I know there is at least one other thread on a similar topic right now, but my question is more specific than what I have seen. I hope someone knowledgeable can just help me understand and point me in a good direction.

I have a ResMed S8 Elite with a humidifier. I have had this machine through the same DME for about 2 1/2 years, but through a recent change in employment, just went with Blue Cross insurance. My old plan paid 100% of DME, but my new one only pays 80%. I can afford it OK, but I don't like getting ripped off and I am always looks for ways to be more frugal. I am now paying $24.11 a month for the kit. That means I pay $289.32 a year, which also means BC pays $1157.28 a year. I verified these numbers with both the DME and BC customer service lines. The DME depreciates this machine over 5 years. Over that time, between me and the insurance company together shell out about $7233. Now, I can buy an Elite with humidifier new online for $694.95. The DME does provide some "customer service," new filters, etc, but that seems like small potatoes. They also provide a replacement if something goes wrong, but some of the online retailers offer extended warranties that do the same thing. BC does have a purchase option, but I have to use an in-network provider, not go online. I can only imagine what the sticker price is in-network.

Here are my questions:
1) Do these numbers sound right, or is something wrong here?
2) Is there a reason that I would not be better off just buying a cheapo $250 machine outright? Do I need data capability after two years of my sleep doc saying my numbers look fine?
3) If I do need the data, is there any reason I should not just buy an Elite or some other data capable machine outright?
4) If I can get an Elite for $700 online, what is going to be the likely mark up "in-network?" Has anyone compared?

Are you sure about the rental term? That its not a "capped rental" wherein the device is "rented" for a set amount of months and at the end of that term becomes the property of the patient free and clear??

For instance the Medicare capped rental is for 13 months after which payments cease and the device becomes the sole property of the patient.

Hey, I'd go for the Resmed S8 II Elite w/EPR in a minute! I was started on the Resmed S8 Elite w/EPR and loved it. The S8 II Elite has their new EasyBreathe technology and it truly is easy breathing w/smoother pressure transitions. I've since been switched to a bi-level due to COPD and I insisted on the Resmed VPAP Auto which also has the EasyBreathe technology and love it.

Medicare reimbursement has dropped since I got my S8 Elite in Oct '06 but at that time the local DME supplier billed $135 a month for 13 months, Medicare allowed $99.95 a month of which they paid 80% ($79.96) and my 20% copy (which my secondary insurance paid) was $19.99.  You do the math. $99.95 a month for 13 months vs the price from an online DME supplier - keep in mind the above was JUST FOR THE S8 ELITE and not the humidifier, hose, mask, filter, etc.


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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 & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

You need to check some of the online retailers to see if they are in the BC/BS network. I purchased a ResMed Autoset II and the Swift LT mask last week online and my insurance is BC/BS. Like a lot of you guys I worked the internet pretty hard to find the lowest price for the equipment. At that point I called the BC/BS member service number and they told me if the online retailer is in network they would pay 80%, if out of network they would pay 70%. Turns out the online shop I used was in the BC/BS network for the state they are located in. All I had to do was fill out a claim form and mail to the BC/BS claims department in the DMEs state. I asked why the form needed to go to the DMEs state and not to my local claims and the response was the claim would be paid based on the the reimbursement rate of the state the DME was located in. This should turn out good because the rate there is higher their than it is here.

I don't if I can name the DME here or not but I will say they were extremely helpful and made the whole process very easy.