Insurance Companies are Stupid!

[rnfuller]

OK, I am PO'd and have to vent!

I have been on CPAP for 5 years now, and my old F&P machine has served me well, but now the heater is out on the humidifier. My old DME as long since gone out of business, and I have be purchasing masks and pillows, filters, etc. out of pocket through CPAP.COM for 4 years now. It wasn't worth it to me to go through insurance and a new DME! I also bought a travel/backup machine out-of-pocket from CPAP.COM.

So, thinking, it has been 5 years since my last insurance claim for Cpap, I called and asked if I was eligible for a new machine. I was told that I would first have to find someone to look at my old machine, and send them a quote for the repair, and if a new machine was cheaper than a repair, I could have a new sleep study and then get a new machine! I asked how often they would replace a machine, and was told as long as it works or can be repaired, never!

I said, "You mean the insurace company would rather spend $4-5K for a sleep study and then another $1-2K for a new machine, than just let me buy a new machine from CPAP.com for $600-800"? She said, well you prescription is only valid for 1 year. I told her I was under the impression that a prescription for CPAP was valid for life. I then went on to tell her that no wonder they charge so much for their insurance if they are that stupid! and then hung up!

Guess I will just buy another one out of pocket and move on! It sucks to spend so much on insurance and then put up with this crap!

If anyone has any suggestions, I am all ears!

Randy

[greatunclebill]

the obvious answer is that your insurance company is very different from all other mainstream companies. this is the first i ever heard of that inspects the machine. if you can't switch insurance, get your doctor to write a prescription for an automatic machine (apap) so they must replace the old cpap.

[Otter]

I said, "You mean the insurace company would rather spend $4-5K for a sleep study and then another $1-2K for a new machine, than just let me buy a new machine from CPAP.com for $600-800"? She said, well you prescription is only valid for 1 year. I told her I was under the impression that a prescription for CPAP was valid for life. I then went on to tell her that no wonder they charge so much for their insurance if they are that stupid! and then hung up!

I agree, it's idiotic. Try talking to someone else there. If you keep asking to be escalated to an employee at the next level of responsibility, you may eventually talk to someone who feels some responsibility for the corporation's bottom line and is capable of reason.

Your prescription may still be good. Mine is good for for life. Also, your doctor may be willing to write you a new script without a new study. My GP didn't have any trouble writing a prescription for my first machine without a sleep study, once I told her about APAP.

[sapphirerose]

My mother's insurance repaired her 10 year old machine instead of replacing it as well, but they didn't ask for a new sleep study or new presription. However, I think that they were just biding their time to get rid of her since she was on Cobra at the time. They got their wish. Now she has a repaired 10 year old machine and no insurance, so they saved the cost of the machine.

[Janknitz]

My mother's insurance repaired her 10 year old machine instead of replacing it as well, but they didn't ask for a new sleep study or new presription. However, I think that they were just biding their time to get rid of her since she was on Cobra at the time. They got their wish. Now she has a repaired 10 year old machine and no insurance, so they saved the cost of the machine.

This may be better for your mom as well, since most insurance companies RENT to own the machine. If they had gotten her a new machine, as soon as she came off COBRA she would have been responsible for the full rental payments herself, which often add up to more than the retail cost of the machine. So maybe she was fortunate, at least she has a working machine and no out of pocket cost.

[Paul56]

Guess I will just buy another one out of pocket and move on! It sucks to spend so much on insurance and then put up with this crap!

If anyone has any suggestions, I am all ears!

Randy

You posted the best suggestion and that is exactly what I do... purchase my own
equipment / supplies and leave insurance out of the loop.

[Elle]

My insurance company asked for mine to be checked by the DME to see if it could be repaired. The RT for the DME came to see my machine and was not told it was to check it out but to talk about new machines. She checked and said it was fine and then I told her that her company was ordering me a new one. She looked a bit guilty because she knew what was up but felt stupid to not have been told before the visit.

