Insurance doesn’t cover rent-to-own

[orand]

I’m newly diagnosed with OSA, so am drinking from the firehose with this wonderful forum.

I just called my insurance asking about their coverage for CPAP machines, and they said that they will cover either a rental up to six months, or a purchase, but not both.  They warned that many DMEs will try to force you down the rent-to-own path, and if I fall for it, then insurance will only cover 6 months of rental and refuse to cover the eventual full purchase.

I assume this means that the obvious best choice is to insist on directly purchasing my new CPAP up front, but wanted to double-check with the more experienced folks here whether that is indeed the best strategy, and any downsides I might not be thinking of.  Thanks!

[Big Guy]

My insurance (Fed. version of Blue Cross / Blue Shield) not only paid in full for two in-lab sleep studies, they also paid for 13 months of CPAP machine rental, which my portion was $9.09 a month. After the 13 months, it was my machine, although the DME did try to convince me otherwise. It didn't work! 

When initially picking up my machine, my out-of-pocket (co-pay) was $60.00 or so. I've seen brand-new ResMed AirSense 10 AutoSets for $600.00 or so. That's with a humidifier and a ClimateLine hose. 

Now that I'm on Medicare, my BC/BS is my secondary insurance. Not sure what will happen when I'm due a new machine in three years or so. 

[SarcasticDave94]

I suppose you can tell the DME to bill for full purchase to be sent to the insurance for approval. Make sure to get a ResMed xPAP, as most here are treated better via the therapy. Some do better with Respironics, but it's not the majority that do. You tell the DME what machine you'll accept not the other way around. And you can discuss machine choice with your doc, but you state your choice. If possible, tell doc to write your preference on the script with the magic phrase Dispense As Written. The DME will hate you for a DAW script, but so what.

Under no, nada, zero, none, not any circumstance do you give the DME your bank account, credit card, debit card, etc. info.

[OpalRose]

I’m newly diagnosed with OSA, so am drinking from the firehose with this wonderful forum.

I just called my insurance asking about their coverage for CPAP machines, and they said that they will cover either a rental up to six months, or a purchase, but not both.  They warned that many DMEs will try to force you down the rent-to-own path, and if I fall for it, then insurance will only cover 6 months of rental and refuse to cover the eventual full purchase.

I assume this means that the obvious best choice is to insist on directly purchasing my new CPAP up front, but wanted to double-check with the more experienced folks here whether that is indeed the best strategy, and any downsides I might not be thinking of.  Thanks!

It seems that insurance policies are varied in their coverage for Cpap equipment.  Don't trust what a DME tells you... always check with your insurance company first.

Under Medicare, the norm is that Medicare Pays for the first three months rental at approximately 10% of the cost.  This is the compliance period.  After that, if you have been compliant, they continue payments for another 10 months, and at that time you own the equipment.  Some Medicare policies require you to pay a portion of the rental and other policies pay 100%.

So you really have to be the one to do your homework and check your coverage first.

[GuyScharf]

Now that I'm on Medicare, my BC/BS is my secondary insurance. Not sure what will happen when I'm due a new machine in three years or so. 

Presuming Medicare approves a new machine, they will pay 80% of the cost.  If BC/BS is a supplemental policy, it will pick up the 20%, possibly with a deductible, depending on which Medicare Supplement plan you have.  In my case, I have Plan F, so the supplemental insurance picks up the remaining 20%, resulting in a net cost to me of zero for a new machine.

[Big Guy]

Now that I'm on Medicare, my BC/BS is my secondary insurance. Not sure what will happen when I'm due a new machine in three years or so. 

Presuming Medicare approves a new machine, they will pay 80% of the cost.  If BC/BS is a supplemental policy, it will pick up the 20%, possibly with a deductible, depending on which Medicare Supplement plan you have.  In my case, I have Plan F, so the supplemental insurance picks up the remaining 20%, resulting in a net cost to me of zero for a new machine.

Yes, I think between MediCare and my BC/BS, my out-of-pocket expense will be zero. BC/BS told me that they will pick-up whatever MediCare doesn't.

[staceyburke]

My experience was a little different. After 5 years I wanted a new machine (ResMed instead of Phillips) and was told mine had to be “non working”. They went on to say if it had been dropped or water damage I could get a new on BUT the Sam model. If I wanted a ReaMed i would have to have another sleep study. With covid that was going to be a while.

So I purchased a used one from Supplier #2. Then went to my primary Dr and took OSCAR charts from my old and mew machine. She wrote me a prescription for the ResMed VAUTO. I submitted it for durable medical equipment and got a check in the mail for full price. Used 799.

I did NOT think I would get but I tried and they approved it.

[Hydrangea]

I suppose you can tell the DME to bill for full purchase to be sent to the insurance for approval. Make sure to get a ResMed xPAP, as most here are treated better via the therapy. Some do better with Respironics, but it's not the majority that do. You tell the DME what machine you'll accept not the other way around. And you can discuss machine choice with your doc, but you state your choice. If possible, tell doc to write your preference on the script with the magic phrase Dispense As Written. The DME will hate you for a DAW script, but so what.

Under no, nada, zero, none, not any circumstance do you give the DME your bank account, credit card, debit card, etc. info.

I agree with what all the others have said, and especially with SarcasticDave.

Don't give the DME any of your financial info, besides your insurance info.  

Don't trust the DME. Call your insurance directly to find out how they cover it. And then do what your insurance says. If they are going to just buy it outright, go that route.

[Homerec130]

DMEs are not your friends, although they may try to be. There used to be some good ones out here in the southwest, but with the recent mergers and buy outs and divestitures the field has drastically changed. I started out with Symbius and had really good experiences. That portion became Pacific Pulmonary and they were bought by Adapt Health. Tibro moved into the equation as well (that is who my wife has). Impossible to talk to billing, it is just leave a message. That is another reason to follow SarcasticDaves advice and never give them any payment info. I am on Medicare and they do a "rent to own" with payments for the first 13 months and then it is yours (at least according to my EOBs). When I got my last machine machine, my compliance was waived because I had already been established.

We are fighting with my wife's DME compliance section as she has a new machine (4th one) and they are giving her the story that she needs to meet compliance. Medicare says she already has. She went thru 3 Dreamstations over a two year period, the first 2 threw error messages that said contract support. She got the third machine and then we changed doctors. Her current doc looked at what numbers she had and said you are on the wrong machine. She ordered a new sleep study and found she has a very complex situation especially due to the meds she is on. She ordered a different type of machine and ordered a trial period on the machine (3 months) to see if it worked. My wife's doc is working with the respiratory therapist at the DME who we found out later the two of them trained together. The therapist is really good as we have worked with her several times. She s the one who questioned the settings the first sleep doc had for the machine which prompted the switch in docs.

[greatunclebill]

Now that I'm on Medicare, my BC/BS is my secondary insurance. Not sure what will happen when I'm due a new machine in three years or so. 

Presuming Medicare approves a new machine, they will pay 80% of the cost.  If BC/BS is a supplemental policy, it will pick up the 20%, possibly with a deductible, depending on which Medicare Supplement plan you have.  In my case, I have Plan F, so the supplemental insurance picks up the remaining 20%, resulting in a net cost to me of zero for a new machine.

Yes, I think between MediCare and my BC/BS, my out-of-pocket expense will be zero. BC/BS told me that they will pick-up whatever MediCare doesn't.

with medicare and tricare for life, i pay nothing for tricare for life and part b cost for medicare. medicare pays 80% and tricare for life pays the other 20% and the medicare deductible. in 6 years on medicare i have paid a total of nothing out of pocket except small copays for drugs which is different,