trying to get my ducks in a row

for about 11 month's worth of the Out of Pocket expenses. It might be worth doing that just to not have to deal with the insurance and DME. Even if you could get them to pay just 20% that might be the way to go. I came very close to buying that same machine until I got my DME to listen to reason and that took walking out of their office once and the calling to tell them I would be back latter that day to get my prescription so that I could buy it online. I probably would have been cheaper for me in the long run though I do like my PR System One Auto.

Good Luck
John

i have southern health care pos:no deductible out of pocket maximum $2000/4000 dme($2500 maximum per benefit year.) member pays $0 if i had value pos it would be $0 after deductible.

Also ask the insurance company about the "set up" fee. Many insurances do not allow contracted providers to charge things like that as setup should be included in the other prices.

Well, I told the DME I was going to buy what I wanted online and they would not be getting my business unless they were willing to work with me. Their response? "You won't be able to get what you are asking for from anyone online either, because you don't have a prescription for it.

That was about a month ago. I still haven't pulled the trigger, as whenever I seem to have time to call the insurance about reimbursement, the office is closed. lol Just driving me crazy, I just want to get a good nights sleep like I did at my sleep study on the machine!

Well, I told the DME I was going to buy what I wanted online and they would not be getting my business unless they were willing to work with me. Their response? "You won't be able to get what you are asking for from anyone online either, because you don't have a prescription for it.

I wouldn't hold your breath for the insurance company to cover an online supplier, but it's going to be less expensive and without all the aggravation for sure.

As long as you have a CPAP rx, online suppliers like cpap.com will sell you ANY CPAP or auto machine you order. Never take a DME's word for anything--they are a bunch of lying jerks.

Cul8rv8--I hope that this does not mean you are going without a machine at all for all this time. That is NOT OK. Get this taken care of TODAY!!!!

Basically my insurance said they would reimburse part of what it costs me, but I have to get prior authorization. So I've been trying to get that. I'm on an extremely tight budget so coming up with even $500 is difficult right now. It sure would help if my mortgage company would hurry up with my loan modification request. Only been dealing with that for 8 months now trying to get that to go through.

Well, my machine is driving away from my house as I speak...yay! Don't know what will happen from here, but I almost don't care! Enjoyed my first night on my s9 auto, and enjoyed even more the next morning see my AHI at 0.1!!

I 'modified' their AMA like crazy, basically I agreed to let them out of responsibility but NOT because of going against medical advice. I crossed out where it said AMA, and I wrote it that I have begun treatment with a different company. Hope my insurance is OK with that!

Also called my insurance last night and let them know of the situation. They said if any claims came through from Preferred Homecare they would have to process them. But at least they're aware of what's going on. Filling out my insurance claim for cpap.com and sending it TODAY in hopes it beats Preferred's claim lol...

Cul - I hope you can get all your insurance stuff worked out too! I'm sure it'll get easier...at some point!

why cant insurance companies use their leverage to their advantage and help comsumers get lower prices for equipment.

why cant insurance companies use their leverage to their advantage and help comsumers get lower prices for equipment.

A lot of insurance companies are "in bed" with the DME's. They pay less than the direct consumer for equipment and the DME's accept it because they make up in volume what they lose in profit margin. Especially when a DME is a preferred provider that's what's happening. Or, the DME may accept less for certain equipment and supplies in exchange for a greater profit margin on other equipment and supplies.

And, the insurance companies believe (rightly or wrongly) that they have some control over the brick and mortar DME's and therefore there is less fraud and abuse.

Just found this forum. Hi!!