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New and need help!!!
#11
Thanks for all the good words.

I inquired about buying the machine outright and was told by the Insurance company that wasn't an option.

I definitely feel that I'm getting railroaded. Just haven't figured out anyway around it yet. Hopefully I'll have a little free time tomorrow and will be able to check with a couple other DME providers and go at the Insurance company one more time.

If all else fails, looks like I'm going to contact someone on the Supplier's list from this site an approach it from that direction.

Once again thanks for all the input!!

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#12
(01-20-2015, 03:23 PM)Sleeprider Wrote:
(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.

A DME can bill whatever they want to the insurance company but that doesn't mean squat. The insurance company has a contracted amount that they will pay each month to a provider. So, the insurance company deducts the excess amount the DME bills, less the deductible if there is one and then the rest is for the patient/client to pay. Once the deductible is met, then the insurance company will deduct the excess the DME billed to get the allowed amount they will pay and then they will deduct the co-pay and the insurance company will pay the difference.

I have to say that I have never had a DME deductible with either private insurance or medicare. A lot of DME's that are out of network will take the normal co-pay of your policy in order to get your business. My in network co-pay last year was 20% and out of network 30% but I have never had to pay the 30% and I am using an out of network DME.

I would ask to speak with a benefits supervisor who will take the time to read through your policy based on the contract they have with your insurance company. Otherwise, you might be getting a standard response to your questions and not a response based on your policy and agreement for your company and the insurance provider.
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#13
(01-20-2015, 05:42 PM)DavRin Wrote: Thanks for all the good words.

I inquired about buying the machine outright and was told by the Insurance company that wasn't an option.

I definitely feel that I'm getting railroaded. Just haven't figured out anyway around it yet. Hopefully I'll have a little free time tomorrow and will be able to check with a couple other DME providers and go at the Insurance company one more time.

If all else fails, looks like I'm going to contact someone on the Supplier's list from this site an approach it from that direction.

Once again thanks for all the input!!

All you (legally) need is a copy of the script from the Doc, and any of the suppliers will be happy to sell you whatever unit you wish to buy.

DMEs are supposed to work *for* us, as their customers, though many seem to ignore that one fact.
*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."
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#14
I left work a little early this evening and went to another DME provider that is a preferred provider for my Insurance. Although the amount billed per month and the number of months changed the final cost of the machine is within a few hundred dollars of the others I checked.

I've pretty much decided to just purchase a machine outright and forget about Insurance (if you can call it that). My biggest concern is lack of knowledge about the whole process.

When I get a machine is it a simple plug and play process? Do adjustments need to be made initially or over time? If so is this something that I can do or does it have to be re-programmed professionally? If so by who and how much cost typically?

Sorry about all the questions, I'm just having a hard time grasping all this stuff flying around in my head!!!
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#15
(01-21-2015, 08:13 PM)DavRin Wrote: When I get a machine is it a simple plug and play process? Do adjustments need to be made initially or over time? If so is this something that I can do or does it have to be re-programmed professionally? If so by who and how much cost typically?

Ideally you will have had a sleep study and your doctor will have prescribed the general type of machine and how it should be set up.

Without such a study you are flying pretty much blind.

My machine provider set up my machine according to my Respirologist's specification. If you buy a machine without a middleman, say over the internet, that expertise will not be available to you.

In my case the cost of the bare machine is only a part of the package. My supplier offers full and continuous support for the life of the machine. Well, at least that's what they claim - time will tell but early indications so far are good.

Luckily I have insurance that covered the full cost of the machine and the service.


Ed Seedhouse
VA7SDH

Your brain is not the boss.

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#16
(01-21-2015, 08:13 PM)DavRin Wrote: I left work a little early this evening and went to another DME provider that is a preferred provider for my Insurance. Although the amount billed per month and the number of months changed the final cost of the machine is within a few hundred dollars of the others I checked.

I've pretty much decided to just purchase a machine outright and forget about Insurance (if you can call it that). My biggest concern is lack of knowledge about the whole process.

