S9 Escape Auto...so upset

Okay, so we have a service that is a health care advocate through my husband's work that has been really helpful throughout this process with me. Here is what they told me about the price difference:

Each model (while billed with a code) will have its own contracted rate. The contracted rates do change per make and model of the machine but the coverage will not change. You have currently met your $3,000 deductible, so you are only responsible for 10% of the contracted rates. Assuming that the $120 “premium” upgrade he refers to is the additional price increase for the contracted rate for that equipment, then you would really only be responsible for $12 (10%) out-of-pocket.

Based on that information and the minimal price increase, I think that you should make sure you are indeed happy with the choice of equipment. If you feel like you are possibly not being given the right costs for your benefits, we can definitely look into that for you.


So, it seems like the price difference thing is allowable with my insurance.

I really don't like the lying about the data (and I emailed him that link last night with the comparisons). I know that's not true what he's saying about the differences. So either he's a liar, or he's stupid. Either way it pisses me off.

The single AHI provided by the AutoSet Escape might be enough data if the AHI is very low.

But if it is high, the machine provides no information to help you figure out what to do.

Type of events (obstructive apneas vs open-airway apneas vs hypopneas)? No.
Length of apneas? No.
Timing of events? No.
Clusters? No.
Flow limitations? No.
Snoring? No.
The machine's pressure response to events? No.
Leak information? No.

The graphical minute-by-minute information provided by the software packages is in no way comparable to a single AHI number.

I think someone in the branding department at ResMed slipped in a big hint to patients when naming this machine.

Escape from anyone trying to force it upon you.

kaiasgram wrote:Hi Amy, and grrrrrrr! Here is a link to the ResMed website page where you can directly compare the S9 Autoset and the S9 Escape Auto side-by-side. Perhaps you'd enjoy delivering a copy of the comparison chart to the guy who's telling you there's no significant differences between the two machines.

http://www.resmed.com/ap/products/produ ... nc=dealers

I actually like this approach. There is one of two possibilities. They are either misinformed, or they are maliciously trying to pull the wool over your eyes. Either way, put the truth in front of them and see how they react. I am betting they will order you an AutoSet. If not, you can go elsewhere. I realize this is stressful. I hate junk like this too. Others on here convinced me not to compromise on an Escape and I am sincerely glad I took that advice. You will too, I am sure. We are only "pushing you" because we care.

pandatx wrote:
So, it seems like the price difference thing is allowable with my insurance.

I really don't like the lying about the data (and I emailed him that link last night with the comparisons). I know that's not true what he's saying about the differences. So either he's a liar, or he's stupid. Either way it pisses me off.

It doesn't seem like your insurance rep understood that the DME is asking you for a $120 payment on top of whatever they bill and collect from your insurance company.

The DME knows that he is going to bill your machine as an "E0601" code cpap whether it is the Escape Auto or the Autoset as I don't believe insurance companies recognize any differences between those machines, so they will collect the same amount with either machine. That is why they don't want to give you the Autoset without collecting the additional amount (i.e. upcharge).

If they are smart, they would give you the Autoset without an upcharge to keep you as a customer so that you will go to them for supplies.

Once I have the machine do I have to use them for the supplies? Or can I change DME's after I get settled with my machine?

I bet the $120 up charge will NOT be part of the 10% copay thing...I bet it is over and above the contracted rate price.
I bet the DME wants $120 and not $12. Up charges are typically above and beyond any contract pricing.

That said....even if it is above your contracted rate and you are responsible for the entire $120 it may be worth it to you so that you don't have to fight them over it. Some people don't like to fight.
Some people like me...will fight over principle and as little as $5.
I would be so mad that I was lied to I would probably tell them where to stuff it and go find someone else...but that's me and you are you and you know how you feel about putting up a fuss or if that additional $ amount is worth fighting over or takes food off your table.

You can buy your supplies from any DME you want to use that uses your insurance network if you want to stay withing your insurance paying for things and 10% copay is a nice copay so I wouldn't blame you there.
A different DME would need a copy of your RX..and that's why you need a copy.

pandatx wrote:Okay, so this is what my insurance liason person says:

Each model (while billed with a code) will have its own contracted rate. The contracted rates do change per make and model of the machine but the coverage will not change. You have currently met your $3,000 deductible, so you are only responsible for 10% of the contracted rates. Assuming that the $120 “premium” upgrade he refers to is the additional price increase for the contracted rate for that equipment, then you would really only be responsible for $12 (10%) out-of-pocket.

