CPAP Rent from DME

[FozzyDaBear]

Hi, I'm currently renting my Resmed Airsense 10 from my DME. I'm only into my second month. The DME said my insurance will pay for the rental for 12 to 13 months. They're currently billing $251 per month to my insurance. I've already met my deductible so I only have to pay for 25% of that per month. At the being of the year, I'll have to sign up for a new insurance plan and meet my new deductible before insurance starts to kick in. I'm thinking it might be cheaper to try to buy one than do the rent to own deal but exploring options.

Is it possible to switch DME's? If so, what happens to machine I'm currently renting?

[big_dave]

That $251 per month sounds very high. You will want to check your EOB and/or call your insurance company to find out what the allowed amount is. Your 25% is based on the allowed amount, not the amount that the DME bills. You will want to find out the actual amount before making a decision.

It is possible to switch DME's. You would need to turn in the machine and start over.

Buying a machine outright is certainly worth considering. The online suppliers on the supplier list generally give better pricing than local DME's, but may or may not be eligible for insurance reimbursement depending on your insurance. The online suppliers do not handle insurance billing.

[Sleeprider]

I would certainly buy a unit. The Resmed Airsense 10 Autoset is currently selling on Amazon for $440 to $515 (prices vary daily). You would have owned your machine by now. It looks like you're using a fixed pressure of 8.0, and anything you buy online can be set to that setting, or you can change to autoset mode. You can continue to get masks and supplies from your current provider, or find the best deal. It sounds like their markup is outta sight.

[FozzyDaBear]

OF the $251.99 monthly rental billed to insurance, the discount is $88.20 and the covered amount is $163.79 so $40.94 is my coinsurance amount. I have Cigna and I called them and they said it could be purchased instead of rented so I'm going to have my DME bill it as a purchase next month and see what happens. Hopefully, they won't fuss about needing more time to track compliance.

I've already met my deductible for this year so if I'm going to buy it through insurance, now would be the time to do it. The DME said they would bill $1600, which the remainder after what's already been billed (yes, total cost of the unit would be $2100). Tracking the rental EOB, the allowed amount is 35% so the covered amount would be $1040. My coinsurance on that would be $260. (based on the DME estimate of course).

Gotta love US healthcare.

[HDCowboy]

I'm in the same boat, just got diagnosed and I have Anthem Blue Cross Blue Shield, already met my deductible this year and also renting a Resmed, an Aircurve S, to be exact. I talked to the DME when they brought me the machine and they said my payment out of pocket for the machine would be $105 a month next year! I started looking on Craigslist and found an AirCurve Vauto barley even used (it had 33hrs on it) and the guy wanted $450 for it, wound up talking him down to $400 on an almost brand new machine that sells for $1800, he even threw in a brand new sealed heated tube and some other goodies with it. Damn if I was gonna pay $105 a month for a machine! DME claimed my ins would only cover a rental and not a purchase. Still have to return the original machine by the end of the year though, just aint felt like driving 50 miles to do it, only used it for like a week.

[Sleeprider]

I think Fozzy has it figured out. Many DMEs put these on rental contracts because they are more profitable, even when insurance will buy after 3-months. Well done getting the straight story from a crooked situation.

[Mosquitobait]

Great that you are able to purchase. For those of you in these schemes, if you have a machine and have to report hours/AHI to DOT, you have to move more carefully. Make sure all info is downloaded and transferred to your doctor so you don't lose compliance for your licensing!