I think I got "hosed"

ScottB · Post by **ScottB** » Tue Sep 12, 2006 9:26 pm

I went in for my 2 nights of sleep study and I have pretty severe apnea. My sleep study place sent my prescription to a medical supply place here in town. I got a ResMed S8 Compact machine with the humidifier option and a ResMed Mirage Activa Nasal Mask. They turned around and billed the insurance company $3100!. I was looking at CPAP.com and the price is about $400 for that unit not including the mask and humidifier. It was a week ago when I got it and not I wish I had done my research. I dont know if I can take it back. I hate the fact that medical benefits keep getting cut back and then I see this and I know why.

Anyone else have a similar experience?

Scott

CollegeGirl · Post by **CollegeGirl** » Tue Sep 12, 2006 9:32 pm

The important question is - what will your copay be? Will you have to shell out more than the cost of the machine would have been by buying from cpap.com? If so, absolutely try to go after your DME for a refund!

ScottB · Post by **ScottB** » Tue Sep 12, 2006 9:34 pm

My copay is 20% but I am sure that the insurance company will not pay them that much. It just makes me mad that I could get a MUCH better machine for that kind of money.

sleepless_in_ny · Post by **sleepless_in_ny** » Tue Sep 12, 2006 9:37 pm

The amount that is billed to the insurance and the amout that the DME ges paid is very very diferent. You can call the insurance co and they can tell you exactly what got paid out, it probablywill be closer to 1/4 of whatis billed. Unfortuantely this is our wonderful medical insranc system. If they billed out at the actual cost they would only get about $30. A very said state of affairs.

bsil · Post by **bsil** » Tue Sep 12, 2006 9:40 pm

We are all probably in the same boat. Didn't know about on-line purchasing until after the fact. Our next machines will be purchased on-line. However, I'd like to think about the all the service that I received from the RT who came to my home and got me started. I didn't have to read a manual to set it up! It was actually the RT who told me about this forum.
Barb

Wulfman · Post by **Wulfman** » Tue Sep 12, 2006 9:48 pm

FInd out from your insurance provider and/or the DME if it is a "rent to buy" type of contract. If it is, and you also find out the particulars from your insurance on the costs, "push the pencil" and see if you can get what you want for the same costs or less from CPAP.COM. Also, ask your insurance provider if you can purchase the machine outright and if they will then reimburse you at the "in-network" rate. Many will, some won't. It will save them (and you) money, which is what they should be doing with your premium dollars.
If it all looks favorable, you can probably get out of your "rent to buy" contract.

Best wishes,

Den

Offerocker · Post by **Offerocker** » Tue Sep 12, 2006 9:52 pm

ScottB: Do I understand correctly that your DME sold you the equipment without your first renting it in order to find out if it 'works' for you?
That's not a good idea, because you need to be 'compliant' - both with the machine and mask. The doctor cannot possibly know what your needs are after one test and your NOT USING the equipment long enough for you and him to determine if it's really working out for you. That's just not good medical advice, and sounds to me like he's either inexperienced, or pompous enough to dictate what is best for you.

I would talk to both your doctor and the DME - AND your insurance company. Hopefully, you're just renting.

Do some research here, about different machines (seems the mask is one of the more popular/better ones).

A good number of us have bypassed the 'brick & mortar (local)' DMEs, and purchased a cpap machine from CPAP.COM. Also, it's a good bet that most have chosen the AUTO Cpap with C-Flex.

Also, you need to consider having a humidifier, either as an integrated one, or a separate one. Doing a search on that here will also provide you with much information. Some like theirs integrated, and others opt for a separate one because of the features that particular HH provides.

Keep us posted, please!

Your homework in this area will be well worth it - even if you may think it's a little late...you certainly aren't the first one to do that!

It takes months to get the sleep apnea test, yet they can stick you with unwanted equipment in minutes!!! exaggerated, but it seems that way.

Wulfman · Post by **Wulfman** » Tue Sep 12, 2006 9:58 pm

Oh, and Scott.......be sure to get the ORIGINAL prescription document from your doctor or DME or wherever it is.

