ADP changes to CPAP in Ontario

[SleepWrangler]

I guess I'll see what they are charging and I will go in with quotes from other places as to what I can get it for. If they are gouging I won't purchase. I would prefer to stay with what I like but I won't overpay for it.

I'm interested to hear about your experience. My assumption was that they will attempt to gouge. The manufacturers discourage competition by limiting availability. For example, the hosts of this board are not able to ship some products cross-border.

[thefabulousmrsk]

I will definately update after tommorow to let you all know how it went. If they want to sell the upgraded mask I'm going to use the excuse I need to check with my coverage and get them to quote me prices so I can do a good comparison.

[ironhands]

the hosts of this board are not able to ship some products cross-border.

this is common with many products. The reason is because they have different pricing agreements within different regions. They may be charging the vendors more in Canada, and in order to protect them from competition in the USA (where the DME's deal with a much higher bulk, and therefore lower cost in some cases) they restrict the sales. The USA sellers just have better buying power, and can therefore afford to sell them cheaper in most cases.

I see it all the time where I work, we get grey market items all the time - items that weren't meant for distribution in Canada (usually asia) that are priced for their economy.

[Hose_Head]

Oh, yeah. I got my elite today. 215$, full kit, no mask, but I already had a wisp I got for $100. Told the doc about my DME experiences and he said he'd call them if they wouldn't sell at the required price.

So I started talking to my Ontario based DME about prices. They provided a trial machine for 6 weeks (finish two weeks from now) for a flat $30 fee. Their brochure says the ADP provides partial funding for the CPAP device, heated humidifier (with starter water chamber), carrying case, standard tube, one filter, power cord, and user manual. This implies they do not supply a mask.

Of course this description fails to meet the ADP program criteria because they must also supply a basic mask and system configuration. It is an omission that implies they expect to always sell an upgraded mask. In addition they sell a series of optional kits starting at $150, $250, and $400. The brochure suggests one these kits are "required" to ensure good therapy. Wording is misleading. It is not required by the ADP.

Thing is I already purchased an S9 AutoSet and mask from the U.S to be picked-up in a couple of weeks. This particular DME will be supplying my backup unit so I'm only interested in ADP (75%) funded equipment and supplies. Also, I will offer to purchase the mask I used for the trial but only at near on-line pricing.

Did you find out what was included in each of those optional kits? Exactly what does one get for $400?

[Hose_Head]

ADP was so helpful! The agent told me that the machine should have a mask within the box. (this is the first I've heard of this??) It will more than likely be hard plastic mask. He told me it probably makes more sense to take the basic mask and shop around for a better mask, because he said he's heard from people paying $300 for a mask. I guess I'll see what they are charging and I will go in with quotes from other places as to what I can get it for. If they are gouging I won't purchase. I would prefer to stay with what I like but I won't overpay for it.

Something to keep in mind is that about the hardest thing about CPAP therapy is to find a mask that works for you. Most on this board have tried several masks before hitting on the one that works best for them.

If you can find a DME that allows you to try several different masks for little or no cost to you, then it may be worthwhile to stay with that DME until you find the right mask for you. To be fair to the DME, purchase that overpriced first mask from them. You then can buy future mask replacements from an online supplier at a lower price.

[SleepWrangler]

Did you find out what was included in each of those optional kits? Exactly what does one get for $400?

Yes, I have a brochure detailing each kit. For $400 you get reusable water chamber, heated tube, memory data card, 4 filters, 3 mask wipes, 1 tube brush, 1 hose lift, 1 cpap pillow, 1 pillow cover, setup & consultation, 2 mask fit & check, 4 download reports, 2 pressure check & change. Personally I don't see the value.

To be fair to the DME, purchase that overpriced first mask from them. You then can buy future mask replacements from an online supplier at a lower price.

The entire process is geared towards sucking money from insurance companies and possibly, to a lesser degree, from meeting class 2 medical device obligations. If the supplies were competitively priced they would have a customer for life. I can only assume over pricing and insurance money more than makes up for the loss of value oriented customers.

[ironhands]

heated tube - $50, data card, 10$, mask fit/check and download reports should be free, as should pressure checks and changes since that's something the doctor would order. setup and consultation they CANNOT charge you for, they're obligated to provide that free under the ADP guidelines. reusable water chamber? isn't that included with every unit with a humidifier(also required under ADP)?

so.. anyone wanna price those 4 filters, 3 wipes, brush, lift, pillow, and cover? pretty sure it doesn't come out to $340

[Hose_Head]

For $400, they should be offering an upgrade from a basic cpap to a full-zoot apap, a high-end mask, heated hose plus a spare heated hose, spare humidifier tank, hose management system, and a lifetime supply of filters, cleaners, etc. Even then, there would be a high profit in it for them.

