Post Reply 
Online suppliers don't take insurance?
Author Message
JJJ Offline

Advisory Members

Posts: 751
Joined: Apr 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: Most recent: Wisp, Pilairo, Mirage Vista
Humidifier: ResMed S9 Autoset
CPAP Pressure: 17-20
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: USA 97217

Post: #1
Online suppliers don't take insurance?
Today I decided to buy the new Fisher & Paykel Pilairo mask. i called several of the suppliers in the Apnea Board supplier list, but none would take insurance. Is that true for all of them? If that's true it's kind of a pain, because local DMEs stock only half a dozen masks and won't special order.
07-18-2012 12:47 AM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #2
RE: Online suppliers don't take insurance?
From what I gather you have to pay in full upfront and than claim from your insurance. Some on online suppliers provide the forms but first check with with your insurance if they accept.
07-18-2012 01:03 AM
Find all posts by this user Post Reply Quote this message in a reply
trish6hundred Offline

Advisory Members

Posts: 6,450
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #3
RE: Online suppliers don't take insurance?
Hi JJJ, If I remember right, when I ordered from Supplier #1 in the supplier list on this board, they always sent me an insurance form in PDF to fill out if I wanted reimbursement. I'm not sure if all the suppliers do this or not. I know it gets to be a big pain in the butt at times.

trish6hundred
07-18-2012 07:12 AM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
mjbearit Offline

Preferred Members-2

Posts: 605
Joined: May 2012

Machine: REMstar Auto AFlex DS550
Mask Type: Nasal pillows
Mask Make & Model: RESMed Swift FX
Humidifier: Heated humidifier - 2
CPAP Pressure: 12.5-20
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: So Cal

Post: #4
RE: Online suppliers don't take insurance?
I'm sure some of them deal with insurance to a point. For example, Supplier #2 gives you all the codes and info you need to send to your insurance company for reimbursement, but I doubt any on-line companies would bill your insurance directly. It would be way too easy to commit insurance fraud on-line, at least I would think so.

As always, YMMV! You do not have to agree or disagree, I am not a professional so my mental meanderings are simply recollections of things from my own life.

PRS1 - Auto - A-Flex x2 - 12.50 - 20 - Humid x2 - Swift FX
07-18-2012 09:39 AM
Find all posts by this user Post Reply Quote this message in a reply
BabyDoc Offline

Preferred Members-2

Posts: 184
Joined: May 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model:
Humidifier: ResMed H5i with Climateline Tubing
CPAP Pressure: 6.0 -16.0 CM
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Beachwood, OHIO

Post: #5
RE: Online suppliers don't take insurance?
Many insurance companies have an exclusive contract with one or two DME's, who offer them discounts.
Unless it is an essential item that the DME doesn't carry or can't get, the insurance company may not accept the mail order form. It's best to check with your insurance company BEFORE you buy, just to be sure they will cover your items.
07-18-2012 10:19 AM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
JJJ Offline

Advisory Members

Posts: 751
Joined: Apr 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: Most recent: Wisp, Pilairo, Mirage Vista
Humidifier: ResMed S9 Autoset
CPAP Pressure: 17-20
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: USA 97217

Post: #6
RE: Online suppliers don't take insurance?
Thanks for all the replies. I called a local DME that I have done business with in the past and they have the Pilairo on order. I know this DME will take my insurance, so that solves my current problem.

I understand the potential for insurance fraud, but I might point out that there are several suppliers of diabetes products (mostly meters and test strips) that openly advertise for Medicare patients. If they can do it I should think that suppliers of CPAP equipment ought to be able to as well. I would bet that it would dramatically multiply their sales volume.
07-18-2012 10:33 AM
Find all posts by this user Post Reply Quote this message in a reply
mjbearit Offline

Preferred Members-2

Posts: 605
Joined: May 2012

Machine: REMstar Auto AFlex DS550
Mask Type: Nasal pillows
Mask Make & Model: RESMed Swift FX
Humidifier: Heated humidifier - 2
CPAP Pressure: 12.5-20
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: So Cal

Post: #7
RE: Online suppliers don't take insurance?
(07-18-2012 10:33 AM)JJJ Wrote:  Thanks for all the replies. I called a local DME that I have done business with in the past and they have the Pilairo on order. I know this DME will take my insurance, so that solves my current problem.

