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Can the DME do this to me?
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Ailu Offline

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Posts: 159
Joined: Oct 2013

Machine: Philips Respironics System One (60 Series) RemStar Auto with A-Flex
Mask Type: Nasal pillows
Mask Make & Model: Fisher Paykel Pilairo Q
Humidifier: System One Heated
CPAP Pressure: Auto-CPAP: 8-9
CPAP Software: SleepyHead EncoreBasic

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Sex: Female
Location: Sierra Nevada Mountains

Post: #1
Question Can the DME do this to me?
Can the DME make me rent the machine when my Insurance allows me to purchase it outright from them?

I know nearly all of them have a terrible reputation for scamming. Is there anything else I should be wary of?

Calling them today and want to make sure I am prepared for anything they throw at me!

-Ailu
Reformed CPAP Outlaw
06-22-2015 09:03 AM
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parkerdt Offline

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Posts: 256
Joined: May 2015

Machine: ResMed A10 AutoSet
Mask Type: Other
Mask Make & Model: WISP, Nuance
Humidifier: Climate Hose and included humidifier
CPAP Pressure: 9
CPAP Software: SleepyHead

Other Comments: I alternate between WISP and fabric Nuance - like both!

Sex: Male
Location: Mebane, NC

Post: #2
RE: Can the DME do this to me?
Didn't your insurance (BCBS I think you said) already tell you they only buy, not rent? Or am I confused?

You might have to go with the BCBS DME if yours is stubborn. Fortunately, my insurance has about 6 DMEs in network locally, and I was free to choose the one I preferred. They had to order my ResMed A10 AutoSet, took them 2 days to get it. Great service. Sad that you are not getting the same great service.

Hang in there - it will all work out.

Dave
(This post was last modified: 06-22-2015 09:30 AM by parkerdt.)
06-22-2015 09:28 AM
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Ailu Offline

Preferred Members-2

Posts: 159
Joined: Oct 2013

Machine: Philips Respironics System One (60 Series) RemStar Auto with A-Flex
Mask Type: Nasal pillows
Mask Make & Model: Fisher Paykel Pilairo Q
Humidifier: System One Heated
CPAP Pressure: Auto-CPAP: 8-9
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Female
Location: Sierra Nevada Mountains

Post: #3
RE: Can the DME do this to me?
Thanks Dave! Yes my BS Insurance only purchases outright, but I wanted to make sure my DME couldn't buy it and then make me make payments to them. Yeah I am probably overthinking things. I guess yet another night of stuggling for breath is keeping me in anxiety about what could go wrong. Rolleyes Thanks for your words of encouragement.

(06-22-2015 09:28 AM)parkerdt Wrote:  Didn't your insurance (BCBS I think you said) already tell you they only buy, not rent? Or am I confused?

You might have to go with the BCBS DME if yours is stubborn. Fortunately, my insurance has about 6 DMEs in network locally, and I was free to choose the one I preferred. They had to order my ResMed A10 AutoSet, took them 2 days to get it. Great service. Sad that you are not getting the same great service.

Hang in there - it will all work out.

Dave

-Ailu
Reformed CPAP Outlaw
06-22-2015 10:00 AM
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justMongo Offline

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Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
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Humidifier: ResMed H5i
CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

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Sex: Male
Location: Калифорния

Post: #4
RE: Can the DME do this to me?
I think of the Sierra Nevada's being in the state of California... however, that's not exactly true as they extend into Nevada.
My point is: In CA, there is Anthem Blue Cross and Blue Shield of California. Separate companies that pay to use the BC and BS name.
As far as I know there is no BCBS unified insurance company in CA.

Of the two flavors of BC and BS in CA, I believe they do rent to own.
That permits them to reclaim the machine if the patient in non-compliant.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
06-22-2015 10:05 AM
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OpalRose Offline

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Posts: 3,181
Joined: Nov 2014

Machine: PR System One REMstar Auto 560 with A Flex
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10 For Her
Humidifier: REMStar heated humidifier with heated hose
CPAP Pressure: Auto Cpap 10-13 AFLEX 1
CPAP Software: SleepyHead EncoreBasic

Other Comments: Started CPAP Therapy October 23, 2014

Sex: Female
Location: Northeast Ohio, USA

Post: #5
RE: Can the DME do this to me?
I would call your insurance again. Chances are you will talk to someone else and get a different response. The norm for insurance is to "buy" by paying rent to the DME for a set amount of months, then ownership is transferred to you.

As justMongo stated, they do this so that they can reclaim the machine if you don't meet compliance.

I know it's a pain to deal with these people, but hang in there!

