[split] CPAP Machine Choices - Jerry Sends Buying CPAP Out Of Network

[Jerry Sends]

I am probably going to buy a machine using $ of pocket. My insurance is terrible. I am Part of the Phillips recall, expecting my replacement in another 6 months (recall registration in 11/21)... Should I buy a Resmed Auto 10, Luna 2, or a travel cpap?
This may be temporary as the Phillips replacement is coming in 6 months...What would you do?

[Gideon]

Resmed Autoset either A10 or 11
Your replacement can be a backup.

Definitely not a Luna, The Resmed travel is not OSCAR compatible and the regular ResMeds are easy to travel with.  The PR travel is OSCAR compatible but is also under recall.

[Jerry Sends]

Thanks,  is $1,250 a fair price to pay for this?

[Gideon]

That's the current going rate,
you can check out Supplier #2 as they have warranteed low hour used devices, call them and they should be able to tell you the number of run hours on the machine you would get. Figure 5 year life at 3000 per year, I have 18,000 at 5 years just as a framework.

[Jerry Sends]

Will do, I am considering buying online, then submitting to my insurance.  The online suppliers are out of network & my insurance does a 10 month rental to own with compliance checks.  If I'm lucky,  they will reimburse some towards my deductible.  The local DME suppliers have the Luna 2.  When I did this through insurance with the Phillips CPAP, it would not have saved me much by going through insurance.

[Jerry Sends]

Wow, insurance is being a PITA.  I hoped to get at least partially reimbursed.  All of the approved suppliers are 3 or more months out from having ResMed machines available.   The insurance refuses to pay a penny towards a machine bought online.   I worked my way up the insurance customer service chain, but only got lies & pushback.  Next step, complaint to State insurance commission.

[Jerry Sends]

Wow, insurance is being a PITA.  I hoped to get at least partially reimbursed.  All of the approved suppliers are 3 or more months out from having ResMed machines available.   The insurance refuses to pay a penny towards a machine bought online.   I worked my way up the insurance customer service chain, but only got lies & pushback.  Next step, complaint to State insurance commission.

The insurance rep just called.  They are going to make an exception and reimburse me for a Resmed 10 autosense from the online supplier at the in network rate - after deductible & coinsurance.  At a minimum,  this takes care of my deductible for the year & I can get back to sleeping.

[Sleeprider]

Jerry, congrats on getting an exception from your insurance. This is an important topic and I have split it from the CPAP Machine Choices mega-thread so it can focus on getting your machine and perhaps help others that are having trouble getting machines on a timely basis through the usual channels.

[Jerry Sends]

What I learned from my skirmish with the insurance "customer service "representatives:

• Don't take no for an answer if insurance refuses to pay or wants to pay at out of network rate, ask for a supervisor 
  
• Ask for the supervisor of the supervisor if you aren't getting anywhere 
  
• The CS lower level CS folks have little power, upper level, significant.
  
• You may have a representative from your employee group within the insurance CS chain, we did.  A Very helpful person. 
  
• You will have to jump through hoops, document the time & steps taken, do your due diligence & explain how frustrating the process has been.
  
• Insurance companies have the power to make reasonable exceptions if they know all the facts & about your medical complexities that put you at greater risk of landing in the hospital 
  
• You can request a "Benefit Level Exception" to move equipment purchases/service from out of network to in network if there are extenuating circumstances such as no machines available locally or long wait lists.
  
• If denied, write an appeal letter stating extenuating circumstances & medical complexities.  This is reviewed by a separate medical board.
  
• You can always submit for reimbursement even if they may deny, sometimes it slips through. 
  
• Insurance companies really want to avoid significant time/paperwork and/or a complaint to the state medical commissioners office.  Be the squeaky wheel. 
  

[Sleeprider]

Wow, that material needs to be in a wiki. Like this: http://www.apneaboard.com/wiki/index.php...&section=8