Throwing money away

[foxhunter]

I recently received my (Medicare provided) new mask at the 90 day interval and was surprised to see the costing. Now mine is paid for by Medicare but i am assuming that insurance companies closely follow the Medicare numbers or maybe pay more.
Be that as it may, I found that Medicare willingly pays a DME supplier $85 more than i can buy the same mask online.
Now Harris Interactive in their survey reported that 18 million people in the US suffer from sleep apnea but only 10 percent are diagnosed. That is still 1.8 million people getting a new mask four times a year, and at a $85 premium adds up to $604 million.
Now I cannot fault the DME suppliers for accepting money so freely offered but hey; government payout or insurance company payout. we are all collectively paying for this boondoggle.
Am I missing something here?

[hayeswildrick]

Am I missing something here?

Nope. Welcome to government run healthcare.

[LSAT]

foxhunter.......I don't mean to be critical, but do you really need a new mask at 90 day intervals? Are you getting it just because Medicare will pay for it, or, is there really a need. I am on Medicare and in 18 months I just received my 3rd mask.

[foxhunter]

good point LSAT,
They sent it automatically.
Actually I do find that the pillows on the LT last about a month before they become too soft to hold in place. So I think 90 days is probably pushing it. Yours may be a different mask?
Good Breathing!

[Hawk256]

good point LSAT,
They sent it automatically.
Actually I do find that the pillows on the LT last about a month before they become too soft to hold in place. So I think 90 days is probably pushing it. Yours may be a different mask?
Good Breathing!

You can request the pillows separately instead of getting a whole new mask. Medicare allows 2 of them per month at a capped price of $36.68 each. If you only need 1 a month, tell the DME to send you 1 replacement pillow each month and to not send a mask every 3 months.

[uperrsc]

Senator Cuburn (practicing MD as well) attended the round table meeting headed by Pres Obama, and said that instead of creating more government programs, we should focus on WASTED dollars. He noted that fraud alone counts for about $400 billion annually in Medicaid alone!!!! He said we should go after the pot of gold, and that is waste and fraud in the current system, not creating more programs which will lead to more waste.

Sen Reid cut him off and said "stop fillibustering". I think all of the Republicans should have walked out. The dems just want to create a huge new government run program and have more power. The FREE MARKET is the answer, and your mask example shows that if individuals had control of the buying process, they would drive lots of waste out of the health industry.

[ScrappinMom]

Sen Coburn is more interested in hearing himself talk than he is in any solution.

Sorry, I couldn't help myself.

[Tielman]

The FREE MARKET is the answer..

According to my Insurance carrier (free market), I can only buy through an "pre-approved" DME, and according to the schedule of provided replacements, etc. I can NOT go and buy a mask and submit it, I can't go and buy ANYTHING and get reimbursement through the insurance unless it's a "pre-approved" DME, and on the regular schedule. My DME doesn't even provide the white PR1 filters, only the grey ones, and from what I can tell it's one of the better ones in town, affiliated with a major hospital chain.

So much for your "free market".... Still don't work. I'm going to have to go and by spare masks, hoses, and machine from my OWN MONEY.

PS: I have *excellent* company provided insurance. A 2009, 4 day hospital stay for a stomach flu cost me $0.00 out of pocket, including a cat scan, MRI, and later a full-body scan among other things.

[LSAT]

There have been many posts discussing the extravagant charges from the DME's. In many cases I agree. However, I just came accross an example that I would like to pass along.

I needed a new cushion for my Quattro FF Mask. CPAP.com's sale price is $45.00 + shipping. My DME charged Medicare $70.00. Of the $70,00 Medicare did not approve $40.45. This means my DME was paid $29.65. $23.72 from Medicare and $5.93 from me. This was a walk-in transaction. While I was there, the DME checked the pressure on my machine and spent 20 minutes showing me, and letting me try on, several masks.

[Pandalaya Lipschitz]

My understanding is that Medicare pays better (other than the doctors) than insurances. Insurances use Medicare allowables to negotiate a lower price for their contracts.

Do keep in mind, in defense of the local DME providers, that accepting insurances costs a LOT of money and expense that the online DME providers don't have to deal with.

[DoninOrlando]

I recently received my (Medicare provided) new mask at the 90 day interval and was surprised to see the costing. Now mine is paid for by Medicare but i am assuming that insurance companies closely follow the Medicare numbers or maybe pay more.
Be that as it may, I found that Medicare willingly pays a DME supplier $85 more than i can buy the same mask online.
Now Harris Interactive in their survey reported that 18 million people in the US suffer from sleep apnea but only 10 percent are diagnosed. That is still 1.8 million people getting a new mask four times a year, and at a $85 premium adds up to $604 million.
Now I cannot fault the DME suppliers for accepting money so freely offered but hey; government payout or insurance company payout. we are all collectively paying for this boondoggle.
Am I missing something here?

It is not quite as widespread as you assume. Many people ony replace the cushions every 3 months, if that, not the mask. Also many like myself do not have full insurance and pay prices much lower out of pocket. I paid $14.50 for my last Quattro cushion replacement. The DME's charge the crazy prices when insurance is paying, but many know to go elsewhere when paying out of pocket.
Don

[hayeswildrick]

In my case, the DME will only replace the full mask and headgear. No parts. So, despite the fact that I'd be very happy getting just nasal pillows or mouth seal for my Mirage Liberty, I end up having the entire thing replaced. I've complained about this, but gotten nowhere. What a waste.

[LSAT]

hayes....I had the same problem with my DME (apria). When I wanted a replacement cushion, they told me that they didn't stock them and I would need to get a new mask. I told them that I had checked and several other local DMEs did stock them and I was going to switch DMEs. I got a call that afternoon that they would order the cushion for me...I had it in 2 days. (I switched DMEs anyway).

[Slinky]

Yup, yup, the ditz at the first local DME provider's I got my equipment from tried to hand me the same BS. You can't buy just the parts. You can't buy just the cushion. Medicare won't pay for .... I printed out the Medicare replacement schedule and shoved it under her nose. Of course, it took her 3 weeks to get the cushion in .... but I made sure she ordered the dang thing and I got it. Just for spite. Earlier she had told me Medicare wouldn't buy a nebulizer for me, then she told me Medicare wouldn't pay for the nebulizer my doctor scripted and so I bought one out of pocket online. I made sure she never got a chance to buffalo me like that again. And I jumped ship (changed DME providers) ASAP.