Auto SV rental

I'm hoping someone here can help me out. I tried searching for an answer to this question, but I am just confused. I finally got my script approved for an AutoSV machine. I also know the machine is quite costly. I just spoke with someone from the DME and she said the machine would be a rental. I just don't understand the numbers. She said:

First month = $681.55
Following months = $493.00/month before deductible, $98.60/month after
Insurance converts from rental to sale from 10 to 13 months and my coinsurance is 20%

I thought my insurance covered 80% of DME. From her numbers I would be paying a lot more than 20%. How is the cost figured?

Also, the price she gave me is figured on my secondary insurance because she said something about my primary insurance only covering up to $1k. How do I find out what I am really going to pay? If I call the insurance companies are they going to be able to tell me?

I would appreciate any insight! Thanks!

How much is your deductible and how much of it is yet to be met ?
You have to pay all of the allowed amount until your deductible is met. Then the 20% co pay kicks in.

There is normally a pie in the sky amount that DMEs bill initially...then your insurance will usually decide that the DME shouldn't get that much money and per their contract with the DME they tell the DME that the amount they can receive is less and what we call the "allowed" amount...usual and customary is another term.

This "allowed" amount is what any payments or deductibles get figured from.
That is unless your insurance allows DMEs to collect fees above the allowed amount. Most of the time that is not allowed.
You do need to call your insurance company to find out how they do things and what they will pay.

It's common for insurance companies to do the capped rental ending with you owning the machine.
ASV machines are expensive, much more so than the regular xpap machines or even the plain bilevel machines.

The humidifier is usually considered a purchase up front...so the higher cost for first time is often higher. That's what Medicare does also. A good number of insurance companies follow Medicare guidelines for how they do things.

If I do some quick math...just figuring the quoted $98 month rental for the machine. If that is 20 % of the allowed amount..that means the allowed amount for monthly rental is close to $500 a month.
10 months means they get $5,000 for that machine not counting the first month.

Do the math..talk to your insurance company...it might be less out of pocket in the long run to just buy a machine on your own if your pocketbook will stand the hit.
Either buy online from some place like cpap.com or maybe a slightly used unit from some place like Secondwind or even from a forum member.

Thank you for the reply! Quite honestly, I am so leary of even using my insurance. My primary insurance co has no websight or way for me to see claims or EOB's unless I call. Before I had my sleep study at the end of last year, the biller at the sleep place told me that my secondary insurance would pay the deductible for my primary insurance (after I met their deductible) and then I would be billed whatever was my portion of the test cost. I did pay the sleep study place the balance of my deductible $150.00 when I had my first sleep study done in November. I can see they tried billing it to the secondary, which denied it saying they had to bill primary first. When I called my primary a month or so back they hadn't received any claims yet. When I talked to the secondary they said the sleep place had bill the primary first. I called and told the sleep place that and still I haven't received anything. So, I don't know what is going on.

My secondary insurance has changed to BCBS at the beginning of this year so I'm not sure if they will pick up the deductible of my primary. I have a $1250 deductible on my primary and $750 deductible on my secondary. Both say they cover 80% of DME, but I'm not sure of the caps.

What a nightmare...after deductibles you shouldn't pay for anything if both the insurance companies will pay 80%.

$750 for the secondary insurance to be met
20% of the next $500 till primary is met since secondary should pay80%...I think secondary should pay on that.
and then after primary deductible is met then secondary should pick up the 20 % after primary pays.
So after the primary deductible is met...you shouldn't have anything out of pocket.