CPAPtalk.com

ShelaghDefunctBrain wrote: What the hell is wrong with you people?
Are you little people with little lives who have nothing better to do than come online and insult others?

you're just a seething vat of ugly waiting to be sprayed on whoever walks by, aren't you?

Julie wrote:The difference between you is that you don't wait, you just start throwing.

Please feel free to enlighten me as to what I should be waiting for?

A 5th, a 6th insult toward someone?

This fellow was new to the forum. He was already overwhelmed with CPAP and people feel this is time to insult him because he neglected to understand from the get go that he should have mentioned he was from Canada?

And then that person makes some asinine comment about how the US is better than Canada?
WTF did that even become part of the discussion?

So feel free to enlighten me as to what I should be waiting for when disgusted by people who do nothing but insult others online!
You may find that acceptable behaviour.
I however don't!

I wasn't talking to you, but to PR, who said the nasty thing to you... just ignore it.

This forum is an international community, and location makes some big differences.
Most of us are painfully conscious of these differences, being forced to learn "on the run" due to our common problem.
A newbie may not yet be aware of how important sharing his/her location is to getting accurate information.
Members may automatically ask for machine and mask information, but "country" can get pushed down the list.
We now know to add it to our check list. Today is a good time to learn, not so much to quibble. Please, get along.

I'm in Europe (the Netherlands) I pay nothing out of pocket. Everything — machine, humidifier and all masks until one is found that works — is covered by our standard health insurance.

I don't know from direct experience how it works in the US but here there are (let's call them) supply companies who work with hospitals (normally more than one so you can choose) and they supply equipment to patients (you don't buy it) and they charge insurance companies a standard rate. I don't know what that amount is, we never have to bother.

p.s. having said that I will add a couple of other points:

1. If you do want to buy a unit, for example a Redmed S9 Autoset + H5i humidifier, you will pay here almost double (taking into account exchange rates) the US retail price
2. There is not always the same degree of choice. For example I ended up buying my Resmed AirFit N10 from a US online store — not available here yet

So there are good points, and bad points, wherever you are.

So a lot of these insurance things are still going over my head, but I think part of the problem is I live in Canada so the insurance works different from the states. I have what is called extended health insurance (through Sun Life) that covers me for extended expenses above what normal free healthcare covers. There is no network, but the flip side to that is most Doctors and medical companies don't direct bill the insurance company. I pay the fees up front, and then submit a claim to Sun Life who reimburses me after the fact.

Therefore unfortunately, the DME can charge me whatever the can get me to pay, and i'm left holding the bag on anything the insurance doesn't repay.

They have given me good service during my trial, without charging me a cent (beyond the deposit on the machine), and even let me take home and try out tons of masks. So I would feel really rude just walking out on them, but by the same token I still can't correlate what they are trying to charge me versus what I see online. Added costs of care, and a B&M office are one thing, but its a large leap to go from the $1,015 I can find the same equipment online, to the $2,771 they are asking.

I believe that is what I have. The DME submitted a claim estimate to Sun Life, who then sent the details to me in the mail.

Code: Select all

CPAP/Bi-PAP machine - Amount Claimed 2,093.00
-> See Note D47 Below
CPAP/Bi-PAP machine - Amount Claimed 678.00
-> See Note D47 Below

Note X001: Payment will be limited to the reasonable and customary amount of $2000 for cpap unit, supplies approved @80% coinsurance, minus any plan deductible which may exist.
Note D47: The estimate for this expense is approved.  Please remember that the actual amount payable is subject to any plan coverage limits and deductible that are applicable. 

Yes it lists two line items for the machine, I have no idea why that is.

I too live in Canada, but in Alberta where there is zero provincial reimbursement for any CPAP machine. I have extended health benefits like yourself, but they are not full coverage.

