Sample DME prices for Supplies

[StevenXXXX]

The following are prices I paid at my local DME on 12-22-10.

Yes, that was almost 9 months ago, but was the latest purchase I have made. Over the years, I have gotten a little ahead of the supply chain & accumulated extras of everything. To keep from not accumulating too many extras was the reason I have gone so long without purchasing any supplies.

I do expect to buy some supplies in the next week.
But my DME is not that quick with filing claims, so it may be another month or so before I know what my BCBS PPO insurance plan paid & what my share is. So, I thought in the meantime, I would post this purchase.

Phillips Respironics ComfortGel Nasal Cushion & Silicone Flap (NO mask frame NOR headgear) - DME price was $ 70.00, BCBS discounted it down to $ 31.18 & paid 80% of that lower amount. My 20% was $ 6.24

Phillips Respironics Premium Headgear for ComfortGel Mask - DME price was $ 48.00, BCBS discounted it down to $ $ 29.09 & paid 80% of that lower amount. My 20% was $ 5.62

Phillips Respironics Deluxe Chinstrap - DME price was $ 39.00, BCBS discounted it down to $ 12.45 & paid 80% of that lower amount. My 20% was $ 2.49

As you can see, the amounts billed by the DME is always quite a bit more than what the insurance will pay for those items. IMHO, even the lower amounts set by the insurance company are still more than what the products are worth.

It has been over 7 1/2 years since I bought a CPAP, so I won't post those prices. But if someone has purchased any CPAP or APAP recently & doesn't mind sharing your information, I am sure that would help someone who is currently in the market looking at prices.

[chunkyfrog]

Part of the 'justification' for (insurance) allowed prices for cpap equipment involves the extensive testing
and paperwork in the government approval process required for all medically-related products.
Another part is the assumption that the DME will provide fitting and technical assistance.
In view of the absence of this later service in so many places, perhaps the prices are still too high.
Another factor is, no doubt, the power held by the manufacturers themselves by the grace of their shared monopoly.
Hate this situation as you like, I know of no reliable 'pirate' sources for new equipment.

[howkim]

From my purchase of 5/11/11:

Filter (white) DME billed $ 23.10 Insurance allowed $ 4.04
Hose DME billed 92.70 Insurance allowed 17.94
Nasal Mask DME billed 600.00 Insurance allowed 56.40

'Nuff said.

[Janknitz]

DME prices are pure fiction. Insurers set the rates for all but a few poor suckers without insurance who make the mistake of paying DME "list prices". One reason these prices are so high is DMEs use them try to justify to insurers when they negotiate rates.

Check online suppliers for realistic rates in a competitive market rather than captive audiences.

[AmIawake]

...IMHO, even the lower amounts set by the insurance company are still more than what the products are worth...

I consider the insurance reimbursement rates to be reasonable.

The providers are playing a game. Even on the web there are tutorials about using the "correct" codes so that the medical providers will maximize the insurance payouts.

Yes, I find it amazing that a non-insured patient would be expected to pay the full marked-up price. There is a message in that. It's not one I am proud of.

[howkim]

For replacing my Mirage Activa mask and headgear last month, the DME billed my insurance $296 for the headgear and $980 for the mask. That's a total of $1276. Our hosts at cpap.com offer the same thing for $127.

[nanwilson]

I don't have insurance and had to pay through the nose (hosehead humour ) for my first machine and mask from the DME. Once I found this site, I learned alot............no longer do I buy through the DME I have double of everything including a machine, all purchased privatly or online.

[poppi2]

Out-of-pocket purchases

CPAP.com 7/6/11

Swift FX Nasal Pillow CPAP Mask with Headgear - Sizes (S, M, L) $127.00
PR System One REMstar Auto CPAP Machine with A-Flex $535.00
PR System One Heated Humidifier $165.00
Control III Disinfectant CPAP Cleaning Solution - 16 oz Concentrate $16.00
Bundle Discount for PR System One REMstar Auto CPAP -$65.00
with Heated Humidifier

5% off UpSellIt was used for a discount of $32.55 (this discount offered via chat while I was selecting items)