Questioning that Insurance "Replacement Schedule"

Well I'm just going to go ahead and put my head out there on the chopping block. This is one of those "dinosaur in the living room" issues. I personally find it pretty disgusting that so many Health Insurance/Medicare/Whatever coverage providers just keep covering such an appalling number of unnecessary surplus supplies. And of course, this is what feeds a regular income to a high percentage of those who post supplies they have gotten for free, on the cpapauction.com. Yes I've benefitted from this on one occasion, but it actually makes me a little sick. There is no way that anyone needs a new nasal pillow or hose or foam filter every couple of months, much less every month!! Why do we support this?? I am not wealthy, and struggle to support myself on a single income. But I just think this whole system is unconscionable and keeps the deductables high and the monthly rates higher than necessary. How do people think these grossly excess supplies are being paid for?

My neck is on the chopping block as well. I agree that insurance, Medicare, Medicaid etc. is being taken for a ride. Last year I met my deductible early in the year (including maxing my out of pocket expense).

I received my machine in August of 2007. At the time I recieved a full face mask and necessary supplies. I did end up getting an Optilife nasal pillow mask in December 2007 when I started having a reaction to the silicone seal on the full face mask so that I could switch between them.

In March of 2008 I met my deductible and out of pocket amount with the insurance company. I did not request any additional supplies since I was stocking up on cpapauction.com at a savings -- I picked up several masks, a couple of hoses, and filters. Didn't feel a need to go through insurance since the items I was purchasing was reasonably priced.

In October or November I discovered that I had broken the elbow on my full face mask that I like (the 431) and asked the doctor to give me a script for supplies. I did go through the insurance company to get a new full face mask, filters, and a hose. No way can I justify getting supplies according to the schedule as I don't feel it is necessary or cost effective.

At the beginning of the year my employer switched insurance carriers -- but I figure I am good for this year with what I have -- if not I will probably just purchase out of pocket by utilizing cpapauction.com.

Supplies are nothing,

I have had 4 PSG's in 2yrs and while you (ok well I) don't want to exclude anyone from having another should they need another sleep study, my 1st sleep lab had me go back the very next nite because I recorded NO Supine sleep. Then 9 months later they only recorded 110 min. of diagnostic sleep and needed 120 min. Yea, they wanted me to go back. By then I was starting to come out of the fog - I fired them, never to return to the Money Mill.

So think about it - filters and hoses are nothing. Ya gotta ask why Insurance Co.'s allow abuse like non-data machines but will pay for another sleep study the very next nite?

I will say it again _ I think we will ALL be better off if sleep centers are testing people who not have been previously diagnosed rather than getting the cash from the cow. We can usu. get enuff data at home if we have data capable machines.

GumbyCT - who thinks we ARE low hanging fruit.

<getting on soapbox>

I'll stick mine out there, too. Everyone is different and everyone's home environment is different....

My skin reacts with the silicone and the seal on my mask becomes unusable after a maximum of 5 weeks. The silicone becomes so floppy and it makes raspberry sounds as it leaks constantly. (Yes, I clean my mask and my face every day.) I am thankful that Tricare will pay for a seal every month.

The house where I live now is very dusty and the fine filter needs to be replaced once a month. So I am also thankful for Tricare providing them when I need them.

I have not yet found a mask that I'm truly happy with, so being able to get a new mask every three months is helpful in trying to find the best one for me. When I find "the one" or when I have exhausted the possibilities, I won't get one every three months. (I have bought some with my own funds, but I don't have infinite financial resources.)

I have been told by my sleep doc that the hose should be replaced every six months because the plastic breaks down with use and over time and that increases the likelihood of microbial growth, even though we use distilled water.

So...one person's "excessive supplies" is another person's "required supplies." If you don't need the supplies, don't accept them. But please don't guilt others because we need supplies more often than you do.....

<getting off soapbox>

I've "been there" for several years. I've never been able to figure out why people let their DMEs (over) charge their insurance for all this extra stuff. The only time I DID use my insurance was when I met my deductible in 2005 when I had my sleep study and when I bought my equipment (through CPAP.COM), my insurance provider reimbursed me for 80% of a much smaller amount than they would have paid had I acquired the items through a local shop. EVERYTHING I have purchased since then has been out-of-pocket.....extra machines, masks, hoses, filters, etc. For one thing, I wanted backup machines and I knew they wouldn't go for that (if at all) for many more years and I wanted to be prepared for "whatever". I'm stocked up for a long time and I'm sure I've saved myself and my insurance provider a good deal of money and I have no regrets about doing it this way.
People who say "My insurance pays......" have no idea how the system works.

I've also been amazed that many people will put more research into buying video equipment, TVs, computers and other types of items they buy......but don't research something that's going to help them breathe every night for years to come.


Den

CorgiGirl wrote:So...one person's "excessive supplies" is another person's "required supplies." If you don't need the supplies, don't accept them. But please don't guilt others because we need supplies more often than you do.....
<getting off soapbox>

No CorgiGirl, I am not "guilting" anyone who actually needs supplies once a month. I believe that you and others in this category are well in the minority, and that the system is just being plundered by folks who pull in all that's offered, to profit. Sorry to all who may be offended by my pointing to the dinasaur.....

Anything that can be had for free people will get. I realize we all have to pay for our stuff, and for every one we pay for we also pay for the two that don't work or pay. "Lincare" likes my INS, They now call me every 30 days, to pump me for what I need, not out of concern for my needs, for their bottom line., I take what I need seeing that I have spares to cover any problems that come up, realizing that parts go bad even if they aren't used, so I rotate my spares. I lot of the time I decline to allow them to ship what I don't need. Most people aren't that responsible, and we all pay for it. The cost of living in a welfare state. Jim

GumbyCT wrote:Supplies are nothing,

I have had 4 PSG's in 2yrs and while you (ok well I) don't want to exclude anyone from having another should they need another sleep study, my 1st sleep lab had me go back the very next nite because I recorded NO Supine sleep. Then 9 months later they only recorded 110 min. of diagnostic sleep and needed 120 min. Yea, they wanted me to go back. By then I was starting to come out of the fog - I fired them, never to return to the Money Mill.

So think about it - filters and hoses are nothing. Ya gotta ask why Insurance Co.'s allow abuse like non-data machines but will pay for another sleep study the very next nite?

I will say it again _ I think we will ALL be better off if sleep centers are testing people who not have been previously diagnosed rather than getting the cash from the cow. We can usu. get enuff data at home if we have data capable machines.

GumbyCT - who thinks we ARE low hanging fruit.

It's true. The filters and hoses are "nothing" in comparison to other health-related expenses (hospitalization for one). Sleep studies are not part of a "replacement schedule" (which was the original subject).

But, in summary......THEY DON'T CARE......because the people who are paying the premiums are the ones who REALLY pay the costs. The insurance providers (with the exception of the federal government) aren't going to go broke......they'll just keep raising the premiums (on everyone) to cover the people who are actually using it.

Den