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New and need help!!!
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DavRin Offline

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Post: #1
New and need help!!!
I've just completed my sleep tests and found to need an ASV machine. I've never had any kind of medical issue in my life that I've felt so un-armed with information.

I'm finding dealing with my local DME providers like pulling teeth. By the time I meet my deductible and go through the 13 month mandatory rent/purchase deal, which obviously put's you into another years deductible cycle, the cost is almost ridiculous.

After weighing all my options I think I'm going to purchase one from someone off the suppliers list on this site. I think I'd rather do this than deal with all the red tape involved and quite honestly it seems my end cost will be much cheaper.

Any pointers? Does and don't? Is my reasoning sound? What should I look (lookout) for? What is the life expectancy of a machine?

I appreciate any help and advice.
01-20-2015 09:30 AM
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justMongo Offline

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Post: #2
RE: New and need help!!!
Check for open box, zero hour machines from Supplier #2.
Most machines last longer than 5 years which is the replacement cycle on most insurance.
By 5 years they can be somewhat obsolete as machines improve.

Look for an ASV machine that is fully data capable so you can track your progress via software.

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.
01-20-2015 10:34 AM
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me50 Offline

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Post: #3
RE: New and need help!!!
First, double check with your insurance company to make sure that you do have a deductible for DME equipment and supplies.

Before I had medicare, my insurance did NOT have a deductible for DME equipment and supplies but did have deductibles for other coverages.

Also, ask your insurance company, if you find out they do have a deductible for DME equipment and supplies, if you would have to meet a deductible again because they require a 13 month rental. I doubt that would be the case.

As I said, most insurance companies do NOT have deductibles for DME equipment. If you are in need of an ASV machine, just know that they are one of the most expensive machines to treat your apnea that there is.

I suggest that you do the math after you get some answers from your insurance company and see which is the most cost effective way to go.

HOpe this helps you some.
01-20-2015 10:48 AM
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Sparkle Offline

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Post: #4
RE: New and need help!!!
(01-20-2015 10:48 AM)me50 Wrote:  First, double check with your insurance company to make sure that you do have a deductible for DME equipment and supplies.

I second this advice. I have a deductible w/my insurance however I did not have to pay anything for my machine. I do have to establish compliance via usage for 21 consecutive days for at least four hours per day (the four hours do not have to be consecutive.)

I felt like you - this diagnosis came from left field. I only went for the sleep test because I was told I was snoring. Sure, I was tired but who wouldn't be tired with the schedules a lot of us keep. I never fell asleep driving or during the day. So when the diagnosis did come I was confused, overwhelmed and yes, in denial - but got over it quickly enough because it is an important health matter.

Good luck!
01-20-2015 11:04 AM
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Sleeprider Online
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Post: #5
RE: New and need help!!!
(01-20-2015 09:30 AM)DavRin Wrote:  I've just completed my sleep tests and found to need an ASV machine. I've never had any kind of medical issue in my life that I've felt so un-armed with information.

I'm finding dealing with my local DME providers like pulling teeth. By the time I meet my deductible and go through the 13 month mandatory rent/purchase deal, which obviously put's you into another years deductible cycle, the cost is almost ridiculous.

After weighing all my options I think I'm going to purchase one from someone off the suppliers list on this site. I think I'd rather do this than deal with all the red tape involved and quite honestly it seems my end cost will be much cheaper.

Any pointers? Does and don't? Is my reasoning sound? What should I look (lookout) for? What is the life expectancy of a machine?

I appreciate any help and advice.

You may have more than one choice of who to work with as a DME. The satisfaction of users varies widely for different companies. I agree with getting a determination of your total out of pocket by working with your insurance company, and verifying that a rent/own requirement applies to your policy. If you do use an alternative supplier, most will give you invoices with insurance codes. It will likely be out of network and a 40% deductible may apply, but you can submit the invoice for reimbursement and applicability towards your deductible.

What is the insurance? Much of the rent/own and compliance requirements are standard for Medicare, but not many private insurance policies. Call the insurer to verify.

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01-20-2015 12:48 PM
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DavRin Offline

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Post: #6
RE: New and need help!!!
Company I work for changed Insurance providers in the middle of my sleep study, which really created a pain, but that's another story.

