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Rice95 Therapy - Printable Version

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RE: Rice95 Therapy - Rice95 - 04-30-2021


Yes. It’s very upsetting. I appreciate your sentiments. 

The next time around I’ll go through a DME. If so, does a DME accept insurance or is that only through a doctor ? 
I’m planning on getting another machine in about 5 years since it’s meeting my needs but I’ll want the better one next time.

RE: Rice95 Therapy - Sleeprider - 04-30-2021

(04-30-2021, 05:03 AM)Rice95 Wrote: Thanks Dave. Its only been 3 months since I've started using it. I could have just bought it outright without the hangup of insurance compliance and paid a lot less for it. 

I have my chart attached from last night. Ive been doing great the last 2 nights with numbers around 1.3. Last night they jumped. 

I've been using a flat pillow and a collar faithfully each night. I suffer from stomach issues so my pressure now is still at 10.5. I'm also going to do away with the ramp eventually-----

My OA increased last night and I'm not sure why  if I'm following the guidelines?

You should follow up with your insurance to see what recourse you may have. Here is what I think happened.  Your machine was not discounted, it was covered by insurance. In most cases any claim is subject to usual copays and deductibles, but sometimes the seller actually tacks on charges and additional costs that are not covered by insurance.  For example, most DMEs will invoice $1100 or more to the insurance company, but are reimbursed the usual and customary costs. That is usually about $600 for a CPAP machine.  Note, they invoice separately for the humidifier and chamber, tubing, mask, filters etc.  Most of the time a DME accepts the insurance reimbursement as payment in full, but in your case they just charged you the difference between what insurance covered and what they wanted.  This is unethical, and you have to realize that this practice exists, and take steps to avoid it. They made a lot of money off you that most providers would not have been able to accept. Check with your insurance company if your provider was in-network.  An in-network provider agrees to accept the insurance reimbursement as payment in full. Out-of-network providers have no agreement, and when you accept a machine from them, you may be subject to much higher costs.  Never, ever use a provider out-of-network, even if you are referred to them. Get a referral to an in-network provider. It's up to you now to research the in-network alternatives and change providers. It's unlikely you have any recourse for the past over-charges.

RE: Rice95 Therapy - OpalRose - 04-30-2021

This is where you have to know your insurance coverage... they will have a list of DME's in your area that they are contracted with.  Then you start calling them and get a feel for how they operate.  Always find out if they sell all brands of cpaps as some will only sell Respironics.  

Be sure that you don't buy another Cpap through a doctor, and don't let them charge anything on your credit card. 
Go through a DME contracted through your insurance.

Also, you will have to determine if you have a high deductible whether to go through insurance or buy outright.  There is also the consideration that some DME's may not sell you supplies without getting your machine through them.

When you contact your insurance, please let them know that you were charged this extra $1100.00. See what they say and what if anything can be done.

Here's a similar issue that my husband went through with a hearing specialist while hearing aids.
Cost of hearing aids was $5500.00 The specialist came back and told my husband that we would have to pay the difference between what insurance paid and the total cost. They then set up a credit card and charged us the difference.
I went on line, and saw that after Humana's write off and payment, we only owed $250.00. They charged us over $3500.00.

I called Humana, explained the situation, and they said that the hearing specialist was contracted with them and had to accept their payment in full and was not allowed to charge us the difference. Needless to say, that the amount was refunded and credit card set up through the doctors office (without our knowledge) was cancelled.
Talk about a scam!

Don't want to hyjack the topic, but just want to show you how they can take advantage if you aren't up to par on what coverage you have.

RE: Rice95 Therapy - Rice95 - 04-30-2021

Opal Rose

Thank you so much. I have already reached out to my doctor and requested my prescription and my diagnosis so I can can this guy and move on. Before I can him, I will find out from my insurance company if they are monitoring my therapy. I would think they wouldn’t be because considering I dropped an 1100.00 bomb , I should own the dang thing

RE: Rice95 Therapy - Sleeprider - 04-30-2021

I'm so sorry this worked out badly due to a greedy, arrogant physician pretending to be your care-taker, and actually only being your taker. It's awful that the sleep medicine business is so full of charlatans and thieves. We are here to do what we can to prevent that and get you back to even, and benefiting from better therapy. We have articles in the Wiki on dealing with your DME and even the link where we distribute clinical manuals is full of "medical mafia" issues. There are great doctors! Just don't use the sleep specialists. It is a thieves den.

RE: Rice95 Therapy - Rice95 - 04-30-2021


Thank you all so much for helping me out. 
I did manage to get my signed prescription today and I have my sleep test in hand today. 

I’m going to stick it out for 5 more years and get the life out of the machine and then take my script to a DME and make sure they are affiliated with my insurance and ditch this Dream machine. Paying 1100.00 for it I’m going to drive it into the ground. Right now it’s meeting my needs. I only have moderate apnea. 

I’ll continue to post and I appreciate all of you so much

RE: Rice95 Therapy - SarcasticDave94 - 04-30-2021

Best to your success. Between now and the time you need a new PAP, you'll be fully versed in DME's and Dr. McQuack's trickery. You stick with us for oh about another day and you'll be much better than they at PAP therapy.

RE: Rice95 Therapy - Rice95 - 05-01-2021

Thank you to everyone!

Well, back to the analysis. My last 2 nights(one posted yesterday)and then this one this morning. 

I don't know why I am still having OA clusters. I am wearing my collar and using a flat pillow and sleeping on my side.

This is frustrating me because my numbers before were 1.3, 1.5 etc...

As you know I suffer from excessive air retention so my pressure is at 10.5. I'm also at a Flex 2 which is very helpful. I'm still ramping but its already up to pressure within 10 minutes and I'm perfectly relaxed by that time and able to fall asleep. I am not able to start at 10.5 right off the bat. 

what's going on here ?   Huh

RE: Rice95 Therapy - OpalRose - 05-01-2021

I can only assume you are still tucking your chin to your chest somehow even with the collar on.  Or your head and neck are tilted forward.

The collar shouldn't be so tight as to restrict movement, but yet you should be able to get a couple fingers under it.  
You don't want an area where your chin can drop below the collar.

Have you read this?


RE: Rice95 Therapy - Rice95 - 05-01-2021


I made sure the collar was a secure fit but not too tight. Should it be able to rotate around the neck or is that too loose? I really thought it was snug last night. I’m assuming if it is snug enough to prevent the chin from dropping that it would still be able to rotate around the neck because it’s not supposed to be skin tight 

Do you think that the collar and the pillow together are too much ? 
My pillow is flat and I’ve gotten good readings with both the collar and pillow together ...this is a mystery 

Yes I read that thread