Cheap tools and the most capable CPAP machines

[Sleeprider]

Mark, keep in mind there is the Craigslist option. While I have a prescription, both of the machines I have came from there. You can extend your search range by using Search Tempest which gives you access to all local listing across the U.S. There is a lot of junk, but a few properly priced gems out there. I'm sure you can find one.

[trailrider]

For me it was getting the mask right that was the critical to getting along with my machine. And the pressure. And not getting tangled up in the hose. Did I mention the cat playing with it, while attached to my face?

[iSnore]

I know how you feel, Mark. If they didn't require a prescription, I'd have probably already bought one impulsively out of pocket. But I've decided to go through the drill first. It's more fiscally responsible to let the insurance pay as much as they will, plus I really hope to get a good sleep study and titration out of it (yeah, I'm probably asking too much).

[Sleeprider]

I know how you feel, Mark. If they didn't require a prescription, I'd have probably already bought one impulsively out of pocket. But I've decided to go through the drill first. It's more fiscally responsible to let the insurance pay as much as they will, plus I really hope to get a good sleep study and titration out of it (yeah, I'm probably asking too much).

Actually, many DMEs seem to get away with charging about $2500 for a CPAP. Consider a 20% copay would be $500, plus any deductible, the cost of buying looks pretty good. Add in the cost of studies, and the nuisance of demonstrating compliance, and insurance may not look like such a good deal compared to roughly equal costs to buy a unit outright from an online provider.

[iSnore]

I know how you feel, Mark. If they didn't require a prescription, I'd have probably already bought one impulsively out of pocket. But I've decided to go through the drill first. It's more fiscally responsible to let the insurance pay as much as they will, plus I really hope to get a good sleep study and titration out of it (yeah, I'm probably asking too much).

Actually, many DMEs seem to get away with charging about $2500 for a CPAP. Consider a 20% copay would be $500, plus any deductible, the cost of buying looks pretty good. Add in the cost of studies, and the nuisance of demonstrating compliance, and insurance may not look like such a good deal compared to roughly equal costs to buy a unit outright from an online provider.

I looked up the Jan 2015 reimbursement rates at CMS.gov for the CPAP, Bilevel, and Bilevel with rate backup codes. Medicare/caid and TriCare require a 13 month rental. Here's what I found:

E0601 $106.47 x .2 = $21.29 x 13 = $276.82 patient (DME gets $1,384.11 total) AutoSet online = $883
E0470 $245.48 x .2 = $49.10 x 13 = $638.25 patient (DME gets $3,191.24 total) VAUTO online = $1,726
E0471 $614.34 x .2 = $127.65 x 13 = $1,659.44 patient (DME gets $7,986.42 total)
No wonder Health Net doesn't approve ASVs!

New
Nasal Mask (A7034) $112.53 x .2 = $22.51 patient
FF Mask (A7030) $180.47 x .2 = $36.09 patient

I think I'll put up with proving compliance (I have no deductible).

[Sleeprider]

iSnore, that is fine as far as you have taken it, however the DME bills separately for the humidifier, hose, fine filter, foam filter in addition to the CPAP/BiPAP/ASV main unit. And in addition to the mask, they bill for the mask cusion and headgear. Even though you buy those as complete units through online sources, they are itemized for maximum billing by every DME I'm aware of.

You are indeed fortunate to have no detectible. Many people I have met on this board have deductibles that require anywhere from $500 to $3000 out of pocket before ANY coverage kicks in, and then the coverage is 80% until the total out of Pocket ($6000) is met. These kinds of high deductible insurance policies are no longer rare. For those people, I strongly suggest looking at alternative avenues for purchasing these things outright. The costs through DME is unquestionably higher, even given the allowable. I think for some people the services provided by a conventional DME can be important, but for many of us, it is both unnecessary and financially burdensome.

[iSnore]

I certainly don't disagree that everyone should consider all the options in their situation, including just buying outright. That's the responsible thing to do.

Here's what I'm looking at (at 20% of the allowed amount):
$21.29 first month AutoSet rental + $12.78 heated hose + $22.51 nasal mask = $56.58

12 more payments of $21.29 = $255.48

[vsheline]

Here's what I found:
...
E0470 $245.48 x .2 = $49.10 x 13 = $638.25 patient (DME gets $3,191.24 total) VAUTO online = $1,726

An example of fair price for premium but slightly used machine (professionally cleaned, with 6 month warrantee) would be the premium model below, from Supplier #2 (a link to the Supplier List is located at top of each forum page):

[start ad]

Gently Used Respironics System One DS760 BIPAP Auto Machine
Optional heated humidifier available for $70.00 at the bottom of this page.
Low hour, gently used, 6 month warranty.
$649.00

[end ad]

Would need to add at least the $70 (heated humidifier) and would need to call before ordering to find out how much more (if any) would would be needed for the heated tube and the larger power supply (80 Watts instead of 60 Watts, I think) needed for the heated tube (which I strongly recommend).