I don't dispute that if I sat with my sleep doctor or sleep clinic technician TODAY, they wouldn't be very helpful. But if that were the way things were done, then they would be.
They haven't learned the stuff because they don't HAVE to. We have (effectively) people who never went to med school practicing medicine, and (if the stories on this site are to be believed) poorly.
I'll say again, if I went to a pharmacist with a prescription for erythromycin, and he came back and said "Oh, you don't want that, you want Amoxycillan, so that's what I gave you", I'd never go back.
(It's not a perfect analogy, because there are some substitutions, like generics, and approved replacements for no-longer-available-drugs which they CAN make, and of course if they have a record of you being allergic to a family drug, they may suggest you not fill the prescription... But the point is still valid.)
The DME should provide equipment, not make decisions regarding treatment, and the fitting of masks and other equipment *IS* treatment decisions.
Liam, who can think of a lot better things to buy with the extra $1150 the local DME charges for his equipment.
Damn DMEs
dme
If you are looking to buy your equipment and pay cash then online is the way to go. No dme can compete the the rock bottom prices that those suppliers are offering. Insurance companies are not a dme's friend. They are the dme's enemy. I guess every geographical area is different, but in my area reimbursement on cpap is very low. The price estimates I gave in prior postings were prices I have seen from my experience. If a company gives good customer service and follows up on a patient the way they should then their profit margin is not huge, but it is enough to operate on and still turn a profit. If the dme drops the machine off and never talks to you again then they are making money hand over fist. It all depends on how they want to do business. In my area we could charge a million dollars for a cpap machine, but the insurance is only going to pay their allowable. The difference is that we don't balance bill our patients.
I am curious...What improvements could most DME's make that would benefit their cpap patients and their treatment aside from price related issues.
I am curious...What improvements could most DME's make that would benefit their cpap patients and their treatment aside from price related issues.
Re: dme
Actually reading Dr's reports. Mine specifically said full face mask in the report, and the DME wanted to give me a nasal mask. And how about worrying about patient comfort instead of profit when suggesting a mask?MelMel wrote:If you are looking to buy your equipment and pay cash then online is the way to go. No dme can compete the the rock bottom prices that those suppliers are offering. Insurance companies are not a dme's friend. They are the dme's enemy. I guess every geographical area is different, but in my area reimbursement on cpap is very low. The price estimates I gave in prior postings were prices I have seen from my experience. If a company gives good customer service and follows up on a patient the way they should then their profit margin is not huge, but it is enough to operate on and still turn a profit. If the dme drops the machine off and never talks to you again then they are making money hand over fist. It all depends on how they want to do business. In my area we could charge a million dollars for a cpap machine, but the insurance is only going to pay their allowable. The difference is that we don't balance bill our patients.
I am curious...What improvements could most DME's make that would benefit their cpap patients and their treatment aside from price related issues.
GRRRRR....
How about joining the rest of us in the modern age. Its 2005. There is a device called an Autotitrating cpap. Offer it to your customers first. They will appreciate it and maybe you. Being given a straight cpap right from the start is rough. Compliance might be a bunch higher also. Lastly , your customers wouldn't feel ripped off being given straight cpap only to read about autos when they find this forum. Give them a chance to make cpap work.
Last edited by chrisp on Fri Feb 18, 2005 5:23 pm, edited 1 time in total.
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Snorenomore
- Posts: 27
- Joined: Wed Feb 09, 2005 11:33 pm
Ok, now I am starting to understand a little more why you titled this subject the way you did.
I just received in the mail today my first invoice from my DME company. I still have insurance this month. They charged my health insurance company $1250! When I picked up the machine in December, I had to pay $95 and now this invoice for January says I have to pay another $127. I was told with my insurance coverage I would have to pay $20 per month...oh oh, did somebody lie to me?
They also told me that when I come off my insurance I will have to pay $125/month. If I am expected to pay $127/month with insurance, no stinking way will they charge me that w/o insurance. Plus I am still going to have to pay for February with insurance...will that be another $127?
I will be turning my dated S6 CPAP back in at the end of the month and buying a machine next week.
