Does This Make Sense? No, It Does Not--An Insurance Rant

[Drowsy Dancer]

OK, what I am about to post is likely old news to everyone here, but I need to vent to an educated audience.

Our gracious website host can sell me outright a duplicate of my current CPAP machine for $595.

My DME (Apria) pretends to charge me $874.72 monthly for renting said machine. I say "pretends" because it then meekly accepts $58.84 as my Aetna "member rate," of which I pay $11.77. UPDATE: Upon doing further research, it turns out that I was buying the machine over time. I think the DME was simply rebilling Aetna the full purchase price and Aetna was countering with paying the rental rate.

$11.77 does not seem like an unreasonable rental rate for what I'm getting*, especially because Apria has frankly been kind of hit-or-miss whether they remember to bill me for it. At first I thought the charge was bi-monthly, but the pattern of charges has not been that regular. And I've had my machine for nineteen months. UPDATE: According to Aetna, it paid, and I paid co-insurance, monthly from 2/2011 through 11/2011, at which point I owned the machine. After only ten easy payments! Now I get billed 2x per year for a service/maintenance contract for the machine (why it gets billed as the original purchase price of the machine I cannot tell you). After five years I can apparently rent-to-own a new machine if I wish.

But but but. I am self-employed. When I send a bill for $875, I d@mn well mean it. Why jack up the nominal price to over ten times what you actually expect to receive? It just makes it seem like you're running a racket (I know, I know--they are, right?).

I feel a little better now.
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*I do see some advantages to renting. I'm assuming that if the machine malfunctions Apria swaps it out and warranty issues are their problem. I also speculate that if the technology or machine features improve in a few years (I'm kind of lusting after the PR heated hose that can't be retrofitted to my current PR machine) I might want to trade my current rental for a new one. I was still in such a sleep-deprived fog when I signed the contract that I don't recall if I am renting-to-own or in perpetual rental status. I could research this; I bet I still have that piece of paper somewhere. UPDATE: the terms of the contract are NOT very clear to me, and I have been practicing law for almost 30 years. You can only discover that it is rent-to-own by learning the terms of the contract between Apria and Aetna, which I still have not seen.

[chunkyfrog]

They love that fog.
All the more reason they would prefer our treatment be nominal--to keep us ditzy.

[Drowsy Dancer]

They love that fog.
All the more reason they would prefer our treatment be nominal--to keep us ditzy.

Even without the fog, I wouldn't have known enough about the practical/financial aspects of CPAP when I got my machine to think of those questions. I didn't find this forum until I was a couple of weeks into treatment. Coulda, shoulda, woulda...it would have been a good idea for me to research this stuff while I was waiting for a sleep study the results of which I was already pretty sure about (I just didn't know how bad I had it).

[chunkyfrog]

If we lobbied for and got a class, it probably would be given by the very people who lie to us already.

[nanwilson]

That fog is their "bread and butter" aka $$$$$$$$$$$$$ . When I bought my machine I actually asked what the difference was between an auto and a straight cpap was.....the answer I got was "about $500", mumble mumble..I didn't mean cost I meant function. Now that I am "educated" , I know darn well there isn't a $500 difference between an auto and a cpap and I know what the difference is between the two functions. The day I bought and paid for my machine is the first and last day I saw or heard from that DME

[lostsheep]

Hi Drowsy Dancer,

I too have Aetna, and chose to use Apria in hopes that they could source a variety of equipment types. They've been OK for me so far, and their RT's have been able to suggest changes in my therapy almost as well as the doctor's office.

At my initial review of sleep titration & prescription, the doc discussed equipment options with me. He suggested rent-to-own, to give things a chance and see how it worked out. I'm glad I did this, as I continued to have troubles after 6 months with CPAP. With a new prescription from the doc it was quite easy to switch. I think the lease agreement is for 10 months, then I own the equipment. I'm now giving the S9 auto VPAP a go - but I'm not sure what will happen when I change insurance policies.

