How Much Did You Pay For Your Machine and Mask?

Here's my question: How much did your DME charge for your machine, and how much did you pay out of pocket? While we're at it, how much did your DME charge for your mask, and how much did you pay out of pocket?

When i purchased my Puritan Bennett 420G to have on hand for travel, I could have picked it up on cpap.com for $297, cpapman.com charges $414; however I was blown away when a local DME was asking $1,275 for the same machine. (The local DME says that they come to my house and set it up FOR FREE!).

My insurance pays 50% for durable medical equipment. So, by buying from the local DME, I'd be paying more than $600 for a machine I could get from a reputable online dealer for half the price, not including my insurance company's contribution. Shoot, in the end, why even involve the insurance company?

There is not question that the local DMEs are charging far too much for their equipment, and we all pay the price in the form of higher insurance premiums and deductibles. Why would any insurance company allow a DME to charge $1,275 for the exact same machine that we can buy at cpapman.com or cpap.com for 1/3 the price?

Again, here's the question: How much did your DME charge for your machine, and how much did you pay out of pocket? Also, how much did your DME charge for your mask, and how much did you pay out of pocket?

I'll take the responses and create a spreadsheet and graphs so we all can see the results.

...this could be interesting.

Dang, once again, i forgot to log on.

I ask all these high-falootin' questions, and I was nothing more than a guest...

Boy, I'm glad someone open up this topic! I was given a resmed s7, (no choice) mask, hose, ect. American Home Patient said insurance would cover everything. Great!. Well, about six month later I start receiving bills from them, $480. then 290. then 260. I called to find out why and they tell me the I'm renting a machine from them @ $120. per month, plus set up charges and all. They said at "some point" I would own the machine. They wouldn't tell what that point was. Finally after many phone calls they said "around" $1500. If they had let my insurance co. buy this machine I would be all set, but as it is, with $1000. deductable, my insur. co. doesn't cover it. I have to pay. This equipment purchased online would be $600. tops.
If I knew what I know now, I would have used cpap.com. These machines are not rocket science. No need for places like American Home Patient.
Now that's off my chest I feel better (tired, but better) Gary

I have pretty good insurance and so far it hasn't cost me anything. But like gar, my insurance is paying something like $120 per month "rent" on the machine. The girl who brought it from the medical supply company said that periodically the insurance company may call them and she will call me in turn, to ask what the number is (hours) I've used it and she said if they're not high enough, the insurance may not pay. You know what, I think I'd rather buy the #@^*! thing than have this hanging over my head!! I got the first mask and after a week of torture, I asked for a different one - she said that's it, the insurance will only pay for them every 3 months. The 2nd didn't work either so I just bought one online. This girl called the other day and when I told her I'd ordered one and paid for it myself, she morphed into the most helpful thing I've ever seen. She didn't want me to pay out of pocket, I need to come in and try on different masks, etc. I got my CPAP in August - she brought it over, and from then on I've had to dig for everything I've wanted - she'd been very little help. Am wondering why she didn't make these offers a couple of months ago!! Money for the company or what??

Geocom, do you live in Wisconsin?
I got my machine through American Home Patient and they do not and will not handle my mask for me. Seems the Hans Rudolph doesn't have the mark up pricing they would like the insurance comapy to pay.

Medicare and /wisconsin Forward purchased my original ResMed S7 Lightweight. At the end of a year I will own the machine. Commical part is, I no longer have Wisconsin Forward because I got married. I now have Humana and Medicare only. I may even drop the Medicare before the first of the year because of a pay raise I will not get because of the Medicare premiums going up.

I think Medicare and Forward were paying something like 400.00 a month for twelve months.

I love messing up paper work for these DME's that like to mess people up.

Here is an old thread you may want to read
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viewtopic.php?t=4153&start=0


I am curious how everyone else did using their insurance and a DME....... below is mine

Here is what I paid for a S7 Resmed Cpap and a F&P 150 heated humidifier and one Swift mask

My Insurance is UHC & the DME is Apria

For CPAP equipment UHC has a $1000.00 deductible and then they (UHC) will pay 80%.If you go out of network then the deductible is $2000.00. I would say I have good insurance. UHC paid for both sleep studies and I paid nothing. I stayed in the network and the only DME that had a contract with UHC was Apria.


Here are the bills I paid to Apria

Jan 13 2005 $156.70 +
$ 68.02
Feb 13 $ 187.26
Mar 13 $ 204.84
Apr 13 $ 411.98

Total I paid $1,028.80

Online S7 $435 + F&P 150 $179 + Swift $115 for a total of $729

My whole deal..Remstar Pro II and P&F HC407 mask with heated humidfier was $860 (charge to the insurance company) Cpap.com has this machine for $594 and the mask is about $50 so the DME is making about $200. Certainly more than they should for 5 minutes work (in my case), but not nearly as gouging as some are reporting.

My quesition is...do any of you contact your insurer or the states attorneys general to report this rediculous overcharging?

I feel very grateful to live in Canada as well as to have excellent extended health insurance through my work. I haven't paid a dime for anything so far. My respiratory equipment supply company recently put in a $2,700 (Canadian) claim to my extended health insurance company which bought me the Remstar Auto CPAP machine with humidifier and two complete sets of hoses with covers and Comfort Curve masks. My insurance pays for the whole CPAP machine once per lifetime, but provides a replacement mask/hose set each year as long as I have a doctor's note verifying that I still have the sleep apnea. If I ever need to replace my CPAP machine, the Ontario government pays up to $780 as part of the Assistive Devices Program offered to every Ontario Citizen. Not only that, the sleep lab tests, my G.P. and the sleep disorders specialist are all covered under our public health insurance program. Doesn't that make you want to move to Canada and put up with all that snow?