[ironhands]

For $400, they should be offering an upgrade from a basic cpap to a full-zoot apap, a high-end mask, heated hose plus a spare heated hose, spare humidifier tank, hose management system, and a lifetime supply of filters, cleaners, etc. Even then, there would be a high profit in it for them.

Only problem is that there's no provision for upgrading from a CPAP to an APAP; they won't contribute anything if you're opting for an APAP. Should also note that they aren't allowed to "upgrade" your CPAP to a fancy one either, because all CPAPs cost the same as far as the government is concerned. Given the cost difference, I don't really see why a consumer shouldn't be allowed to use the ADP portion towards the FULL cost difference between the approved price and the ADP price... effectively paying 100% the cost difference after the ADP kicks in 75% of the CPAP cost, but those are the rules, and deviating from them puts the DME vendor at risk of losing their ADP license - which pretty much puts them out of business.

[SleepWrangler]

For $400, they should be offering an upgrade from a basic cpap to a full-zoot apap, a high-end mask, heated hose plus a spare heated hose, spare humidifier tank, hose management system, and a lifetime supply of filters, cleaners, etc. Even then, there would be a high profit in it for them.

The $400 option estimated value is $200 using on-line retail pricing and completely discounts the value of unnecessary hand-holding. The Ontario government has corrected the gouging of taxpayer funded ADP and this particular DME has responded by introducing "required" (aka optional) overpriced care packages.

My strategy is to 1. Return the loaner evaluation machine and achieve sign-off /w dated paid-in-full sign-off, 2. Order an ADP funded package: ResMed S9 Elite /w H5i Humidifier), 3. Get price sheet for optional and consumable supplies. I won't mingle or even discuss the next step until the previous one is completed in full.

[ironhands]

I'd also recommend buying the mask that's currently being used for the loaner from the cheapest online supplier as well, prior to returning the kit, that way they're almost obligated to give you the "basic mask" that's supposed to be included in the kit (even though you may not end up using it).

[thefabulousmrsk]

Alright, so here's how it all went down with my DME.. I'm assuming I can list prices here. These are posted in the DME office for anyone to see if you walk in so it's not private knowledge. However if not someone let me know and I'll remove. I have to say the salesperson was nice and I actually liked him. I take none of any up selling personally because I know that's probably what he is told to do. Also he was the only one in the office. Now I know why they never answer the phone! It rang through out my visit and he had to ignore it help me. Again I blame this more on the DME ownership/management then the sales guy.

I walked in, told him I wanted the Resmed S9 Autoset. Without hesitation he went and got the machine. While he was getting it I saw they had the cpap pricing list right on the desk and it was $860, just like it should be. Here's where it all fell apart though..
"The breakdown of the cost of this equipment is as follows:
Cpap Unit- 860.00
Comfort Kit-400
Full face mask-339.00
Total cost- 1599.00
Client's portion-954.00
ADP portion 645.00.

(no Apap pricing mind you, but it was 1020 just as it should be.)

I find this completely misleading! If I did not know better I definitely would have shelled out 954.00. Yes I have coverage but still if for some reason I was denied or delayed my claim I'm out that money for some time if not completely! So I told him I wanted no part of the comfort kit (which was the sd card, climate line tubing and wipes filters etc.)

I did however cave and buy the mask. I wasn't going to. But ultimately I do have coverage and it's reimbursed to me. It was way over priced... but the idea of coming home with a machine I could not use comfortably over something I'm fully reimbursed for seemed not worth it to me. I should've just bought the mask before hand and I would recommend that to anyone else. Here's what I did do though. I told him I wanted the basic ADP mask as well. The 339 was only for my face mask therefore for that price I should get the basic mask and the upgraded mask. He told me it was only for people who couldn't afford the face mask. So I simply told him, that's not what ADP says, I should know.. I called my buddy there yesterday.. Did you know I work for the government? LOL, and he gave me the "basic" mask which is a F&P Flexifit 405. I actually don't think it's a bad mask, seems similar to the one I first had in the trial and I liked it, just had sinus issues causing me to switch to the face mask. However keep in mind I'm one of those rare people who took to cpap like a fish to water. Mask fits (other that sinus issues) has not been much of a problem, I've adapted quickly to each mask.

