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[Equipment] 4 Months in and frustrated
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mattmill Offline

Members

Posts: 19
Joined: May 2016

Machine: DreamStation Auto
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10
Humidifier: DreamStation
CPAP Pressure: 6-15
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Brunswick, Maine

Post: #1
Angry 4 Months in and frustrated
To be clear, it's not the cpap usage that is frustrating me, it's the process of getting stuff...

Sorry for the rant but maybe some can help me figure a way out of this financial mess.
Using Dreamstation Auto 8-15cm pressure with humidifier and P10 nasal pillows. 100% compliant since starting 5/2/16. So all is good with usage (AHI typically <2).

Found out that my "compliance/rental period is now 13 months but was told 3 and then request purchase from UnitedHealth. Using a local DME I now find out that it's going to be paying about $1800 (me and insurance) for just the blower unit. Since I started in May I will be dealing with 2 calendar years of deductibles. This year is obviously met and now supplies/rental is 15% but come January rental will be $140/month until deductible is met (should be April if no other medical costs).

So, if my math is correct, I pay $189 in rental costs this year, and $642 next year if my employer doesn't change the plans. This is on top of the $452 initial purchase of the humidifier unit and 1st mask and hoses.

The new mask I just ordered came open with 2 of the pillows removed (sm and lg, I use med).

Is this common to get so grossly over charged like this? How do you all deal with this as well as the open packaging? I have ordered pillows in the past and they usually come in a ziplock baggie, didn't think about it until I received this mask and was missing parts. I have also received pillows in original packaging.

Anyone have experience with returning the machine and rebutting off the supplier listing? #1 is 639 with humidifier and heated hose and the great big internet store they are $470.

Thanks for letting me rant on this I spent over 2 hours on the phone with the DME and Insurance to try to work on this.

matt
09-15-2016 12:23 PM
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PoolQ Offline

Advisory Members

Posts: 986
Joined: Jul 2015

Machine: AirCurve 10 VAUTO
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: Integrated
CPAP Pressure: 6.2, 15, PS4.0
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Sillicon Valley

Post: #2
RE: 4 Months in and frustrated
my compliance period was 3 months and my rental is 13 months.

To my surprise I did not get tagged with a copay or deductible with the new year starting.

It's my understanding that your insurance company will negotiate the cost and tell you what your deductible/ out of pocket is and that the DME billing has zero to do with it. Talk with your insurance company to find out what you will pay.

yep pretty standard for them to remove the other masks and yes they "sell" them to other customers to make a few more bucks. My guess is that you could push the issue and get them to send you all three sizes if that is what the manufacturer supplies as standard parts.

Pretty sure Supplier #1 will do the paperwork with your insurance, not sure how payment works with them, but you will get the price applied to your deductible.
09-15-2016 03:14 PM
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srlevine1 Offline

Advisory Members

Posts: 227
Joined: Sep 2015

Machine: ResMed Airsense Autoset (S10)
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage Activa LT
Humidifier: Internal to S10
CPAP Pressure: 12-15.6
CPAP Software: ResScan SleepyHead Other Software

Other Comments:

Sex: Male
Location: Westlake Village, California USA

Post: #3
RE: 4 Months in and frustrated
(09-15-2016 12:23 PM)mattmill Wrote:  To be clear, it's not the cpap usage that is frustrating me, it's the process of getting stuff...

Found out that my "compliance/rental period is now 13 months but was told 3 and then request purchase from UnitedHealth.

Using a local DME I now find out that it's going to be paying about $1800 (me and insurance) for just the blower unit. Since I started in May I will be dealing with 2 calendar years of deductibles. This year is obviously met and now supplies/rental is 15% but come January rental will be $140/month until deductible is met (should be April if no other medical costs).

So, if my math is correct, I pay $189 in rental costs this year, and $642 next year if my employer doesn't change the plans. This is on top of the $452 initial purchase of the humidifier unit and 1st mask and hoses.

The new mask I just ordered came open with 2 of the pillows removed (sm and lg, I use med).

Is this common to get so grossly over charged like this? How do you all deal with this as well as the open packaging? I have ordered pillows in the past and they usually come in a ziplock baggie, didn't think about it until I received this mask and was missing parts. I have also received pillows in original packaging.

Anyone have experience with returning the machine and rebutting off the supplier listing? #1 is 639 with humidifier and heated hose and the great big internet store they are $470.

