CPAP machine and supplies? Insurance or not?

[Fatheaded]

Explain to me the benefits or not of going through insurance or just paying cash for a new cpap machine and supplies? Is one way preferred to the other?

[Melman]

It depends on your insurance coverage. Some have insurance that pays 100%. Mine doesn't but I pay much less than I would without insurance. The only way to know is to check with your insurer and compare with suppliers on the list at the top of this page. If your dealing with a DME I believe it's best to use insurance even if your overage is poor. Most DMEs charge inflated prices bur your insurance provably has a contracted lower rate that will limit what you pay. There is no one size fits all answer.

[Rich66]

I tried going through my DME to buy a mask, and would pay with a credit card. I think they had to look up how to do that, if they could do that, and they told me to try someone else on the internet. It was like a cuss word to them. So, I went to the Bezos company, and did well with them. You can't order a whole assembly of a mask, but you can order each individual piece and get all the pieces. And Medicare is paying 100% of the resupplies for the Bezos bought mask.

[Rcgop]

What the DME calls supplies I call replacement parts. I pay 20% so I replace only when broken and they don’t break. I am using a hose from 6 years ago. My tank is still the original.  Mask and mask parts every 6 months but that is going to change. Everything still looks and works like new. 

Ok, filters are supplies. I change them once a month.

[Sleeprider]

As mentioned above it depends on your insurance deductibles, copays and the amount of hassle and expense to get sleep studies etc. If you have a prescription for CPAP, you can currently buy a new Resmed Autoset for #499 from Supplier #1 with code RESMED23. So if that pencils out for you, then go for it, and you can be using CPAP by the end of the week.

[Crimson Nape]

I tried once to use a DME through my medicare insurance. My co-pay was higher than what I could buy it for outright via the internet. I never used insurance again.
- Red

[Sleeprider]

I tried once to use a DME through my medicare insurance.  My co-pay was higher than what I could buy it for outright via the internet.  I never used insurance again.
- Red

Now I feel guilty. I get 100% coverage for my Vauto, but was recently bitching my DME had the nerve to try to charge me $10 per month for a PAP monitoring device.  I actually escalated it to Medicare and had the charges withdrawn.  OMG, I'm cheap!

[Melman]

I tried once to use a DME through my medicare insurance.  My co-pay was higher than what I could buy it for outright via the internet.  I never used insurance again.
- Red

Hmm. I recently bought a spare airsense 11 water chamber from my DME and my medicare advantage copay was only $9 vs $29 at supplier 1.

[Sleepster]

My supplies cost me about half as much if I use my insurance. I have to get my prescription renewed via a doctor's appt every year.

[unadvisedfun]

Doing it again: I would buy an aircurve vauto out of pocket the day I got my diagnosis. Supports cpap apap and bilevel modes of therapy.

One consideration is the trade-offs for delayed care. I developed hypertension in the 6 months between diagnosis of apnea, referral to a sleep doc, multiple sleep doc appointments and finally getting a machine through insurance and a DME.

Changing mode of therapy can be challenging with insurance: I needed bilevel but insurance wasn’t interested in paying for that or the in lab sleep study to prove it was medically necessary. I got a barely used bilevel out of pocket and sleep better than ever.

I realize not everyone can afford that upfront cost but sometimes it is a time ( time= delayed treatment) versus money trade-off. In my case it was cheaper and faster to get my own bilevel machine.

Yes I could fight the insurance company, schedule the study, have another office visit to talk about the results, finally get the prescription updated with the DME, wait for the dme to call and ask for something, and wait for it to arrive. Meanwhile I would have endured months more poor sleep and payed a copay near the cost of a used or maybe even a new machine.