Warning to all Medicare XPaP patients

[TuckNRoll]

The Medicare program has recently implemented a "competitive bidding" plan which will start out in 10 of the largest Medicare service areas on July 1st 2008 and eventually be Nationwide. This plan which is meant to save millions of dollars is going to affect each and every Medicare recipient of durable medical equipment in very negative ways.
Here is what is currently playing out in the first round of the program.
-All DME providers who hold a Medicare number and wish to provide equipment to Medicare recipients are required to submit bids on several different product categories (one of which includes CpaP and BipaP equipment and supplies).
-The bids are then evaluated by Medicare and contracts will be offerred to the winning (lowest) bidders.
-If you wish to receive equipment through Medicare, you will be required to go to a contracted supplier to obtain your equipment. (If you already have a supplier, they have the choice to "grandfather" you and you can still use them for your supplies).

The major downfall to this program is as follows:

1. The contracted supplier(s) will be purchasing the least expensive equipment that they can get their hands on, to even come close to making a profit by selling them. Therefore, you will more than likely receive a far inferior piece of equipment to what many speak of on these message boards. More than likely the machines will not be of the "data friendly" type that we hear so much about here.
2. The contracted supplier will be much less likely to offer multiple trips to your home for mask fittings, service calls, etc. since the bids that they placed will be far below the current allowables that they receive from Medicare. The new way of doing business will be to minimize any unnecessary trips. (Mind you that the bids were placed 7-8 months ago when a gallon of gas was in the $2.25-$2.50 range and we are currently in the $3.25-$3.75 range at least where I am, so they more than likely did not take this into consideration when they placed their bids), not to mention higher shipping prices from the manufacturers that they are buying from.
3. If your current supplier does not wish to "grandfather" their current Medicare patients, you will be forced to change to a contracted supplier. You do not have a choice in this matter, it is up to your provider whether they can afford to provide their equipment at the new contracted prices or not.

I know that many of you out there will respond about the "outrageous prices that DME companies charge for the equipment that they provide", but when it comes down to it, they don't just provide a product, they provide a service as well. Just as an example:

step 1: Your doctor prescribes the piece of equipment and either sends the orders to the DME or tells you to go out and find a DME to provide the equipment.

step 2: An intake person at the DME company receives the orders and begins the process of verifying your insurance benefits. (mind you that calling any insurance company to verify benefits can sometimes take hours of holding and being transferred to multiple individuals).

step 3: A delivery person is sent out to deliver the equipment and set it up at your home. (not to mention spend a significant amount of time explaining how the equipment works). And if the company is accredited (which will be manditory in 2009), they will spend a significant amount of time going over paperwork and having you sign a mountain of it.

step 4: A respiratory therapist will do a follow-up visit to be sure that you understand the equipment and are using it correctly. (again another requirement of accredited companies).

step 5: A technician is required to be on 24/7 call to provide any after hours services that may occur such as equipment failures.

step 6: A billing person will send out the bills to your insurance company in order to be paid for the equipment.

step 7: A secretary will build a file for each patient.

step 8: When payment is received from the insurance company, it must be properly processed.

Step 9: If there are problems with the insurance company paying the claims, someone must call them and spend a significant amount of time straightening out whatever the problem may be.

step 10: When you are due for your monthly supplies, someone must pull the supplies and either ship them to your home or have a delivery technician deliver them to you.

Now I am sure that I could list several other scenarios that a DME may have to contend with during this entire process.

Sure you can go to a Website and order the same piece of equipment for a fraction of the price, but you will never receive the personalized service that "MOST" DME's provide. Don't get me wrong, there are certainly a large number of "bad eggs" in the bunch and they give us all a bad name, but that is something that we will always have to contend with.

[Goofproof]

Please feel free to start DME bashing, I think I just read one of the DME ads. Now I'll have to go cry for them. Jim

[Slinky]

My DME supplier delivers, but, they are on my way into town so I've delivered and picked up more from them than they have delivered to me.

That being said, yeah, I've seen the blurbs about the proposed change and it does NOT sound good. I wrote my Congressmen about this almost a month ago now.

[Goofproof]

My DME supplier delivers, but, they are on my way into town so I've delivered and picked up more from them than they have delivered to me.

That being said, yeah, I've seen the blurbs about the proposed change and it does NOT sound good. I wrote my Congressmen about this almost a month ago now.

Mine ships my supplies I order, then I get in the car and take them back and make them give me the ones I need. Jim

[Guest]

Hello TuckNRoll. I appreciate your detailed carefully done post. I have been hanging around here and had my eyes opened. I do wonder if all of this activity is helping patients. It seems a crazy way to do things.

Why are people driving around? Seems expensive and wasteful. The equipment is simple and there are lots of decent mask systems that come with many sizes of cushions.