Thanks for letting me rant on this I spent over 2 hours on the phone with the DME and Insurance to try to work on this.

matt

A few comments ...

(1) The compliance period (90 days) and pay-to-own rental period (13 months) are standard.

(2) Your prescribing physician should have written the prescription for the entire unit, the unit, humidifier, heated hose, etc. -- so there is no add-ons to be privately purchased.

(3) Your DME will attempt to maximize profits in any manner possible, so their advice is somewhat suspect as a conflict-of-interest.

(4) If a supplies package was sealed and the normal package includes three sizes, then you have a right to a sealed package with all of its contents. The idea that a sanitized package would be compromised is an issue you might want to pursue.

(5) Your physician might be able to help you with the insurance issues; and if not, ask for your company's plan administrator. Insurance companies have more respect for the company paying the bills and who might switch coverages than they do individual patients.

(6) You may need to threaten to change providers if you do not get satisfaction from your DME. Most DME's would rather deal than lose more of their revenue stream. Insist on dealing with an executive and decision-maker rather than clerical support staff.

(7) Always be polite and professional -- and document (date, time, event, person) your encounters.

Best of luck.

"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
09-15-2016 05:47 PM
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Sleeprider Online
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Advisory Members

Posts: 3,344
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: #4
RE: 4 Months in and frustrated
Good answers from srlevine1. The insurance coverage through DME system was made for people with excellent coverage and low or zero deductibles. I purchased an Auto CPAP and Auto BiPAP through Craigslist in 2015 because my insurance had high deductibles. I also bought a couple P-10 masks through Supplier 1 an was reimbursed for out-of-network supplies at 60%. By self financing, I saved a lot of money and retired my old M-Series auto with 20,000 hours of use.

Late last year I came under coverage that had no deductible or copay, so I pursued getting my current machine. this machine is rented for 13 months. Since none of the cost falls on me, I don't care if the insurance company policy ends up costing them more. I received a new mask/frame/pillow, all invoiced separately to the insurance company, even though they are sold as a kit. They removed the S,M sizes and included 2-large, and charged for it I'm sure. Every month I get 2 new nasal pillows. At 6-months, I got a replacement heated hose, humidifier water chamber and mask kit. Yes, I'm hoarding for the day this kind of coverage is no longer available.

You need to use the strategy that makes the most financial sense, with a good understanding of how the system works. The free market is relatively inexpensive. Insured supplies are very expensive, and depending on deductible and co-pay may cost more than simply buying. If you buy out of pocket, it will not be applied to your deductible or copay limits. It may however be reimbursible as out of network, or even in-network. You have to be an accountant or medical billing specialist to figure it out.

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09-15-2016 06:16 PM
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FrankNichols Offline

Advisory Members

Posts: 714
Joined: Mar 2016

Machine: AirSense 10 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed F10 and/or P10
Humidifier: Builtin
CPAP Pressure: 17-19
CPAP Software: ResScan SleepyHead Other Software

Other Comments: I've figured out how to get my AHI down to 5, I quit sleeping!

Sex: Male
Location: Live Oak, Florida

Post: #5
RE: 4 Months in and frustrated
You left off the location information in your profile, but I am pretty sure you are living in the USA - just saying...

I am not a Medical professional and I don't play one on the internet.
Started CPAP Therapy April 5, 2016
I'd Rather Be Sleeping
09-15-2016 06:49 PM
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mattmill Offline

Members

Posts: 19
Joined: May 2016

Machine: DreamStation Auto
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10
Humidifier: DreamStation
CPAP Pressure: 6-15
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Brunswick, Maine

Post: #6
RE: 4 Months in and frustrated
(09-15-2016 06:49 PM)FrankNichols Wrote:  You left off the location information in your profile, but I am pretty sure you are living in the USA - just saying...

Whoops, fixed. Rolleyes


Thanks for the advice everyone. I guess it's more the system than he individual DME that's broken. I'm starting to run the numbers under different scenarios to see what makes the most sense. I'm finding prices quite a bit lower and need to investigate that they are sealed units and not refurbished or used. I'll probably hang on until the end of the calendar year as that's not going to make a huge difference until new insurance kicks in January first. I'll make some inquiries and look over paperwork to see if I'm bound by anything to continue the current rental.

Thanks
09-15-2016 10:42 PM
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