When I get a machine is it a simple plug and play process? Do adjustments need to be made initially or over time? If so is this something that I can do or does it have to be re-programmed professionally? If so by who and how much cost typically?

Sorry about all the questions, I'm just having a hard time grasping all this stuff flying around in my head!!!

Be sure to get an Auto CPAP and you should have no trouble getting the pressures correct. You will get a lot of help to get started, but the Auto machine will make it much easier, and will continue to adapt. One big advantage to buying it yourself is that you will end up with a fully data capable auto PAP that is much higher quality than what most DMEs want to supply.
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#17
(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.



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.

Hi DavRin, Welcome..
Good for you.. doing your homework up front.. My suggestion is to have the guidance of the respiratory therapist IMHO and sleep Dr. Settings can be a challenge. Getting an appropriate mask is important as well.
The names of the machines can be confusing .. make sure it's ASV capable if that's what was prescribed by the Dr. Make sure it's fully data capable as others have suggested. Suggest you get a copy of your prescription and diagnostic and titration sleep studies. The process can be more complicated for sure and overwhelming in the beginning. Different brands of ASV have different ranges in the prescription settings . There are threads on here about them.
There are alot of folks on here who use ASV and know alot more than I do about them. Just my 2 cents , hope it's helpful.
Archangle has a useful links in name area reccomend reading. Perhaps go on the manufactures websites to read about ASV machines.
All the best.
3
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#18
(01-20-2015, 09:30 AM)DavRin Wrote: I've just completed my sleep tests and found to need an ASV machine.

(01-20-2015, 05:42 PM)DavRin Wrote: I inquired about buying the machine outright and was told by the Insurance company that wasn't an option.

I definitely feel that I'm getting railroaded. Just haven't figured out anyway around it yet.

(01-21-2015, 08:13 PM)DavRin Wrote: I've pretty much decided to just purchase a machine outright and forget about Insurance (if you can call it that). My biggest concern is lack of knowledge about the whole process.

When I get a machine is it a simple plug and play process? Do adjustments need to be made initially or over time? If so is this something that I can do or does it have to be re-programmed professionally? If so by who and how much cost typically?

Hi DavRin,

If I were in your situation, I think I would simply buy a machine from Supplier #2, if that supplier happens to have a suitable machine available. Their inventory varies week to week.

All ASV machines will automatically adjust Pressure Support within a range, but I recommend that the machine also should be one which has the ability to auto-adjust EPAP to treat obstructive apneas more optimally (I think this will make it easier to determine appropriate pressure settings), and also has a heated tube.

For example (from Supplier #2 site):

1. Gently Used Respironics System One BIPAP Auto SV Advanced DS960 Machine with Heated Humidifier for around $1,400 plus more to be upgraded to heated tube (which requires larger power supply and different humidifier lid).

2. Or, I think better because simpler and more automatic: Gently Used ResMed ResMed S9 VPAP/BIPAP Adapt SV with Heated Humidifier - REF - 36037 for around $1,250. (REF# 36037 or 36067 or higher are recommended, not 36007 like mine.)

You need to ask/demand/obtain copies of your full sleep reports, one for each night, including all data. Will be many pages, with tables of data and event graphs, etc. You have a right to this for your own personal medical records.

You also need to get a copy of the prescription, which should include heated hose, and mask of patient's choice. You have a right to a copy of your prescription. Even if they insist it be marked "Patient Copy" it can still be used to order machine and supplies. (Supplier will be happy to call doctor for verification whenever needed.)

There are many threads on Apnea Board about how ASV machines work and/or adjusting the settings, by members who have had fairly easy times or fairly hard times, and have succeeded in their ASV therapy.

I suggest you (or others) email me any specific questions, if desired. Just started a new job this week, and soon I may not have time to be visiting the forum except infrequently.

In the meantime, I suggest searching the forum for ASV threads using search phrase "adaptive servo ventilator" or the like.

Take good care,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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