OpalRose
06-22-2015 10:34 AM
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Ailu Offline

Preferred Members-2

Posts: 159
Joined: Oct 2013

Machine: Philips Respironics System One (60 Series) RemStar Auto with A-Flex
Mask Type: Nasal pillows
Mask Make & Model: Fisher Paykel Pilairo Q
Humidifier: System One Heated
CPAP Pressure: Auto-CPAP: 8-9
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Female
Location: Sierra Nevada Mountains

Post: #6
RE: Can the DME do this to me?
(06-22-2015 10:05 AM)justMongo Wrote:  I think of the Sierra Nevada's being in the state of California... however, that's not exactly true as they extend into Nevada.
My point is: In CA, there is Anthem Blue Cross and Blue Shield of California. Separate companies that pay to use the BC and BS name.
As far as I know there is no BCBS unified insurance company in CA.

Of the two flavors of BC and BS in CA, I believe they do rent to own.
That permits them to reclaim the machine if the patient in non-compliant.

Yep, here in Northern California, Anthem Blue Cross is a for-profit, Blue Shield is non-profit. Not that it makes much difference, I've heard... but I can tell you that very few docs up here will partner with Anthem. But most of them take Blue shield.

(06-22-2015 10:34 AM)OpalRose Wrote:  I would call your insurance again. Chances are you will talk to someone else and get a different response. The norm for insurance is to "buy" by paying rent to the DME for a set amount of months, then ownership is transferred to you.

As justMongo stated, they do this so that they can reclaim the machine if you don't meet compliance.

I know it's a pain to deal with these people, but hang in there!

Well crud!!! I took your suggestion and called Blue Shield to ask again. This time I got a CSR who actually wears a CPAP! After checking, he told me that there is no provision to buy, only to rent. Ugh! 4

My copay is 10% of whatever the rental is. What's the deal with renting? Do I have to rent the machine forever? Or do they usually do a "rent to own"?

-Ailu
Reformed CPAP Outlaw
06-22-2015 12:11 PM
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parkerdt Offline

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Posts: 256
Joined: May 2015

Machine: ResMed A10 AutoSet
Mask Type: Other
Mask Make & Model: WISP, Nuance
Humidifier: Climate Hose and included humidifier
CPAP Pressure: 9
CPAP Software: SleepyHead

Other Comments: I alternate between WISP and fabric Nuance - like both!

Sex: Male
Location: Mebane, NC

Post: #7
RE: Can the DME do this to me?
I see your concern, now. My guess would be (and it is a guess) that your DME can bill you for the co-payment (10%) but is going to bill your insurance for the 90% that is covered. How your insurance reimburses the DME is really out of your control. Just make sure you are in compliance, and they are not going to take it away. Compliance is usually 4 hours/night on 70% of the nights during the first 90 days.

I did see the paperwork from my DME to my insurer; I had to initial that I'd in fact received the machine, verify the serial number, etc. My insurance was billed $2000 for my ResMed. And something for the mask of course, but I don't know that part....

So your co-pay is likely to be in the $200+ range assuming pricing is similar, which it may or may not be. Now whether the spread your co-pay over some rental period is a question only your insurer can answer with certainty. Likewise, they are the ones who can tell you what the rental time period is.

Dave
(This post was last modified: 06-22-2015 12:20 PM by parkerdt.)
06-22-2015 12:15 PM
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justMongo Offline

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Posts: 3,855
Joined: Sep 2013

Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: ResMed H5i
CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

Other Comments: μολὼν λαβέ

Sex: Male
Location: Калифорния

Post: #8
RE: Can the DME do this to me?
The life of a machine may be 5 years; and no insurance company will pay rental for 5 years.
I believe they will rent to own over a period of 12 to 13 months.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
06-22-2015 12:22 PM
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Mosquitobait Online

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Joined: Apr 2015

Machine: Resmed AirSense 10 For Her
Mask Type: Nasal pillows
Mask Make & Model: Airfit P10
Humidifier: integrated, Climate line tube
CPAP Pressure: 9-12
CPAP Software: ResScan SleepyHead

Other Comments: RLS and Bradycardia

Sex: Female
Location: Minneapolis

Post: #9
RE: Can the DME do this to me?
I hate to make you call the insurance company, but they are the ones who determine if it is 12 or 13 months and then you own.
06-22-2015 01:16 PM
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Adoniscmj Offline

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Posts: 168
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Machine: Resmed AirSense10 Autoset for her
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Integrated
CPAP Pressure: 6 to 9
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Everett, Washington

Post: #10
RE: Can the DME do this to me?
(06-22-2015 09:03 AM)Ailu Wrote:  Can the DME make me rent the machine when my Insurance allows me to purchase it outright from them?

I know nearly all of them have a terrible reputation for scamming. Is there anything else I should be wary of?

Calling them today and want to make sure I am prepared for anything they throw at me!

I took my machine back and purchased one online, because the DME was charging me for the humidifier and it is part of the machine, not separate. I have a ResMed Air Sense 10 Auto Set. I asked them about this and their explanation didn't make sense to me. I said that is like buying a car stereo and paying extra for the CD player even though it is integrated with the stereo. I have filed a complaint with the Attorney Generals office about this. So go over your bill very carefully. I would just buy online before I will ever deal with these local DME crooks ever again.
06-22-2015 01:26 PM
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