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The Devil in the Details
#1
Question 
The Devil in the Details
I started Cpap back in July of of 2016.  My insurance at the time was Health Net and the deal was after 13 months of rental, I would own the machine.  I crunched the numbers on the cost of the machine and supplies, finding that my insurance would save $5 in that time frame.  So okay.  I rented the machine from the only DME that was in network , Apria.

My insurance changed to United Healthcare in December and then again to Anthem in March.  I've paid a little bit extra to Crapria in the last two months because I was told it was a partial month charge because I was at the end of my rental period.  I called both times and questioned the extra charges.  I got a 3rd bill for more than what my EOB said I owed, so I called again.  This time I was told that every time my insurance changed, I lost all credit toward purchase because the contract was reset.  She was however, unable to tell me what the contract was with Anthem and she was unable to explain the extra charge above what the EOB said I owed.

So I called Anthem. They said that I was going to be paying a rental fee FOREVER, which would vary based on whether I had met my deductible and/or my max out of pocket each year.  (Until my insurance changes again!) 

Baconjurer said to self "Um, no.  Buy a  machine." 

So my question is - I've done well with my current set up. But I assume it's not the latest on the market. Is there any need to be concerned about obsolescence on supplies or parts down the road in the next few years if I simply replace my current equipment?  Is there anything I need to check on before I buy?   I plan on shopping among the suppliers on the list.
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#2
RE: The Devil in the Details
Things change so fast that who knows when they will change models.
You do appear well up to date with equipment, so you should be fine for a few years yet.
However, masks appear to change at the manufactures whim, I think they try to get the upper hand on others.
The machine is fine, but if you do camping etc it might be worth looking at a 12Vdc model, otherwise you will need a convertor to change it from 12Vdc to 24Vdc, however they can be obtained at a ridicules cost for what they are.
Otherwise I would stick with what works for you.
You could buy a second hand machine, but then you have to weigh things up, is it worth it?
Second Wind do second hand machines that have a limited warranty, but the cost of new machine have come down a bit.
If what you have works for you I would stick with it, I think you are well up to date with equipment.
I am NOT a doctor.  I try to help, but do not take what I say as medical advice.


Every journey, however large or small starts with the first step.

Sleep-well
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#3
RE: The Devil in the Details
(10-17-2017, 02:11 AM)baconjurer Wrote: So my question is - I've done well with my current set up. But I assume it's not the latest on the market. Is there any need to be concerned about obsolescence on supplies or parts down the road in the next few years if I simply replace my current equipment?  Is there anything I need to check on before I buy?   I plan on shopping among the suppliers on the list.

The ResMed AirSense 10 series is likely to be around for at least another three to five years as it has been a great machine for so many of us. As for supplies, only the masks are likely to change, but I see no mass discontinuance of the basic masks since many of us have found them to be of strategic value after searching and searching to find one that fit, was comfortable, and did not leak like a sieve. Machines have a useful life of between 5 - 7 years if used continuously; and some even work well past ten years.

As for the ownership of the machine and the insurance situation ... I suggest that you make your situation known to the California Insurance Commissioner in the form of a complaint. If a new  machine has not been physically provided by each insurer -- they may not have any claim on its ownership. Which DME does your EOB say they are paying? Approach that company and offer a buyout and the opportunity to avoid a formal complain to the insurance commissioner.

I started with Health Net and Apria (who lost the current Medicare contract); then my company switched policies and we went to another provider. I was told that each insurance company had their own billing system and I was likely to pay a rental co-pay until I reached my deductible each year. One call to our company's insurance agent and the problem was resolved in my favor. 

I even mentioned contacting a reporter to demonstrate why the costs of healthcare were so high -- price gouging.  Example: the cushions for my mask are fair-traded at $31.00. My insurance company is billed  $17.94 by the DME and they make a profit and so does the manufacturer. (That is retail -- so it includes transportation, advertising, and everything else).

Best of luck resolving the issue -- but I would try some old-fashioned arm-twisting before buying my own machine.

