Aetna Insurance Advice

Hello,

I have an HDHP through Aetna. Ive met my deductible for theyearbecause I had my sleep study done. I got my CPAP through a DME that the sleep center sent it to (they rotate through a few, everything worked out well).

Ive searched on here and have read a number of threads about Aetna and forcing rentals. Since I have an HSA with my HDHP, I can buy a CPAP outright, but since it seems that Aetna follows medicare guidelines and limits rental to 13 months, Im curious to know which of the items are going to be automatically replaced, which are going to be charged in the monthly rental, etc.

My EOB shows:



What it doesnt show is which are going to be billed to me monthly, which are one-time expenses, which the DME will automatically provide, etc.

I know I should call them, but I have effectively been working nights the last week and a half (CPAP gets methrough it much better than I did before), so it has been tough to make a call.

Any ideas?

Really, this whole setup is quite stupid. If I want to spend my own money on a CPAP, why shouldnt I be able to just go buy one cash without even having a prescription. Its not a drug, heck, it isnt even O2.

I work, I make fine money and the cost of the equipment and my therapy isnt an issue. But I still dont want to pay more than I need to, and since HDHPs were supposed to let the consumer take their healthcare into their own hands, I want to do so by making sure Im paying out as little as I need.

Any insight would be appreciated.

Thanks!

Generally the blower part of the machine is a rental and everything else (including the humidifier) is a purchase, but the only way to be certain is to call Aetna and ask.

I have my e-request in to Aetna, and will call tomorrow or Saturday or Monday. But that info helps!

Is it true that rental is 13 mo?

It's generally either 12 or 13. You'd have to ask them.

All of the other supplies to have a replacement schedule with your insurance, but you don't have to get them replaced that often. That's just the soonest they'll pay their part of the replacement. Your DME will probably call you to let you know you are eligible for replacement parts, but you can pick and choose what (if any) you want. It's generally recommended to have a spare of everything sitting on your shelf at home in case something breaks.

And, you CAN just go buy your own machine. There are many online vendors that sell CPAP machines and equipment. Also, it's possible that if you wanted to pay cash at your DME, they would let you purchase it outright at the rate negotiated by your insurance company (the insurance company wouldn't pay towards it, but you'd get the discounted rate). If your copays are high, it is definitely worth it to see if you can buy the machine online for the same or less.

Aetna got back to me. The CPAP machine max purchase price is $380. Given that, the price seems pretty decent. They told me that I could purchase outright, and given that Ive met my deductible for the year, they would reimburse 90%.

Keep in mind that I have an HDHP with HSA, so I might have a bit more flexibility.

But Im pretty happy with that!

I purchased a machine with Aetna insurance about July of last year, my insurance covered 100% so it cost me nothing outright, but then the next year my insurance changed to covering 90%, since the cpap company billed it out every 13 months I started getting a bill for 10% starting in January til the end of the 13 months that I was responsible for. Might be different in your case, just thought I'd share.

Interesting. My HDHP always would just pay 90% after I paid my deductible up until I hit my cap.

When I asked Aetna how to, they gave me a non-answer.

I just switched to Aetna in early Dec.on a small group plan. I called them a few days ago to find out how often I can purchase cpap supplies and have it covered by them. They said I can buy supplies as often as needed. Since I have a high deductible the purchases would count towards the deductible. I asked about ordering online and they said purchases online would not count towards the deductible. This seems crazy since it would cost me less, and thus take me longer to fill my deductible quota (seems like a win for me and a win for them, maybe a bigger win for them!) The DME I use only carries ResMed and I really want to try the innova hybrid. But if I buy it myself it wont count towards my deductible. I am going to check out some other dme's in the area. It all seems crazy to me.

well, cpap.com wants $549 for an icon premo. My DME charged $115 for the humidifier (not sure why, as it is built in, but whatever), plus $380 for the CPAP. That's $515. Seems OK to me.