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CPAP, a vital necessity but what a scam!!!

This area is for Sleep Apnea questions and general Sleep Apnea Discussions.


Do you agree

Poll ended at Sun May 22, 2011 11:39 am

Yes it is a rip off!!!
5
45%
No there are good reasons for the cost.
5
45%
I just don't care, you should end it now!!!
1
9%
 
Total votes : 11

CPAP, a vital necessity but what a scam!!!

Postby jouuueee » Thu May 12, 2011 11:39 am

I just did the math. First let me provide a little history. I have Aetna insurance. I did my first sleep study in Aug of 2009. Then another in September of 2009. I was prescribed the CPAP and received it by the end of September 2009. Since then Americoast Maryland has billed my insurance $134.00 a month for 20 months. That’s $2680 for the machine, M Series BIPAP Auto. My insurance paid $83 and I paid $9.38 for 20 months. So the total cost actually paid, just for the machine not including mask, filters, hoses etc…, was over $1800. I called Americoast and asked what was the purchase price and they said the insurance decides. I called the insurance and they said Americoast has that information. Why do I feel like I am participating in pyramid scheme? To put things into perspective. I can buy a new 46” LCD high resolution flat panel TV, PS3 with a few games and an IPhone for what amounts to a loud air compressor. The filters are a dead give way that we are being ripped off. I can buy 3 20”X20” 3M Micro Allergen Extra filters for my AC unit which are of a much higher quality and will last for 9 months of 24hr use for the same price I can buy 3 .75”x1.5” foam filters that last 3 months. We are being taken full advantage of. From the cost and process of the sleep study all the way down to the cost, quality of the filters. Americoast is not doing anything illegal and the insurance is using the same formulas as the government. I could continue to pay $9.38 for the rest of my life if it meant I got a good night’s sleep. But fair is fair and wrong is wrong and there are a lot of people who can’t afford this or other healthcare necessities because costs have not relation to value. Does that sound familiar, my condo cost me $168,000 in 2006. The unit above me just sold for $95,000. America! America! God mend thine every flaw, Confirm thy soul in self-control, Thy liberty in law.
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Postby Vicki » Thu May 12, 2011 11:48 am

Just Google "CPAP Supplies", buy your supplies online at a fraction of the cost and then submit your receipts to your insurance for reimbursement. You probably get the "out-of-network" reimbursement, but when I do the math, I break even without the angst of dealing with a DME. Of course the DME is expensive, they have to make a profit somewhere.

Vicki
Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Vos Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.
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Postby jrinker » Thu May 12, 2011 1:42 pm

Try taking a field trip to a local hospital or rehab center, visiting people who have had heart attacks or strokes. Both of these (and many other unpleasant conditions) could result from untreated apnea. Look at the average cost of their treatment. Talk to their friends and families to find out what devastating effects their loved one's illness has had on them.

Then decide if sleep apnea treatment is a scam.

jrinker
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Postby SleepyToo » Thu May 12, 2011 9:37 pm

Regardless of what you think, it is the system that we have. Both sleep apnea treatment and your condo. You have to learn to live with it, and work it to your advantage, if you can. Sometimes that is not possible, I know, which makes the whole system stink. However, in many cases you can find ways around the system. As Vicki suggests, once you know your equipment, including mask, requirements, you can shop online. The online places don't have such good follow-up/service arrangements, but if you can live without those services, you will be fine. Even your machine can be bought that way, and set up per your doc's prescription. No support on changing the pressure if the doc recommends that, though. DMEs do need to cover their overheads, so the amount the insurance company paid is probably quite reasonable.
SleepyToo
Philadelphia Area
Diagnosed September 2009, Respironics System One w/ C-flex and humidifier
Aloha nasal pillows
Not a medical professional, just a patient with severe OSA (31) who has done a lot of reading.
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Re: CPAP, a vital necessity but what a scam!!!