Talk about a rip off. If your situation is anything like mine, I can see the reason for saying the heck with insurance companies and DME's and just straight out buying a machine.
Snorenomore,
Starting to get wise after being a masked man for 2 months.
I just received in the mail today my first invoice from my DME company. I still have insurance this month. They charged my health insurance company $1250! When I picked up the machine in December, I had to pay $95 and now this invoice for January says I have to pay another $127. I was told with my insurance coverage I would have to pay $20 per month...oh oh, did somebody lie to me?
They also told me that when I come off my insurance I will have to pay $125/month. If I am expected to pay $127/month with insurance, no stinking way will they charge me that w/o insurance. Plus I am still going to have to pay for February with insurance...will that be another $127?
I will be turning my dated S6 CPAP back in at the end of the month and buying a machine next week.
Talk about a rip off. If your situation is anything like mine, I can see the reason for saying the heck with insurance companies and DME's and just straight out buying a machine.
Snorenomore,
Starting to get wise after being a masked man for 2 months.
See what I mean MelMel. Another happy DME customer.
Jimmy Hoffa isn't dead. He's a DME somewhere in Texas.
Relax http://www.worldofkitsch.com/music/midi/beegees.mid
Cheers,
Chris
Jimmy Hoffa isn't dead. He's a DME somewhere in Texas.
Relax http://www.worldofkitsch.com/music/midi/beegees.mid
Cheers,
Chris
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ElaineP
Want another example of another happy DME customer? This is a company that the Dr.'s office uses to do the sleep study and supply the equipment. They made all the decisions without my knowledge of the type of cpap, mask, etc.
I was given a Resmed 6 Lightweight and they charged the insurance company $2500.00 for it. The insurance allowed $1500.00. It can be bought online for a about $325.00 and is now obsolete. (I received it the first of the year, so it was already an old model).
They charged the insurance company $400.00 for the mask, an Ultra Mirage nasal, and the insurance allowed $240.00.
They charged the insurance $50.00 for the hose, and they allowed $30.00.
Last but not least, They charged $300.00 if which the insurance allowed $180.00 for about 10 - 15 minutes at the most to show me how to assemble the machine. I had to drive 35 miles to pick it up.
I have to pay 20%, which is $390.00. I would have saved money to buy it outright before the DME ripped off the insurance company and the patient.
And that's not the end of the story...
I was having trouble using the machine, because of dry mouth and throat, and the RT decided, hey, you need a heated humidifier. I asked how much it costs, and he said it ran around $300.00. This was after the 1st of the year, and I have a large deductible to pay. So they said I could pay it on time, it wasn't a problem. I asked several times, the price of the humidifier.
Well, I got the summary from the insurance company, and here's what they
charged:
Humidifier - $860.00 of which the insurance allowed $516.00, and last but not least, they charged another $300.00 diagnosis (in other words) how to hook up hoses and fill the chamber with water, 10 minutes and another 35 mile trip, of which the insurance allowed $180.00. Now I have another balance of $696.00 that I owe Sleep Rite (the DME), because I have a $750.00 deductible. I have thought of calling the BBB, because I was told the wrong price in the first place.
This is why people can't afford medical insurance anymore. Okay, rant is over.
I was given a Resmed 6 Lightweight and they charged the insurance company $2500.00 for it. The insurance allowed $1500.00. It can be bought online for a about $325.00 and is now obsolete. (I received it the first of the year, so it was already an old model).
They charged the insurance company $400.00 for the mask, an Ultra Mirage nasal, and the insurance allowed $240.00.
They charged the insurance $50.00 for the hose, and they allowed $30.00.
Last but not least, They charged $300.00 if which the insurance allowed $180.00 for about 10 - 15 minutes at the most to show me how to assemble the machine. I had to drive 35 miles to pick it up.
I have to pay 20%, which is $390.00. I would have saved money to buy it outright before the DME ripped off the insurance company and the patient.
And that's not the end of the story...
I was having trouble using the machine, because of dry mouth and throat, and the RT decided, hey, you need a heated humidifier. I asked how much it costs, and he said it ran around $300.00. This was after the 1st of the year, and I have a large deductible to pay. So they said I could pay it on time, it wasn't a problem. I asked several times, the price of the humidifier.
