CPAP machine cost

[jimfromgeorgia]

Something just isn't making sense to me. Received my first CPAP machine Thursday, a Sandman Intro. The Healthcare place I was referred to by me doctor told me they will bill my insurance, and in my case, the monthly cost will be 190 dollars, of which my insurance will pay 80%, I will pay 20%, about $38. Then after 12 months, the insurance company considers it to be paid for and its mine.

So in 2009, my deductible will reset and i may be paying more until my deductible is met for the year. Not sure but I think that's how it works.

But that means this machine is costing close to $2000. But if I look online, I can find this machine for about $399. The mask I am using for now anyway is about 79.

So what's up with that? Am I missing something here, or is just the price inflated due to the processing through the insurance company and the healthcare company and all that.

Just curious.

[Wulfman]

Something just isn't making sense to me. Received my first CPAP machine Thursday, a Sandman Intro. The Healthcare place I was referred to by me doctor told me they will bill my insurance, and in my case, the monthly cost will be 190 dollars, of which my insurance will pay 80%, I will pay 20%, about $38. Then after 12 months, the insurance company considers it to be paid for and its mine.

So in 2009, my deductible will reset and i may be paying more until my deductible is met for the year. Not sure but I think that's how it works.

But that means this machine is costing close to $2000. But if I look online, I can find this machine for about $399. The mask I am using for now anyway is about 79.

So what's up with that? Am I missing something here, or is just the price inflated due to the processing through the insurance company and the healthcare company and all that.

Just curious.

Nope. You're not missing much. That's one of the reasons why our insurance premiums/costs are so damned high. Yes, there's a portion of it that has to do with going through the insurance providers, but I purchased all of my equipment through CPAP.COM and then billed my insurance provider for the amount I paid and received a reimbursement for 80%. We both saved a significant amount of money.
Since CPAPs and APAPs are both billed under ONE insurance billing code, E0601, you could have had a fully data-capable APAP for the same money. In fact, I'd suggest trying your darndest to get it swapped for the Sandman Auto.
And, yes, if your insurance fiscal year-end is on December 31, your deductible will start all over again and it'll cost you even more.

Far too many people don't "do the math" and it ends up costing them far more than necessary. In most cases, they'd be better off purchasing online and saving their money (including insurance expenses). In reality, the insurance providers/companies won't "lose" money......they'll just keep passing on their higher expenditures back to you and me in higher premiums.

Den

[Gerald]

The Wulfman is right..........

And I'll add a little more. Health "insurance" is actually a pre-payment system with a small component of insurance.

The doctors, hospitals, and medical equipment dealers love it......because they don't have to chase us for payment.

The medical industry gets wealthy....and the customer ("patient") gets the shaft.

Welcome to reality. Bend over, please.

[Snoredog]

well you will find most of the online prices for Resmed and Respironics inflated and gouging like gas prices, but you can buy a Sandman Auto for $699 at cpap.com with humidifier. For a few bucks more you can get the software which is very good and tells you every aspect of your sleep:

https://www.cpap.com/cpap-machine/covid ... chine.html

Before the price manipulation by Resmed and Respironics you could buy their top machines for $600-$700. The 420e is an excellent buy and still a great little machine. You can buy it for $425.00.

https://www.cpap.com/cpap-machine/purit ... -cpap.html

You will find cpap.com has some of the best prices around, if you find a lower price they will match it. I have purchased from them for at least 8 years, always have treated me right. If you have a medical savings plan at work that is the best way to buy it, then you get what you want.

[yorkiemum01]

I too, six months into therapy just 'did the math', and my insurance applies all my 'rental fee' to
my $2500 deductible, and requires a 14 month rental before the product is considered 'purchased'.
Well, at $111.99 a month (my cost) for the rental, I'm turning it back over to the DME, and bought
my unit from a private seller here on the forum, for under $500 with humidifier.
I wanted to be certain of which machine was best suited for me, so tried a couple during my rental period.
But, it has been a costly endeavor.

[plr66]

OMG, I am so constantly aware of the cognitive issues I now have as a result of this OSA. (Yep, that's my story and I'm sticking to it). I knew it didn't make sense when they were breezing through the part about me still having $1000 deductable and blah blah blah....but I also did not do the math. (Even in the best of times, I've had trouble understanding insurance...). So I have had my machine for about 10-11 days, and I have actually had a great experience with all the folks at the Home Health place I'm working with. Do I still have the ability to just return the machine and say "thanks anyway"? I have just 3 months until my $2500 deductible starts over....so it looks almost absurd how much I will pay. Or maybe I still don't get it. Doesn't this mean that I will end up paying 100% of the monthly payment for 10 months to own the thing? (And I believe that means I would pay about $120/month for 10 months?)

[Wulfman]

OMG, I am so constantly aware of the cognitive issues I now have as a result of this OSA. (Yep, that's my story and I'm sticking to it). I knew it didn't make sense when they were breezing through the part about me still having $1000 deductable and blah blah blah....but I also did not do the math. (Even in the best of times, I've had trouble understanding insurance...). So I have had my machine for about 10-11 days, and I have actually had a great experience with all the folks at the Home Health place I'm working with. Do I still have the ability to just return the machine and say "thanks anyway"? I have just 3 months until my $2500 deductible starts over....so it looks almost absurd how much I will pay. Or maybe I still don't get it. Doesn't this mean that I will end up paying 100% of the monthly payment for 10 months to own the thing? (And I believe that means I would pay about $120/month for 10 months?)

Time to sharpen up that pencil. Get in touch with your insurance provider and compare notes. Sometimes (or quite often) they'll buy the machine outright (or in a couple of months) if they are asked to do so. If you're looking at personally spending $120 out of your own pocket over 10 months (and have to start over again on your deductible at the first of the year), I'd say you could be spending a great deal more than what you could buy the same machine (or better) for from CPAP.COM.

When I started in the Spring of 2005, I calculated that my 20% co-pay alone would come close to buying all of my equipment over that period of payments......the rest of the money from the insurance provider was going to be "gravy" for the DME. I can read the manuals and programmed my machine and didn't see how or why I would NEED a local DME. So, that's the way I went and haven't looked back.

Den

[THier]

I informed my insurance company I could save them a bunch of $$$$$$ if they would allow me to purchase a machine,, and them reimburse me. No problem they said,, they would pay 80% and I could pay the other 20%.

OR

I could let them pay twice as much and me not pay a penny, which do you think I went for?

Tom