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question and no time
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Sleeprider Online
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Advisory Members

Posts: 3,345
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #11
RE: question and no time
Hope it all works out Marc. When you're pushed for time, it's hard to get everything straight. Your insurance can verify their requirements for rental or purchase. The extra charges don't make sense to me unless it is based on copay or deductible.

If you ever need to run your CPAP on DC battery power, you'll be glad you have the PRS1 Auto 12 volt unit instead of the Resmed 24 volt power pig. Other than that function and data are mostly the same. Cost differential is in large part integrated components in the Resmed, including humidifier, WIFI modem and it is a more progressive design. Full disclosure, I have a couple PRS1 units (Auto CPAP and BiPAP), and like that they are smaller and carry on the motorcycle and travel well. Keep us posted how it goes.

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(This post was last modified: 08-04-2015 08:02 PM by Sleeprider.)
08-04-2015 07:59 PM
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Marc615 Offline

Members

Posts: 17
Joined: Aug 2015

Machine: unsure
Mask Type: Other
Mask Make & Model: unsure
Humidifier: unsure
CPAP Pressure: unsure
CPAP Software: Not using software

Other Comments:

Sex: Male
Location:

Post: #12
RE: question and no time
Thanks for all the assistance.
They had a 560 auto non heated, said they don't sell the heated hose unit.
It was an after hours appt with one lady in the office that didn't have any answers to billing or costs so i declined getting the machine until I could speak with someone that could break down full cost analysis and tell me not only what the monthly charge is going to be but how long would it be for? is the machine mine at end of 10 months paid in full or a balloon payment at the end?
no answers?

she said if I was to buy the machine the code charge would be $970 to insurance and another 250 for the humidifier, 135 for maske, 35 for hose. I did catch that they had $15 for filters added to the initial bill when the machine comes with a set already. I told them they would have to remove the filter fees.

she said for rental my portion would be 9.70 a month for 10 months which indicated to me that the rental is a 10 month 10% payment until paid in full with no balloon at the end based on the rental fee vs the purchase fee but she couldnt verify.

in the meantime, I brought my old (new condition) remstar M series in and set my pressure to 14 as the scrip was 11-18.
they also said they dont have the p10 pillows. she tried the swift fx and it was ok, but then I tried the wisp nasal mask and it was very comfortable.

I only walked out with my old machine adjust, a new hose and mask and think i will be back this week for the 560 if someone can verify costs at the office. I think either way rent to own for 10 months or purchase will cost the 970 machine and 250 heated humidifier. seems high compared to online but Insurance is not paying online suppliers.

from stories I have seen, what she was telling me (still have to verify during business hours with accounting) for the duration of the next ten months the charge to insurance would be as follows with me not having a deductible but having a 10% co-pay responsibility.

next ten months billed to ins= machine $97.00 a month, humidifier one time charge $250, headgear $89 one time, mask$35 every few months, misc filters etc. at ten months the machine is mine and then only maintenance costs of replacement filters, masks, etc.

I need to work on making the the machine term shorter before picking it up so that it is paid off within this calendar year where my deductible has already been met though.
does this sound reasonable?
08-05-2015 10:27 AM
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Sleeprider Online
Wiki Editor
Advisory Members

Posts: 3,345
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #13
RE: question and no time
I think you hit on the biggest problem with rental is that it will span two deductible periods. The math in that case becomes whether you should buy out of network with 40% copay? You would have to ask your BCBS insurance.

Let's assume, you buy a PRS1 Auto with heated tube and humidifier for $750 from Supplier #1 (there are less expensive alternatives). Assuming you have met your deductible this year, your total cost with a 40% copay is $300.00 after reimbursement. You own the machine, no B.S. from the DME. If you rent for $10 over the next 10-months, your cost is only $97, but you might end up in a new deductible period where your costs are the full rental including your copay. In other words, I think you will easily exceed the cost of out-of-network purchase after reimbursement.

That assumes out of network is a 40% copay for you, not something less. If your out of network is 20 or 30% this is a no-brainer. You can choose to get masks and supplies through that DME or not. The total cost of a complete mask through online suppliers is $100 and that gets reimbursed based on out of network policy. I have found that it beats the DME markups and charges for individual mask components. I have one of the flavors of Anthem BCBS and out of network is not a problem. Your policy will likely be different.

Ask your insurance about out of network, and alternate DMEs in your area. Shop. As long as you have a working M-Series, you can take your time and get the right unit and equipment you want.

______________________________________________
Organize your SleepyHead Data
Post your SleepyHead Data from Imgur
Robysue's Beginner's Guide to Sleepyhead
(This post was last modified: 08-05-2015 10:48 AM by Sleeprider.)
08-05-2015 10:42 AM
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Mosquitobait Offline

Advisory Members

Posts: 746
Joined: Apr 2015

Machine: Resmed AirSense 10 For Her
Mask Type: Nasal pillows
Mask Make & Model: Airfit P10
Humidifier: integrated, Climate line tube
CPAP Pressure: 9-12
CPAP Software: ResScan SleepyHead

Other Comments: RLS and Bradycardia

Sex: Female
Location: Minneapolis

Post: #14
RE: question and no time
Another thing to consider is just buying the machine through insurance and getting the heated humidifier online. With Resmed Airsense, you couldn't do this since the humidifier is integrated, but you certainly can do so with others.

Finally, I want to mention that your deductible may not include durable medical equipment. In other words, you wouldn't have a big payment in January because of a rental in January.
08-05-2015 10:51 AM
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Marc615 Offline

Members

Posts: 17
Joined: Aug 2015

Machine: unsure
Mask Type: Other
Mask Make & Model: unsure
Humidifier: unsure
CPAP Pressure: unsure
CPAP Software: Not using software

Other Comments:

Sex: Male
Location:

Post: #15
RE: question and no time
(08-05-2015 10:51 AM)Mosquitobait Wrote:  Another thing to consider is just buying the machine through insurance and getting the heated humidifier online. With Resmed Airsense, you couldn't do this since the humidifier is integrated, but you certainly can do so with others.

Finally, I want to mention that your deductible may not include durable medical equipment. In other words, you wouldn't have a big payment in January because of a rental in January.

thank you for the update, I am calling BCBS again...
08-05-2015 12:15 PM
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MobileBasset Offline

Advisory Members

Posts: 198
Joined: May 2015

Machine: ResMed AIRCURVE 10 V Auto
Mask Type: Nasal mask
Mask Make & Model: Fisher Paykel Zest
Humidifier: Integrated
CPAP Pressure: 10 (minE 6,maxI 12, PS 3)
CPAP Software: ResScan SleepyHead Other Software

Other Comments:

Sex: Female
Location: Florida

Post: #16
RE: question and no time
I usually don't get hung up on the deductible issue with payments rolling into the new year because I never have a year anymore where I don't easily exceed my deductible. Too many annual visits required these days. However it would depend on the amount of your deductible so YMMV.

if you can't decide then you don't have enough data.
08-05-2015 01:57 PM
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