Why is time being spent on verifying, billing, and collecting insurance for such a small amount of money? Seems like half the money involved is being spent collecting money. No wonder it costs so much to get so little.

Why don't the Respiratory Therapists post cpap setup videos on the web and be done with it? After 25 years of cpap, why is education limited to face to face or tongue to ear? Why not use technology? Is it about patients or their pay checks?

What is the big deal about equipment failures? Cpapauction has good machines selling for next to nothing.

Bottom line is that there seems to be a disconnect in the system. Is the dealer serving the patient or Medicare? Seems like Medicare to me. Was that your point? I can see why dealers are having trouble. The system is pointed in the wrong direction.

[TuckNRoll]

[quote="Anonymous"]Hello TuckNRoll. I appreciate your detailed carefully done post. I have been hanging around here and had my eyes opened. I do wonder if all of this activity is helping patients. It seems a crazy way to do things.

Why are people driving around? Seems expensive and wasteful. The equipment is simple and there are lots of decent mask systems that come with many sizes of cushions.

Why is time being spent on verifying, billing, and collecting insurance for such a small amount of money? Seems like half the money involved is being spent collecting money. No wonder it costs so much to get so little.

Why don't the Respiratory Therapists post cpap setup videos on the web and be done with it? After 25 years of cpap, why is education limited to face to face or tongue to ear? Why not use technology? Is it about patients or their pay checks?

What is the big deal about equipment failures? Cpapauction has good machines selling for next to nothing.

Bottom line is that there seems to be a disconnect in the system. Is the dealer serving the patient or Medicare? Seems like Medicare to me. Was that your point? I can see why dealers are having trouble. The system is pointed in the wrong direction.

[Slinky]

Well, I am here to tell you that my first local DME has an, at least, 3 state wide "service" area. AND THEY DO NOT DELIVER DIDDLEY SQUAT! The PATIENT is the one who GOES TO their office to PICK UP their equipment. They are "taught" at that office how to assemble their CPAP w/the integrated humidifier and fitted w/their mask, etc. And not a lot of time is willingly spent teaching the patient anything. There is no place to LAY DOWN to fit the mask. The patient HAS to have an appointment to see the RT, ANY equipment the patient needs has to be PICKED UP at the supplier's office by the PATIENT except for the SMALL things such as A filter which they will mail (and then PROBABLY only because I had to get a bit unpleasant w/them and they preferred that to having me come in the office to get that ONE filter). AND IF you should need assistance after 5 PM or on a holiday or weekend - ha! Rots o'ruck.

The BIGGEST failure in the sleep profession system is the DME supplier. Followed VERY CLOSELY by the sleep doctors themselves, then the sleep labs and it seems the real heroes of the sleep profession are the sleep techs!!

Ooops! I forgot. We've read, in this forum I believe, of the patient who had an appointment to PICK UP her equipment, had to wait quite some time before she could GET an appointment, only to find out that her equipment pick up and training was part of a GROUP CLASS (one of the reasons for the delay in getting an appointment). No privacy in mask fitting, no privacy in asking questions or getting answers, all as part of a group and the patient was NOT advised before hand that it would be a group "learning" session. When the patient complained about no privacy ONLY THEN were they told that they could have REQUESTED a private training session.

[bap40]

My sleep study and DME were all in the same place. Now the sleep doc is not even there. He is in another state so one never does get to see or even speak to him. The scripts are all for basic CPAP and their DME will not give you anything else. The talked me right out of getting what I wanted right off the bat. After being told various lies about data capabilities being useless and how wonderful the straight CPAP is, I was getting more and more frustrated. When I called them about 3 weeks later telling her "BAD LADY" that if their own doc would not write me a script for what I wanted, my own doc would. The lady actually had the balls to call my own doc and tell him all the reason why I didn't NEED another kind of machine! Then she told me that my doc was going to call me about it! She made it sound as if she got him to agree!!!! Of course he never did call me and when I saw him about a week later, I asked him and he said she was telling him all the reasons I did not need the other machine. He said his first impression was that it was all MONEY. He said he was supposed to call her back and did not do so on purpose. He was not impressed at all by her and her demands. At that visit he wrote me a script for exactly the machine I wanted and I fired that DME and went to one connected with the local hospital and found them to be very upfront, not lie, and give me what I wanted with no problems at all. So the horrible DME ended up loosing in the end. The old DME even lied to me about how the insurance worked too. She was so far off base on every aspect of care, I don't see how she actually got any patients, but most people have no clue to start with either. I had done my homework beforhand and knew what was what. A rocky road but only took me one month of fighter with her to get out and get what I wanted..... Yes, DME's are out for themselves.

[MrRandom]

Medicare could save so much money if patients were allowed to have more control over their own care and more choices, not less and less.

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[MrRandom]

He said his first impression was that it was all MONEY.

