I'm calling the insurance company again to try to work something out.

Thanks

MidnightOwl unlogged in · Post by **MidnightOwl unlogged in** » Thu Jan 10, 2008 11:03 pm

The DME I used had 2 prices - one was the list price which they probably charged cash customers and the other was the price they had negotiated with my insurer in order to be considered "in network" . That price was very close to the online prices. And my insurance did not allow them to charge me more than this price. I think you want to find out if your insurer has this kind of arrangement with the DME company you want to use.

alpha1340 · Post by **alpha1340** » Fri Jan 11, 2008 12:02 am

I know your insurance covers $2500 per year but on cpap machines I would ask them if they require a rental or if they purchase it outright.

Mine insurance BCBS does not have a cap on Equipment per year.

Some insurances have where you have to rent the machine for say 10 months. You pay a copay of say 10%. But after the 10 month rental the machine is yours. I would ask if the insurance does this with their cpap/apap/bipap machines.

Guest · Post by **Guest** » Fri Jan 11, 2008 1:58 am

alpha1340 wrote:I know your insurance covers $2500 per year but on cpap machines I would ask them if they require a rental or if they purchase it outright.

Mine insurance BCBS does not have a cap on Equipment per year.

Some insurances have where you have to rent the machine for say 10 months. You pay a copay of say 10%. But after the 10 month rental the machine is yours. I would ask if the insurance does this with their cpap/apap/bipap machines.

From what the DME told me, my insurance does the "rent to own" thing. So apparantly they would be paying monthly instalments until the limit runs out and then I would continue until I hit the amount the machine retails at, at which point it would become my property.

Slinky · Post by **Slinky** » Fri Jan 11, 2008 4:23 am

Be aware that Medicare requires a 13 month capped rental after which time the CPAP becomes the property of the patient. The following figures will give you an idea of the billing and insurance reimbursement process. Mind you these prices are for CPAP and NOT for a bi-level but still it can you an idea of how it works. (These are 2007 levels, they dropped again in 2008). Check the price of a Respironics M Series Auto w/A-Flex at cpap.com to give you some comparison idea to the CPAP vs bi-level prices.

Monthly Billed Amount: $135.00
Medicare Monthly Allowed Amount: $74.96 (this would be the equivalent of an insurance contracted amount)
Medicare Monthly Reimbursement Amount: $59.97
Patient or Secondary Insurance CoPay: $14.99

So for many insurances w/a lengthy rental requirement (vs a 3 month rental and purchase) the Medicare Allowed Amount would be the equivalent of an independent insurance's "contracted amount", etc.

"Some" local DME's will abide by the Medicare rates when selling to those who are self-pay or those w/poor insurance coverage and large copays, others will charge the BILLED amount above to the self-pay patient AND to those w/poor insurance coverage and large copays.

jjposey · Post by **jjposey** » Fri Jan 11, 2008 8:57 am

Did you check to see if http://www.billmyinsurance.com is out of network?
Whoops! I see this has already been mentioned. Sorry.
On the other hand, did you ask your insurance what they consider "billable" from the DME and what they disallow so you will know the max the DME is allowed to charge you and the insurance?
That should tell you what your out of pocket should be. (again I'd get that from the insurance NOT the DME- they'll take you for every dime they can)

Guest · Post by **Guest** » Fri Jan 11, 2008 10:23 am

Deal with your local DME

heckler · Post by **heckler** » Fri Jan 11, 2008 1:24 pm

This is un friggin real.

So I called back the DME and asked them to give me a strict quote on how much I will actually pay out of my pocket once all is said and done. I mentined I saw this thing online for the fraction of the price. She puts me on hold for a minute, then comes back and gives me another one of the confusing speaches about insurance caps, rentals, accessories. In the end it seems I only have to pay 200 bucks at best, and some more if the mask has to be changed often. She said the 4000 dollar price tag was "retail" and blah blah blah not what I would pay.

I'm still suspicios as hell, but I guess now it would make the most sense to go through them.

Wulfman · Post by **Wulfman** » Fri Jan 11, 2008 1:28 pm

heckler wrote:This is un friggin real.

So I called back the DME and asked them to give me a strict quote on how much I will actually pay out of my pocket once all is said and done. I mentined I saw this thing online for the fraction of the price. She puts me on hold for a minute, then comes back and gives me another one of the confusing speaches about insurance caps, rentals, accessories. In the end it seems I only have to pay 200 bucks at best, and some more if the mask has to be changed often. She said the 4000 dollar price tag was "retail" and blah blah blah not what I would pay.

I'm still suspicios as hell, but I guess now it would make the most sense to go through them.

See if you can get it in writing (from the DME and your insurance provider) as to exactly what you're going to be paying.......

Den

heckler · Post by **heckler** » Fri Jan 11, 2008 10:21 pm

Yeah, I am going to do that.

am i getting ripped off?

Check if Insurance has a negotiated discount with the DME