Sorry if this has been discussed before - did a search and couldn't find anything...

I was recently diagnosed with severe obstructive sleep apnea.  I need to work on getting a machine.  I did a TON of research after the two part study (the improvement was very noticeable) with relation to the machines I want based on my lifestyle (I like to go camping and I live in Colorado so automatic altitude adjustment and DC power are just as important to me as reporting capabilities) and Crohnie gave some advice in another thread that re-affirmed the research I had done.

On Weds., I went to the Dr to talk over the results.  He said his assistant would call and coordinate a durable equipment provider for me and that it would probably be Apria.  I've heard a lot of negative things about them and the local BBB doesn't think they're too great either.  They owe me a call back today where I'm going to insist they hand me the prescription and diagnosis so I can shop around to different places.

I called the insurance company and asked what my options were.  They gave me a laundry list of "in-network" providers yesterday.  I asked what would happen if I went "out of network" and was told my deductible would double, and they would only cover 60% of the total bill as opposed to 90%.

I called one that is close to my house (American Home Patient) and was told that because I was with United Healthcare, I would have to go with a Fisher Paykel machine even though they also carry Resmed and Respironics products.  This didn't make sense to me in that I would have thought that it was against Federal Trade Commission rules for an insurance company to collaborate with a manufacturer.  Additionally, I could go to a place like CPAP-Supply.com or CPAP.com and get a great setup for a lot less than what a lot of DME providers charge.

Based on more great advice from Crohnie, I verified that the insurance codes for the machine are exactly the same - makes no difference what the brands are (you can see this on CPAP-Supply.com).

What has everyone else done?  I hate fighting with insurance companies but I don't want them to dictate what my lifestyle should be based on what they will pay for.  Are there implications in the future with relation to replacing future supplies (hoses, masks, filters, etc.)?

Thanks for your help!

I can't help you much, as I have Medicare and Tricare, but I can tell you don't let them get away with telling you what Make of machine you can have, I would fight them all the way! Does United Health Care have stock in Fisher Paykel? Or is it their machine is the cheapest? Either way it sounds fishy to me! It can be more than frustrating dealing with those people, I do wish you luck, and welcome aboard!

Check w/the two online suppliers you've been interested in and ask them if they have an "unadvertised special" or "unadvertised sale" price on the equipment you want and figure 40% of that as your copay.

Then visit the local DME suppliers your insurance company is contracted with. Fortunately, you have more choices than just Apria (some of their offices are pretty good) and American Home Patient. Find out which xPAP they are willing to provide, try as many masks in-office as they will let you then let them give you the prices en total for all equipment. Will it be outright purchase for all or some form of capped rental for the xPAP? What will your TOTAL copay be? You may well find you can do better w/your 40% copay w/an online DME supplier than w/the locals if you can find a good "unadvertised sale or special".

At the very least you will have had the opportunity to find a promising mask fit whilst visiting the local DMEs. Just DON'T SIGN anything until you are SURE this is the way you want to go. Don't get too excited over their high prices. Its your total copay when all is said and done that is important. If it works out to your advantage to go w/one of the locals, by all means do so. And I'd certainly check w/a few more online DME suppliers too just in case.


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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.

Well, here's a funny one.

Called my Dr and they are out of the office until Tuesday because of the holiday (I pretty much expected that).

I went to the United Healthcare Website and downloaded the list of DME providers for my particular plan.

I focused on two providers near the house that had "respiratory service" in their name.  The first one I called I asked what products they carry and they said Respironics.  She asked which insurance company and I told her and she said no problem, they could outfit me.  I told her what American Home had told me with relation to being restricted to a Fisher Paykel and she said, that's not true, you aren't limited to brand.  I told her what I wanted and she said they could accommodate.

Hope other folks realize they can shop around and don't take what's told to them for granted.  It's a bit frustrating.

Lincare did me the same way.Told me they would bring my machine the next day.They ask what insurance i had and when i told them they said it would take 2 weeks to get my machine.When they bought the machine respironics sleepeasy and mask f&p 431 they said thats all my insurance would cover.I called the insurance company and they said that wasnt true.I have changed dme and they are working with me to get what i need.

Just for the record...I was afraid to use Apria...but the one locally here turned out to be excellent...just have to know how to talk the talk and walk the walk....can't let your gruad down.  On the other hand when first Dx'd I used American Home Patient...they could not keep their bookkeeping straight and I had a lot of problems with them getting supplies.

I was going to use an online bendor when I got the BiPAP.  Glad I didn't, the one I got from the local DME was defective...no way of telling prior to using, and the replacemnt came the next day (used) then the new one came a week later.  The RT came to the house all times to deliver, P/U and switch out.  So it worked out better.


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BiPAP Auto M 13/8 Mirage Nasal Swift. 20 years+ undx'd. RLS/PLMD, Hypersomnia & more.