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Apnea's Adventures in Insurance Wonderland
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Mark Douglas Offline

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Posts: 513
Joined: Apr 2015

Machine: Sys 1 (60) RemStar BiPAP Auto with Bi-Flex 760P Auto Bi-Level (Variabl
Mask Type: Nasal mask
Mask Make & Model: PR Wisp
Humidifier: PR Sys One heated
CPAP Pressure: RiseTime 3 Fxd E-9.0 / I-11.5
CPAP Software: SleepyHead EncoreBasic

Other Comments: Hashimoto's thyroiditis.

Sex: Male
Location: SW Ohio

Post: #11
RE: Apnea's Adventures in Insurance Wonderland
(04-24-2015 01:14 PM)trailrider Wrote:  Interesting story Mark! But I thought the Resmeds need 24V...(I could be wrong, too lazy to go look). Well at least you will have a machine to get started and to get fitted for a comfortable mask.

Now the hard part comes in getting used to it. Best of luck for the next three weeks with that!

Yes I was talking about the 12x24vdc upverter . I'm disappointed she had no clue.

No I won't as reported docs favorite DME is not in network. Hmmmm I wonder if he owns it?

After pet DME quotes me a ridiculous price will take quotation from 1800 and offer chance to recalc her bid Rolleyes If no go will buy elsewhere. I Do appreciate they both have made extra effort to help me so am trying to work with them. I do not know if you read elsewhere where our GP was ME before becoming MD and I know if I take notebook with SleepyHead installed it will get him wound up and he and I will just bypass all this other crapia.... At this moment I am just waiting on next paycheck to go get my machine.

I will continue the ins merrygoround just because now I'm curious how outlandish it will become and as info to those who will stagger in here half awake.
Do I care they are going to "win" by outlasting me? H no I just wanna feel better! Auto CPAP costs a lot? Eh I have more than that in the flat-screen and the DVR I built to go with it. Priorities and all that.

I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
04-24-2015 02:54 PM
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Sleeprider Online
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Advisory Members

Posts: 3,375
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #12
RE: Apnea's Adventures in Insurance Wonderland
A couple points of order. First the uvula may be inflamed from the apnea and snoring and could reduce in time with therapy.

A Respironics machine is MUCH easier and less expensive to run from DC 12-volt power. Other aspects are essentially equal although the PRS1 auto will also track RERA which only the Airsense 10 Autoset For Her will do in the Resmed line.

Nice to see you stepping up to take control, but with the prescription in hand, you can go anywhere. The DME will not compete with the online providers, even though their price is the same. They are there to sell you continuing RT services, not just the machine.

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04-24-2015 06:58 PM
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me50 Offline

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Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #13
RE: Apnea's Adventures in Insurance Wonderland
Mark

Have you talked with your insurance company to see what DME's are IN Network with your insurance company? I refused to use Apria and went out of network for my machine and supplies.

I don't know if you have a deductible or not (most insurance companies don't have deductibles for Durable Medical Equipment but may have deductibles for other medical procedures, etc.).

when I went out of network, even at 30% of the allowed amount for a VPAP auto, I was paying less than $20 per month for 13 months which was less than $300 total, not the RETAIL amount that the DME will quote to someone without insurance or that wants to pay for it outright, it was less expensive than buying it outright. I don't have a DME deductible though. I was fortunate to get my machine when I did because my insurance has raised the out of network to 40% now.

SO call your insurance company or look online under your specific plan and find an in network DME and verify with your insurance company whether you have a deductible or not for DME.
04-24-2015 08:41 PM
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Mark Douglas Offline

Advisory Members

Posts: 513
Joined: Apr 2015

Machine: Sys 1 (60) RemStar BiPAP Auto with Bi-Flex 760P Auto Bi-Level (Variabl
Mask Type: Nasal mask
Mask Make & Model: PR Wisp
Humidifier: PR Sys One heated
CPAP Pressure: RiseTime 3 Fxd E-9.0 / I-11.5
CPAP Software: SleepyHead EncoreBasic

Other Comments: Hashimoto's thyroiditis.