Well, I got the summary from the insurance company, and here's what they
charged:
Humidifier - $860.00 of which the insurance allowed $516.00, and last but not least, they charged another $300.00 diagnosis (in other words) how to hook up hoses and fill the chamber with water, 10 minutes and another 35 mile trip, of which the insurance allowed $180.00. Now I have another balance of $696.00 that I owe Sleep Rite (the DME), because I have a $750.00 deductible. I have thought of calling the BBB, because I was told the wrong price in the first place.
This is why people can't afford medical insurance anymore. Okay, rant is over.
I want to emphasize that when I say my insurance company paid the DME $2900, that's AFTER discounts. The bill is confusing, so I went through it and only added together the amounts the insurance company paid. I still owe the DME $360.
And I went to their office. They did not come to my home.
There are good people at these companies. The company that dispensed my equipment also did my titration study. I really liked the technician at the study. I only wish she had been around when they dispensed my equipment. Instead I dealt with the owner of the company who was trying to push masks on me that I knew I didn't want.
And I went to their office. They did not come to my home.
There are good people at these companies. The company that dispensed my equipment also did my titration study. I really liked the technician at the study. I only wish she had been around when they dispensed my equipment. Instead I dealt with the owner of the company who was trying to push masks on me that I knew I didn't want.
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rested gal
- Posts: 12881
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
hi MelMel,
You seem to care and you asked:
2) As chrisp said, go to bat with the doctor and the insurance company to try your very best to see that the patient receives an autopap (preferably the one with C-flex) right from the start. Autopap instead of straight CPAP.
3) Call the customer every other day or every three days for the first two weeks, to find out what problems they might be having. After those first two weeks, still call them at least once every two weeks for three months, and once every few months thereafter during the entire first year.
4) Give every new customer the URL to this message board and the URL to the talkaboutsleep.org message board. Your customers might be the ones who will start countering the "evil DME" posts with accounts of how well they are being treated by your store. Word of mouth is powerful advertising, especially on the internet message boards.
5) Be sure that every customer receives a heated humidifier whether they will end up turning the heat on or not.
6) Give every new customer a FAQ sheet with helpful suggestions including:
a. controlling rainout - include information about the heated hose and the URL to sleepzone.com.au
b. a list of the "best" masks and the pros/cons of each. Include hints for making each one work best (e.g., Breeze nasal pillows will seal better if they are large enough to sit almost completely outside the nostrils; straps should be almost floppy loose with the Activa, etc.
c. suggestions for ways to hang the main air hose above the head.
d. a list of any support groups you know of, and the URLs to cpaptalk.com and talkaboutsleep.org
e. a clear explanation about how billing/reimbursement works so that the customer doesn't get angry or feel blindsided when they see the price difference in what is billed and what you actually receive. Hard to explain, I know, and a lot of people still won't understand it, but do try.
Good luck, MelMel.
You seem to care and you asked:
1) Let customers take a mask home and try it out for a week before they are stuck with it. Unlimited try-outs of as many masks as they need to try for perhaps a small weekly fee to cover your cost of disinfecting your rotating "rental tryout masks". When the customer finally finds a mask that suits them, they can buy it new. Be sure you have the best brands/models of masks for the try outs. You've seen the names of the four or five "best" masks, I'm sure, in posts on this board. Don't send people home with cheap Respironics masks even for a try-out. Masks are the biggest stumbling block of all, so do everything you can to help them find a comfortable one.I am curious...What improvements could most DME's make that would benefit their cpap patients and their treatment aside from price related issues.
2) As chrisp said, go to bat with the doctor and the insurance company to try your very best to see that the patient receives an autopap (preferably the one with C-flex) right from the start. Autopap instead of straight CPAP.
3) Call the customer every other day or every three days for the first two weeks, to find out what problems they might be having. After those first two weeks, still call them at least once every two weeks for three months, and once every few months thereafter during the entire first year.
4) Give every new customer the URL to this message board and the URL to the talkaboutsleep.org message board. Your customers might be the ones who will start countering the "evil DME" posts with accounts of how well they are being treated by your store. Word of mouth is powerful advertising, especially on the internet message boards.
