Am I getting ripped off?

[willaien]

Was referred to a sleep dr. Diagnosed with sleep apnea (had to pay because I hadn't met my deductible). Now I have met my deductible, and for the dr's treatment, they're gonna bill my insurance $4000 for APAP to get my settings and I don't know if that includes a cpap machine at the end or not. My out of pocket is going to be $800. I'm going to call them tomorrow and get a breakdown of what this all means, but I feel like it's just for the APAP 2 week treatment. 

I feel like me and my insurance is getting taken for a ride by this doctor. Should I find another provider and just pay out of pocket? Feeling very frustrated right now.

Edit: it's possible that he's just gonna prescribe an APAP machine and I keep it, but I am not sure. Need to call them.

[Dormeo]

Get that breakdown, including the exact name and model of the machine. Let us know what you find out.

[Jeff8356]

That breakdown will be needed.  Did they mention anything about titration or PSG?  That would make more sense for that price.
The Dr usually doesn't supply the APAP machine. That typically comes from the DME.

but I feel like it's just for the APAP 2 week treatment.

Not clear what that means.  Will you be trialing an APAP for 2 weeks?

[Sleeprider]

Your insurance can be your ally in this. There is no requirement that a patient diagnosed with sleep apnea take a clinical titration sleep study. Nearly all insurance recognizes the use of Auto CPAP as effective in determining therapeutic pressures. Decline the titration study and request a Resmed Airsense 10 or 11 Autoset be dispensed for self-titration. This is your right. You can carry your diagnosis anywhere to get this prescription. You have a diagnosis and can skip ahead to the dispensing of auto CPAP. Explain to your doctor's office you simply do not have the disposable income to pay the costs and wish to self-titrate. If he refuses, use your primary care doctor.

[willaien]

Ok, an email cleared up a lot.

Insurance deductible + copay = $850 out of pocket for a Resmed Airsense 10 Auto. Including mask, etc. Which is not a trial for getting settings, but is what I will be using long term.

What appears to be happening is while I will own this equipment after 10 months, they're having me pay the rental fees up front and that goes into next year - thus I have to meet the deductible again (which it won't), which is why the price was so high. Insurance is essentially only helping to cover the first 3 months of the rental period and the extra accessories.

They appear to be acting as the DME or passing on the costs.

I thought that this was all being done with the 20% copay, thus my concerns.

This saves a couple hundred over buying it outright from one of the major suppliers, and starts next years deductible, so I think it makes sense to go with it.

[Brazen]

I don't know if I completely understand but...
You've met this year's deductible, right?
Can you ask them to charge you total cost of the machine now, instead of spreading it out over the next 10 months, and then only have to pay co-pay?  (I really don't know if it can work that way)

My DME charges me $80/mo for the machine, my insurance picks up their share and I'm left paying $23/mo.  After 12 months I own the machine.
I also have to pay a portion of the heater every month (which doesn't make sense when it's part of the machine) and I paid one time for hose, filter, headgear, and mask.

It's a racket.

Once you get your machine... make sure it has a SD card (may or may not come with one, I had to supply my own) and download the OSCAR software. Read the wikis on how to screenshot and save your OSCAR data and share it here for the experts to help guide your settings to optimize treatment.  You've landed in a good place.

[willaien]

You've met this year's deductible, right?
Can you ask them to charge you total cost of the machine now, instead of spreading it out over the next 10 months, and then only have to pay co-pay?  (I really don't know if it can work that way)

I have met this year's deductible, however I believe the rental requirement is a requirement of the insurance. They don't want to pay all at once just in case I am non-compliant.

[Big Guy]

I had an in-lab two night sleep study. I had BC/BS and Medicare at the time. No idea as to how expensive my two night sleep study was, but I understand it was on the pricey side. Medicare picked up 80% of the cost and BC/BS covered the rest. 

I was presented with a ResMed AirSense 10 AutoSet for a local DME. It cost me $56.00 initially out-of-pocket for the machine, and I think it was like $8.00 or so a month for 13 months, and then it was mine. 

That was my total cost!

[Jeff8356]

Insurance deductible + copay = $850 out of pocket for a Resmed Airsense 10 Auto. Including mask, etc.

Depending on your situation, for that price it may make more sense to buy the machine yourself from one of the online suppliers.
You can find them ranging in price from $913 to $1200 (no mask).  Supplier #2 also has "open box" units for less.  Then choose a mask.
You can ask your Dr for the printed Rx and get everything on your own.  It may cost sightly more up front but you can avoid all the headaches dealing with insurance and traditional DME's.

[Brazen]

@Big Guy
Medicare and BC/BS did you good!

@williaien. Yes, I forgot about that compliance piece.  My insurance had to see my 30 day compliance report before they would start paying.