Insurance laps on rental cpap

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
smith972
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Insurance laps on rental cpap

Post by smith972 » Thu Apr 12, 2018 12:07 pm

We currently have Cigna and have met our out of pocket costs. The insurance runs out the end of the month and cobra for both us is too expensive...1400 a month. Cigna will rent the machine for 6 months and then buy it.

If I don't pick up.the cobra for me will the insurance company make me turn the machine it or do I just own it?

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SewTired
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Re: Insurance laps on rental cpap

Post by SewTired » Thu Apr 12, 2018 12:33 pm

They will have you pay what remains as Cigna will now be out of the picture. It could be pretty pricey. You'll have to work out if that is worth it or whether it makes more sense to buy a machine from an online retailer and return the one you have now, while you still have that option. If the DME gives you an amount, make sure that it is in writing and signed by the DME manager.

To get a machine from an online retailer, you will need a copy of your prescription from the doctor. There's probably detail I'm leaving out, but the first thing to do is find out how much you will owe when Cigna ends this month.

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Janknitz
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Re: Insurance laps on rental cpap

Post by Janknitz » Thu Apr 12, 2018 2:32 pm

Make sure you get everything in writing, as Sew Tired pointed out. And they are not allowed to increase the price now.

For example, they may have billed $3000 for the machine set up, but Cigna's contracted price (just examples here) was $1,200 paid in 12 equal installments of $100 each. That means that if you've had the machine for 6 months, you would owe $600, not $2400. They may try to get the full price, not the contracted price out of you.

Be careful too that if you get new insurance the DME doesn't try to charge you for a brand new machine without swapping out this one. I've seen that happen before, too. Make sure you understand your new insurance coverage for DME including deductibles, co-payments, and whether they require you to rent to own or allow an outright purchase. Also what documentation you will need.

If you have to go without insurance (or even if you do get insurance) you should price shop what it will cost to replace this out of pocket--look at CPAP.com and secondwind.com.

You MIGHT be able to negotiate with the DME for a reasonable amount. If you turn the machine in the DME is stuck with a used machine, so they may be willing to make a deal with you to buy it out without charging too much (so I'm an optimist!). But you should know the value and how much has already been paid to them before attempting to negotiate.
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D.H.
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Re: Insurance lapse on rental cpap

Post by D.H. » Thu Apr 12, 2018 6:08 pm

I would price a new machine on the internet. Then see what it would cost you to buy the machine you're currently renting.

Also, ask them if you have coverage for "on going treatment." When I changed insurance, I was advised that I would be covered by my old insurance for six months of post-operative care on the old insurance. I was also advised that they would only cover it if new insurance didn't cover it and would make up the difference if they covered it as out-of-network. Make sure you don't have that type of coverage (I think it's rare, but ask anyhow).

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smith972
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Re: Insurance laps on rental cpap

Post by smith972 » Fri Apr 13, 2018 12:23 am

I don't have my machine yet. I don't go to get my Rx until the 23rd. So my mom says she has an old machine from 4 years ago that she does not use. As soon as she sends me the make and model I won't know. At least I have the mask from the hospital and I am hoping hers has a way to download the software which means I can start on the machine 10 days before my drs visit. I ha e to do 21 days on the machine before I can go to CDL school. Waiting til the 23rd is killing me. I don't understand why I need an office visit to just get the Rx.

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smith972
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Re: Insurance laps on rental cpap

Post by smith972 » Fri Apr 13, 2018 1:36 am

The machine my mom is sending me a reamed S8 escape system with a data card.

Just so I can start using it what settings Shoukd I use. I am trying to get a head start on my 21 days of usage so I can get to CDL school.

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prodigyplace
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Re: Insurance laps on rental cpap

Post by prodigyplace » Fri Apr 13, 2018 3:25 am

How are you going to prove compliance? The doctor likely will not do it without the prescription.
The free Sleepyhead software has a disclaimer saying it is not to be used to show compliance.

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LSAT
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Re: Insurance laps on rental cpap

Post by LSAT » Fri Apr 13, 2018 4:55 am

The S8 Escape will not show any data that works with Sleepyhead. Shows compliance only.

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lamar2217
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Re: Insurance laps on rental cpap

Post by lamar2217 » Fri Apr 13, 2018 6:28 am

The word is lapse not laps. :D

D.H.
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Re: Insurance lapse on rental cpap

Post by D.H. » Fri Apr 13, 2018 6:39 am

LSAT wrote:
Fri Apr 13, 2018 4:55 am
The S8 Escape will not show any data that works with Sleepyhead. Shows compliance only.
It does collect data, it's just that SleepyHead can't read it. Perhaps you sleep doctor will be able to read it with other software.

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Last edited by D.H. on Fri Apr 13, 2018 7:59 am, edited 1 time in total.

