After insurance, patient responsibility is $175.66.
My supplier for these items has been my doctor.

CPAP: $1430
Heated Humidifier: $603
Mask interface: $235
Headgear: $80
Tubing 6 ft: $82
Filter disposable: $40
Humidifier chamber: $78
Nasal cushion: $81

I looked up filters and they are significantly cheaper on some websites. Is my doctor massively ripping me off? Need I even ask? Is this what you guys are paying?

Note: The CPAP was returned but now I need to get it back because other fully data capable cpap fell through (see other post). I had a nasal pillow mask for 2 days but returned it and got a zest. Either I'm crazy or I'm paying for two??? If I'm paying, shouldn't I have 2 in my possession?

Nope, actually that's just about right. Yep, you can buy all of it much cheaper from a reputable online DME supplier. But the online suppliers don't have the expense of working w/insurances and having payments doled out in dribbles over a 10 to 13 month period. They get paid cash right up front. The locals have so much insurance paperwork they have to have a good size staff just for that, plus they have to shell out up front for the equipment - and then get their investment and profit back strung out over a 10 to 13 month period. There is some justification for the decidely higher prices from the locals in all fairness. I doubt you are paying for two masks, your insurance most likely won't pay for more than one mask every 3 months AT THE EARLIEST.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

Well, I've just figured out why insurance is so expensive. Simply ridiculous.

Now I have a few questions if you can help about the specific items below. The CPAP listed below is SleepStyle™ 200 series (the one I'm trying to switch for the Elite). I'm confused how I'm paying a separate amt for a heated humidifier and a humidifier chamber. Maybe the chamber is the extra container that I'm supposed to switch out in 3 months??? But why would I be charged separately for the heated humidifier which is not a separate part of the CPAP?

I'm assuming "mask interface" is the Zest mask. Headgear probably is the straps to the Zest??? Have no idea what the nasal cushion could be other than the first mask I had unless they charge for the Zest gray foam insert that is part of the mask.

CPAP: $1430
Heated Humidifier: $603
Mask interface: $235
Headgear: $80
Humidifier chamber: $78
Nasal cushion: $81

Sorry for all these questions. Just trying to understand.

Well, it is interesting. Medicare will pay for a mask every 3 months, headgear every six months, and those masks that have detachable cushions a new cushion once a month. So, the local DME suppliers bill each separately - but they don't SELL them separately, only BILL them separately. Most will NOT sell "just" the cushion, or "just" the mask or "just" the headgear. And the majority of insurances follow Medicare guidelines. At least w/Medicare, the savvy patients can force the issue and get a new cushion, or a new mask, or a new headgear on the Medicare replacement schedule but they usually have to get very FIRM AND shove a print out of the Medicare replacement schedule in the DME supplier's face to do so.

The same holds true for the humidifier. Makes no difference if the humidifier is part of the CPAP or not, they are billed separately. Medicare insists on a 13 month capped rental (rent to own) for the CPAP - but - pays up front for the humidifier and other accessories.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

Brian, it is NEVER a good idea to post your e-mail address in a public forum like this. If you want to share you e-mail address w/someone in this forum send them a PM (private message) and give you e-mail address in that.

You will see in the lower left hand corner of a reply from someone you want to PM a small box w/PM in it. Click on that box and you will be all set to send them the PM.

I will send you one now so you see what I mean. You will get an e-mail message that you've been sent a PM. You click on the URL in that e-mail message and it will take you to a link to that PM.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

maf79 wrote:

After insurance, patient responsibility is $175.66.
My supplier for these items has been my doctor.

CPAP: $1430
Heated Humidifier: $603
Mask interface: $235
Headgear: $80
Tubing 6 ft: $82
Filter disposable: $40
Humidifier chamber: $78
Nasal cushion: $81

I looked up filters and they are significantly cheaper on some websites. Is my doctor massively ripping me off? Need I even ask? Is this what you guys are paying?

Note: The CPAP was returned but now I need to get it back because other fully data capable cpap fell through (see other post). I had a nasal pillow mask for 2 days but returned it and got a zest. Either I'm crazy or I'm paying for two??? If I'm paying, shouldn't I have 2 in my possession?

