BiPap Machines: Rent or buy?

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BiPap Machines: Rent or buy?

Postby Miss Pam » Sun Nov 05, 2006 10:41 pm

I changed jobs and had a 3 month lag with my health insurance. I received an EOB for my BiPap machine that the insurance company had denied payment. The date of service was when I was not covered. In ordering my overdue supplies I discovered that I had actually be renting my machine and that the ins co was paying the montly rental cost of $400!! Now I am responsible for that. Do people normally rent or buy?
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Postby jerryinnc » Mon Nov 06, 2006 6:16 am

i don't know for sure but my ins company is buying my S8 i have had it lest than a week so i am not much help to you sorry. :-D
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Postby sprottn » Tue Nov 07, 2006 9:29 pm

My RT told me that most insurance companies will not cover BiPAP unless you had "a failure" with CPAP first and that it was all documented.

Also she told me the insurance will pay the rent until the unit is paid for but if I asked them to buy it, they would BECAUSE once it is paid for, if it breaks, I would have to pay for repairs but as long as it is RENTED the repairs are covered under the rental.

So, I guess you should ask how much extra you are paying if you rent and if it seems outrageous compared to paying outright for it then buy it, otherwise keep renting so they will cover repairs if needed.
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Postby christine » Wed Nov 08, 2006 4:12 pm

Double check with your DME about the monthly rental rate, $400 sounds high for a straight BiPAP or autoBiPAP, unless your rent-to-own period is a lot shorter then most or something. I know the allowable for Medicare for BiPAP ST (E0471) is $600-675, depending on where you are in the country, because that's what I have. I checked regular BiPAP (EO470), and it looks like its around $215-260 (depending on state). Medicare 2006 Fee Schedule for Respiratory Assist Device (RAD), Bi-Level Pressure Capability, without Backup Rate

Most insurance companies, including Medicare, will 'rent to own' equipment like CPAP & BiPAP for about 12-18 months; some insurance companies will purchase immediately or after 3-6 months, while others continue to rent forever & ever. Sometimes insurance companies may even pay for a CPAP outright, but rent or rent-to-own a BiPAP because of the difference in cost. You would have to speak to your DME's billing department directly to find out what your situation was and how many months your insurance had paid in & how many are left before you take ownership or what the deal is. Do you have insurance now and is it going to cover your BiPAP & related supplies? Is there a possibility the new insurance would cover the purchase of your machine? Your DME may write off the months you owe for then; I had something similar happen with some of my other medical equipment and my DME wrote off a lot of $$$$. At the least, maybe you can get them to accept an amount equal to Medicare's monthly rental, for the months you are responsible for.

Good luck!
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Postby CrohnieToo » Wed Nov 08, 2006 6:21 pm

Whoa! $400 a month does sound fishy! I guess it varies by state, but Medicare in Michigan only pays $99 monthly rental (rent to own) for 15 months. That is for the machine itself; the mask, supplies, etc. are separate. But neither are they rented, they are purchased outright. (My DME charges Medicare $135 monthly rental but accepts the $99 from Medicare and the balance from my secondary which is still a bargain for the DME since if all I had was Medicare they would have to accept the $99 plus my $20 co-pay. I don't know what my secondary pays but they also have a contracted lower price than self-pays).

We all know that Medicare and insurance companies pay considerably less than self-pay but I'd be doing some real fast talking and negotiating w/them!
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Postby Miss Pam » Sun Nov 12, 2006 5:45 pm

Thanks everyone...I think I will check in with my ins co and find out what their routine is. I think renting is more expensive, but I can see that there are so many problems to deal with and frequent equipment changes that perhaps renting is less expensive for them until the patient is able to find a machine and mask that works for them. I'm pretty happy with what I have at this point. Maybe they'd be willing to buy now. I don't forsee things changing, unless of course I happen to drop 50 lbs, which I really need to do...but oh...that's another forum!
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