Based on that information and the minimal price increase, I think that you should make sure you are indeed happy with the choice of equipment. If you feel like you are possibly not being given the right costs for your benefits, we can definitely look into that for you.


So, it seems like the price difference thing is allowable with my insurance.

I would be careful with accepting that $120 "premium" charge.
You could end up paying 100% of it.

I would not even try to attempt to tell you what your insurance will or will not pay for. And $12 may very well be all the extra you would pay.

But, most insurances consider the extra bells & whistles to NOT be required for effective therapy & they just flat out won't pay for them.

At the least, I would be telling the DME that if they persist in billing the extra $120, you & your insurance may pay it, but they will never see another dime for your future purchases of supplies.

Remember, you will be buying supplies & accessories for a very very long time. That could add up to a significant amount of sales to the DME.

EDITED to say:
Boy, that Pugsy is fast.
She snuck in my reply before I could hit the Submit button.

So, even if I get the machine through them, what do I need tell them exactly that I need regarding RX for future supplies?

pandatx wrote:So, even if I get the machine through them, what do I need tell them exactly that I need regarding RX for future supplies?

You do need your prescription.

If you do not already have it, get it from your Doctor or the DME before you agree to go any further with the transaction.

I know it may be a pain in the you know what to get your RX and go to someone else, but I really am starting to think you ought to. That is terrible and if they treat you like that who knows how they will treat you in the future. What if your machine dies in a day or two? Then you still have to deal with them even if you did decide to get your supplies from someone else. I would just try to go somewhere else right away and try to find an ethical DME (although I am starting to think they are few and far between!).

I just went for a machine and called around first. I finally found a place that agreed to give me the machine I requested, but when I showed up, they pulled the bait-and-switch and gave me a brick. This even after we agreed to the exact model number over the phone.

After I called them on it, they tried to pull the "we will need to check with your doctor and insurance company" and I called them on that too. They ended up profusely apologizing and now I am actually happy with them. However, if they tried to make me pay them $120 extra (or even $12 extra) I would not have given them that opportunity.

Why must people try to rip us off all the time? Aren't they profiting enough from us? Unbelievable! I think they recognize that we are easy targets. I am glad you did your research!

what mask did you get? What hose?

I use a Swift FX and a cliamteline hose. Every three months I get three medium pillows, three filters and a new hose. Ever 6 months, I get a new tank and mask. But that is what my insurance company allows.

btw, I just bought a S9 Escape Auto as a backup machine and discovered that while you can get your daily AHI data, they don't make it easy. You have to go into the clinicians menu. Not a big deal for me as this is my back/travel machine.

If it were me, I would give one more half hearted try to have that DME take back the brick and give you an S9 AutoSet and make sure that your out of pocket is acceptable. Otherwise, I would ask for your money back or stop payment and find another DME. You will be dealing with these bozos for supplies for a long while. Best if your have a cordial relationship.

just my thoughts.

-tino

Okay, so a different person just called me and said they'd have no problem giving me the other machine. He said he was going to order it and have it overnighted and that hopefully I'd have it by Thursday afternoon or Friday. He agreed with me about the different data info as well. So...let's all keep our fingers crossed that this will be resolved happily. I won't hold my breath....I'll let you guys know. Thanks so much for the info and feedback. You've been so helpful xo

Learn how to check for it & do check the "Run Hours" before you accept the next machine. The "Usage" hours can be zeroed out by the DME, but NOT the "Run" Hours.

I personally always insist on -0- hours, but since you will have used the machine they did give you for a few days, I might be inclined to also accept the same number or less hours on the next machine - but that is a decsion you need to make.

I haven't used the machine they gave me. I haven't even taken it out of the bag.

pandatx wrote:I haven't used the machine they gave me. I haven't even taken it out of the bag.

Then, insist on the next one having -0- Run Hours.

Call them now & say "I assume the next machine will have -0- Run Hours".
They already know not to mess with you anymore.
That will give them the incentive to not piss you off again when you pick up the next machine.