Postby Todzo » Thu May 12, 2011 10:07 pm

jouuueee wrote:I just did the math. First let me provide a little history. I have Aetna insurance. I did my first sleep study in Aug of 2009. Then another in September of 2009. I was prescribed the CPAP and received it by the end of September 2009. Since then Americoast Maryland has billed my insurance $134.00 a month for 20 months. That’s $2680 for the machine, M Series BIPAP Auto. My insurance paid $83 and I paid $9.38 for 20 months. So the total cost actually paid, just for the machine not including mask, filters, hoses etc…, was over $1800. I called Americoast and asked what was the purchase price and they said the insurance decides. I called the insurance and they said Americoast has that information. Why do I feel like I am participating in pyramid scheme? To put things into perspective. I can buy a new 46” LCD high resolution flat panel TV, PS3 with a few games and an IPhone for what amounts to a loud air compressor. The filters are a dead give way that we are being ripped off. I can buy 3 20”X20” 3M Micro Allergen Extra filters for my AC unit which are of a much higher quality and will last for 9 months of 24hr use for the same price I can buy 3 .75”x1.5” foam filters that last 3 months. We are being taken full advantage of. From the cost and process of the sleep study all the way down to the cost, quality of the filters. Americoast is not doing anything illegal and the insurance is using the same formulas as the government. I could continue to pay $9.38 for the rest of my life if it meant I got a good night’s sleep. But fair is fair and wrong is wrong and there are a lot of people who can’t afford this or other healthcare necessities because costs have not relation to value. Does that sound familiar, my condo cost me $168,000 in 2006. The unit above me just sold for $95,000. America! America! God mend thine every flaw, Confirm thy soul in self-control, Thy liberty in law.


Hi,

"You can have anything you want, as long as you help enough other people get what they want". I remember this statement from some Zig Ziggler tapes, it seems to be a restatement of the golden rule from a monetary angle.

Most of our large hospitals and institutes of learning started as religious works of mercy and care. But, when you help people the truth of the above statement will make you eventually (sometimes generations later) quite rich. But, "money is the root of all evil" and the next generation may well not learn your values. Eventually you have a mess so corrupt that it breaks down from within, and since the wolves are always out there it also falls prey.

Since I am religious, my answer to this is "pray or prey". I also believe us wise to volunteer our time, money, and support to causes which move us in other directions. So I type a note or two here and get ready to spread the message in my own community amongst it's officials from every part.

What you say about the treatment of OSA I believe you would find true about anything the medical field treats. If you want to change that, gather your information, see who else is interested, get the word out while making yourself one who can and does contribute out of love for your fellow man. You would help us all.

Hoping for a better world,

Todzo
AHI=52 SpO2 Nadir=55% (!!!) Focus & Vigilance problems w/PTSD from Trauma
CPAP since 2003 Respironics REMstar Auto A-flex with EncoreViewer and SleepyHead SW
Pulse oximeter CMS-50-F, night audio recorded via Audacity or Linux “sox”. Zeo.
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Postby LTee43 » Thu May 12, 2011 10:41 pm

jrinker wrote:Try taking a field trip to a local hospital or rehab center, visiting people who have had heart attacks or strokes. Both of these (and many other unpleasant conditions) could result from untreated apnea. Look at the average cost of their treatment. Talk to their friends and families to find out what devastating effects their loved one's illness has had on them.

Then decide if sleep apnea treatment is a scam.

jrinker


I was probably a good stroke candidate and do know a couple of friends who were epic snorers that died in their sleep. Both were never formally diagnosed as having SA.

LT
No, I wasn't sleeping. I was checking my eyelids for pinholes!
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Postby CrohnieToo » Fri May 13, 2011 12:22 am

You guys are missing the point here. jouuueee clearly stated in both the subject of this thread AND in the original message of this thread that CPAP is a VITAL NECESSITY. It is the usual or "normal" method of obstaining the equipment that he she feels is a scam and is asking your opinion about. Not the VALUE of PAP therapy but the SOP of obtaining it.
ResScan 3.10 - Resmed S8 ResLink & oximeter
ConTec CMS-50D+ oximeter - Philips EverFlo 5L Oxygen Concentrator
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Postby Vicki » Fri May 13, 2011 11:32 am

I think what has people up in arms is that Jouuueee says "I could continue to pay $9.38 for the rest of my life if it meant I got a good night’s sleep." not seeming to recognize that the effects of untreated OSA go far beyond just not getting a good night's sleep.

