Insurance and DME supplier vs Online purchases

[ajthatch]

New to the forum but am a 7+ year CPAP user.

I’m not sure I understand the whole insurance/DME supplier relationship so I'll rant a bit.

By insurance requiring you to first rent the equipment for 10+ months, you are most likely going to reset the deductible at the first of the year (depending on when you start) and with a high deductible, you are basically buying the machine yourself at full retail (or more).

You can save a lot by purchasing online, but most of those suppliers won’t enter you in the Care Orchestrator or Airview system, which most of the doctors around here seem to insist on using.  My doctor monitors my data and occasionally sends prescription updates to the DME supplier who then loads it via Care Orchestrator to my machine.  So I guess for that ‘convenience’, you are forced to pay 2X what you could get the same machine for online.   It doesn’t feel to me like the patient’s best interests (at least financial) are being considered.  I can understand doctors looking for a consistent means of monitoring and understand the DME supplier has to make a profit, but 2X plus vs online purchase seems excessive to me.

Anyone else feel this way or am I viewing it incorrectly?

[Lucid]

Hi, ajthatch  Every insurance plan is a bit different, so it's hard to speak to your specific case.  With Medicare, though, you sign a contract with the DME that specifies usage requirements.  Assuming you meet those, you will own the machine outright after a specified number of months.  You don't get tripped up by deductibles.

You mention renting the machine for 10+ months.  It likely converts to ownership after that.  Anyway, that's the question to ask or to check in the contract.

Glad you asked the question.  It will be useful to hear from those with experience with different plans.

[ajthatch]

Thanks for the reply.  I talked to the insurance company and DME supplier today.  If I go through insurance it will be rent for 10 months and then we own it. Since the deductible resets in January, it would cost me $990 out-of-pocket with insurance.  If I don't go through insurance, their purchase price is $890. Keep in mind I can get this same machine online today for $550. However, this one is for my wife (her first one) and she isn't comfortable with me entering any prescription updates and the local DME only does so for equipment they sell. Thus, we will opt for full purchase out of pocket. 

So my real point in all this is the insurance coverage mostly seem a sham to me. The only way they would ever cover 80% of the total cost would be if we hit our $4500 deductible in January/February of a given year and then get a CPAP in February - what are the odds of that lining up?  

At least I received a new Philips DS2 as part of the recent recall, so by the time either of us needs another update we will be on Medicare and won't have the $4500 deductible issue.

[Uzupan]

I just purchased my ResMed airsense 11 from my supplier because my insurance was about to change and I would start all over on the rental with the deductible. So my supplier sold me my ResMed airsense 11 for 795. Not bad considering I only have had the machine since September.

[clownbell]

Insurance is a balancing act. One can select a plan with low monthly premiums but deductibles are high. Or a plan with low deductibles but higher monthly premiums. I'm not aware of one with low premiums and low deductibles.

Medicare is great. It pays for 80% and you pay for 20% -- or you could you pay 0% if you have so-called "medigap" insurance. Monthly premiums for regular Medicare are deducted from your social security check. Medigap involves an additional monthly premium.