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LSAT
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Re: Insurance laps on rental cpap

Post by LSAT » Fri Apr 13, 2018 7:07 am

D.H. wrote:
Fri Apr 13, 2018 6:39 am
LSAT wrote:
Fri Apr 13, 2018 4:55 am
The S8 Escape will not show any data that works with Sleepyhead. Shows compliance only.
It does collect data, it's just that SleepyHead can't read it. Perhaps you sleep doctor will be able to read it with other software.
DH...Wrong again...The S8 Escape only collects usage data..

Fully customizable, the S8 Escape II has reminders for accessory replacements like your mask or machine filters. Take advantage of the remote downloading capabilities with the ResScan Data Card which provides usage data that helps you monitor compliance.

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Pugsy
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Re: Insurance laps on rental cpap

Post by Pugsy » Fri Apr 13, 2018 7:07 am

I am a bit confused so can we clarify things a bit?
At first it sounded like you already had a machine and was losing insurance coverage and was still in the rent to own period maybe and wondered what to do.
Now it sounds like you haven't even seen the doctor for follow up after the sleep study in the "hospital" which I assume must have been a titration sleep study or you wouldn't a mask from the hospital.

So it sounds like you have been diagnosed with sleep apnea....done something to get some sort of mask but now you have to go back to the doctor on the 23rd to get final RX and all that stuff so that if you had insurance you could get the machine and start therapy.

And to top it all off you are trying to go to CDL truck driving school so you will have special requirements because of the sleep apnea diagnosis and you are extremely early in terms of the stages of all that this involves even if the truck driving school thing wasn't in the picture.

So let's back up and confirm where we are at and then see what your options are.

You had a sleep study that said you had sleep apnea...is this correct?
Then you had something done in the "hospital" and you came out of it with a mask...did they have you wear a cpap mask and sleep with the mask and machine blowing?
Is the doctor visit on the 23rd so you can get the official results of whatever you had done and RX for the machine and all that stuff?

The S8 Escape...it doesn't gather any data that is going to help you.
It does gather hours of use that can be used to prove compliance in terms of getting the CDL school people to let you go to the school but that data is not easy to get because the machine is so old that it needs a special card reader and software.
Plus DOT requirements now include more than just hours of use. It has to be proven that the therapy is working and effective also.
The Escape won't give you that needed extra data even if you had the special card reader and software.
So even if the school was okay with hours of use only just for the school....getting your medical card from DOT approved doctor so you can actually legally drive a big truck the Escape isn't sufficient.

If the CDL school knows about the sleep apnea diagnosis...it's on your record...you are going to need a machine that shows hours of use AND therapy effectiveness which means full efficiency data. The Escape won't give you that.
Now there are ways to get machines without insurance...and if you already have a cpap mask you should also have a starting pressure to use and this would be something you would be getting from the doctor on the 23rd.

So can you please clarify your situation so that we can offer more specific ideas as to how you can overcome this hurdle?
Just where are you in this sleep apnea diagnosis procedure?

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prodigyplace
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Re: Insurance laps on rental cpap

Post by prodigyplace » Fri Apr 13, 2018 8:46 am

Perhaps they got titrated but had not yet received a machine.

In fact they state later they have not yet received a machine.

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Re: Insurance laps on rental cpap

Post by Pugsy » Fri Apr 13, 2018 8:58 am

prodigyplace wrote:
Fri Apr 13, 2018 8:46 am
Perhaps they got titrated but had not yet received a machine.

In fact they state later they have not yet received a machine.
That's the impression I got especially with the mention of "brought a mask home from the hospital"...assuming it was a cpap mask.

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smith972
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Re: Insurance laps on rental cpap

Post by smith972 » Fri Apr 13, 2018 9:08 am

Pugsy you are correct. I had a home sleep study. Was diagnosed with sleep apnea. Went back to the hospital for a sleep study with mask and pressure.
When I go to my Dr on the 23rd I pick up my my Rx and at this time they send my info to the DME to get my machine.
I called Cigna to find out if they rent or buy and they said they rent for 6 months and buy if I am compliant. My insurance will end by the end of the month and my husband and I can't afford the 1400 a month for both of us on COBRA. Since he is sicker than me we will just pay the 600 a month to maintain his insurance until I get insurance thru my job.

I decided to be honest with the company I want to drive for and told them I was just diagnosed. In order to get my DOT card I have to be 70% compliant in a 30 day window. This means 21 straight days of usage.

I in no way intend on not being compliant with using my machine every single night because I will be driving an 80k killing machine up and down these streets.

I just want to get to school as quickly as possible. My bags have been packed for 3 weeks now and it's been one thing after another with this being the last (hopefully) delay. I was originally told by my Dr that I did not have sleep apnea. Only to find out Tuesday, when the hospital called to remind me of my sleep study, that she misread or read the wrong report.

The sleep lab will have the Rx to my Dr by Monday but I can't get an appointment until the 23rd. Since I am not using a DME I don't understand why she is holding my Rx til we meet face to face. I don't need to see her face. I just need my Rx so I can get the machine.

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