hi all... just found this board while trying to figure out if i am asking too much.
i have a 4 year old machine that the sleep doc wanted me to try and repair instead of ordering a new machine. i have new insurance so i said no to that.
i looked and compared and decided on the aircurve 10 vauto. my treatment has changed a few times since my initial and follow up sleep studies.
couple this with the 5 year replacement cycle of the insurance company and i opted for a unit that has additional capabilities that are not needed now, but likely in the future.
all of the dme providers so far say its a special order item that costs 5k for them to get and it is not covered by insurance.
i call my insurance and they say that there is nothing that stands out as to why this would be denied.
my thinking is that the dme cant make all that much money on it and thats why they wont order or are quoting 5k out of pocket. is that true or am i over thinking this?
is this a rare machine or too much to ask for?
i wish i saw this board when i initially started cpap treatment... it would have save me a lot of time and money back then....
Switch suppliers. There is no such thing as a special order CPAP. They don't custom make them per user or design them on the fly. They are mass produced. They are so mass produced that CPAPs all have the same insurance codes.
CPAPs and autoPAPs have one code
biPAPs have another code
ASV PAPs (those used to treat central apnea) have another
No matter the machine and no matter the bells and whistles it does and does not have, the insurance pays the same amount based on that code. So if the machine you would like to have has more bells and whistles and the supplier would "lose" money, then yeah, they're going to try and talk you out of it.
Now, the problem is you are requesting a bilevel. Those things cost more and most insurance will balk at paying for one without you first "failing" regular CPAP. Is your current machine a bilevel? if it is, then there will be no problems. If it isn't, they may say on the phone, sure, we'll pay for it, but in reality, they may refuse at first.
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Much success to you as you continue your CPAP therapy.
Hang in there for more responses to your post.