Sex: Male
Location: SW Ohio

Post: #14
RE: Apnea's Adventures in Insurance Wonderland
Thanks Sleeprider Smile
With only past experiences in moving air, lots of air to go on I'm partial to the the idea of the aggressive response of the resmed to upsets IF the PID parameters/limits/span/ throttling range are tight (what are correct terms in autocpap machines any way? ) OTOH if I go back down island on a sailboat the 12vdc machines seem make more sense. Yet if the upverter for the resmed has good regulating capabilities to protect the machine.... but that adds another failure mode ....Aye yi eeee so much to learn in a big hurry. This is great! Wink

I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
04-24-2015 09:05 PM
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Mark Douglas Offline

Advisory Members

Posts: 513
Joined: Apr 2015

Machine: Sys 1 (60) RemStar BiPAP Auto with Bi-Flex 760P Auto Bi-Level (Variabl
Mask Type: Nasal mask
Mask Make & Model: PR Wisp
Humidifier: PR Sys One heated
CPAP Pressure: RiseTime 3 Fxd E-9.0 / I-11.5
CPAP Software: SleepyHead EncoreBasic

Other Comments: Hashimoto's thyroiditis.

Sex: Male
Location: SW Ohio

Post: #15
RE: Apnea's Adventures in Insurance Wonderland
me50 your comments close the circle. I have tried to get answers. grrrrrr. Cigna says 15% in network . 15% of WHAT? Cigna says carecentric has the answer. Carecentrix says they send it out to (crapria?) . So WTH is carecentrix even involved? I simply cannot pin anyone down for an out the door price. I am not going to give anyone a blank check or access to my CC w/o fixed dollar bid. Used car salesmen are easier to deal with.
I can drive 20 min and walk out the door with everything I need for a flat price from an internet storefront. With no further entanglements.

I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
04-24-2015 09:24 PM
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big_dave Online

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Posts: 411
Joined: Apr 2012

Machine: PR System One DS560
Mask Type: Nasal pillows
Mask Make & Model: F&P Pilairo Q or ResMed Mirage Activa
Humidifier: PR System One
CPAP Pressure: 14 - 20
CPAP Software: SleepyHead

Other Comments: Former ResMed S8 Autoset II user

Sex: Male
Location: Eugene, Oregon

Post: #16
RE: Apnea's Adventures in Insurance Wonderland
(04-24-2015 09:24 PM)Mark Douglas Wrote:  me50 your comments close the circle. I have tried to get answers. grrrrrr. Cigna says 15% in network . 15% of WHAT? Cigna says carecentric has the answer. Carecentrix says they send it out to (crapria?) . So WTH is carecentrix even involved? I simply cannot pin anyone down for an out the door price. I am not going to give anyone a blank check or access to my CC w/o fixed dollar bid. Used car salesmen are easier to deal with.
I can drive 20 min and walk out the door with everything I need for a flat price from an internet storefront. With no further entanglements.

I had a similar experience. When I was first diagnosed, I called both Apria and Lincare asking for price quotes on an S9 Autoset. They both acted like I was speaking Chinese and they couldn't give me a straight answer. I lost my insurance after my sleep study and before I could get a machine, so I could not afford to write anyone a blank check. The only way I could get a machine was by buying one on Craigslist.
04-25-2015 01:35 AM
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me50 Offline

Advisory Members

Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #17
RE: Apnea's Adventures in Insurance Wonderland
(04-24-2015 09:24 PM)Mark Douglas Wrote:  me50 your comments close the circle. I have tried to get answers. grrrrrr. Cigna says 15% in network . 15% of WHAT? Cigna says carecentric has the answer. Carecentrix says they send it out to (crapria?) . So WTH is carecentrix even involved? I simply cannot pin anyone down for an out the door price. I am not going to give anyone a blank check or access to my CC w/o fixed dollar bid. Used car salesmen are easier to deal with.
I can drive 20 min and walk out the door with everything I need for a flat price from an internet storefront. With no further entanglements.

