Save Big Money and Big Headaches by Being a Savvy Health Care Shopper

Arwyn Robinson asked some key questions and saved about $1,200 on a CPAP machine.

My dad always said that if something sounds too good to be true, it probably is too good to be true. 

So I loved hearing how Arwyn Robinson recently applied that healthy skepticism to obtaining a CPAP machine. In the process she saved herself a major headache and about $1,200. 

Arwyn’s husband Aaron suffers from sleep apnea, a disorder that causes worrisome breaks in his breathing at night. His doctor ordered him a continuous positive airway pressure, or CPAP, machine to stream warm air into his nose while he sleeps, keeping his airway open.

Arwyn works in the benefits industry in Idaho, so she handles the health care purchases for the couple. They are on a high deductible health plan that requires them to pay the first $5,000 before their health benefits kick in any coverage. 

Arwyn’s on guard to protect herself from overpaying – and our health care system is designed to make us overpay.

Here comes a showdown. 

The durable medical equipment supplier called Aaron and gave him what sounded like good news. His insurance plan would cover the CPAP machine. The cost for the rent-to-own program would be $90 up front and then his coinsurance – the out-of-pocket cost not covered by the plan – would be $17 a month for 10 months. Seemed like a decent deal!

Know your health plan

Aaron relayed that information to Arwyn and she knew it sounded too good to be true. The couple still had $1,100 remaining on their deductible for the year. They would have to pay that full amount before their insurance paid a single dollar. 

Arwyn dug deeper. She found some troubling Better Business Bureau reviews of the supply company. Many of them were billing related - patients getting overcharged and other hassles. Overcharging and bogus bills are common throughout health care, but they can be particular problems with CPAP machines and supplies, as I wrote several years ago for ProPublica. (I’m proud of the headline: You Snooze, You Lose: Insurers Make the Old Adage Literally True.)

Arwyn called the device supplier and recorded their interaction. Arwyn’s conversation is a fantastic example of how a health care consumer needs to be informed to be protected from costly misinformation. 

Obviously it’s not fair that the burden of being correct has to fall on the patients. A functional health care system would be trustworthy. But we don’t have a functional health care system. We have a health care system riddled with incompetence and predatory and deceptive practices. That’s why I wrote Never Pay the First Bill and turned the book into The Never Pay Pathway health literacy videos. Patients need to be informed and be on guard. 

A customer service representative named Anna took Arwyn’s call. Anna sounded like she knew what she was talking about, but was 100% wrong. 

Anna said the device supplier had checked with Arwyn’s insurance, and she would not have to pay any deductible. The health plan would kick in coverage right away. “That really does create a puzzle here,” Arwyn told her. “We have a $5,000 family deductible which we have not yet met. Federal guidelines state there is not a first-dollar benefit until the deductible is met. So how is it we’re not paying the full cost of our equipment up front?”

Arwyn explained to Anna that she was trying to avoid a problem. If she signed up for the rent-to-own program on the promise that it would be covered by insurance – only to find out that it would not be covered – the device company would come after her for the full payment. That might not be the best deal for the couple. 

A three-way call

Arwyn put Anna on hold to do a three-way call with her insurance company. Once the insurance representative was on the line, she confirmed that Arwyn and Aaron had not yet met their deductible, so they would be on the hook for the cost of the CPAP machine. 

In that case, how much would the rent-to-own program cost if they paid out-of-pocket? Arwyn asked the device supplier. 

Anna said they would be charged $625 up front and then $65 a month for nine months. Total: $1,210.

Arwyn got the make and model of the machine and found one online for $990.

So she’d save $220 buying it on her own instead of running it though her insurance plan. 

Arwyn canceled the order. Before she ended the call she urged Anna to figure out why her company was providing the wrong information about her deductible. “I would hate to have another patient in my shoes,” Arwyn said. “Another patient would potentially be very upset if  you said $90 up front and it turned out to be $625.”

Arwyn decided to buy the machine on her own and found an older model on Facebook marketplace for $300. She took it to a different medical device supplier and got it sanitized, tested and calibrated for $64. It didn’t count toward her deductible to pay cash, but she figured that’s OK when she was saving about $900. 

A few days later her new device supplier called her with even better news. Someone had returned a newer model CPAP machine, so they could clean it and sanitize it but were not allowed to resell it. Would she like it for free? Done! She went from being asked to pay $1,210 to paying nothing. 

It’s worth noting, Arwyn said, that people might want to check with their local medical device supplier to see if they’ve had any returns. They might be able to pick something up for free. 

So what’s the takeaway? Patients need to know their health insurance coverage details better than their medical providers think that they do. Unfortunately you can’t trust your medical providers to get it right. That will ensure you go the right route when getting the medical treatment and services you need. 

Key takeaways: 

1. Know your plan. 

2. Question the experts, and correct them, if necessary.

3. Be firm but polite. “You don’t have to yell and scream. You can ask questions like, ‘I’m confused. Please explain this.’”

4. Do a conference call with your insurance company and medical provider to make sure the information is correct. 

5. See if there’s an alternative path to getting what you need. Often there is a better price.

The Never Pay Pathway Health Care Curriculum

I love to see working Americans have their mindset flipped by effective health literacy education. Our health care system isn’t broken. It was designed this way. It’s no accident that employers and working Americans keep paying more than they should for health care. But employees are not powerless.

I’m looking for bold employers to equip their employees with my Never Pay Pathway health literacy videos. They’re based on my book, Never Pay the First Bill, and the knowledge will transform the way your employees engage the health care system.

The videos are an ENGAGING resource that will save money for your employees, their families - and your health plan. Let’s stop overpaying for our health care, shall we? Email me at neverpay@marshallallen.com for more information.