Any DME will tell the insurer the machine is toast so they can sell you a new one and the insurer knows this. Play the game and get your new machine paid for.

[mebeingme]

F&P does not repair units! There is your out.....you can call F&P and they will fax you a statement stating nonrepair.

[Goofproof]

As your blower is OK, just get a stand alone HuD, they are better than the built in ones. Jim

[-tim]

Find a local place that does TV repair. Take the machine in and see if they can fix it. If the heater is gone, its most likely one of the high current drivers that has given up and that should be easy to spot and repair it.

[mowdoc]

I agree with everything said so far , , , , BUT , , , , , just drive over to your insurance agent's home and park near his/her car.

Mine (female) lives on the 7th fairway of an elite golf course and drives a shiny new red Porsche.

Guess that kinda makes us the "stupid" ones huh??

As long as we keep putting up with this treatment, they will continue taking our money for not much in return.

Just sayin

[motherall]

Not necessarily so....first read your policy to see the coverage you have. Speak to your insurance company and ask for a supervisor. My company insists on a sleep study every two years to verify that the type of system I have is the best for me. Yes my prescription is for life as to the need but case in point, last sleep study my pressure was adjusted from 14 to 10. We get replacment machines every five years although I just got my first replacement after seven years. My card is to be read every 6 months minimum by the doctor. If worst comes to worse, you can trip on your hose and drop the machine to the floor...oh dear.

[LSAT]

OK, I am PO'd and have to vent!

I have been on CPAP for 5 years now, and my old F&P machine has served me well, but now the heater is out on the humidifier. My old DME as long since gone out of business, and I have be purchasing masks and pillows, filters, etc. out of pocket through CPAP.COM for 4 years now. It wasn't worth it to me to go through insurance and a new DME! I also bought a travel/backup machine out-of-pocket from CPAP.COM.

So, thinking, it has been 5 years since my last insurance claim for Cpap, I called and asked if I was eligible for a new machine. I was told that I would first have to find someone to look at my old machine, and send them a quote for the repair, and if a new machine was cheaper than a repair, I could have a new sleep study and then get a new machine! I asked how often they would replace a machine, and was told as long as it works or can be repaired, never!

I said, "You mean the insurace company would rather spend $4-5K for a sleep study and then another $1-2K for a new machine, than just let me buy a new machine from CPAP.com for $600-800"? She said, well you prescription is only valid for 1 year. I told her I was under the impression that a prescription for CPAP was valid for life. I then went on to tell her that no wonder they charge so much for their insurance if they are that stupid! and then hung up!

Guess I will just buy another one out of pocket and move on! It sucks to spend so much on insurance and then put up with this crap!

If anyone has any suggestions, I am all ears!

Randy

Your insurance company will not pay anywhere near those amounts....probably about 50% or less.

[kempo]

At lest your insurance company did buy you a heated humidifier. Mine would not. This year my deductable went up from $500 a year to $1,200 a year. When it comes time for me to buy my next xpap I will be on medicare and I figure that's going to be busted by then. So I will just buy my next one from cpap.com out of pocket and bypass all the BS that comes with dealing with insurance. It will probably wind up costing me the same out of pocket plus I'll buy what I want instead fighting with a DME over what's best for me.

[idamtnboy]

When it comes time for me to buy my next xpap I will be on medicare and I figure that's going to be busted by then. So I will just buy my next one from cpap.com out of pocket and bypass all the BS that comes with dealing with insurance.

You know, my wife has been on Medicare since June 2006 and I have been since June 2009. We have had zero problems with Medicare Original coverage and BCBS. Well not zero. I had to call BCBS about a @1.46 bill from a doctor resulting from a revised payment schedule from Medicare that came into effect after the normal billing window to BCBS. A ten minute call to BCBS took care of the problem.

I kind of think Medicare Original is less problem than the Medicare Advantage plans may be.