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Holey buckets, Batman! This is "coverage"?!
#1
Angry 
So I'm 3 months into treatment and supposedly following manufacturers recommendations and insurance allowances for replacement supplies.   The original paperwork from my supplier states: "Replacement Supplies: Recommendations of manufacturer and what most insurance companies will allow for billing.  Monthly; Cushion/Pillow and Disposable Filter (fine particulate)".   And then the X3 and X6 monthly, but I'm not there yet.  So, I've stopped by and picked up a new cushion and filter set each month.  Doctors order, right??  Now I get a bill from my supplier for the new cushions and filters.  2 cushions listed at $325 total, and they only cover $36.37!?!?  And a bit over 50% for the filters!?!?

What!  Really!!  Is this life with CPAP??

BTW, the Simplus FF cushion went from $125 to $200...each!
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#2
Check online prices for replacement supplies. Masks last a lot longer than you think.
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#3
(04-03-2017, 08:25 PM)JinMHK Wrote: So I'm 3 months into treatment and supposedly following manufacturers recommendations and insurance allowances for replacement supplies.   The original paperwork from my supplier states: "Replacement Supplies: Recommendations of manufacturer and what most insurance companies will allow for billing.  Monthly; Cushion/Pillow and Disposable Filter (fine particulate)".   And then the X3 and X6 monthly, but I'm not there yet.  So, I've stopped by and picked up a new cushion and filter set each month.  Doctors order, right??  Now I get a bill from my supplier for the new cushions and filters.  2 cushions listed at $325 total, and they only cover $36.37!?!?  And a bit over 50% for the filters!?!?

What!  Really!!  Is this life with CPAP??

BTW, the Simplus FF cushion went from $125 to $200...each!

Don't mistake invoice with reality.  What the insurance allows is all that is paid.  If you are balance-charged, that is illegal.  The invoice price is pure fiction.  Depending on your copay and / or deductible the "allowed" or covered price is all that can be billed, and your percentage comes from that.
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#4
That cushion is $200? I found it online for $30. Double check to make sure I was looking at the right part.
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#5
Ditto what Sleeprider said. If you need to, call your insurance company and run the bill by them to see what they say.

Insurance won't pay for a replacement cushion for me yet, so I ordered one on Amazon for $20. Works for me!
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#6
Supplies last longer than than you think. Check the "manufacturer recommended " replacement not the DME recommendation. The only thing I found there was the filter every2 months. 

Insurance will allow for than you need. I use nasal pillows and have yet to wear one out. After a year, my humidifier, hose, and mask are like new. I have changed the head strap, pillow, and chin strap just because I could. In the future I will make them last longer.
Dont-know  I am an accountant so any advice given here is not medical. If I give any financial advice, you can take it to the bank. However, you will have a hard time cashing it in. Okay
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#7
As Sleeprider said, you can probably ignore the statement price unless you received an actual bill for the inflated price.  when I got my Amara View mask my DME billed insurance $333.51. Insurance disallowed $253.34. I paid $16.03 and insurance paid $64.14.   I won't see a bill for the difference. 

It's the same for every medical service I receive from routine visits to my Dr. to Xrays. It's the way the system works and why I pity the poor people who have no insurance.

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#8
(04-03-2017, 08:25 PM)JinMHK Wrote: So I'm 3 months into treatment and supposedly following manufacturers recommendations and insurance allowances for replacement supplies.   The original paperwork from my supplier states: "Replacement Supplies: Recommendations of manufacturer and what most insurance companies will allow for billing.  Monthly; Cushion/Pillow and Disposable Filter (fine particulate)".   And then the X3 and X6 monthly, but I'm not there yet.  So, I've stopped by and picked up a new cushion and filter set each month.  Doctors order, right??  Now I get a bill from my supplier for the new cushions and filters.  2 cushions listed at $325 total, and they only cover $36.37!?!?  And a bit over 50% for the filters!?!?

What!  Really!!  Is this life with CPAP??

BTW, the Simplus FF cushion went from $125 to $200...each!

it would depend what your problem is

mine was not the tongue
it was central plus some OSA when the throat tended to collapse some 

there are various external stimulation attempts being studied
to counter various problems
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#9
(04-03-2017, 08:25 PM)JinMHK Wrote: So I'm 3 months into treatment and supposedly following manufacturers recommendations and insurance allowances for replacement supplies.   The original paperwork from my supplier states: "Replacement Supplies: Recommendations of manufacturer and what most insurance companies will allow for billing.  Monthly; Cushion/Pillow and Disposable Filter (fine particulate)".   And then the X3 and X6 monthly, but I'm not there yet.  So, I've stopped by and picked up a new cushion and filter set each month.  Doctors order, right??  Now I get a bill from my supplier for the new cushions and filters.  2 cushions listed at $325 total, and they only cover $36.37!?!?  And a bit over 50% for the filters!?!?

What!  Really!!  Is this life with CPAP??

BTW, the Simplus FF cushion went from $125 to $200...each!
 The DME normally show you what Medicare will cover and how often.
You need to know what your specific Insurance will cover and how often. 
Your yearly deductible and percentage covered can make a huge difference from one plan to another.
in practice you should only replace what needs to be replaced. I have been using the same mask and pillows for 6 months now. Hose lasts years unless you damage it.
I replace filter every couple of months and  purchased 12 on ebay for $10 shipped.
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#10
(04-04-2017, 10:14 AM)Melman Wrote: I pity the poor people who have no insurance.

I have yet to use my Private health Insurance for my Pap Treatment.
I almost never reach my annual deductible before DME costs would be covered at 80%
Purchased a low hour Resmed Auto 10 for $185
Heated hose on ebay for $31 shipped.
Resmed P10 fit pack on Amazon for $59 shipped. 
American Sleep Apnea association will provide Cpap/Apap package with mask for $100 donation if you have a prescription.
Plenty of affordable options available for those that look.
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