CPAPtalk.com

Well newby here and to the whole cpap thing,,, but I guess I am lucky, I have good insurance, and paid nothing,
Just received
Breas pv10 cpap,
Resperonics H2 humidifier,
and an IQ mask.

I am fighting for a different mask, I used a Profile Lite to start my study, and finished with a Comfort Classic.

Tom

I got the remstar auto (had to fight for it) with HH, 2 hoses, and a swift. They made me rent for 1 month and that cost me $42. I called them on friday and told them to just turn it into a purchase instead of a rental and my total for everything will be $300. I can get a new hose every month and new mask parts every 3 months. The mask ( swift ) was billed at $200 I believe and my cost is $24 regardless of what mask I get. I think they billed my machine at $2000 but my cost was only ~$200.

I guess I am one of the lucky ones. I have very good insurance and they paid for everything. It is mine to keep. I received a very good machine and after trying a mask that didn't work, was able to exchange it for whatever I wanted. I stll haven't gotten a statement from ins. to see what the DME charged for the equipment. I am going to buy my next mask out of pocket, though just so I can have a choice between the two. I still haven't checked to see how often my insurance will pay for a new mask.

Health net insurance / Apria HME supplier

Monthly rental of S7 CPAP $13.00
My copay for humidifier $53.00
Final month rental of S7 $13.00
My copay for swift headgear $21.60
My copay for Remstar auto CFlex $130.00

Total outlay for complete unit $230.60

Copay for backup ultra mirage full mask $27.35

Tom

My insurance has a "lifetime" maximum of $2,000 for anything apnea-related; obviously not much if I went to a DME. (That 2k includes the cost of the sleep studies also.) So I figured I would buy my first machine out of pocket, get reimbursed from my FSA acount and save the insurance funds for another sleep study when and if needed, mask replacements and a small machine for travel. However, the way my FSA is set up, I have to submit for insurance reimbursement first, before getting any FSA money. And because CPAP.com is not a "preferred provider;" my fork over is 40%; even though getting the same thing from a "preferred" DME would have cost at least 3 times as much. Upshot was my machine and mask and travel machine cost me about $800 out of pocket.

Just curious, when you buy equipment on the internet do you have to have a prescription? I don't have a copy of mine (never did have one). My DME says my insurance only pays for a new mask every year, but i think i will check into that.

Susan -

I think you need a prescription on the internet sites for a machine. Maybe not for the masks. Others here would surely know.

Jerry

Susan,

Jere is correct. You DO need a prescription (or a copy) to purchase a CPAP machine on the Internet (or any DME supplier for that matter) but not for a mask. Be sure to get your prescription from your doctor.....you never know when you may need it.

Den

As a followup to Den's comment, I have a copy of my prescription that I carry with me when I travel (which is often). In this past year, I've had to go to a local DME to replace a broken mask and broken humidifier tank.

Both places required a prescription for the mask and tank. (which is rather silly--see story below).

If I did not have my prescription with me, I would have been in trouble!

George

As a total diversion from the topic: I had to have my water tank replaced in Madison, Wisconsin. I tracked down a local DME that had a storefront operation. When I protested that I had to go back to my hotel to get my prescription, I commented that it was just downright silly that a water tank would require a prescription. Striking a defensive posture, the man behind the counter said, "Well, have you ever heard of a bong?"

"A bong?" I said.

"A bong." he said

"A bong."

"yes, a bong."

"Looky here at this tank." He held up my Fisher Paykel humidifier tank. "You stick your CPAP hose here, and then you put the 'bowl' in here, and there you have it...a bong."

"A bong?"

"Yes, a bong. That's why you need to show me your prescription."

"Good God!" If I had not been in Madison, I wouldn't have believed it.

I don't get how they can do that.... require a prescription for something that legally DOESN'T require one. The logic he presented for demanding a prescription --that it could be used as a bong-- is absurd (but hysterically funny!!!) Kind of peculiar reasoning... guess he assumes that having a prescription precludes the possibility that one might use the thing for a different purpose. Pretty stupid assumption!!! Besides, why would one bother to go to a DME for such a purchase when just down the street they can stop in at the local head shop?

Go figure.



My night time ritual may never be the same again.

Only in Wisconsin. What do you expect from cheese heads.

I am a transplanted Buckeye to Wisconsin.

But you couldn't use one as a bong!!!! Oh wait, I am revealing too much about my youth Never mind

At the time I got my machine (Fisher & Paykel HC221 LE Straight Cpap), I had Aetna HMO insurance. The DME charged Aetna $930 for the machine, carrying case, and filters. They also charged the insurance company $250 for a Flexifit Nasal Mask which I couldn't use. I got a Breeze and I'm not sure how much the DME charged for that one but I never paid a penny out of pocket for any of it. The mark-up DME's do on this equipment is nonsense. The DME never came to my house either. I either had to meet him at my sleep doctor's office or at his office. I could have gotten the same stuff online for about $400 total but my insurance wouldn't pay anything if I got it online. How silly can you get!! I don't have any insurance now so I'll be doing all of my shopping on the net.

From another topic I posted earlier, but it fits well in this thread too...

Well... I called BMI, my DME and my insurance company. Since I have already met my deductible for the year, I only have to pay 10% of the negotiated monthly rental of $166.85/mo for the machine and humidifier. The contract is for 10 months, so they are billing the insurance company $1668.50 for the machine/humidifier!!(which I could buy on cpap.com for only $760) For the remainder of this year, I will be paying $16.69/month. After the first of the year, I will have to pay the full $166.85 until I meet my deductible, which is only $300, so overall my out of pocket for the machine will be $350.07 if I am running my numbers correctly.

I did not get numbers from them for my mask, as I assumed that the mask is just purchased outright from the DME.

Can anyone tell me why insurance in the country is so expensive????

I cannot believe it.
American Home Patient is bilking Medicare for my ResMed S7Lightweight for a 2 year contract of $175.00 plus Tubing 8 feet smooth bore 51.28NA is says on the contract, Humid Air II $384.00 now if my multiplication is correct this is attrotious.

American Home Patient is billing Medicare $4,200for the two years?

Is this what the rest of you is getting on my contrat?

How can I stop this fraud as I call it?

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, tubing, medicare