Best of luck.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#4
RE: The Devil in the Details
baconjurer, we have been seeing the Airsense 10 Autoset on Amazon for about $440, and the for-her version for in the low $500s.  I think you are best advised to stick with what you are currently using.  The Airsense 10 came out in 2014 and replaced the S9 which came out in 2009.  If we project forward, the machine models seem to have about a 5-year model life.  The truth is, even the S9 is a very good machine and little has change therapeutically.

I think for the lowest price and least hassle, just go through Amazon, although a warranty may justify doubling the price...sure!  Eat-popcorn Good luck, and drop that old machine off at Apria.  It's been paid for time and time again over the past 3 years. What a racket!
Sleeprider
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#5
RE: The Devil in the Details
(10-17-2017, 02:11 AM)baconjurer Wrote: So my question is - I've done well with my current set up. But I assume it's not the latest on the market. Is there any need to be concerned about obsolescence on supplies or parts down the road in the next few years if I simply replace my current equipment?  Is there anything I need to check on before I buy?   I plan on shopping among the suppliers on the list.

Equipment - mask, hoses, machines.

Masks:  Buy online whatever you are currently happy with.  They don't really go obsolete, and if your mask model does become unavailable, there is generally a "new and improved" version that takes its place.

Hoses: it's just a hose.  Some hoses are a smaller diameter than normal, and some machines have settings for those while some do not.

Machines:  You have a prescription, and probably all CPAPs can be configured to match.  Some have certain adustability options, and some have better recording capabilities than others.  You can always get what you already have if you are happy with it.
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#6
RE: The Devil in the Details
I vote for strong arming. You had a contract. They (all the theys involved) cannot change the terms of the contract without your consent. IMO
Sleep-well
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#7
RE: The Devil in the Details
(10-17-2017, 03:44 PM)Cpapian Wrote: I  vote for strong arming.  You had a contract.  They (all the theys involved) cannot change the terms of the contract without your consent.  IMO

I'm gonna get in trouble I bet. Contracts between patient, insurance, and DME's are like NFL owner and player. NFL is Not For Long regarding contracts IMO; they are never fully fulfilled as originally drafted (contract not player) and signed.

Bye. I'm already sitting in the corner. Thank you but I will take my coffffeeeeee with me.

Dave B.

lots-o-coffee
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: The Devil in the Details
(10-17-2017, 03:55 AM)Sleep2Snore Wrote: Things change so fast that who knows when they will change models.
You do appear well up to date with equipment, so you should be fine for a few years yet.
However, masks appear to change at the manufactures whim, I think they try to get the upper hand on others.
The machine is fine, but if you do camping etc it might be worth looking at a 12Vdc model, otherwise you will need a convertor to change it from 12Vdc to 24Vdc, however they can be obtained at a ridicules cost for what they are.
Otherwise I would stick with what works for you.
You could buy a second hand machine, but then you have to weigh things up, is it worth it?
Second Wind do second hand machines that have a limited warranty, but the cost of new machine have come down a bit.
If what you have works for you I would stick with it, I think you are well up to date with equipment.

Thanks.  I wasn't sure about the machine.
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#9
RE: The Devil in the Details
(10-17-2017, 04:03 PM)SarcasticDave94 Wrote:
(10-17-2017, 03:44 PM)Cpapian Wrote: I  vote for strong arming.  You had a contract.  They (all the theys involved) cannot change the terms of the contract without your consent.  IMO

I'm gonna get in trouble I bet. Contracts between patient, insurance, and DME's are like NFL owner and player. NFL is Not For Long regarding contracts IMO; they are never fully fulfilled as originally drafted (contract not player) and signed.

Bye. I'm already sitting in the corner. Thank you but I will take my coffffeeeeee with me.

Dave B.

lots-o-coffee
Ha Ha!  This is why fresh eyes are helpful.  I work for a plaintiff firm.  Heck yes to reading the contract and arm twisting and complaining to the insurance commissioner.   Thank you. I was overlooking those points entirely.
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#10
RE: The Devil in the Details
If you do decide to go it alone (but I would do some cage rattling as suggested in above posts first) Supplier #1 has been advertising their sale prices on the western Oregon radio station I listen to, particularly ResMed.
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