CPAPtalk.com

And one more (little) thing:
Medicare may require a sleep study; but your doc may be able to over-ride that. --or not.

"The main issue for you is your Medicare Advantage plan- will they reimburse 80% if you buy on-line, or only if you buy through an in-network DME?"

Checked and latest version is they pick up 85% for network DME, 70% out of network.

Eideard,
You said that you pay 20%. What do you pay 20% of?

I have BCBS. The insurance code is E0601. They charge BCBS $285 a month for, I believe, 12 months. After that, I’ll own the CPAP. This works out to $3,420. With my 20% copay, it costs me $684. The S9 with humidifier costs a little less than $1,100 on the internet. So I’m saving around $400.

The DME would charge the same with a less expensive CPAP that is billed under E0601. For a less expensive CPAP, the savings would be less than $400. If I bought a CPAP for less than $684, it would be cheaper for me not to use insurance.

By the way, BCBS does pay the ENTIRE $285 per month less the 20% I pay. There is no reducing the bill by 50% or something like that like they sometimes do for other medical expenses. My contact at the DME verified this. The DME is getting paid around three times what the cost is on the internet. No wonder why insurance is so expensive.

Now that I’m thinking about this, I’m going to call BCBS and ask about the possibility of buying a CPAP from the internet.

Luckily, my DME is good so I am happy to work with them. They let me try different CPAPs during my compliance period and I can try masks on before buying them. For Resmed, Respironics, and F&P masks there is a 30 day free return if I don’t like the mask. Many people do not have a DME as good as mine. They would rather not deal with their DME.

Anyways, the point of this email is that you paying 20% may not be as good as it sounds.

Typically Medicare Advantage plan users will see that the original billed amount gets reduced to what Medicare would allow. Any co pays would be based on what Medicare would allow and not necessarily the pie in the sky amount that a DME will bill out. Always best to verify though...just in case.

While there's a small chance the machine is messed up, it's more likely your needs have changed.

You may need a different CPAP pressure, or you have a different medical condition.

Also consider the possibility that your CPAP may be working perfectly, and you've got a different problem. We apneacs and our doctors tend to have tunnel vision on apnea/CPAP and miss things that have other causes.

If you get a new machine, be sure to get a "fully data capable" machine. Read the links in my signature to find info on how to get the right machine and how to avoid being screwed by the DME (CPAP seller).

Please fill in the equipment on your profile. There's a link in my sig line on how to do that.

However, do check your machine very carefully. Remove the water tank before moving it, so you don't spill water into the blower unit.

Do you change and clean the filters often? Be sure it's not clogged.

Turn it on, disconnect the mask from the air hose, and plug the output of the hose with your thumb. Listen and feel for any air leaks in the system. (blower, hose, humidifier, connections, etc.) Put the mask on and hook up. There should be somewhere on the mask where air is supposed to leak out. Be sure it is leaking the "normal" amount of air and the exhaust holes aren't plugged. Be sure it's not leaking elsewhere.

Turn it off, remove the water tank, and give it a good visual inspection. Look in the air inlet on the back, and the air outlet on the front. While you're at it, look for the model number. It's probably something like 1020923.

Eideard wrote: I really don't want new overnight study. Been happy with results for 7 years. Saw sleep doctor about 6 months ago and he saw nothing out of line. Just want to use existing prescription on new machine.

If the software is halfway decent, I don't have problems. Longtime geek - online since 1983.

Did you take either the whole machine or the smartcard into the doctor during your 6 month ago visit? Did he examine the machine or the card before saying he saw nothing out of line? If your machine has a smart card, it's sort of like a poor man's mini sleep study every night.

If you get a good PRS1 (Respironics) or S9 (ResMed) machine, the programming is pretty easy, if you know the pressure setting you want. No software required, just multiple button pushes. Discuss it here before you decide which one to buy.

Eideard wrote: Taxpayers get to complain about lease - tab picked up by Medicare.

I really don't want new overnight study. Been happy with results for 7 years. Saw sleep doctor about 6 months ago and he saw nothing out of line. Just want to use existing prescription on new machine.

Run, don't walk from that Apria office. Billing for >13 months for a CPAP device is DEFINITELY Medicare fraud. Call their tip line and depending on what they find, there might even be a reward.

Eideard wrote: Current Medicare Advantage plan will pick up 85% of purchase price. My concerns are ease of programming it myself - if I buy mail order. Ease of handling paperwork if I deal with firm that doesn't handle Medicare related paperwork for me.

If the software is halfway decent, I don't have problems. Longtime geek - online since 1983.

For geek points, I think I recall that some of the S9s have a port for a pulse-ox.

For paperwork, I know my father uses American Home Patient. They like to try and get away with sending bricks, but otherwise they seem to be good for working with private pay / medigap.

DiverCTHunter wrote:For geek points, I think I recall that some of the S9s have a port for a pulse-ox.

They do - but it requires a very expensive adapter and a very expensive very specific oximeter.

I looked at it when I purchased my ResMed S9 AutoSet in Jan 2012.

Since no one ever buys them (because of the very high cost), I never could get an "exact" price.
But the range is about $ 850

It's your AC adapter casuing it. If it turns on and off and sputters then get a new adapter. Look on line the model number on Amazon or Ebay. That's what I did and it now works good as new.

The cpap repair guy's and cpap represenative wont tell you that. They wont to squeeze as much money as possible from us by servicing it and getting a new motor or a new machine.