Insurance and Mail/Internet DME

Anyone have any tips on dealing with insurance companies when purchasing machines (requiring pre-auth) from the much less-expensive Internet/mail order vendors? Or should I just give up and swallow the chunk of deductible (yeah, it's out-of-pocket one way or the other, so why pay almost twice as much with my local DME who will then telemarket the crap out of me?)?

(Off-topic aside: Every time I deal with an insurance company, I am more convinced some kind of serious reform is necessary. As an extreme example, filling out an on-line form to receive a blank form in the mail is just plain insane...)

If your insurer really will reimburse you for an online purchase, the hassle of getting reimbursed will not be as bad as the hassle of fighting a DME to get the machine you want for all the extra out of pocket money you'll pay. But be absolutely certain you have all your ducks in a row for reimbursement if your online purchase BEFORE you put out the money. Good online vendors like our host will help you.

The one downside to online purchases is that you may be without the machine if you have to return it for warranty work. It's not a bad idea to use some of the money you save for a backup on Craigslist.

Janknitz wrote:If your insurer really will reimburse you for an online purchase

Yes, I know. I'm asking if anyone has any tips for getting an insurance company to pay when they throw as many roadblocks in the way as possible. It is the "if" that is the issue.

Janknitz wrote:online vendors like our host will help you.

Online vendors will not perform the actions of a B/M DME (file pre-cert, file claim, provide compliance information to the insurance company, et al) - it's how they can so roundly beat the B/M on price even including the negotiated discounts. And it is this very lack that the insurance companies use to deny the claims.

Janknitz wrote:It's not a bad idea to use some of the money you save for a backup on Craigslist.

Wasn't really the question, but to put it to bed I already have two machines (the one I'm using now with over 18,600 hours on it and an ancient spare). I'm hoping to hear from people who have real-world experience battling insurance companies when trying to save themselves (and the insurance companies, for that matter) money.

To be clear; I am currently arguing with my insurance company, have not yet purchased the new machine, and have gotten so far only one concession - I can have the pre-cert provided by my medical provider instead of the DME. Other than that, its an uphill slog, one that I won't waste any of my precious-little time left on earth pursuing if it's a fruitless cause. That's why I'm looking to hear from those who have already gone before and lived to tell the tale.

Geez, pardon me.

deleted. Can't address your specific question.

Janknitz wrote:Geez, pardon me.

My sincere apologies if I came off sounding unappreciative of your reply, I just wanted to clarify what information I was looking for. In re-reading my original post I was somewhat vague, and so wanted to be more specific about what I was interested in knowing. Blame my having to talk to insurance company representatives, I suppose...

LinkC wrote:My online DME not only does the insurance claim work,

Seriously? I haven't found one Internet vendor who performed this service; but then, I admit to searching for the one machine that will match my prescription (yeah, it's that frelling specific) and price-searching only. I do have a "routine" Internet vendor I've been using years now for little stuff like masks/headgear, but haven't needed anything yet this year (looking at stretched-out headgear...) and that I should be able to submit straight, since it doesn't require pre-auth or compliance information.

LinkC wrote:but agreed to waive my co-pay to gain my business

He, he...I wouldn't ask that of anyone, since I have high- and unmet-deductible, so in my case that would be the equivalent of asking for a free machine. I don't mind paying out-of-pocket, I'd just like it to be applied to my deductible in case I break my arm or something later this year.

I have not used my insurance at all this year for cpap supplies, I have not yet satisfied my deductible, (which is outrageous),
but it is very empowering to not have to stick with a schedule and DME business hours to get what I need.
To simplify things next year, I plan to choose my Medicare supplement based on factors other than cpap needs.
I feel that I can control the price and quality of my equipment by retaining as much power as I can.
The system is indeed broken; and I don't expect it to improve. I wash my hands of these vermin.
--{meaning the insurance and local DME's, of course}

Liberty Medical online advertises that they accept Medicare and most private insurance.
Whether they will file at the level you are wanting (initial pre cert) I don't know. Might check with them and see.
I have no idea about their prices though. Can't find them listed at their site at a quick glance.
I think there was one other online seller that advertise that they would file insurance but I can't remember their name.

Apparently, cpapsupply.com no longer submits claims to Medicare (I understand they did at one time.)
Somewhere I read that Medicare will not accept a claim from any source other than the SUPPLIER.
This leaves out reimbursing the patient, no matter who is the supplier.

Pugsy wrote:Liberty Medical online advertises that they accept Medicare and most private insurance.
Whether they will file at the level you are wanting (initial pre cert) I don't know..

Oh, I'd bet they do...they look a whole lot like a B/M DME, and you're right, prices are not available on the site, nor is a direct order. You need to contact their friendly representatives. Oddly, though, they do have provider manual downloads for the machines they list on the site...pulled the System One (not 60 Series) Auto provider manual to verify. (So much for that super-secret. ;)

But otherwise, based on a review of their website, they look like the worst of both worlds.

Off-topic aside: Thanks to the above reminder, ordered new headgear from a place I never ordered-from before just to try 'em out. Was amazed at the number of hoops I had to jump through to order a non-prescription part. If I ordered a mask, I'd probably have to give them my daughter...