[CPAP] Insurance and DME vs online purchase

[Br1sleep]

Hi all, I was a longtime Dreamstation user until the recall. I've had the machine for way more than 5 years and got my doctor to write a new Rx so I can get a Resmed. They warned me that if I go through a DME, I have to return every 3 months for insurance to continue to pay--that insurance treats a new machine as if you're a new cpap user and they want to assure compliance. (Does this concur with others' experience?) I now have a high deductible insurance and aetna will only pay 80% of the machine cost anyway, which would go towards my deductible (so I'll be paying). I assume DME equipment cost is way higher than buying online, though the cost would be adjusted down to aetna's negotiated price.

I'm trying to compare that cost (and the out-of-pocket to go to a doctor at 3 months, 6 months, then a year) vs just buying the machine online (which insurance won't cover).

Anyone have experience and thoughts about this? Also, any warnings about the online suppliers I should be aware of? I've used Supplier #1 for supplies for years and they seem to be reputable.

thanks so much!

[SideSleeper]

Verify with your insurance first--don't just take someone's word that they won't pay. I know Medicare doesn't require you to go back when you get a new machine and go through the rental thing again--I guess they think if you have been compliant for more than 5 years you are going to use this new one .

[S. Manz]

I buy my own machines and disable the modem. This way I don't have to deal with my medical data to be disseminated among god knows how many people AND I don't have to deal with some bozo insurance agent threatening to pull the plug on my sleep.
The cost difference is certainly worth what I get in return which is my privacy and peace of mind, so this is something very personal and only you can make that decision and since if you have an EX already, you also have the choice.
If you decide not to use insurance, then you need to send your data to your doctor by email (using the SD card that comes with the machine), on a regular basis or when he/she wants to review your data.
Now, Resmed does not even ask if you want to send your data to their cloud servers, they just go ahead and upload your data every day, which from a privacy point is crazy, so if you don't want them to have the data, the only way to do it with Resmed machines, is to disable the cellular modem which involves opening the machine up and disconnecting the connector marked J302, otherwise Resmed gets your data whether you want them to or not and they will give this data to anyone they like, whether or not you want them to.

[factor]

This could help
http://www.apneaboard.com/wiki/index.php...d_Medicare

Search medicare on wiki.

I am not on medicare.  I have private insurance.  

I don't use insurance at all because its a waste of time.  Unless you need something like a sleep study then it helps.  I have a copy of my prescription.  I keep a scanned copy and a real paper copy.  I buy all my own equipment online.  I have had good luck with Suppliers #29 #38.

[Horseshoez]

Interesting thread; I'm 14 years deep into an old REMstarPro M-Series and will be buying a new machine this fall. When I got my current machine back in 2007 the DME I got it from was an absolute nightmare to deal with and I had to threaten them with legal action before they left me alone; after that I swore "never again". This time around I'd like to buy a machine online, and like the OP of this thread, I have a high deductible plan, so my HSA is going to do the heavy lifting on the purchase. The most significant wrinkle is I never got a copy of my prescription back in 2007 and I'm not even sure the ENT who wrote it is even in business any longer; how difficult is it to get a PCP to write a prescription without going through another sleep study?

[dkcdkc]

The most significant wrinkle is I never got a copy of my prescription back in 2007 and I'm not even sure the ENT who wrote it is even in business any longer; how difficult is it to get a PCP to write a prescription without going through another sleep study?

I last had a study in 2010 but the doctor failed to sign it appropriately. He has since retired and vanished.  Last year Medicare happened to notice and forced me to get a new study or they would cut off benefits.  I managed to get the study but it was hard.  After 20 years I am so acclimated to the CPAP that I have great difficulty falling asleep without it.  But I finally managed. I don't think a PCP or other would write a prescription without a test or other backing.  Good luck.

[Horseshoez]

Thanks @dkcdkc, I was kind of afraid this was going to be the answer. At 20 years you're well in front of me, but like you, not only do I have great difficulty falling asleep without it, I actually fear even trying to fall asleep. I just got over my second case of COVID (yes, I'm fully vaxxed, this case was a walk in the park compared to last year), and need to schedule a follow up appointment with my PCP, I'll test the waters regarding a new CPAP prescription when I go in. Who knows, I might get lucky, my PCP back in 2007, same office but different doctor, referred me to the ENT, so maybe they have something in their records which will allow them to write a new prescription.

[staceyburke]

I and my son bought machines at Supplier #2 in the supplier list at the top of site and neither of us were asked for a RX

[Horseshoez]

Awesome, thanks @staceyburke!

[Phil7]

I has a sleep study 11 years ago and was assigned (without any choice) a horrible CPAP supplier with a static pressure.   It was bad.   1 year in, I asked my MD for a prescription so I could buy my own.  He had no issue with that (and actually retired 6 months later).  I uploaded my prescription to an online dealer who to this day always insists it's a lifetime prescription.

I've tried to get into insurance paying for machines and supplies, but it's extremely difficult to do on your own.  I gave up on that myself.

The interesting thing now is that CPAP machine costs have doubled during the last year from an average of $500 to $1000 for an AirSense 10 right now.   The price gouging in this industry is crazy.    Resmed and Phillips suing competition out of business and limiting customer choice is also crazy.   And, I know 5 years in I'm going to start getting warning notices on the AirSense 10 trying to use fear to get a new unit.   This whole industry has turned into a big anti-consumer scam operation.