Insurance provider is Federated, I think a division of Cigna.

DME, said they would be billing the insurance company $599.00 a month for 13 months. I found that amazing. I asked twice to make sure I was understanding it correctly.

I called the Insurance provider and was told that I had a 2,000.00 deductible per year on DME's and I'd pay 30% after that. I'm going to call again and make sure this is correct before making a decision which way to go.

I'm also going to check with a couple more DME suppliers in the next couple of days to see if these numbers are correct. The initial DME supplier said everybody would be priced the same. This may be the case, but I'm certainly going to check with a couple more before I commit to spending that kind of money.

Thanks everyone for the responses. I greatly appreciate it.
(This post was last modified: 01-20-2015 01:17 PM by DavRin.)
01-20-2015 01:15 PM
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Peter_C Offline

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Post: #7
RE: New and need help!!!
Where to start. First, currently machine-wise you only have a few choices to pick from (mine being one of them) - regardless of which brand you go with, be sure to get the complete "heated hose" option, besides humidity~! ASV machines seem to use a bit more 'air', and cold air sucks.

I do agree with the above to explore all insurance options fully, first.

DMEs generally suck, and I love working with Supplier #1 personally (I went for years with no insurance, so had to cover my own costs for a time). While most folks can get a new machine every five years, due to costs, etc my S8 VPAP Auto 25 is/was at least eight years old when it was replaced. I am only on 'tube' number 3 in over 12+ years. Masks can become a great expense until you find a magic one that works well for you and does not leak too much, or create pain.

The big mask issue, is we can tell you our favorites, which you may well hate. Only you can figure out if nasal pillows, nasal mask, or FFM (Full Face Mask) is the best for you. Some mouth-breathers successfully learn to stop, while others that never mouth-breathed before start to 'hiss' when on their dream machine. Big leaks can kill therapy.

Best luck to you, and welcome.

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
01-20-2015 01:23 PM
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trish6hundred Online

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Post: #8
RE: New and need help!!!
Hi DavRin,
WELCOME! to the forum.!
Hang in there for more suggestions and answers to your questions.
Much success to you as you get your insurance situation figured out and start CPAP therapy.

trish6hundred
01-20-2015 01:56 PM
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justMongo Offline

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Post: #9
RE: New and need help!!!
(01-20-2015 01:15 PM)DavRin Wrote:  DME, said they would be billing the insurance company $599.00 a month for 13 months. I found that amazing. I asked twice to make sure I was understanding it correctly.

They will bill for $599 per month; but will accept about half that from the insurer. If they could get the machine for $2000; and you have a $2000 deductible, you'd be asked to pay the $2,000. Insurance is a criminal enterprise run by felons.

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.
01-20-2015 02:40 PM
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Sleeprider Online
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Post: #10
RE: New and need help!!!
(01-20-2015 01:15 PM)DavRin Wrote:  Company I work for changed Insurance providers in the middle of my sleep study, which really created a pain, but that's another story.

Insurance provider is Federated, I think a division of Cigna.

DME, said they would be billing the insurance company $599.00 a month for 13 months. I found that amazing. I asked twice to make sure I was understanding it correctly.

I called the Insurance provider and was told that I had a 2,000.00 deductible per year on DME's and I'd pay 30% after that. I'm going to call again and make sure this is correct before making a decision which way to go.

I'm also going to check with a couple more DME suppliers in the next couple of days to see if these numbers are correct. The initial DME supplier said everybody would be priced the same. This may be the case, but I'm certainly going to check with a couple more before I commit to spending that kind of money.

Thanks everyone for the responses. I greatly appreciate it.

Let's see, at $599/month you'll hit your annual deductible in 3 1/2 months and have a balance due of $90 that fourth month. With monthly costs of 30% or $180 to you, you would exceed the $3200 cost of an online machine at in another 6 months (10 months total). You will pay another $540 to own through the 13th month, but your insurance will have paid another $3770 over 9 months. (I'll believe it when I see it).

What a deal, I figure you can have this machine for as little as 3-times the retail value! I think everyone wins with this! Huhsign

Sarcasm probably doesn't suit me. You need to get the real cost of this thing at the insurance approved price.

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01-20-2015 03:23 PM
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