RE: CPAP machine and supplies? Insurance or not?
Through my DME I get a box of supplies every three months at no cost. Different goodies in each box because of the insurance replacement schedule.
I tried to order something else through them using insurance and they couldn't figure it out, suggested I just order from vendor #1.
I have figured out they are charging insurance an inflated cost that I will bring to their attention. $400 for 3 airtouch cusions, heated hose, and 6 filters. Even at full retail that would only be $200ish, and we know they don't pay that.
RE: CPAP machine and supplies? Insurance or not?
My insurance is very high deductible (~$13k for the family or $6.5k for an individual), and in fact provides me no benefits whatsoever until I get to that deductible. At least it's 100% coverage after that, but since it is unrealistic for me to spend those kinds of dollars in a year without serious trouble like multi-night hospital stays, I get to play "Deal or No Deal" every time I spend money on medical stuff. I always ask the cash price, and then decide if the inflated price charged to insurance is going to get slashed down to below that price or not. I found that physical therapy is cheaper for me to pay for out of pocket, didn't even try to bother with CPAP stuff since the black friday deals looked solid. As was mentioned a couple posts ago, I also felt like the time was worth pushing for at full tilt with my own wallet open. Still took me almost a week to get my papers in order and the machine to ship.
RE: CPAP machine and supplies? Insurance or not?
Wow, do I feel fortunate now....
This year I am on a HDHP that had a deductable of $3200 and out of pocket max of $7200
Next year I am on surest, less per month, 5k out of pocket max, no deductible... but it is pay as you go for services which you can lookup prior to getting something done and it varies wildly at different locations here at the denver metro area.
On both plans cpap supplies are covered 100%,
RE: CPAP machine and supplies? Insurance or not?
There are many factors when considering whether or not to use insurance. What is your deductible? Have you met your deductible? What time of year will you be having a sleep test, getting equipment, etc?
I started my sleep apnea adventure with a pulmonologist in October 2022. I liked him but the cost of a home sleep test or in-clinic test was 3x higher than the average listed online. This was in-network at a hospital that has financial issues. I have a high deductible plan, so I would be responsible for the entire cost. I shopped around and found another in-network sleep doc that was much more reasonable (it was a different hospital group). I took my sleep tests early in 2023, so even though I had to pay for those, I met the deductible early enough that my ResMed Aircurve ASV and supplies are much cheaper than they would be if I paid all the cost out of pocket. (Coincidentally, this was also the year I started on prescriptions I didn’t have in 2022 so, again, more towards the deductible.)
Now I have to calculate what costs will be in 2024 when I don’t have the sleep tests. I’ve gotten whatever supplies insurance has covered, so I think those will last me for a while. It probably won’t make sense to run replacements through insurance.
Side note: I spent a lot of time talking to the DME before I got my equipment. They were more helpful than the insurance carrier when explaining my coverage (in fact, the insurance company was so inept that they told me to “just ask the equipment supplier what’s covered”). And they gave me more information about starting and adapting to therapy than the doctor did.