5) Be sure that every customer receives a heated humidifier whether they will end up turning the heat on or not.
6) Give every new customer a FAQ sheet with helpful suggestions including:
a. controlling rainout - include information about the heated hose and the URL to sleepzone.com.au
b. a list of the "best" masks and the pros/cons of each. Include hints for making each one work best (e.g., Breeze nasal pillows will seal better if they are large enough to sit almost completely outside the nostrils; straps should be almost floppy loose with the Activa, etc.
c. suggestions for ways to hang the main air hose above the head.
d. a list of any support groups you know of, and the URLs to cpaptalk.com and talkaboutsleep.org
e. a clear explanation about how billing/reimbursement works so that the customer doesn't get angry or feel blindsided when they see the price difference in what is billed and what you actually receive. Hard to explain, I know, and a lot of people still won't understand it, but do try.
Good luck, MelMel.
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Janelle
For those of you having big co-pays after your insurance has paid, or the DME is telling you one price and then charging another, do this:
Wait until you get the Explanation of Benefits for the equipment from your insurance company. Look at that column that says "You Owe Provider". If this is lower than what was quoted you or billed to you, that is ALL you owe. This is part of the negotiated contract and the allowable. And if the DME says different they are WRONG. You only owe the negotiated contract difference, not what they necessarily charged.
If you have already paid, go back and find that EOB and demand a refund if you are owed one. Most bookkeepers or billing offices for these places haven't got a clue as to the negotiated price or allowable amount. Tell them according to your insurance you only owe X amount not what was billed you. You might have to fax them a copy but it's a lot better than paying what they do not deserve.
Wait until you get the Explanation of Benefits for the equipment from your insurance company. Look at that column that says "You Owe Provider". If this is lower than what was quoted you or billed to you, that is ALL you owe. This is part of the negotiated contract and the allowable. And if the DME says different they are WRONG. You only owe the negotiated contract difference, not what they necessarily charged.
If you have already paid, go back and find that EOB and demand a refund if you are owed one. Most bookkeepers or billing offices for these places haven't got a clue as to the negotiated price or allowable amount. Tell them according to your insurance you only owe X amount not what was billed you. You might have to fax them a copy but it's a lot better than paying what they do not deserve.
Thanks for your input Rested Gal. It is very valuable to hear what is important from another point of view. I can definitely see why dme's get a rotten reputation. As some advice to other patients out there... when you get set up somewhere along the line you should have to sign an "assignment of benefits" usually this is what gives the dme permission to bill your insurance. This is also where you are usually told how much out of pocket expense you will have. Make sure they put this in writing somewhere for you. I know it isn't fool proof but it will help later on down the road. At least it will give you a small bit of ammo when you go to fight the "wretched dme". There is always the loophole of when they checked your benefits the insurance said one thing now they are doing another, but at least maybe it will help. Also, don't be afraid to call the insurance company before receiving your cpap. Ask them what your coverage, deductible and maximum benefit is. Also make sure your provider is in network and going to accept in network assignment. Insurance companies go by a series of codes when providers bill. They are called HCPCS (hicks picks) codes. The code for cpap is E0601. Sometimes that will help when the insurance company tells you what your benefits are.
The issue of auto cpap is a good one. I will be totall honest with you and say that the reason none of the dme's want to give out auto cpap is because it is much more costly then regular cpap. Where I work we do not give out used cpaps unless we are giving one free or at reduced to a patient with no insurance at all. But I know that is not the case with most companies. Do your homework and ask them if you are receiving a new machine. If not, tell them you want one. Most companies get reimbursed the same amount whether it is a new or used machine unless they are billing to medicare. (sad but true I know)
I can see where being the on the patient end of cpap can be very confusing and frustrating. I am not an expert by any means but I am dedicated to providing the cpap patients I see with quality care. Input from all of you on this message board is very helpful. I hope some of my input can be helpful to all of you too.
