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The Circle of Incompetence
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archangle Offline
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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: #11
The Circle of Incompetence
If it's midnight and an insurance company tells you it's dark outside, go check for yourself.

The DME is probably a better suspect, but the insurance company could be lying or confused as well. It's entirely possible the DME did get told by the insurance that it wasn't covered. Or the DME described it so badly they didn't understand, etc.

If you're only going to use the CPAP on battery power at home during power outages, rather than lugging a battery around while traveling, you can make a MUCH better and cheaper home emergency power supply with a deep cycle marine battery, a good charger, and the ridiculously overpriced ($90) ResMed DC adapter. (I see the bastards have raised the price.)

The downside is it's heavier (about the size of a car battery.) You can also spill the acid if you turn the battery over. Put it in a cheap battery box and put it somewhere you want kick or turn it over. You have to check the water every 6 months or so. However, you'll get 4 or 5 nights of power and it's a lot cheaper. Especially since almost all of these kinds of batteries die after a few years, just like a car battery.

However, the insurance probably won't pay for it, but you might very well get it cheaper than the "official" batteries after copay. Especially if you can get the insurance to buy the overpriced ResMed DC-DC converter.

There's also a Sears 1150 jumper battery that's around $160 that would probably power your CPAP for a night if you turn the humidifier off. It produces 120V AC, so you don't need an adapter. This is safe for the S9 series CPAP, but some of the older CPAP machines such as the S8 series may have problems.

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.
05-07-2014 09:52 PM
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JohnNJ Offline

Preferred Members-2

Posts: 103
Joined: Oct 2013

Machine: ResMed S9 AutoSet & ResMed Power Station II
Mask Type: Nasal pillows
Mask Make & Model: Respironics Wisp & ResMed Swift FX
Humidifier: ResMed H5i & ClimateLine (distilled / fresh daily)
CPAP Pressure: 9.4 - 10
CPAP Software: ResScan SleepyHead

Other Comments: First night - November 25, 2013

Sex: Male
Location: New Jersey, USA

Post: #12
RE: The Circle of Incompetence
Wait. It gets better.
05-08-2014 12:20 PM
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JohnNJ Offline

Preferred Members-2

Posts: 103
Joined: Oct 2013

Machine: ResMed S9 AutoSet & ResMed Power Station II
Mask Type: Nasal pillows
Mask Make & Model: Respironics Wisp & ResMed Swift FX
Humidifier: ResMed H5i & ClimateLine (distilled / fresh daily)
CPAP Pressure: 9.4 - 10
CPAP Software: ResScan SleepyHead

Other Comments: First night - November 25, 2013

Sex: Male
Location: New Jersey, USA

Post: #13
RE: The Circle of Incompetence
Update:

The DME price for the ResMed battery went from $1,100 to $2,100 to $4,680 and now $890.

Carecentrix confirmed with Cigna that it is covered, subject to my deductable and co-pay.

And all it took was a call to the President of the DME from the Cigna company plan rep.

I would recommend the deep cycle marine battery and the adapter paid out of pocket rather than go through this BS.
05-22-2014 11:52 AM
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jaycee Offline

Preferred Members-2

Posts: 115
Joined: May 2014

Machine: S-9 Autoset
Mask Type: Full face mask
Mask Make & Model: Quattro Air Large
Humidifier: 5i
CPAP Pressure: 9-13
CPAP Software: ResScan

Other Comments: RT at a DME

Sex: Male
Location:

Post: #14
RE: The Circle of Incompetence
Has anyone ever had their insurance pay for a battery back up ??

I've worked for 2 different DME's and I've never seen it happen. If it is an insurance covered item, your DME is only allowed to charge what the covered rate is (the retail price doesn't matter). Your 15% copay would be based on the covered rate, not the retail price.

As a word of warning, I've seen multiple times when insuance companies said an item was covered and then the patient ends up getting the bill because insurance denied the claim.

My advice: Get it in writing that your insurance company will cover it (with the billing code they will cover it under). If there is a billing code for it, there should be an allowable price and that is what the DME will base your 15% copay on.
05-22-2014 12:04 PM
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JohnNJ Offline

Preferred Members-2

Posts: 103
Joined: Oct 2013

Machine: ResMed S9 AutoSet & ResMed Power Station II
Mask Type: Nasal pillows
Mask Make & Model: Respironics Wisp & ResMed Swift FX
Humidifier: ResMed H5i & ClimateLine (distilled / fresh daily)
CPAP Pressure: 9.4 - 10
CPAP Software: ResScan SleepyHead

Other Comments: First night - November 25, 2013

Sex: Male
Location: New Jersey, USA

Post: #15
RE: The Circle of Incompetence
(05-22-2014 12:04 PM)jaycee Wrote:  Has anyone ever had their insurance pay for a battery back up ??

I've worked for 2 different DME's and I've never seen it happen. If it is an insurance covered item, your DME is only allowed to charge what the covered rate is (the retail price doesn't matter). Your 15% copay would be based on the covered rate, not the retail price.

As a word of warning, I've seen multiple times when insuance companies said an item was covered and then the patient ends up getting the bill because insurance denied the claim.

