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Insurance question....is this typical?
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Roxy Offline

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Machine: ResMed S9 Autoset H5i
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Post: #1
Insurance question....is this typical?
I have had my respironics auto with heated hose since August. I get a new mask every 6 months, new cushions every month and new heated hose every three months. I see the eob's and the insurance company has paid the DME about $6,000 so far. I saw that today, the paid the DME $3,000. I assume that is for the machine. I can't believe how much more than the going rate insurance pays for the equipment. Is this typical? Thank goodness, I don't have any out of pocket but I am just curious if this type of overpayment to DME's is typical.
12-21-2012 09:33 PM
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zonk Offline

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Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
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CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #2
RE: Insurance question....is this typical?
maybe some insurance ceo getting kickbacks from the DME
what goes around comes around Too-funny
12-21-2012 10:13 PM
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PaulaO2 Offline
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Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #3
RE: Insurance question....is this typical?
Wow. Holy cow.

They could have bought two machines for that price.

Most insurances "rent" the machine for a certain number of months. In the end, they are paying a lot more than if they just bought it for you outright.

DMEs also typically charge much, much more for masks than is necessary. It's freaking ridiculous.

PaulaO2
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www.ApneaBoard.com


Breathe deeply and count to zen.

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.
12-21-2012 11:52 PM
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dcgrafix Offline

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Posts: 203
Joined: Sep 2012

Machine: Philips Respironics System One RemStar Pro with C-Flex+ (461CA)
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Mask Make & Model: ResMed Mirage Quattro Large
Humidifier: Respironics System one
CPAP Pressure: 8
CPAP Software: SleepyHead EncoreBasic Other Software

Other Comments: Diabetes type 2

Sex: Male
Location: BC Canada

Post: #4
RE: Insurance question....is this typical?
(12-21-2012 09:33 PM)Roxy Wrote:  I have had my respironics auto with heated hose since August. I get a new mask every 6 months, new cushions every month and new heated hose every three months. I see the eob's and the insurance company has paid the DME about $6,000 so far. I saw that today, the paid the DME $3,000. I assume that is for the machine. I can't believe how much more than the going rate insurance pays for the equipment. Is this typical? Thank goodness, I don't have any out of pocket but I am just curious if this type of overpayment to DME's is typical.

YES!!
It is freaking ridiculous.
But it sounds like you are getting a lot of equipment as in masks & cushions.

I was told my cushions should last up to a year not to mention the mask & Hose.

It is no wonder why medical is in such trouble.
Their getting raped & we are getting raped!
Vicious circle!!
12-22-2012 01:51 AM
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Shastzi Offline

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Posts: 1,174
Joined: Dec 2012

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: FitLife Total face mask
Humidifier: F&P HC150 with Hybernite heated hose.
CPAP Pressure: 15cm-20cm H2O (auto)
CPAP Software: SleepyHead Other Software

Other Comments: CMS50-F wearable Oximeter; Software: SPO2 Assistant

Sex: Undisclosed
Location: Florida, USA.

Post: #5
RE: Insurance question....is this typical?
Uhm, yah. I think the companies are hosing each other and then later upping the premiums/co-pay and cutting benefits so the consumer ends up picking up the tab.

Sometimes there just isn't enough hot pine tar and feathers to go around.....

Oh-jeez
12-22-2012 08:36 AM
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Roxy Offline

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Joined: Aug 2012

Machine: ResMed S9 Autoset H5i
Mask Type: Full face mask
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Humidifier: H51
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments:

Sex: Female
Location:

Post: #6
RE: Insurance question....is this typical?
After paying $175.00 per month for the rental, my insurance company just paid the DME more money than the consumer would have for a brand new, not three month old machine. Go figure!!!!! I am amazed that the insurance company (largest in the state) didn't negotiate with the DME that the rental cost is applied to the purchase price. Now I know why the DME was so eager to get me to use them. They waved my copay for all equipment so I have no out of pocket.

Now we know why medical/insurance costs are so insane!!!


Several years ago after knee surgery, my insurance company rented an ice machine for me. The rental cost was approximately 4 times the cost of just purchasing the exact same machine at the typical consumer rate.
12-22-2012 09:29 AM
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IDRIck Offline

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Posts: 60
Joined: Nov 2012

Machine: Resmed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
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CPAP Software: ResScan SleepyHead

Other Comments: Pad-a-cheek anti leak strap

Sex: Male
Location: Idaho, USA

Post: #7
RE: Insurance question....is this typical?
My insurance company bought the humidifier, hoses, and mask outright at ~50% the DME's list price and had the cpap machine set up on a $90/month rent to own schedule for 11 months. I petitioned them to purchase the machine after 100% compliance in first 21 days and a 98% reduction in AHI. They agreed, saving me $720 in 2013 rental fees as my deductible turns over on Jan 1. An awesome Christmas gift! Smile
12-22-2012 11:01 AM
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PaulaO2 Offline
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Posts: 8,065
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #8
RE: Insurance question....is this typical?
Slightly off topic: I just got a new power wheelchair via Medicare. The price list is jaw dropping but one in particular made me write to my congress folks.

Two Group 34 deep cycle batteries: $1200.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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.
12-22-2012 12:30 PM
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