Vicki
Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Vos Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.
User avatar
Vicki
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Posts: 6404
Joined: Tue May 31, 2005 8:21 pm
Location: Southern California
Machine: DeVilbiss IntelliPAP
Mask: Fisher & Paykel Flexifit 431
Humidifier: Rarely as needed
Year Diagnosed: 1999

Re: CPAP, a vital necessity but what a scam!!!

Postby thatbpguy » Sun May 15, 2011 11:20 am

jouuueee wrote:I just did the math. First let me provide a little history. I have Aetna insurance. I did my first sleep study in Aug of 2009. Then another in September of 2009. I was prescribed the CPAP and received it by the end of September 2009. Since then Americoast Maryland has billed my insurance $134.00 a month for 20 months. That’s $2680 for the machine, M Series BIPAP Auto. My insurance paid $83 and I paid $9.38 for 20 months. So the total cost actually paid, just for the machine not including mask, filters, hoses etc…, was over $1800. I called Americoast and asked what was the purchase price and they said the insurance decides. I called the insurance and they said Americoast has that information. Why do I feel like I am participating in pyramid scheme? To put things into perspective. I can buy a new 46” LCD high resolution flat panel TV, PS3 with a few games and an IPhone for what amounts to a loud air compressor. The filters are a dead give way that we are being ripped off. I can buy 3 20”X20” 3M Micro Allergen Extra filters for my AC unit which are of a much higher quality and will last for 9 months of 24hr use for the same price I can buy 3 .75”x1.5” foam filters that last 3 months. We are being taken full advantage of. From the cost and process of the sleep study all the way down to the cost, quality of the filters. Americoast is not doing anything illegal and the insurance is using the same formulas as the government. I could continue to pay $9.38 for the rest of my life if it meant I got a good night’s sleep. But fair is fair and wrong is wrong and there are a lot of people who can’t afford this or other healthcare necessities because costs have not relation to value. Does that sound familiar, my condo cost me $168,000 in 2006. The unit above me just sold for $95,000. America! America! God mend thine every flaw, Confirm thy soul in self-control, Thy liberty in law.


I work for an insurance carrier. Are the costs too high? Absolutely. But they are what the are and insurance companies have no control over it. My CPAP machine was billed out to my carrier at $2,300. The insurance only pays $1,550. However, I can buy one new on Amazon for $850.

What I did was to not rent the machine and just had the insurance billed for a new one up front. For the first one ONLY I took the over priced unit as it was all tangled up in the sleep study... On the other hand, if this doesn't work out I can get good $$ for it used.
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Re: CPAP, a vital necessity but what a scam!!!

Postby SleepyToo » Sun May 15, 2011 12:31 pm

thatbpguy wrote:I work for an insurance carrier. Are the costs too high? Absolutely. But they are what the are and insurance companies have no control over it. My CPAP machine was billed out to my carrier at $2,300. The insurance only pays $1,550. However, I can buy one new on Amazon for $850.


Can you explain why the insurance companies have no control over costs? They are the ones that negotiate with the providers, so don't they have some control? The providers insist on getting their x% of the action, and will raise costs if the insurance companies reduce how much they pay. Something needs to be done to break this vicious cycle and reduce margins to a reasonable level while allowing everyone to stay in business. That includes the patient who gets hit with exorbitant charges for everything - especially if they have been unfortunate enough to lose insurance coverage.

