Real cost of machine

[3winks]

Perhaps some one can help me with a provider question--I was just prescribed a new bipap unit and when I went to pick it up the provider said that my final cost would be 20% of the cost of the machine which I have no problem with--- But she said the cost was 3700 dollars and I said keep it. My question is what's going on when I can buy the same machine direct for 1700 to 2000 why is their cost almost double? The people that sell them direct are making money. Why do the medical people have to make double or more? I don't have a problem paying 20% of 1700 but 3700 I do. I really feel like someone's getting screwed and I think its me. Is there a work around? Thanks

[Pugsy]

What insurance do you have?
Which model "bipap" or bilevel device? The regular bilevel or the high end bilevel that deals with centrals.

Depending on which insurance you have....the billed amount normally has nothing to do with what is finally paid/allowed and the 20% copay is calculated on the allowed amount and not necessarily the billed amount unless they happen to bill the allowed amount.

[amenite]

My first DME tried to get me to pay several hundred more than the going price to buy a CPAP machine they had provided me under a rent to own contract a few months earlier (insurance changed mid-contract). When I called them out on it they chose to take it back rather than bill me a more reasonable amount to close out the agreement. Their loss IMO. These machines must be a pretty good revenue generator esp. in cases of the more expensive devices like BiPAP.

"...my final cost would be 20% of the cost of the machine..."

Regardless of what they said, your cost is 20% of the *price* of the machine - that is 20% of (their cost + their markup). It has nothing to do with the cost of the machine to them - my guess is they are charging whatever they can get away with.

[JDS74]

Call your insurance company and ask them if they will reimburse you if you purchase the machine directly yourself.
If they will, get a copy of your scrip and shop around online to get the best price. submit the bill and get 80% of it back.

That's what I do with my supplies and my first Respironics ASV machine.

Or ... There are members selling lightly used machines on this board or places like Second Wind or even Craigs list. Insurance will probably not reimburse if you buy that way but the price will be lots lower.

[houstonrockets83]

I have some decent priced machines available, NEW and GENTLY USED, check my threads on the forum if interested.

[houstonrockets83]

That $3700 the DME is talking about is about 2k plus profit for them. It is a huge money making business.

[Pesser]

Perhaps some one can help me with a provider question--I was just prescribed a new bipap unit and when I went to pick it up the provider said that my final cost would be 20% of the cost of the machine which I have no problem with--- But she said the cost was 3700 dollars and I said keep it. My question is what's going on when I can buy the same machine direct for 1700 to 2000 why is their cost almost double? The people that sell them direct are making money. Why do the medical people have to make double or more? I don't have a problem paying 20% of 1700 but 3700 I do. I really feel like someone's getting screwed and I think its me. Is there a work around? Thanks

You can buy a brand new bipap with a two year warrenty at http://www.secondwindcpap.com. It should cost you about $822. No insurance company compliance hassel.

[kaiasgram]

I have some decent priced machines available, NEW and GENTLY USED, check my threads on the forum if interested.

Whoa, hang on --

I think Pugsy's scenario is the most likely one: The amount the DME quoted to the OP is likely irrelevant -- the actual amount is the insurance's allowed amount. This amount is usually significantly less than what the DME quotes to the patient. Patient pays whatever percent (in this case, 20%) of the allowed amount. OP needs to check with his/her insurance to find out the allowed amount before concluding s/he has to buy out of pocket or pay 20% of the DME's inflated (and likely meaningless) price.

[OkyDoky]

I have some decent priced machines available, NEW and GENTLY USED, check my threads on the forum if interested.

Whoa, hang on --

I think Pugsy's scenario is the most likely one: The amount the DME quoted to the OP is likely irrelevant -- the actual amount is the insurance's allowed amount. This amount is usually significantly less than what the DME quotes to the patient. Patient pays whatever percent (in this case, 20%) of the allowed amount. OP needs to check with his/her insurance to find out the allowed amount before concluding s/he has to buy out of pocket or pay 20% of the DME's inflated (and likely meaningless) price.

Agreed. The price and your 20% cost will be determined by the allowed amount of the insurance company, which if you look at any of your EOB's from the insurance company that is much less than what is billed.

[Pugsy]

Also...before we go selling something or telling someone where to go get it cheaper....
how about we make sure that we aren't talking about apple bipap and orange bipaps...
they aren't all created equal...are we talking plain bilevel for maybe just higher pressure needs or comfort on exhale or are we talking about one of those high end bilevel machines in the ASV category.

$3700 might not be $3 K off if someone is looking at one of the ASV models.

To really know if it is or isn't a reasonable amount we need
1...have to determine exactly which model bilevel device we are talking about
2...know what insurance is involved and is this amount just the billed pie in the sky amount and there will be a substantial write off one the "allowed" amount is known.
Some insurance companies do pay the pie in the sky amount...most don't...but more information is need for sure so that and informed and educated decision is made.

[3winks]

Actually the machine is a respironics DS760HS

[3winks]

Insurance is Premier advantage

[Pugsy]

Not familiar with how that plan works.

Call them and ask them what they pay/allow for
the bipap/bilevel machine HCPCS code E0470
and heated humidifier HCPCS code E0562
Insurance companies use HCPCS codes and not model or brand names

They might allow all or part or greatly reduce the allowable amount and the only way to know is ask.
Your 20% copay is based on the allowed amount which may or may not be close to the billed amount.

[3winks]

Thanks pugsy ---I don't think they will tell me --but I will try tomorrow

[kaiasgram]

Thanks pugsy ---I don't think they will tell me --but I will try tomorrow

I've heard of this happening -- you could start by asking what your 20% copay will be for that HCPCS code instead of asking what they will pay the DME or what the allowable amount is.