So all said and done. I paid $594. Not pleased about the mask experience... but I will say he was very helpful in regards to my insurance claim and told me what to submit and if I have any problems to give him a call. (though who knows if he will be able to answer the phone!!) Also a note I should mention. Due to my husband's crazy schedule we've had the loaner cpaps for over 2 months.. in fact my husband STILL has his. He has to submit a quote first. No rental fee charged to us. Makes me feel a bit better about overpaying for a mask! LOL

[thefabulousmrsk]

ADP was so helpful! The agent told me that the machine should have a mask within the box. (this is the first I've heard of this??) It will more than likely be hard plastic mask. He told me it probably makes more sense to take the basic mask and shop around for a better mask, because he said he's heard from people paying $300 for a mask. I guess I'll see what they are charging and I will go in with quotes from other places as to what I can get it for. If they are gouging I won't purchase. I would prefer to stay with what I like but I won't overpay for it.

Something to keep in mind is that about the hardest thing about CPAP therapy is to find a mask that works for you. Most on this board have tried several masks before hitting on the one that works best for them.

If you can find a DME that allows you to try several different masks for little or no cost to you, then it may be worthwhile to stay with that DME until you find the right mask for you. To be fair to the DME, purchase that overpriced first mask from them. You then can buy future mask replacements from an online supplier at a lower price.

Ultimately I did purchase my mask from DME for my own convenience.. but why would that be "being fair" to them. If they are charging way over market value for a product they are not being fair to me, why should I have to shop around for a better price. You know during trials those are not new masks right? I specifically asked this question and the DME told me that they send them for disinfection after each use and reuse them. Who knows how many people try that same mask. Same with the hoses... and the machines well those can go for as long as they are functioning and even then they can probably repair them cheaply.

There is nothing wrong with being an informed consumer. I actually feel that the language the DME uses is geared to prey on the uninformed. The pricing is the same for those who have coverage and those who don't. As it's necessary medical equipment consumers shouldn't have to shop around for better prices. I can understand even a $50 difference.. but the difference between what my DME is charging and that same mask on a online Canadian supplier I found.. $159. And that's just the mask.. that's not other supplies like climate-line tubing, SD card, Filters.. etc.

[SleepWrangler]

So all said and done. I paid $594. Not pleased about the mask experience... but I will say he was very helpful in regards to my insurance claim ...

I bet he was willing to help with the insurance claim. It is the only reason the DME infrastructure exists. In the end we still pay because employment benefits are rolled-up into employment total compensation for taxation and headcount budgeting. There's no such thing as a free lunch.

For a new S9 AutoSet you paid a good price even when compared to on-line. You should feel good about your purchase. I paid $100 more than you for a "gently used" AutoSet and new mask (I didn't qualify for APAP funding).

I actually feel that the language the DME uses is geared to prey on the uninformed.

Big time. That coupled with the severe gouging is outrageous.

Great post thefabulousmrsk. I think there's now enough content in this thread that people who bother to search will have enough information to make good choices and not get blindsided.

[thefabulousmrsk]

I bet he was willing to help with the insurance claim. It is the only reason the DME infrastructure exists. In the end we still pay because employment benefits are rolled-up into employment total compensation for taxation and headcount budgeting. There's no such thing as a free lunch.

Completely agree with you. Anyone who's stayed with a company/organization any length of time has probably experienced this first hand. Also, I just don't like being the what I feel like as the middle man in what I feel like is a utterly ridiculous gouging... I feel like I'm being used! LOL

Great post thefabulousmrsk. I think there's now enough content in this thread that people who bother to search will have enough information to make good choices and not get blindsided.

Thank-you. My husband was with me. He's actually going on Cpap. Aren't we a great pair?! His insurance does it a bit different, they ask for the quote then send him the money. So he just got the quote today. He had no idea I had researched it this much and in the middle of the appointment he turns to me and said "I didn't know you were such an CPAP nerd!". I responded "Well hun, I'm technically talking APAP right now, so I think you mean APAP nerd!". When we got out of the office he told me I was bad ass! LOL.

You got a good deal for the APAP and mask. I think the ADP requirements for meeting APAP are a bit ridiculous. My doctor originally wanted to put me on an Apap trial to see if they could find a set pressure. I asked him if I could just be prescribed APAP and he said yes, I met the criteria. Here's what I don't get. So, OHIP pays for another sleep study. Then the consultation with the doctor, who may just tell me I still need Apap. If they did find a set pressure the difference in cost through ADP $160. ADP and OHIP are different programs granted, but both under the Ministry of Health and Long Term Care. Sure there are different pots of money, but they both fall under MOHTLC, which ultimately is funded by Ontario taxpayers. There is no way another sleep study and doctor visit costs would justify the savings of $160. Annnnnd let's be honest here, doing another sleep study was not something I wanted to do if I didn't have to!