DME charge ins for E0601 regardless of series?

The DME is still trying to give me inferior machines. I have a $2,000 limit for DME. My question is the PR machines (150, 250 & 450) all seem to have the same code - E0601. Does that mean the DME has to charge my insurance for E0601 regardless of the expense of the machine? Is that why they are trying to give me the 150 and then yesterday the 250? Does the DME get paid the same any way? If so, that means my insurance shouldn't be billed any more $ just because it's a 450. Am I correct?

Or a 560, as long as your RX says to 'fill as written'.
They want to make a pile of money; and don't really care if you croak.

Yep, they get X amount of dollars no matter which machine they supply when that billing code is used.
Those lower in models are the basic, cheapest machines...they have more profit margin when they supply them.
It is all about the almighty dollar. They try to sneak in the up charge thing to make up the difference when you push the request for the higher end models with data. If your insurance company doesn't allow up charges...and you call them on it...they dig in their heels and won't give you what you want.

HMOs aren't like regular insurance companies though...best find out from them what they allow or don't allow.
They often force people to use one supplier. I hope in your case that is not so. I would fire that DME so fast.....and probably call them a few choice words in the process.
The wholesale price difference between what they offer and what you want..is not all that great and if they are getting $2000...there is room for ample profit even with the APAP. Check online prices...you can buy the PR S1 APAP with humidifier for $650...and they are making money on that.

You have to call your insurer to find out. As Pugsy pointed out, SOME HMO's like my Kaiser insurance pay for a particular machine, but MOST insurers pay by HCPC's code E0601. They don't care which E0601 machine you get because they will pay only one amount, regardless of what the DME charges.

You can't assume that the HMO is going to pay $2000 for your machine, either. Each insurer sets its "allowable fee" for a given piece of equipment. Whatever that insurer's allowable fee is for a CPAP that's all the DME is going to get. Whatever that amount is counts toward your annual DME "allowance".

I am really learning (the hard way) about CPAP's. No one including my doctor has taught me anything about what there is out there. If it weren't for this forum, I would be stuck with the PR DS150 forever! I finally got a new mask after going 3 weeks of very little sleep because of the massive leaks in my Quattro FX full face mask. I got a Mirage Softgel Nasal Mask with a chin strap and have used it one night. It was so much more comfortable than the full face mask! By the way the DME said I absolutely would not benefit from nasal pillows ("bullshit"). I still woke up frequently and only got 5 hours sleep, but what an improvement!

Back to the CPAP machine, my doctor is on vacation so the PA said she would write an Rx for the PR DS450. The DME delivered a DS250. I figured out why the PA said the DME didn't even need an Rx. It was because the original doc's Rx said something like, "CPAP w/C-flex." That is why I received the S9 Escape. I bitched and complained about the air I was receiving and the fact that there was consistently condensation in the tubing and water droplets fell in my face all night (I was using a high humidity level because of waking up several times each night with extreme dry mouth)! The DME FINALLY switched it out to a PR DS150. As some of you may recall, I was told that it was a "Mercedes." I figured out why the DME said they didn't need a new Rx - the DS150 was NOT what the doctor ordered! It didn't have exhale relief which I specifically complained about the day the RT delivered it! All this time I have bitching and complaining that I have difficulty exhaling (pressure of 14) and the RT said that was normal. Well, the DME was out-of-compliance by not giving me AT LEAST a DS250 w/C-flex (or something like that)! The "bitch" (excuse my language) told the PA that when I wanted the DS 450 I would have to pay out-of-pocket" for the "upgrade!" I explained to the PA that it would be considered an upgrade from the original Rx, but if she wrote a new one for the DS450 it had to be honored (I verified this with my insurance co). I guess the DME talked her in circles and they tried to deliver a DS250! I refused it and called the PA to ask why she didn't Rx the DS450. She said she checked with a lot of doctors and they all concurred that by having data capability it wouldn't change anything. My pressure would remain at 14. I had already given the PA (2 days prior) why I (and the doctor) would clinically and medically benefit from download capability. The final word I got today was, "call the DME because they are trying to get you a discount for upgrading to a DS450!" I politely told the PA that that was not acceptable. I told her that since the "doctors" said download capability wouldn't change anything, I wanted an APAP! At that point she said she could not authorize that, but she would email the doc (on vacation) to tell him what I wanted. I can only imagine what she said in her email! The DME has called me 4 times today but does not leave a voicemail (I would have a recorded message on my phone as evidence!!!). I refuse to talk to the DME lady (being polite) because she hung up on me yesterday. So, I go in for surgery next week without a machine with C-flex capabilities. In the meantime I am going to gather data to give to my doc when he returns to get an APAP!

I need your help with the key words to use with the doc, DME and medical group and really have my facts down, and to request the best APAP and give the doc the specific name of the machine and the rationale of why it is medically necessary. The insurance has no problem covering it with an Rx and approval from the medical group. Unfortunately, my HMO medical group only uses this one DME. Otherwise I would tell them where to shove it and go to another DME.

So, in my "spare" time in getting prepared for surgery, my homework is to have a "Solid" reason to give the doc as to why I need an APAP. I have given up on the DS450 (thank GOD) and am moving on to the APAP which no doctor could argue that it would not benefit me! I just need to be strong and convincing! The insurance co already said they would honor the doc's Rx with medical group approval. I would love to see the DME's face when the new Rx comes in for an APAP!

Any suggestions you have would be greatly appreciated! Thank you for your wonderful support and suggestions! I don't know what I would do without you!