So, this is the sweet deal that I got, and I still wonder if it was "ethical". I saw the sleep specialist after the 3rd CPAP trial that he had ordered to discuss results. Before I had chances to ask any questions, he asked if I had bought my CPAP unit yet. I told him "no" as I had questions that I wanted to clarify with him. I also explained that I did not have full coverage for CPAP equipment, and I asked if he would have any concerns if I ordered the CPAP machine he was prescribing from a Canadian online distributor which was much cheaper than downstairs (located in a prime real-estate tower). Well, he got angry. He said that he had serious concerns. He said that every time I had gone to the sleep clinic, I had not paid anything for the sleep study or CPAP trials, and they weren't allowed to bill provincial healthcare; the respiratory tech I was seeing was excellent at her work and I would need her to make adjustments to my machine.

I kept calm, and told him that I was a bit of a geek and could install servers, vertical market software and there were only 2 buttons to press to get into the clinician's menu of the PR 550 (big thanks to this forum). He replied that I obviously knew more than most of his patients. Now, what he told me next truly surprised me; he said something like if your insurance can pay $1300 and you top it off with $200, that would be a reasonable offer for the PR 560 and I am sure the respiratory tech downstairs will accept your offer.... I couldn't believe my ears as they usually sell this machine for $2500...

BTW, as I was returning my equipment one time at the sleep clinic, I was surprised to see my doctor there - usually there are only 2 receptionists and 2 respiratory techs - so when I asked the tech if he came down often (I thought to attend to a sick patient), she replied "once in awhile", and that day he had come to talk to the other doctor there about changes that would be happening at the sleep clinic... I had my doubts before, but it became clear that my doctor directly or indirectly benefited from CPAP sales through his prescriptions.
The fact that he wrote his initial report to my family doctor saying that I had mild sleep apnea made me wonder why he was saying that it was mild to moderate when I saw him on my second visit. Did I really need the device? did he need extra funds for private school for his kids?... I did ask my family doctor to refer me for a second opinion which she thought was reasonable given the confusion; well, I used the Watermark Ares sleep home test device, and the results showed that my results were at the beginning of moderate sleep apnea. This second doctor told me that he did not benefit from the sale of any equipment, but as I needed a CPAP device, he thought it was best that I work with the original specialist as he had more experience than him, especially when dealing with other health concerns.

Therefore, may I suggest that you inquire if your doctor owns the place that wishes to sell you your device. You can probably negotiate a better price but do ask them for a quote to bring to your insurance company before you buy.

Good luck.

The bigger rip of ( or I guess I should say the continuing one after you get one of these machines ) is the cost of replacement filters and mask parts. I am saying this with over 10 years experience using a CPAP machine. My insurance company covers zero percent of CPAP supplies. I feel like the prices are all completely jacked up since some companies at least cover partial therefore the prices are completely ridiculous $24 dollars for some little filter that I bet cost 10 cents to make ( I was in the scientific supplies business for 35 years ) . Don't get me wrong, CPAP is a useful medical device, I know I need one and it has a benefit. But come on manufacturers and insurance companies, we know this game you are playing and it's not pretty.

HD wrote:The bigger rip of ( or I guess I should say the continuing one after you get one of these machines ) is the cost of replacement filters and mask parts. I am saying this with over 10 years experience using a CPAP machine. My insurance company covers zero percent of CPAP supplies. I feel like the prices are all completely jacked up since some companies at least cover partial therefore the prices are completely ridiculous $24 dollars for some little filter that I bet cost 10 cents to make ( I was in the scientific supplies business for 35 years ) . Don't get me wrong, CPAP is a useful medical device, I know I need one and it has a benefit. But come on manufacturers and insurance companies, we know this game you are playing and it's not pretty.

You are responding to a 3 year old post...BUT....I don't know where you buy your supplies, but on e-bay filters can be bought for less that a buck and a hose can be bought for under $5. Even from Amazon most supplies are VERY cheap.

LSAT wrote:on e-bay filters can be bought for less that a buck and a hose can be bought for under $5. Even from Amazon most supplies are VERY cheap

+1

ChicagoGranny wrote:

LSAT wrote:on e-bay filters can be bought for less that a buck and a hose can be bought for under $5. Even from Amazon most supplies are VERY cheap

+1

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