My DME Experience

[trekwars2000]

So I'm on a High Deductible health plan (HDHP) so I just pay out of pocket for almost all my medical expenses. I do get the negotiated rates which are often hard to find before hand. I have spend lots of time on the phone with my "insurance" and they can't tell me anything. There best solution is to ask the provider/doctor/DME what their contracted rate is.

This is what I have decided to do with my DME. That said, I did order my own APAP and have been using it for 10 days, because I still wouldn't even have an appt with my DME until at least Friday. They had some hoops they have to jump through. First let me say, I tried to stop by this DME and get some pricing info and do an appt the day I got my prescription. They said they couldn't do anything until they ran some stuff through my insurance (to find the negotiated rates perhaps) and then I could get prices and come in and look at all the options before deciding anything.

So when I call today for an appt, they ask why I am calling as the machine they have already ordered for me is still being shipped. I asked why they ordered a machine and they said it was because my doctor put a specific machine on the prescription. It's funny that I have a copy of my prescription (which is how I ordered online) and that is NOT the case. He did sign that my mask was a AirFit P10 though. So I get told they have ordered the AirSense10, which I think is exactly what I have anyway, as my prescription does say APAP. I ask what the cost is and she says ~$7/month. I tell her that can't be right and that I want to know what the 100% is. We do some math and figure it out to be about $37/month. I ask how many months it is and she isn't sure, she thinks 3 or 4 and then "we" purchase it outright. I ask that cost and, you guessed it, she doesn't have the number. She did guess it would be around 800 or 900 total. So I think not bad.

Then we start talking about the other stuff on the first charge. She started by saying that it would be $48, but that wasn't right. I asked her what the 100% (negotiated rates) line items where and she came up with the following:
Humidifer- $124
Mask - $161
Headgear - $54
Tube - $36
and Filters (2) - $6

I ask about the humidifer being built in and she said they can still charge extra for that. I asked about the tube, as I assumed it must have been a headed tube, but no it's that one that the machine comes with. Same answer though, they can charge extra for it. Same same on the headgear that is physically in the packaging with the mask...

So the machine that may have been 800-900 was suddenly another $200 or so. The mask/headgear is well over $200, for the same thing I think I can get here for $90-100 and on Amazon for around $70... WOW. Don't get me started on the filters... So I told them to cancel any appointment I would have and to cancel the order that I never authorized for the machine.

So much for using the DME for supplies.

I'm going to try to submit a reimbursement to see if the stuff I have bought from here is covered out of network by insurance (against my deductible)...

[flightco]

If you already own the exact machine, why are you bothering with them at all?

[Sheriff Buford]

DME's are a nightmare!!

Sheriff

[trekwars2000]

If you already own the exact machine, why are you bothering with them at all?

Because I can still use them for supplies, get a second mask. Use their mask exchange policy etc. Also, if that machine was "super" cheap to me I would have returned my first machine, which has a 30 day return policy. I didn't think they would be cheaper, esp. on the machine, which is why I just bought it in the first place.

I also wanted to see how "slow" the process was, esp. when they are using words like "severe" to describe my condition and telling me my oxygen desaturation levels were under 50% at times during my sleep. And saying I shouldn't drive etc. Hardly seems severe if the process takes this long...

[Pugsy]

Welcome to DME Hell.
There are some good ones out there though...unfortunately not nearly as many as we need.

[chunkyfrog]

Prices vary greatly depending on where you shop.
My DME gets way more for filters than I would have to pay at cpap.com.
But Medicare pays if I get them locally--not if I shop for a good price.
I let Medicare pay--because I have to pay for insurance--might as well use it.

[dreamingofdreaming]

Same boat here. You will probably see lower amounts on your explanation of benefits. My mask & headgear is around $49 (over $100 online) , they do charge additionally for the hose. I had to buy the humidifier chamber up front with the hose. The cost for the machine is a 12 month rental, then it's mine. The total cost for the machine with the purchase of the humidifier and hose comes out to just over $700 ( cheaper than buying through online). Like another user said, filters seem to be cheaper through CPAP.com, but you have to pay for shipping. Shipping is free through my DME. Your DME is going to bill you for what they think your portion is, and bill your insurance. They will then get your explanation of benefits back from your insurance carrier and you'll get another bill showing your deductible applied and you are now billed for the portion that was first billed to your insurance company. This will go on every month. Keep track of your explanation of benefits and what you have paid and what they are billing you for. I have to call my DME every month. It is a headache, but I pay less this way and if I do need to use my medical for anything else, at least what I have to pay goes towards my deductible.