That's been my impression of this whole thing, I don't like that it seems to gravitate toward profits rather than my health care.

[bap40]

I agree with above post. It is so sad when making money off of patients who are usually ignorant when they first start therepy is NOT RIGHT...

I called several places before I quit my old DME and went with the most up front, friendly and supportive help before I chose the one I have now. I would do that before you choose and get yourself in a fight for your machine and I guess life.

This board urged me not to SETTLE and that is what I had done and with them all pushing me to get what I wanted. I did the awfully hard task of firing and rehiring.

[Warbird]

I am generally happy with my DME here in Houston. They have done some things that just makes me scratch my head and say huh? For example, when it is time for my Insurance to pay for another mask, I get a phone call from a friendly person that asks about my equipment, tolerance, any problems, etc. then asks if I want them to send me a new mask, hose and filters. Several times, I had problems with my current mask and requested another type and the friendly voice said no problem. In about a week, supplies and new mask arrive at my home boxed up. I have tried three different masks so far. Last time, I knew that it was about time for a new mask, I took the initiave to call them and request another type of mask.

Wow, first of all, they required that I make an appointment to get fitted. Ok, I said, let's make an appointment. The man said "You cannot just call in and make an appointment for TODAY! Huh? I explained that I did not ask for one today. He said that I would have to get my sleep Dr. to write a new RX for a new mask. Huh? I explained that their phone rep has sent me three different masks already why another RX now? My original RX specified the Resmed S8 Vantage and setup and mask as requested by the patient. He stated that since I had already picked out a mask, I would have to get another RX. I asked to speak to his supervisor and suggested that he didn't seem to want my business. I finally received my new mask with my appointment when I suggested to the supervisor that I would just take my original RX to another DME that wants my business. Sometimes, you just have to squeak to get some grease!
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[MrRandom]

Well, I am here to tell you that my first local DME has an, at least, 3 state wide "service" area. AND THEY DO NOT DELIVER DIDDLEY SQUAT!

I wonder if we have the same DME. Mine is like that too. Will not bring anything to me, I have to go to them and have to have an appointment for it. There are no beds in there and they are really stingy with the masks. The guy kept complaining to me that the mask costs over $200 so I shouldn't try to switch masks much. I'm like I don't care how much it costs if I can't sleep with it it's useless! Then he told me I can only switch once then have to wait 6 months for medicare to pay again.

They are still leaps and bounds ahead of the other DMEs I've been to around here. When I had a nebulizer, the other one would not bring me a new canister, would not even mail it to me, because I'd moved too far away (17 miles, not that far IMO, but I didn't have a car then and couldn't go to them and it's rural here, no busses out there). So they pushed me off on another DME, which promptly started charging me all over again for the equipment rental which I had never got from them and was only a couple months from being finished with and owning it. And I had to go in there and pretty much throw a fit and they still wouldn't replace my canister. It was almost a year old and had a crack in it and they acted like I couldn't get a new one that my insurance wouldn't pay, which was a lie. They were so snotty and rude, it was awful. It's disgusting what we have to go through to get decent medical care in a profit-based system like this. Thank god for the internet. I bought a new and better canister online, cheaper than even my copay would have cost me at that DME. The bastards.

The BIGGEST failure in the sleep profession system is the DME supplier. Followed VERY CLOSELY by the sleep doctors themselves, then the sleep labs and it seems the real heroes of the sleep profession are the sleep techs!!

This I disagree with. I love my doctor. He is so smart. I have not been very impressed with the sleep techs I've worked with. They seemed nice enough, but not as smart or knowledgeable as my doctor. Unfortunately the doctor is so unaccessible because my care is delegated out to all these other people who don't care to read my file or understand what is going on with me. They just want to get paid it seems. Seems like the doctor is the only one who actually wants to help ME not make money. He's worth every penny I have spent on him, just wish he were more accessible and I could completely cut out these DMEs and technicians.

[Slinky]

Ah, but you see, at least you had access to the sleep doctor even if difficult. Far too many sleep labs are doing as bap40's sleep lab, no doctor on staff at the lab, totally unaccessible to the patient.

Or, as at least one of our local hospitals has done, let their on staff sleep docs go (there were 4, one sleep neuro and 3 sleep pulmos) and now have a sleep doctor who just dictates the results and recommendations FOR THE REFERRING PHYSICIAN, is available to consult w/the REFERRING PHYSICIAN, but is totally inaccessable to the patient.

The trend seems to be the sleep profession is becoming a "cash cow" and some doctors are jumping on the bandwagon to get the necessary minimum training to adopt sleep as their sub-specialty since they need to spend so little time w/it: just read the scoring tech's report, dictate their interpretation of the scoring, recommend the therapy, send it on to the referring physician and wash their hands of the "case". And take a look at what they charge for all this "work".

[Guest]

bap40 what was the name of that "BAD" DME?