Should you use health Insurance to Buy Medical Equipment like a CPAP Machine

December 21st 2005

Remstar Auto

My Dad recently got diagnosed with sleep apnea. This is a condition that many people are unaware that they have because they are asleep when it occurs. If you are overweight and snore it is a good idea to get tested for it because sleep apnea has been shown to lead to strokes, high blood pressure and other ailments. The treatment is a sure-fire way to stop snoring.

My father attended a sleep study and the doctor prescribed him a CPAP machine for treatment of his sleep apnea. The prescription was sent to a medical supply outlet similar to Apria. These companies are good at filing the claims and going through the rigermarole in getting you your medical device or equipment.

But is it always best to go through an insurance provider to get your equipment? Not necessarily. Many medical equipment providers benefit by pushing the lowest cost item at the highest price.

Let me explain how this works. The DME (durable medical equipment) provider typically wants to sell the low end equipment at the high end cost. That makes sense; they make much more money that way.

My dad was offered a Remstar Plus CPAP machine where he would only have to pay 20% of the cost. The DME was selling the equipment for $1,250. That works out to $250 out of pocket for my dad.

This is a low end machine. I checked online and found the same machined for $330. Something is happening here; either the insurance companies are lazy or they don’t care about the price, and the cost is just passed along to the premium payer. To be fair, the $330 is a cash price, and I would expect the insurance companies to want at least 30 day terms.

Any order over $100 came with free shipping on the internet site. The CPAP supplier also had upscale models for much less than the DME wanted for their low end model. The top of the line CPAP by Remstar, the Remstar Auto, listed for a mere $760 online. This is almost $500 cheaper than what the insurance would pay for the bottom of the line.

For $760 you would get a humidifier. The DME did not even offer this choice. The humidifier adds moisture and will not dry your throat out. The better machine also includes an auto function and C-flex. Both functions make sleeping easier.

Either way you need to get a prescription from the doctor. My advice is do some research before you go with whatever the insurance company or doctor offer.