[Janknitz]

One factor to consider if you are calculating out of pocket costs using insurance for a capped rental is deductibles. You may or may not have met your deductible for this year, but it's already August, and come January (in most cases) the deductible will re-set. So you may pay a lot more than you calculated you will have to pay when you factor that in.

[trekwars2000]

One factor to consider if you are calculating out of pocket costs using insurance for a capped rental is deductibles. You may or may not have met your deductible for this year, but it's already August, and come January (in most cases) the deductible will re-set. So you may pay a lot more than you calculated you will have to pay when you factor that in.

As mentioned, I'm on a high deductible health plan. Unless something catastrophic happens to me or my family, I have not and will not come close to my deductible this year. In fact, it would be better to have the majority of it be next year if I do not meet my high deductible this year.

[trekwars2000]

Same boat here. You will probably see lower amounts on your explanation of benefits. My mask & headgear is around $75 (over $100 online) , they do charge additionally for the headgear and the hose. I had to buy the humidifier chamber up front with the hose. The cost for the machine is a 12 month rental, then it's mine. The total cost for the machine with the purchase of the humidifier and hose comes out to just over $700 ( cheaper than buying through online). Like another user said, filters seem to be cheaper through CPAP.com, but you have to pay for shipping. Shipping is free through my DME. Your DME is going to bill you for what they think your portion is, and bill your insurance. They will then get your explanation of benefits back from your insurance carrier and you'll get another bill showing your deductible applied and you are now billed for the portion that was first billed to your insurance company. This will go on every month. Keep track of your explanation of benefits and what you have paid and what they are billing you for. I have to call my DME every month. It is a headache, but I pay less this way and if I do need to use my medical for anything else, at least what I have to pay goes towards my deductible.

The DME provider provided me the negotiated rates they have with my insurance company. I don't know why they seem so high to me. Normally my stuff isn't too bad and it actually seems cheaper than what other people have quoted around here (when I compare to the sleep study costs). For instance, my PSG was $405 and my PSG with titration was $495. A normal sick office visit for my kids is about $43. All in all I've had zero complaints with my insurances' negotiated rates until now. Of course, until now I haven't been able to price shop something against an online vendor. I can't take my kid to the Amazon doctor

[palerider]

... I can't take my kid to the Amazon doctor

Well, you COULD, but the airfare to south america would eat up any cost savings on the doctor.

[amenite]

...
I also wanted to see how "slow" the process was, esp. when they are using words like "severe" to describe my condition and telling me my oxygen desaturation levels were under 50% at times during my sleep. And saying I shouldn't drive etc. Hardly seems severe if the process takes this long...

It's really a sad state of affairs, I waited something like 4 weeks after my first and only sleep study to be told I had severe apnea, then another 1-1.5 weeks to get my first machine. And if I had driven into a tree and survived during those weeks I would have been treated immediately no questions asked (Except of course "show us your insurance card, then sign here, here and here"). I suppose the deductible would have been met.

[trekwars2000]

...
I also wanted to see how "slow" the process was, esp. when they are using words like "severe" to describe my condition and telling me my oxygen desaturation levels were under 50% at times during my sleep. And saying I shouldn't drive etc. Hardly seems severe if the process takes this long...

It's really a sad state of affairs, I waited something like 4 weeks after my first and only sleep study to be told I had severe apnea, then another 1-1.5 weeks to get my first machine. And if I had driven into a tree and survived during those weeks I would have been treated immediately no questions asked (Except of course "show us your insurance card, then sign here, here and here"). I suppose the deductible would have been met.

Don't get me started on the sleep study wait time. I went in for my annual physical the 2nd week of June. I got my machine the last week of July. I had to do two sleep studies, first the normal PSG and then the titration one. Each time the sleep center was scheduling between 4 and 6 weeks out. I got placed on a short call/cancel list and got them each time within about a week or so. However, between waiting for the results to come back, etc, it still took nearly 6 weeks to get my machine from me saying to my doc, "I know I have sleep apnea"