15% of the contracted price is not a bad deal for in network. You don't have to give a blank check or cc/debit card to anyone. They are supposed to bill you each month and crapria makes so many mistakes that I would never give them a credit/debit card. My insurance company, when I was using Apria, paid 100% of everything and my insurance company was billed for masks and other supplies I never got. If you live in a competitive bid area, that is even better for you. 15% for a cpap auto will be a lot less for you than my out of network for a vpap auto.

However, you have to do what is best for you. Being on fixed incomes in my family and also trying to rescue some children from an unhealthy environment (which hasn't been inexpensive), insurance was the best option for us.

If you are still working (and if your spouse is still working), then it might be easier for you to pay outright if that is what you feel is best. Just get a script that says what you want and include all supplies and mask of your choice with DISPENSE AS WRITTEN on it. If you are going to pay outright and won't have to deal with apria but once, get a price quote from them and a few others that are out of network. I imagine you will find a better deal with one of the suppliers on the list at the top of this forum but who knows? Since Apria won the competitive bid with social security, they probably will not give you a good deal because they are getting most of the business except from people like me that get fed up with them, return the machine and go out of network. I have heard Lincare is just as bad as Apria

Hope you find a great deal on a machine/supplies soon and get yourself started on treatment.
(This post was last modified: 04-25-2015 01:58 AM by me50.)
04-25-2015 01:56 AM
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Mark Douglas Offline

Advisory Members

Posts: 513
Joined: Apr 2015

Machine: Sys 1 (60) RemStar BiPAP Auto with Bi-Flex 760P Auto Bi-Level (Variabl
Mask Type: Nasal mask
Mask Make & Model: PR Wisp
Humidifier: PR Sys One heated
CPAP Pressure: RiseTime 3 Fxd E-9.0 / I-11.5
CPAP Software: SleepyHead EncoreBasic

Other Comments: Hashimoto's thyroiditis.

Sex: Male
Location: SW Ohio

Post: #18
RE: Apnea's Adventures in Insurance Wonderland
Was told I would hear from DME Saturday April 25 with info on cash price or hand off to in-network DME. Hear the crickets chirping? Not particularly reassuring.

I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
04-27-2015 10:50 AM
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bwexler Offline

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Posts: 563
Joined: Mar 2012

Machine: PRS 1 BiPAP autoSV Advanced, with Heated Tube humidifier
Mask Type: Nasal mask
Mask Make & Model: Sleepweaver √Član
Humidifier: Resperonics Heated Tube humidifier
CPAP Pressure: Max pressure 25.0 cm H20, Max
CPAP Software: SleepyHead EncorePro

Other Comments: CMS 50i with Software for SpO2

Sex: Male
Location: San Marcos, CA, USA

Post: #19
RE: Apnea's Adventures in Insurance Wonderland
If your waiting for the phone to ring you are far more patient than I am.
I have had my PR 960 ASV machine for a year and a half and I am still trying to decide if I wanted a Resmed or a PR.
And like you I would never mess with the settings in the clinicians menus.

Crapria is not so bad, it seldom takes them more then 2 or 3 tries to get an item correct. However if you order more than one item, expect a separate shipment for each item. Although they did manage to ship 3 packages of 2 fine filters all in the same 12 inch square box, even though they would have all fit in a standard greeting card envelope.
04-27-2015 02:18 PM
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Mark Douglas Offline

Advisory Members

Posts: 513
Joined: Apr 2015

Machine: Sys 1 (60) RemStar BiPAP Auto with Bi-Flex 760P Auto Bi-Level (Variabl
Mask Type: Nasal mask
Mask Make & Model: PR Wisp
Humidifier: PR Sys One heated
CPAP Pressure: RiseTime 3 Fxd E-9.0 / I-11.5
CPAP Software: SleepyHead EncoreBasic

Other Comments: Hashimoto's thyroiditis.

Sex: Male
Location: SW Ohio

Post: #20
RE: Apnea's Adventures in Insurance Wonderland
It is a 'speriment. Will they ever call? I will buy a machine Friday May 1. If they call after that it I will tell them I cannot trust my health to them.

Tom Peters said you can have 80% of any market if you just show up. So far they haven't shown up.

The sleep Doc's office is however on the ball so far.

I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
04-27-2015 02:37 PM
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