My Aetna Insurance sucks for CPAP machines?

Aetna insurance told me this:

Please be aware that Aetna does not purchase CPAP machine and they are
provided on a continuous rental basis only. Claims will be submitted by
your provider monthly for this rental until the contracted purchase
price is reached, however, you will still not 'own' the equipment. Once
the purchase price is reached, the provider will then submit semi-annual
claims to Aetna for a maintenance agreement which will also be processed
against your benefits in place at that time. By providing this
equipment on a continuous rental versus purchase, it the machine
requires repair for any reason, the cost is covered under the
maintenance agreement and would not be your financial responsibility to
pay out-of-pocket. There is not a maximum dollar limit on your Plan for
durable medical equipment.

I have already met my deductible for the year, so I will be paying 20% for the machine. I will be paying about $16 every 6 months for the machine, $80 if I haven't met deductible yet. I will be paying maybe $550 for a Machine w/ Humidifier. Probably leaning towards the DreamStation CPAP Auto. Assuming I don't reach my deductible until half the year, it will add $400 in maintenance fees over 5 years. Total cost would be about $950 for 5 years. If I were to want a new CPAP machine, I would have to return this back to the DME.

My question is, Is it worth it?! Has anyone's CPAP machine broken within 5 years? Is it better to buy Online/Ask if DME will price match online prices w/o involving my insurance?

There are manufacturers warranties. Check on cpap.com our host.

At that price you can buy two new ones, one for back up, one for use.

Assuming your math is correct, the benefits are that the cost is spread over a long period of time, and you have no risk of loss if the machine breaks down out of warranty. The disadvantages are, you will be under surveillance of the DME and insurer to use the machine and demonstrate medical benefit on a routine basis. In addition there will be delays in issuing the machine and dealing with any service request; it's just the nature of the beast.

Outright purchase will cost you the full amount at once. You may be able to submit an out of network claim so the expense is applied to deductible and reimbursed at the rate allowed. If you are willing to use a PRS1 60 Series Auto with heated hose, your cash price right now is $444 on Amazon, and I don't think you'd give up any important features. You might also ask Easybreathe.com what they can work out. Apparently they will file insurance claims, and I'm curious to see if that is a solution to the Aetna dilemma. I think a key advantage is you own the machine and no one can screw with you to order doctor visits or compliance checks.

It's your choice. Most machines either break down soon after starting or last much more than 5-years. If you can keep water out of the blower, and protect it from falls, it should last a long time.

notwabbitseason wrote:I have already met my deductible for the year, so I will be paying 20% for the machine. I will be paying about $16 every 6 months for the machine, $80 if I haven't met deductible yet. I will be paying maybe $550 for a Machine w/ Humidifier. Probably leaning towards the DreamStation CPAP Auto. Assuming I don't reach my deductible until half the year, it will add $400 in maintenance fees over 5 years. Total cost would be about $950 for 5 years. If I were to want a new CPAP machine, I would have to return this back to the DME.

My question is, Is it worth it?!

You say, "sucks", I say, "excellent".

This illustrates the big advantage of larger deductibles and larger out-of-pockets. When these costs were small, consumers paid no attention to what was being paid for medical expenses. This contributed in a big way to the increase in medical and insurance costs.

Now that more of these costs are being born by individuals, those individuals are paying attention to what is being spent on what.

Kudos to notwabbitseason for making a good financial analysis, and thanks to Sleeprider for helping!

Individual insurance coverage is usually a result of an agreement between the employer and the insurance company.
When employees ask for low premiums, they get it--and what goes with it.
Some blame belongs with the insurance company, but some should be laid on the employer.
Too many opportunities for shady business exist in these private deals.
I honestly believe in many cases there is only the ILLUSION of oversight.

Thank you for all of your replies!

I think I will purchase my CPAP online from cpap .com and go to the DME to purchase the humidifier and order supplies through them since I already met my deductible. At the end of the day, I just want to be able to call the machine mine and use it as a spare eventually.

Great forum! I have read over 30 pages and I hope I am here to stay! (Still need to register though. )

Find out what the exemptions are before signing up. What happens if the cause of machine failure is your fault? You got water into it? What happens if it is stolen or lost by the airlines? Will you get a loaner if it in for repair? Check with the DME as well because what Aetna says may not be what actually happens.

Aetna doesn't do so well for us either. I believe we only go to one company in the area. Apria. I have a dreamstation apap I bought cash money. Apria sent an order to Apria and I am getting a new dreamwear and filters for 18 bux. That's not bad. I guess they will send new ones out every 6 months and a new humidifier as well.

Must have changed in the last (2) years. Wife had hip and neck surgery in 2014 and my max out of pocket for the year was met. In November Aetna paid SuperCare outright for a S9. NO RENT TO OWN involved.

hobbs wrote:Must have changed in the last (2) years. Wife had hip and neck surgery in 2014 and my max out of pocket for the year was met. In November Aetna paid SuperCare outright for a S9. NO RENT TO OWN involved.

I believe most insurance companies have many different policies depending on where you live and/or who your employer is.

Cereal Killer wrote:I believe most insurance companies have many different policies depending on where you live and/or who your employer is.

Exactly. Aetna like many health care companies can be used by companies to manage their specific plan which can be quite different from others.

The company I work for self insures itself but uses Anthem/BCBS to manage the plan. It covers things that others with that same healthcare don't.

Insurance policies are in no way uniform; as they say, your mileage may vary. (YMMV)
If you want any control, get assigned to negotiate with the insurance company.