Thanks
MelMel
The issue of auto cpap is a good one. I will be totall honest with you and say that the reason none of the dme's want to give out auto cpap is because it is much more costly then regular cpap. Where I work we do not give out used cpaps unless we are giving one free or at reduced to a patient with no insurance at all. But I know that is not the case with most companies. Do your homework and ask them if you are receiving a new machine. If not, tell them you want one. Most companies get reimbursed the same amount whether it is a new or used machine unless they are billing to medicare. (sad but true I know)
I can see where being the on the patient end of cpap can be very confusing and frustrating. I am not an expert by any means but I am dedicated to providing the cpap patients I see with quality care. Input from all of you on this message board is very helpful. I hope some of my input can be helpful to all of you too.
Thanks
MelMel
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wading thru the muck!
- Posts: 2799
- Joined: Tue Oct 19, 2004 11:42 am
MelMel,
Thanks for all the information you provide. So that people reading this forum have a clear understanding of what you are saying I will reiterate:
wader says:
"Because the DME is free to get paid by the insurance company up to the allowable maximum for whatever machine they provide you, they are going to give you the cheapest machine they can get away with. Some DMEs may think they are doing you a favor by giving you a machine that is slightly better than the worst, but only the cream of the crop DME's will give you the best money can buy."
The reason so many of us on the forum preach about going the cpap.com route is that their price for the best money can buy is less than the Local DME price for the bottom of the barrel. For most people going the insurance/local DME route is relegating them to the bottom of the barrel.
Thanks for all the information you provide. So that people reading this forum have a clear understanding of what you are saying I will reiterate:
wader says:
"Because the DME is free to get paid by the insurance company up to the allowable maximum for whatever machine they provide you, they are going to give you the cheapest machine they can get away with. Some DMEs may think they are doing you a favor by giving you a machine that is slightly better than the worst, but only the cream of the crop DME's will give you the best money can buy."
The reason so many of us on the forum preach about going the cpap.com route is that their price for the best money can buy is less than the Local DME price for the bottom of the barrel. For most people going the insurance/local DME route is relegating them to the bottom of the barrel.
Sincerely,
wading thru the muck of the sleep study/DME/Insurance money pit!
wading thru the muck of the sleep study/DME/Insurance money pit!
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Guest
Excuse me, but that is NOT TRUE with all DME's. I know several DME's here that work with the patient to select the machine and the patient has a CHOICE, within the guidelines of his/her insurance anyway, and within the selection of equipment carried by that DME, so that it is not an absolute decision by the vendor made purely to the vendor's benefit.wading thru the muck! wrote: wader says:
"Because the DME is free to get paid by the insurance company up to the allowable maximum for whatever machine they provide you, they are going to give you the cheapest machine they can get away with. Some DMEs may think they are doing you a favor by giving you a machine that is slightly better than the worst, but only the cream of the crop DME's will give you the best money can buy."
Other than my very first machine 10 years ago, I've made my own personal choice on machine and masks with the DME's advice. They have not interfered with those choices to give me a cheaper "whatever" at any time.
Maybe I have the only good DME company in the entire world. I find that very hard to believe, though. I just find the blanket condemnation of ALL DME providers here to be a little excessive.
It would be helpful to others if you identified where you are so someone could benefit, and maybe even identify the DME? I know there is a lot of DME bashing but I think if there is a good one we should know...Anonymous wrote:Excuse me, but that is NOT TRUE with all DME's. I know several DME's here that work with the patient to select the machine and the patient has a CHOICE, within the guidelines of his/her insurance anyway, and within the selection of equipment carried by that DME, so that it is not an absolute decision by the vendor made purely to the vendor's benefit.wading thru the muck! wrote: wader says:
"Because the DME is free to get paid by the insurance company up to the allowable maximum for whatever machine they provide you, they are going to give you the cheapest machine they can get away with. Some DMEs may think they are doing you a favor by giving you a machine that is slightly better than the worst, but only the cream of the crop DME's will give you the best money can buy."
Other than my very first machine 10 years ago, I've made my own personal choice on machine and masks with the DME's advice. They have not interfered with those choices to give me a cheaper "whatever" at any time.
Maybe I have the only good DME company in the entire world. I find that very hard to believe, though. I just find the blanket condemnation of ALL DME providers here to be a little excessive.