Wow I never realized it was so expensive. I am caught in the middle of insurance companies. Husbands company had to switch insurers but the union is fighting it so we are in limbo while the lawyers fight it out. I can get my c-pap under the old insurance but I am not sure what is going to happen once all the legal issues are settled. I could get caught paying the co pay twice.

My question, why don't the insurance companies pay all in one payment instead of over a 10 month period?

Webbie - I found a set of two filters (the same ones) online for $4.95. Per this bill my insurance/I'm paying $40 for 2 filters.

maf79 wrote:

Webbie - I found a set of two filters (the same ones) online for $4.95. Per this bill my insurance/I'm paying $40 for 2 filters.

That is highway robbery!! No wonder we pay such high premiums for insurance. They certainly are not budget conscious!

BECAUSE the insurances want to make sure you USE this equipment you are paying for rather than just stick it in a closet somewhere after a few nights of unsuccessful use. THAT is what the compliance data is for. Proof of use.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

I found this site: [Commercial Link Deleted. Please refer to posting guidelines] This is where i get my Remstar Pro M Series Ultrafine and pollen filters.  Seems to be the best pricing I have seen so far.

Who owns machine -- oxygen concentrator after 24 months. I know this is a new topic, but I didn't find any infomation on it.

CrohnieToo wrote:

BECAUSE the insurances want to make sure you USE this equipment you are paying for rather than just stick it in a closet somewhere after a few nights of unsuccessful use. THAT is what the compliance data is for. Proof of use.

My insurance was about to start over (actually, as of tomorrow, Sep 1) when I got my sleep studies done and was told I have SA - so, I talked with my sleep lab, DME, and insurance company and was able to get it all situated so that they would do a one time charge for payment rather than for a rental so that I wouldn't be out the cost of my 20% (I'd already hit my 20% so the rest was for the insurance company to pay based on my plan).  So, I say it can't hurt to talk to people, and just make sure they know that you are not going to give up on the treatment, that you plan to use it every day, if a situation like mine were to come up.  Maybe I was just lucky, I don't know - but thankfully they did the one time charge instead of rental for me.

-Kristin Hope

It depends on your insurance. With Medicare the xPAP becomes your sole property after 13 months of "capped rental". The issue of the 02 concentrator is an entirely different matter which is still up in the air. Until recently the concentrator was a life time rental w/Medicare, I don't know about the various insurances. Congress, etc., the powers that be, have tried to make the concentrators a 3 year, then 5 year, "capped rental" but there's a LOT of opposition to that as "just" a concentrator is NOT sufficient for most of us who require 02 supplementation for lung or heart issues and so it is all still up in the air.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

Thanks for your reply, I wanted to know

Usually, most insurnaces, Medicare included, purchase the CPAP accessories outright, w/just the CPAP purchased under the capped rental.

Generally, local DME suppliers will only sell a mask as one unit altho they bill as two: headgear and mask. Medicare allows a mask purchase every 3 months, BUT, a headgear purchase every 6 months, so most local DME suppliers will therefore tell a Medicare client that they are eligible for a new mask every 6 months. Medicare also will pay for one mask cushion a month, BUT, most local DME suppliers will not even sell mask parts, again telling you you are only eligible for a new "mask" every 6 months. Many insurances follow the Medicare schedule for replacement of accessories.

It can be worthwhile to call your insurance company and ask what local DME CPAP suppliers they are contracted with. It is often well worth your while if you have the option of more than one contracted local DME supplier to "shop" each of them to determine how lenient their mask exchange policy is, how helpful their RRT is, what CPAP they prefer to provide and IF they will provide you w/a fully data capable CPAP at no extra cost if you insist.

As far as mask exchanges: Resmed, Respironics and Fisher & Paykel will all replace most of their masks that patients have tried and not been successful with FREE to the local DME supplier IF the supplier will fill out a form and return the mask and form W/IN 30 DAYS.

Most insurances contract w/the local DME suppliers by insurance (HCPCS) code and NOT by brand and model. The HCPCS code for the basic bare bone compliance data only CPAP and for the fully data capable CPAPs as well as the fully data capable APAPs is the SAME: HCPCS code e0601. In other words, you should be charged NO MORE for a fully data capable CPAP than for a bare bone compliance data only CPAP even tho the bare bones CPAP costs them less.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.