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Re: Yet Another DME struggle
Posted: Sat Nov 14, 2009 12:15 pm
by Wulfman
peppi wrote:I'm sorry, we don't sell those models because they cost too much.
Man I can relate. I called Aetna and told them I wanted to buy my machine on line.
I have an in network deductible of $600 and out of network of $1500.00
So they referred me to three Orlando in network DMEs. I want an ResMed S8 Autoset II which my doctor finally agreed to after a 1/2 hour of my best salesmanship (my profession).
So armed with the scrip for an Autoset II, they try to tell me the thing is too much money.
How much? $1800.00!!! WHAT! I can buy it on line all day long on the Net for $588.00 and possibly cheaper on auction!
They suggested I do that. So I will.
I don't think I will ever deal with a DME, in the long run it will cost you more. Example, parts, the DME wants to sell the entire nasal mask , not just the pillows. This stuff all adds up.
Given the support here, I feel confident I can set the machine up myself and the DMEs can go pound salt.
Did you ask them (and if you didn't, I would recommend doing so) if they considered YOU to be in-network and whether they will reimburse YOU? I did that with my initial purchase back in 2005......and they did. I purchased all of my equipment from CPAP.COM and then submitted an invoice to my insurance provider (with me as the billing party and them as the party being billed)......and they reimbursed me at the standard, in-network 80% DME rate.
Many/most insurance providers have provisions for reimbursing their members/insured for out-of-pocket expenses.
Den
Re: Yet Another DME struggle
Posted: Sat Nov 14, 2009 6:33 pm
by SnoozyWoozyCat
Wulfman wrote:[Did you ask them (and if you didn't, I would recommend doing so) if they considered YOU to be in-network and whether they will reimburse YOU? I did that with my initial purchase back in 2005......and they did. I purchased all of my equipment from CPAP.COM and then submitted an invoice to my insurance provider (with me as the billing party and them as the party being billed)......and they reimbursed me at the standard, in-network 80% DME rate.
Many/most insurance providers have provisions for reimbursing their members/insured for out-of-pocket expenses.
Den
Wow Wulfman -- wish I had thought to ask this when I called my insurance company before I bought my machine. They told me if I purchased from a out of network provider, I would be subject to separate deductible and higher co-pay. I never thought to ask if
I would be considered in network. Jeez, it's like a game of chess working through all the ins and outs of this!
Re: Yet Another DME struggle
Posted: Sat Nov 14, 2009 6:50 pm
by Autopapdude
Why don't you get your own prescription (a nice generic one for "cpap or autopap, with mask and humidifier" and buy it at Cpap.com? I have United Healtcare now, and they reimburse at the 80% level, once whatever your copay is met. I'd call UHC, and find out what they'd reimburse if you self-purchased, and sent them the bill. That is what I did, and when one divides the cost of the Autopap I have, it ends up being about $40 a year for 4 years. I think that is well worth it to get what you want and need, and cut out the middleman/salesman.