Cost of machine???

Fortunately, my insurance covers me 100% when it comes to equipment and accessories. My question is this: I've noticed the machine I have is listed on CPAP.com for $529. My Respiratory Therapist Dr. said that the machine cost $1600 and that is the best I can get for my insurance allowance. Supposedly my insurance allowance is $1250. It sounds to me my Respiratory Therapist Dr. is ripping someone off and denying me the best possible machine I can get. Anyone have any input or thought about this and what I should do? Thanks.

Just because your insurance provider covers you 100%, doesn't mean you shouldn't try to help them save some of YOUR money (I assume you DO pay some monthly permiums?). Theoretically, the "collective" effect (if everybody did this) would help keep the cost of insurance down (but that's not something I am willing to put money on).
Yes, the ripoff artists are upcharging this equipment about 250 to 300%.

This is what I did:
Got prescription from my (sleep) doctor.
Lots of research and reading on the Internet. Compared prices features and suppliers.
Checked the prices of equipment with several local DMEs. At this point I knew I was going to buy online and from whom.
Got (pre) approval from my insurance provider to purchase out-of-pocket and send them an invoice (from myself) and that they would reimburse me.
Ordered all of my equipment from CPAP.COM and charged it to my credit card.
Sent insurance provider my invoice with a copy of the invoice from CPAP.COM (to show them that I wasn't overcharging THEM).
Insurance provider reimbursed me 80% (your mileage may vary on the percentage).
Paid off credit card bill

CPAP.COM is, by far, the best way to go!!!
BILLMYINSURANCE.COM and CPAPFORSENIORS.COM are also good alternatives.


Best wishes,

Den

I don pay a monhtly premium for my insurance, but I don't pay any out of pcoket expenses for my equipment. I guess the thing I'm questioning is, why does my Respiratory Therapist say my machines is $1600 and CPAP.com has it for $529? I feel like he's ripping off the insurance company, which wouldn't be surprising, but I also feel like he's denying me a better machine because he says the machine costs that much and my insurance limit is $1250. I like the idea of buying it myslef and then having my insurance company reimburse me, but I'm not in the financial situation to be able to do that right now.

Why don't you call BILLMYINSURANCE.COM and see if they can work with your insurance provider. You may only get a "basic" CPAP from your local RT, but through BMI, you can probably get whatever you want.

Den

I was googling for a respironics sizing gauge a couple of hours ago when I ran into this Respironics Suggested Retail Prices

The suggested retail price for a Remstar Pro 2 with cflex is $1525 (no mistake)
The suggested retail price for a Remstar Pro 2 with cflex and humidifier is $1860
The suggested retail price for a Remstar Auto with cflex is $1900.

Neither Doctor or therapist are misleading you - they were probably basing their info on the manual recieved from the horse's mouth.

Or perhaps the horse thieve's mouth?

O.

Den, just to add my two cents.... I called my insurance company and told them how they were getting over charged by my DME on my equipment and told them I could save them money ordering from CPAP.com. They said they appreciated the attempt to save money. So I ordered some stuff from CPAP.com and then submitted the invoice to my insurance company just as instructed by my insurance. About two weeks later I received my explanation of benefits statement telling me that they were paying "zero" on my purchase. I called them and asked what was going on and they told me that since I didn't order from a "in plan provider" that I fell in the "out of plan provider provision" and that my money went to a new $400.00 deductable. I explained that I had already paid my deductable and they told me that I had a separate deductable for out of plan providers. I explained to the insurance rep that I told the last rep I was going to order online and they said that was OK and to go ahead because it would save me and them money. So for trying to save the insurance company $300 bucks I end up paying an extra $400.

I should have known better because every time I call Humana insurance I get a different answer depending on who I talk to.

Dale

Interesting numbers ozij

That means my local DME who wants $1450 for an Remstar Auto w/heated humidifier (after the arguing to get them to give it to me at all is a BARGIN!! LOL

I wouldn't give the DME the time of day for that price except my copay is 20% so just under $300 for ME vs $725 to buy from cpap.com. My particular insurance co will not pay for it from cpap.com, or an invoice from me. We have had many conversations on that and 3 levels of appeal. They will consider it out of plan and pay 60% after I meet a deductable that will be far more than the machine.

So, I get to waste the insurance co's money to save $300 for myself. But, since my machine is "on order" due in today, I don't have it in hand, nor have I made it through the rental period and purchase. So I have a good 3 months before I will know if I am doing the right thing.

I also intend to watch it plugged in and make sure that there are zero hrs on it, the ones that can't be erased, as well as check for stickers that indicate referb machine. I would prefer it in a sealed box when I arrive, but I don't expect that to happen. I am a trusting soul.

Dale,

Good answer, I have the same situation in my post above.

Huge deductable for out of plan and will never meet it.

Also an in plan deductable for DME's. So I never expect to get hoses, masks etc after this calendar year that I don't have to pay for. I will get every hose and mask that I can from the DME (and the ones on my list that are most expensive and save the cheaper ones I want to try to buy for myself from CPAP.com) while this year's in plan deductable was met (sleep studies took care of that one).

Dale and Guest,

Like I said....."This is what I did"
I had also met my deductibles by way of the sleep study and doctor's visits by then, so that didn't factor in. I was also prepared to pay for everything out-of-pocket (even if they hadn't reimbursed me) because I wasn't about to let the locals soak my insurance provider for those inflated costs. One local DME wanted to push a (plain) REMstar Pro machine on me for about $1500, heated humidifier for several hundred more, UMFF for $255 (they finally decided that they MIGHT throw in the headgear). I bought everything from CPAP.COM (including the software, cardreader and extra "pieces and parts") for less than $1000.00.
I don't know what it is with these insurance providers.....I can't figure it out!
EXCLUDING deductibles, they SHOULD reimburse you for out-of-pocket purchases at "in-network" rates.....especially if you submit a bill from YOURSELF.....no different from medications purchased out-of-pocket. My insurance provider would have only paid CPAP.COM at the 60% (out-of-network) rate, too.....but since I had purchased the stuff, they considered me "in-network".

Guest,
You machine will probably not have ZERO hours on it, but should be probably less than 20. The "total hours" clock can't be reset and that time will include some testing before it left the factory.

Best wishes all,

Den