None of this, unfortunately, is considered fraud. DME's claim Medicare intermediaries TELL them to part out the masks and CPAP accessories in billing. And technically, you and your insurer are only paying for one nasal pillow as it's billed, so there's nothing wrong with delivering only one (or two...

She did however give me the # to Apria and they are contracted under United in which the united health care rep failed to tell me. Go with what the rep says. never mind the DME's all they want is the sale. Most of them only know what end of the pen you sign your name with and not much else. They al...

Whether a DME company is in network or not, there are certain guidelines that govern their behavior. First, almost all follow Medicare guidelines when billing for CPAP and supplies. This means that if Medicare wants each part of the mask billed separately then that is what most DME's will do regardl...

My DME provided a loaner WITH a humidifier for the 4-6 weeks my machine was back for warranty replacement. In my case, without a humidifier, I get nose bleeds within 3 nights. Your DME is cheap, nothing more. That is sorta how I feel my investigation turned out today. I was here and elsewhere and w...

Just read the all the responses and I am very pleased with the comments as they are honest and blunt. I will leave this thread going for another week and then send the comments to Mr. Stanfield.

The following was published in a DME trade newsletter. With all the suggestions here I thought I would gather your solutions and forward them to Mr. Stanfield. What Are The Alternatives To Administrative Pricing Editorial Commentary by Wayne Stanfield On several recent trips to DC to meet with Congr...

The DME/insurance cartel holds us all hostage and needs to be broken. As a member of my state DME association we are constantly trying to get Medicare and the insurance companies to see reason when it comes to the rules governing certain DME items like CPAP. You and the rest of your DME buddies wou...

I remember reading a previous forum discussion re medicare. I believe the 5 years starts from the time you own it, which is after your initial 13 month (?) rental period. The clock starts ticking from the delivery date not when you own it. A redetermination is needed to correct the initial date as ...

chunkyfrog wrote:And the poor slobs with no insurance can bloody well croak.

We have a patient assistance program that in most cases reduces or eliminates the charges. We also have used equipment that we donate to select hardship cases........But that is not what you meant was it??????

I can help you with this. I have been in this industry for 26 years as well as being an insurance agent for seven years. There are several questions you will need to answer first: 1. Were you referred to this physician by your personal physician? 2. What insurance company is this? 3. What type of co...

The DME/insurance cartel holds us all hostage and needs to be broken. As a member of my state DME association we are constantly trying to get Medicare and the insurance companies to see reason when it comes to the rules governing certain DME items like CPAP. You and the rest of your DME buddies wou...

The DME/insurance cartel holds us all hostage and needs to be broken. Don't forget how this so-called cartel is enabled. It is government regulation at the federal and state levels that is the enabler. When we solve problems, to be effective we should go to the root. Change the regulations and open...

Any co-pay is not dependent on DME...it's part of your health ins policy. Mine is approximately 15-20% for covered equipment/supplies. However, there are some DMEs who waive the copay, accepting whatever the Ins covers as payment in full. And mine even ships Priority 3-day! (I live close enough the...

I just brought home a shiny new ResMed S9 Elite yesterday, so my experience with the DME is pretty fresh still. The two big ones from yesterday were: 1) A billing agent who was completely incapable of properly calculating my bill. I actually had to walk her step by step through the calculation in o...

I believe what a lot of DME providers get wrong is that the State Respiratory Boards do have rules about allowing patients to adjust these devices. While I am unsure if this makes it a law, a respiratory therapist could lose their license for this type of violation. I am unaware of this rule having ...