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DME RANT !
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big_dave Online

Advisory Members

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: #11
RE: DME RANT !
My sleep study was covered by insurance, but I lost my insurance before I was able to get a machine. I've figured out that my out of pocket expense is about equal to what the typical CPAP patient pays in deductibles and copays. But then, I've searched aggressively for deals, like $150 for my machine on Craigslist (plus $70 for my humidifier from Secondwind). I've got a big stockpile of supplies. If you want to save money, buy supplies when you can find good deals, not when you need them. Of course, insurance won't cover machines from Craigslist or mask parts from eBay.
08-14-2013 12:39 AM
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Sleepster Offline
Wiki Editor
Moderators

Posts: 4,995
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #12
RE: DME RANT !
(08-14-2013 12:08 AM)Paptillian Wrote:  I'm not sure I am making the right decision. Would appreciate some sense slapped into me! Having spare parts would be GREAT, but not if it would cost me a bundle.

Send an email to your DME explaining that you want to be able to get supplies paid for by your insurance company, but you don't want them sent to you on any schedule. Tell them you'll notify them if and when you want something, and tell them you'll need an estimate of the out-of-pocket cost to you.

Just because you're eligible for supplies doesn't mean you need to receive them. Often the out-of-pocket cost to you is so small, and the insurance company's contribution is so small that DME's aren't keen to furnish supplies. They want the contract with the insurance company so they can sell you the machine, so they're stuck having to provide the supplies. At least that's what my experiences have led me to believe.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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.
08-14-2013 11:01 AM
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SuperSleeper Offline

Administrators

Posts: 9,974
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #13
RE: DME RANT !
Yeah, be careful of dealing with your local DME.

Mine was Walgreen's Home Health Care, and they would call me up at regular intervals and say something like "Hey, you're eligible to receive a new mask and hose, do you want us to send you one?".

I'd say "Yeah, sure... sent it".

After I got it, I found out that my insurance replacement schedule wasn't as often as the many times the DME called me. Turns out when they said, "you're eligible..." that didn't mean that insurance would pay for it - it only meant that I was eligible according to the DME's policies to be sold a new mask or hose (therefore I was always "eligible" for new parts).... had nothing to do with insurance eligibility. So, I ended up paying for a mask/hose combo out of my own pocket since they sent it to me a few weeks before I was actually eligible for it via my insurance Since that point, I checked my insurance replacement policies FIRST (to make sure they'd pay the lion's share of the replacement supplies), before agreeing to accept DME-supplied headgear, masks, hoses, filters, etc.

Like Archangle likes to say, "If it's midnight and a DME tells you it's dark outside, go and check it yourself." Oh-jeez

But that said, FIND OUT what your insurance/Medicare replacement schedule allows and take advantage of the opportunities to stock up at the proper times, unless your deductible/out-of-pocket costs are so high that it makes it cost-prohibitive. If I remember correctly in my case, due to those reasons, it was often cheaper for me to order masks & filters online than to go through the local DME and my insurance policy, since I never seemed to max out my out-of-pocket or deductible costs.

Coffee

SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


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.

08-14-2013 02:58 PM
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DreamDiver Offline

Preferred Members-2

Posts: 77
Joined: Jul 2013

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: Quattro FX Full Face
Humidifier: ResMed S9 H5i
CPAP Pressure: 10.4 | 11.8
CPAP Software: ResScan SleepyHead EncoreBasic EncorePro

Other Comments:

Sex: Male
Location: Georgia

Post: #14
RE: DME RANT !
(08-14-2013 12:08 AM)Paptillian Wrote:  Having spare parts would be GREAT, but not if it would cost me a bundle.
If I were to allow a DME to autobot my hose and mask needs, I would end up almost paying my deductible by the end of the year. Very little would be paid for by the insurance company unless I had an expensive procedure earlier in the year. It's just cheaper in the long run to buy what I need outright. The house always wins.

dreamdiver.org
(This post was last modified: 08-14-2013 06:55 PM by DreamDiver.)
08-14-2013 06:54 PM
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