[Drowsy Dancer]

Wow, I actually found my contract with Apria in my CPAP file. It appears that I own my humidifier outright, and I am renting never-to-own my CPAP proper. Oddly, the initial rental amount listed was in the $60 range, and not the $875 range.

Perhaps this bears further investigation. OTOH, then Apria may notice they're not billing me every month. But still.

[Drowsy Dancer]

Here's another gem just in. Replacement water tank for humidifier: $134. Aetna member rate: $7.46. My copay: $1.49.

It's all smoke and mirrors.

[greatunclebill]

most of us already know how this works. it's not a big deal to me. i pay the portion that my insurance tells me that i am responsible for and don't worry about all the big numbers.

it's really no different than car repair. joe blow manufactures your car part for $3 and sells it to your auto parts store for $25. the auto parts store will sell it to you for $75. but you need to have it installed by a mechanic. the auto parts store charges your mechanic $40 for the part. your mechanic then takes 2 hours to install the part and charges you $125 for the part and $150 for labor. total bill for the $3 part is $275 installed plus tax.

everything we buy is marked up for the end user but sold to the middle man/insurance/mechanic/distributor at a greatly reduced price.

[chunkyfrog]

My brother had a 10 cent part break in the tranny of a car he had.
The dealer refcused to sell him the part, wanted to install it at about $800.
My brother called the main office--in Japan, and the dealer gave him the part.

[Slinky]

The local DME providers have a "pipedream" price that they can charge only to the uninsured.
Then there is the "allowed" price which is the price set by Medicare or negotiated w/your insurance company.
Then there is the 80% of the "allowed" amount that Medicare will pay
and finally there is the 20% amount of the "allowed" amount that is your "copay"

[Bons]

The local DME providers have a "pipedream" price that they can charge only to the uninsured.
Then there is the "allowed" price which is the price set by Medicare or negotiated w/your insurance company.
Then there is the 80% of the "allowed" amount that Medicare will pay
and finally there is the 20% amount of the "allowed" amount that is your "copay"

I'm getting old. I can still remember when doctors and DME's gave you a break if you didn't have insurance....

[hyperlexis]

Welcome to American healthcare.

The real problem is the total cost passed on to the insured by such bureaucratic nonsense -- if the total allowable amount paid at the end of the lease or final purchase is say, $1,000, but you can buy the same machine for $600 online, by all rights you should be able to buy the same machine at lower cost, and have the insurer reimburse the expense. However that's not generally what happens. My BCBS-IL plan will only reimburse the full amount if you use a participating DME. EVEN if that DME charges far more than other, non-participating vendors. Totally senseless, unless there is some backdoor deal going on where the participating DMEs kick back money to the Insurer later on without telling the insured person stuck with the unnecessarily inflated co-pays.

So the insurer willingly pays more, the insured person is forced to pay a higher co-pay, and overall healthcare costs go up for everyone (in theory).

[49er]

The local DME providers have a "pipedream" price that they can charge only to the uninsured.
Then there is the "allowed" price which is the price set by Medicare or negotiated w/your insurance company.
Then there is the 80% of the "allowed" amount that Medicare will pay
and finally there is the 20% amount of the "allowed" amount that is your "copay"

I'm getting old. I can still remember when doctors and DME's gave you a break if you didn't have insurance....

Both of my sleep doctors have given me a price break due to not having health insurance. Unfortunately, the first one, in addition to blaming my failure to adjust to cpap on psych problems, provided horrible follow up care. I have always wondered if that was due to not having health insurance even though she gave me a break on price.

I definitely had the experience of a local DME wanting to price gouge before I discovered cpap.com.

49er

[Komodo]

. And I've had my machine for nineteen months

You might want to CALL your insurance (Aetna) and double check that you don't already own your machine. Nineteen months of rental, with no end in sight, doesn't sound right to me.
Most rentals are 13 months or LESS. After that, you own it outright.

I used to have Aetna, their lowest level of coverage, and let me tell you it was really bad, but as bad as it was, after 13 months, my cpap belonged to me!