My advice: Get it in writing that your insurance company will cover it (with the billing code they will cover it under). If there is a billing code for it, there should be an allowable price and that is what the DME will base your 15% copay on.

No offense but this is the kind of thing I ran up against through this whole process. You worked for two DME's and you think it's not covered. IT IS COVERED if the doctor prescribes it. My plan already confirmed it.

By the way, the code that was used is for miscellaneous backup power, not specifically a backup battery for a CPAP machine (A9900).
05-22-2014 12:32 PM
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jaycee Offline

Preferred Members-2

Posts: 115
Joined: May 2014

Machine: S-9 Autoset
Mask Type: Full face mask
Mask Make & Model: Quattro Air Large
Humidifier: 5i
CPAP Pressure: 9-13
CPAP Software: ResScan

Other Comments: RT at a DME

Sex: Male
Location:

Post: #16
RE: The Circle of Incompetence
(05-22-2014 12:32 PM)JohnNJ Wrote:  No offense but this is the kind of thing I ran up against through this whole process. You worked for two DME's and you think it's not covered. IT IS COVERED if the doctor prescribes it. My plan already confirmed it.

By the way, the code that was used is for miscellaneous backup power, not specifically a backup battery for a CPAP machine (A9900).

None taken.

Like I said. Be aware that if your insurance company denies the claim (something they often do even after telling a patient that something is covered), you are the one paying the bill.

Just because a doctor orders something doesn't mean the insurance company is going to pay for it.

If a DME knew that insurance would cover batteries, they would gladly suggest them to patients and we would sell a lot of them. That is how a DME makes money, by selling equipment.

I've never actually sold a Resmed power system to a patient because I feel they are way to expensive but I have sold many of the Resmed cables designed to go from the machine to the battery (I think we charge $106 and change for them).
05-22-2014 01:25 PM
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JohnNJ Offline

Preferred Members-2

Posts: 103
Joined: Oct 2013

Machine: ResMed S9 AutoSet & ResMed Power Station II
Mask Type: Nasal pillows
Mask Make & Model: Respironics Wisp & ResMed Swift FX
Humidifier: ResMed H5i & ClimateLine (distilled / fresh daily)
CPAP Pressure: 9.4 - 10
CPAP Software: ResScan SleepyHead

Other Comments: First night - November 25, 2013

Sex: Male
Location: New Jersey, USA

Post: #17
RE: The Circle of Incompetence
(05-22-2014 01:25 PM)jaycee Wrote:  If a DME knew that insurance would cover batteries, they would gladly suggest them to patients and we would sell a lot of them. That is how a DME makes money, by selling equipment.

If you read my original post, the DME assumed it would not be covered. They never asked or submitted it for review. A-holes to the Nth degree.

I assure you the ResMed Powerstation II is covered by my Cigna plan, just like any other medical equipment. You just have to keep looking for someone with at least half a brain to do their job.
05-22-2014 01:50 PM
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jaycee Offline

Preferred Members-2

Posts: 115
Joined: May 2014

Machine: S-9 Autoset
Mask Type: Full face mask
Mask Make & Model: Quattro Air Large
Humidifier: 5i
CPAP Pressure: 9-13
CPAP Software: ResScan

Other Comments: RT at a DME

Sex: Male
Location:

Post: #18
RE: The Circle of Incompetence
Have you received it and received verification that your insurance did in fact pay their portion of it?

Like I said, I would gladly suggest these to patients if I knew they were covered (by the various insurances in my state). I just emailed my Resmed rep to get his input.
05-22-2014 02:04 PM
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JohnNJ Offline

Preferred Members-2

Posts: 103
Joined: Oct 2013

Machine: ResMed S9 AutoSet & ResMed Power Station II
Mask Type: Nasal pillows
Mask Make & Model: Respironics Wisp & ResMed Swift FX
Humidifier: ResMed H5i & ClimateLine (distilled / fresh daily)
CPAP Pressure: 9.4 - 10
CPAP Software: ResScan SleepyHead

Other Comments: First night - November 25, 2013

Sex: Male
Location: New Jersey, USA

Post: #19
RE: The Circle of Incompetence
(05-22-2014 02:04 PM)jaycee Wrote:  Have you received it and received verification that your insurance did in fact pay their portion of it?

Like I said, I would gladly suggest these to patients if I knew they were covered (by the various insurances in my state). I just emailed my Resmed rep to get his input.

And the circle continues...

I had a dozen people like you try to prove me wrong and they all failed. Contact your insurance reps, not the ResMed rep. He's only a sales guy.
05-22-2014 02:09 PM
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jaycee Offline

Preferred Members-2

Posts: 115
Joined: May 2014

Machine: S-9 Autoset
Mask Type: Full face mask
Mask Make & Model: Quattro Air Large
Humidifier: 5i
CPAP Pressure: 9-13
CPAP Software: ResScan

Other Comments: RT at a DME

Sex: Male
Location:

Post: #20
RE: The Circle of Incompetence
Resmed sales rep gets a commission, therefore he is motivated to sell them if they are a covered item.

The insurance rep you are talking to isn't the one that ultimately approves or denies your claim. Different person. Different department.
05-22-2014 02:14 PM
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