I feel so bad for the Americans who must pay out of pocket for everything. It represents a substantial financial hardship for something so critical to one's health. Mind you, we Canadians also have slightly higher taxes and longer waiting times for some medical services than Americans. The richest Canadians travel to the U.S. for faster medical procedures on a private pay basis. I guess there are some strengths and weaknesses in both systems. Still, I prefer being a Canadian overall.

~ OTB

My insurance is Cigna HMO, I have unlimited DME.
I got to choose which machine and mask I wanted.
I walked away with a Remstar Auto with C-flex, Heated Humidifier,
and a Ultra Full Face Mask. The insurance company rented the
machine for a month and now is mine...I ordered a Swift from
this site out of pocket from me....I only get a new mask every
six months...no out of pocket expense from me except for the
Swift and the appointments....Feeling very blessed...

I am not sure what my insurance (Harvard Pilgram HMO) was billed for my Remstar and ComfortLight . I know they rented @100 per month but I have not heard back from them or the INS company about my usage, but the DME came out after I had been titrated and whent through the extremely complicated technical process to adjust my pressure from 7 to 14 I am guessing they made note of the usage numbers. I was givin a Mirage Ultra full face mask at my titration by a sympathetic tech. My DME billed my insurance 109.40 for my Activa mask + 34.55 for the headgear so a total of 139.55 for what CPAP.com is charging 97.99 + 7.00 = $104.99 .

I do not have a copay for Durable Medical with a yearly limit of $1500.
New mask parts every 3 months new mask every 6 what the Insurance company "expects" I was able to get the activa about 1 month after the Comfortlite by calling and explaining that I was having problems with the treatment due to the mask. Thye said It might get kicked back without a letter of medical necesity and I should have my Dr. write one and it would go through ok but it never came to that they just payed the DME.

Grabraham wrote:...the DME came out after I had been titrated and went through the extremely complicated technical process to adjust my pressure from 7 to 14...

LOL!!!!!!!!!!!!!!!!!!!

American Home Patient has come to my home. They never went to my apartment either.

I took the machine home plugged it in, put water in the humidifier tank and went to sleep, that is until about an hour later could not sleep due to obscene noises coming from my mask.

Has anyone here gone first through their DME, done the initial 3-month rental and acquired their mask, supplies, etc., and then when it comes time to re-authorize, just return the CPAP machine and shop online for the model you *really* want? Seems to me the DME would still make out okay, having charged full freight supplies and humidifier.

I guess I am lucky, I have 90% DME, I have BC/BS FEHB I just looked at the letter I recieved, Apria billed $1053.00 for my unit with the humdifier, and the mask, and they have changed the mask three times, for free. or so they say but I do not believe them. anyway it costs me $10.53 each month and it will be mine in Apr.

My old CPAP unit died. I went looking for a replacement. American Home Patient only offered to provide me with the minimal CPAP unit (brand and model not specified) for "about" $1,500. I went looking on the internet. I found cpap.com on the internet. Once I understood the options, the decision was trivial. I bought my replacement machine from cpap.com.

It appears that American Home Patient typically gets insurance to reimburse a flat fee for the units. They then jack up the price so they make their profit from the 20% to 50% copay from the insured. Also since they usually only get one price from the insurance agency they provide the minimum featured units.

They would not allow me to select the unit. The number of items I needed to do to get insurance coverage was overwhelming: a second sleep study, initial lease to buy, all mask, humidifiers and accessories paid by me after they decide which one to provide.

My last unit was obtained this way and I suffered for 7 years with a piece of junk. The unit was so noisy and the mask systems fit so poorly, that my wife and I slept in different rooms many nights.

I now have a Remstar Auto with the new Comfort Curve under the nose mask. I have to put my ear next to the unit to hear it. The mask doesn't hiss or burp. My wife has had her first night of quiet sleep in 7 years.

I paid $760 for the unit with the humidifier, and $123 for the mask. I will never try to use my insurance for this again. I would rather take out a loan and pay for it myself so I can get the proper equipment. It's like needing a car and the insurance and American Home Patient only offering bicycles.

Oh and if you have never experienced the CFlex system, I highly recommend it. My diagnostic pressure is 14 and CFlex makes it so much more comfortable breathing out. The unit also comes with a smart card which records use data for diagnosis. My doctor had no clue that this existed. Most of his patients have the insurance buy their units, and they virtually never pay for this feature.

Finally, the auto pressure system works for me. The unit is set at a baseline of 10 and can automatically increase up to 20 if I need it. So I only get the highest pressures when I am in a deep enough sleep where my apnea kicks in.

Remember the insurance companies and medical device suppliers are only worried about the dollars. The result is that their incentive is to give you the minimum features in your CPAP at the lowest price to them and the highest price to you. You use this machine every night and it is an intimate part of your life. Should the insurance companies and medical device suppliers be deciding what comfort you have? Would you trust them to decide what mattress to sleep on? I don't trust them to decide what CPAP unit I should live with.

One final note. My doctor was extremely good at diagnosing my condition. On the other hand he had absolutely no clue to the available equipment and how to obtain it. In general this will be true for most doctor's since they do not wish to have a conflict of interest with the medical supply companies. The message - don't expect guidance about the choice of units from your doctor.