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In the US...How long should it take???
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Sleeprider Online
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Post: #11
RE: In the US...How long should it take???
SpeedyD, what insurance do you have? What is the policy for out of network DME? My last policy (BCBS) had a 40% copay for out of network vs 20% in network. I think using one of the online suppliers penciled out, considering I got my equipment immediately with no hassle or huge markups. You might want to have a talk with your insurer, and make sure you know their DME policy for in-network, out of network and what their policy is on rental vs purchase. If you get 100% coverage, then it might be worth this hassle, but otherwise, I'd be looking at alternatives.

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11-26-2015 10:50 AM
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Snowbird47 Offline

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Machine: AirSenseâ„¢ 10 AutoSet CPAP Machine with HumidAirâ„¢ Heated Humidifier
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Post: #12
RE: In the US...How long should it take???
DMEs are a crap shoot. After my sleep study I saw my doc (just my internist not a sleep doc) and got a copy of my study and a scrip (I told him I wanted APAP ,and mask of choice, he said no problem). I awent around to a couple of local DME supliers and saw that they were at best incompetent and uninterested. I did my research on this board and ordered the equipment I wanted from one of the suppliers listed at the top of the forum. All came promptly and I was off to the races.

ONE MONTH later the sleep center called and said they were ready to see me. Even though my study showed an AHI of 70, it was apparently not much of an urgent situation.

Bottom line, take charge of your own treatment.
11-26-2015 11:36 AM
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SpeedyD Offline

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Machine: Airsense 10 Autoset FH
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Sex: Female
Location: USA

Post: #13
RE: In the US...How long should it take???
(11-26-2015 11:36 AM)Snowbird47 Wrote:  DMEs are a crap shoot. After my sleep study I saw my doc (just my internist not a sleep doc) and got a copy of my study and a scrip (I told him I wanted APAP ,and mask of choice, he said no problem). I awent around to a couple of local DME supliers and saw that they were at best incompetent and uninterested. I did my research on this board and ordered the equipment I wanted from one of the suppliers listed at the top of the forum. All came promptly and I was off to the races.

ONE MONTH later the sleep center called and said they were ready to see me. Even though my study showed an AHI of 70, it was apparently not much of an urgent situation.

Bottom line, take charge of your own treatment.

Uninterested, unmotivated, all this describes DME. They have no idea what we are dealing with.
My AHI is 94. No hurries.
11-26-2015 12:14 PM
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SpeedyD Offline

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Posts: 73
Joined: Nov 2015

Machine: Airsense 10 Autoset FH
Mask Type: Full face mask
Mask Make & Model: Respironics Amara view
Humidifier: Built in
CPAP Pressure: 5-18
CPAP Software: SleepyHead

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Sex: Female
Location: USA

Post: #14
RE: In the US...How long should it take???
(11-26-2015 10:50 AM)Sleeprider Wrote:  SpeedyD, what insurance do you have? What is the policy for out of network DME? My last policy (BCBS) had a 40% copay for out of network vs 20% in network. I think using one of the online suppliers penciled out, considering I got my equipment immediately with no hassle or huge markups. You might want to have a talk with your insurer, and make sure you know their DME policy for in-network, out of network and what their policy is on rental vs purchase. If you get 100% coverage, then it might be worth this hassle, but otherwise, I'd be looking at alternatives.
I am med mutual. I have called insurance many times. They just said it is 85-15%. Nothing about in or out of network.. Sigh. I'm taking a nap now so I can properly finish cooking Thanksgiving dinner.
11-26-2015 12:17 PM
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Sleeprider Online
Wiki Editor
Advisory Members

Posts: 3,390
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: #15
RE: In the US...How long should it take???
Enjoy the nap. When business hours are back in session, ask the insurer how they would reimburse out of network DME and how to file a claim. I suspect it's a 30% share for you, in which case, you'd save a lot just doing it. You have a prescription, right? If you can afford to wait for insurance reimbursement, it's really the best. Seriously, online DMEs charge less than $900 for a top of the line APAP complete with heated hose and all the rest. Lincare will charge you $1800 for any CPAP, try to give you a cheaper one, and will charge you separately for the humidifier and heated hose. Your copay will be higher.

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11-26-2015 01:48 PM
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SpeedyD Offline

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Posts: 73
Joined: Nov 2015

Machine: Airsense 10 Autoset FH
Mask Type: Full face mask
Mask Make & Model: Respironics Amara view
Humidifier: Built in
CPAP Pressure: 5-18
CPAP Software: SleepyHead

Other Comments:

Sex: Female
Location: USA

Post: #16
RE: In the US...How long should it take???
(11-26-2015 01:48 PM)Sleeprider Wrote:  Enjoy the nap. When business hours are back in session, ask the insurer how they would reimburse out of network DME and how to file a claim. I suspect it's a 30% share for you, in which case, you'd save a lot just doing it. You have a prescription, right? If you can afford to wait for insurance reimbursement, it's really the best. Seriously, online DMEs charge less than $900 for a top of the line APAP complete with heated hose and all the rest. Lincare will charge you $1800 for any CPAP, try to give you a cheaper one, and will charge you separately for the humidifier and heated hose. Your copay will be higher.

I fought so hard to get the right machine ordered and I'm still gonna get hosed!!! Arghh!
This is causing me anxiety. I will be making a personal visit tonlincare office tomorrow!
11-26-2015 02:26 PM
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