I have no sympathy for those who refuse to buy coverage because they are healthy. We have to buy insurance for our cars, even though we have no intention of having a crash. We just never know when the accident, or health problem, will occur, do we.
SleepyToo
Philadelphia Area
Diagnosed September 2009, Respironics System One w/ C-flex and humidifier
Aloha nasal pillows
Not a medical professional, just a patient with severe OSA (31) who has done a lot of reading.
SleepyToo
 
Posts: 1066
Joined: Thu Sep 17, 2009 6:36 pm
Location: North of Philadelphia
Machine: PR System One
Mask: Resmed Swift FX
Humidifier: Yes, integral with PRS1
Year Diagnosed: 2009

Postby CrohnieToo » Sun May 15, 2011 5:48 pm

Interesting that we blame the DME providers for the exhorbitant costs when the providers claim it is the insurance companies that set the cost, that the insurance companies tell the providers how much they will pay and if the provider isn't willing to accept that the insurances just won't do business w/them.
ResScan 3.10 - Resmed S8 ResLink & oximeter
ConTec CMS-50D+ oximeter - Philips EverFlo 5L Oxygen Concentrator
PR SystemOne BPAP Auto w/Bi-Flex & Humidifier - EncorePro 2.2.14.0
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Joined: Mon Mar 20, 2006 9:18 pm
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Year Diagnosed: 2006

Rent to own

Postby PerryA » Mon May 16, 2011 10:05 pm

My first CPAP was on a rental basis until the predetermined (but not disclosed to me) amount was paid. After that, the insurance has paid for the machine outright.

I suspect the first machines are typically rented because of the potential it is not the proper solution and will be discontinued. Why pay for a $1000 or $1200 machine and supplies if three months of use determines the CPAP is not the right solution and it needs to be discontinued?
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Postby jouuueee » Tue May 17, 2011 11:11 am

Thank you Todzo, un-expected and very profound. I will try to take what you said to heart. I think what best describes what you said for me is “One person can make a difference”.

CrohnieToo, thanks for getting it. I am grateful for the technology that has brought so many benefits. I can afford it, new, used or rented, I have the money. But not everyone can. Unfair pricing tactics are used in the medical industry. There is nothing wrong with profit, we all have to earn a living but gauging and price fixing have become trademarks of an industry that profits at the expense of peoples health needs.

Vicki, you are right. For me the most immediate benefit is a good night’s sleep. That rest bit allows me to better handle the daily stresses of my life which to me will have the greatest long term benefit. But I do realize that there are other ways this equipment is helping me and others I just prefer not to think about those subjects that remind me of my mortality.

I want to be very clear this post was a way for me to exercise the feeling I had of being ripped off. It was not intended to be little the health values of this equipment. There are a lot of people in this industry that truly want to make a difference. The person I spoke to at Aetna was as upset as I was about the process and the person at Amercost was frustrated too. So now we have a patient, healthcare provider and medical equipment vendor that all agree but can’t do anything about it. Who do you go too next?
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Postby acocacolagirl » Wed May 18, 2011 7:41 pm

It is both the insurance companies and the DMS. We need to regulate insurance companies so they can't keep taking advantage of us and raising prices by 30% or more every year. And what about DMS who rents a wheel chair (for example) and charge $80 a month to your insurance or you when a new wheel chair can be bought for just over $100?

My insurance doesn't even cover cpaps. Thank goodness my parents were willing to buy the machine for me...and after much research and compairing of features, I desided on the DeVilbiss which only cost $400. Of course F.P. suggests I replace parts of my mask pretty often so that they can keep making money off of me. They are out of luck. I'm not replacing anything that is not broken.
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Postby Vicki » Thu May 19, 2011 12:19 am

You might want to rethink the mask. I have a Fisher & Paykel Flexifit 431 where just the silicone can be replaced. It is important to do that every 3-6 months because the silicone breaks down. What happens is that the mask starts to leak and you have to start tightening the mask more and more. As an aside, I wash the silicone everyday because 1) The oil off of my face makes it leak like crazy if I don't and 2) By washing the oils off, I extend the life of my mask.

Vicki
Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Vos Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.
User avatar
Vicki
Moderator
 
Posts: 6404
Joined: Tue May 31, 2005 8:21 pm
Location: Southern California
Machine: DeVilbiss IntelliPAP
Mask: Fisher & Paykel Flexifit 431
Humidifier: Rarely as needed
Year Diagnosed: 1999

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