Den

ScottB · Post by **ScottB** » Tue Sep 12, 2006 10:01 pm

Thanks for the speedy replies. I will make some calls in the morning and I am going to the medical supply tomorrow to have my mask checked out. Thanks for the tip on the prescription too. I haven't seen it personally and I guess I will need it to order another machine when the time comes.

KimberlyinMN · Post by **KimberlyinMN** » Wed Sep 13, 2006 11:05 am

ScottB wrote:I went in for my 2 nights of sleep study and I have pretty severe apnea. My sleep study place sent my prescription to a medical supply place here in town. I got a ResMed S8 Compact machine with the humidifier option and a ResMed Mirage Activa Nasal Mask. They turned around and billed the insurance company $3100!. I was looking at CPAP.com and the price is about $400 for that unit not including the mask and humidifier. It was a week ago when I got it and not I wish I had done my research. I dont know if I can take it back. I hate the fact that medical benefits keep getting cut back and then I see this and I know why.

Anyone else have a similar experience?

Scott

I can relate. I even brought in the printouts for what I can get the stuff here to see if they would "match" the prices. I was told that the reason their markup was so high was for their "service" as well. Now, I guess in a way I can see that with the machine itself. If I have a problem with the machine, I can bring it in and they will give me a loaner while they deal with the company on getting it repaired or replaced. (Although I guess I am also the person who buys the extra warranty on other merchandise as well.) The mask? Now that bugs me. They billed it all out separately to add up to $275 and I could have bought that here for around $80. The only good thing that I found was that I had already met my $300 deductible so I only am responsible for 20%.

Kimberly

Guest · Post by **Guest** » Wed Sep 13, 2006 11:18 am

I'll admit that I'm on the fence about the costs. Sure you can buy one online for far less than you can through a traditional facility.
However, you had better know what size you want. You had better know which one you want. There isn't any trying even one or two on.
I know how I loathe having to talk to my insurance company. I can't even begin to imagine doing battle with them day in day out trying to get paid for something I already gave to someone.
There most certainly is a lot of increased overhead in providing something in a physical environment. There is very obviously a massive increase in cost when trying to bill to insurance comapnies.
Does it totally justify the extra 100-300 dollars? That's where I'm on the fence. The low end of that scale I'd say absolutely it's justified. The higher end is where I'm not sure.

Jimmy_CPAPed_Corn · Post by **Jimmy_CPAPed_Corn** » Wed Sep 13, 2006 11:46 am

I can relate. I even brought in the printouts for what I can get the stuff here to see if they would "match" the prices. I was told that the reason their markup was so high was for their "service" as well.

By all means, keep going and complaining to DMEs about their horrible high costs, etc. and what you can get it for "online."

You'll really be helping future first-time patients in this confusing process when DMEs quit carrying CPAP devices altogether due to insurance payers having lowered their obviously-inflated reimbursement rates because they too went 'online' to see these great prices. New patients will just have to go online too and figure everything out by themselves.

Who needs to actually try on a new mask? Who needs to be trained/acclimated on their new device? Who needs some face-to-face counseling? Who needs a home visit or to take in their CPAP for service? Who needs their data cards read? No one I guess.

Face it: DMEs have overhead, medical staff, water bills, etc.
They simply bill AT REIMBURSEMENT LEVELS or above. Reimbursement amounts aren't a surprise to DMEs. They know what they'll receive from insurance. They've done it before.

Who can put a value or number on the service a DME provides, or doesn't, provide to patients?

snoregirl · Post by **snoregirl** » Wed Sep 13, 2006 12:41 pm

The mask from the DME is usually a straight purchase. You have tried it on and if it works for you it is yours. You can order more masks online if you choose.

You need to find out if the machine is a purchase or rent to buy.

If it is rent to buy and you will really be spending $600 copay on it (20% of $3000) then I would take it right back before you get to another messy billing cycle (but after you order online and get a new machine). You need to verify that the 20% was actually off of $3000 or some lesser number. Chalk the first month copay on learning experience and order online since you can get a better machine for $600 cash with no insurance coverage than you have now.

Add a little to that and you can have an APAP.

Do what was advised and get the prescription and sleep study even if the calculations show that you should keep what your have (for example if the billed amount results in $1500 "actual paid rate", since then you 20% would be more like $300).

You may want a different machine in the future and the prescription is good online.

I think I got "hosed"

I think I got "hosed"

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