I understand the potential for insurance fraud, but I might point out that there are several suppliers of diabetes products (mostly meters and test strips) that openly advertise for Medicare patients. If they can do it I should think that suppliers of CPAP equipment ought to be able to as well. I would bet that it would dramatically multiply their sales volume.

One major difference is that I do not need an RX for a BG meter or strips. I have had to make emergency purchases of these items when I boneheadedly left them at home and no one ever asked for an RX. My HMO goes by RX simply as a billing thing.

Masks and machines do require and RX.

As always, YMMV! You do not have to agree or disagree, I am not a professional so my mental meanderings are simply recollections of things from my own life.

PRS1 - Auto - A-Flex x2 - 12.50 - 20 - Humid x2 - Swift FX
07-18-2012 01:43 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
archangle Offline
Wiki Editor
Advisory Members

Posts: 3,159
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed S9 H5i
CPAP Pressure: 16-20
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments: Happy PAPper

Sex: Undisclosed
Location: USA

Post: #8
RE: Online suppliers don't take insurance?
Some insurance won't pay for online purchases.

Some will reimburse as an "out of network" provider with a separate deductible and a higher copay.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
07-20-2012 08:04 PM
Find all posts by this user Post Reply Quote this message in a reply
PollCat Offline
Apnea Board Polling Administrator
Monitors

Posts: 1,576
Joined: Feb 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: H5i Cleanable with ClimateLine
CPAP Pressure: 10 - 18
CPAP Software: SleepyHead

Other Comments: CPAP-ing since 1995; Type 2 Diabetes; Chronic Asthma; Gout

Sex: Male
Location: Westfield, IN

Post: #9
RE: Online suppliers don't take insurance?
I've been having a running battle with both Medicare and the Blues because I used Supplier #1 to get my new CPAP and masks at a lower price than the insurance company's and Medicare's DMEs had the equipment. I figured that 75% of the cost for out-of-network purchases was more feasible than what my out-of-pocket costs would have been by using their DMEs. Of course right now I'm out the entire amount of the equipment. Hammer


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.
07-22-2012 10:57 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
JJJ Offline

Advisory Members

Posts: 751
Joined: Apr 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: Most recent: Wisp, Pilairo, Mirage Vista
Humidifier: ResMed S9 Autoset
CPAP Pressure: 17-20
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: USA 97217

Post: #10
RE: Online suppliers don't take insurance?
(07-18-2012 01:43 PM)mjbearit Wrote:  
(07-18-2012 10:33 AM)JJJ Wrote:  I understand the potential for insurance fraud, but I might point out that there are several suppliers of diabetes products (mostly meters and test strips) that openly advertise for Medicare patients. If they can do it I should think that suppliers of CPAP equipment ought to be able to as well. I would bet that it would dramatically multiply their sales volume.
One major difference is that I do not need an RX for a BG meter or strips. I have had to make emergency purchases of these items when I boneheadedly left them at home and no one ever asked for an RX. My HMO goes by RX simply as a billing thing.Masks and machines do require an RX.

The diabetes suppliers make their business on the test strips for Medicare patients. Medicare will not reimburse them without a prescription from the doctor for the test strips.

I still submit that online suppliers are missing out on a huge amount of business by not taking insurance.
07-22-2012 11:11 PM
Find all posts by this user Post Reply Quote this message in a reply
Post Reply 


Possibly Related Threads...
Thread: Author Replies: Views: Last Post
  Insurance won't pay for power cord? CharlotteYork 13 906 11-17-2016 11:58 PM
Last Post: tzk321
Sad Help Finding A Machine, No Insurance SJGino 23 789 11-17-2016 09:03 PM
Last Post: SJGino
Angry INSURANCE RECORDS: DO YOU REALLY WANT TO KNOW? srlevine1 5 556 11-15-2016 06:31 PM
Last Post: Galactus
  [CPAP] Insurance / Getting first CPAP rjbbjr 14 628 11-11-2016 01:06 PM
Last Post: Mosquitobait
  DME or Online? EnigmaGrey 6 388 10-09-2016 10:31 AM
Last Post: TonyJ
  Insurance woes: Who has my "compliance" and "post pap" documentation? luminous 8 1,296 08-15-2016 12:09 AM
Last Post: SaldusMiegas
  ASV and Insurance Question rozenbob 15 717 08-06-2016 08:43 PM
Last Post: DeepBreathing

Forum Jump:

Who's Online (Complete List)