More DME antics

snoregirl · Post by **snoregirl** » Sun Dec 31, 2006 1:29 pm

For once I agree with Mattman (at least part of his statement) "The real solution is to revamp insurance"

What I believe is needed is to

Revamp it so those of us who want it can get benefits while buying online.

Revamp it so a set amount of benefit can be paid for the machine of patient's choice

Revamp it with pricing for goods and pricing for service not some combination that the goods overpricing "covers" the service.

Reexamine what a reasonable price is for all equipment sold is since even though we may choose to buy oneline for ourselves, those incredible medicare prices affect us all via our tax dollars.

All this needs serious examination.

Now on the removing of pillows from kits, I have not had that "pleasure", but if one ASKED the patient to donate unused sizes or better yet offered a 2 for one swap of a size the patient could use I could see that as acceptable. But not just taking stuff from the package without asking. That is just plain wrong no matter how you slice it.

I had this (removal of parts) happen with fine filters (but not nasal cushions) and I was not pleased. In this case it wasn't the value of the item, but the audacity of the RT that really stuck in my craw. And then when I asked for them the glib "well no one uses those" response.[/quote]

dataq1 · Post by **dataq1** » Sun Dec 31, 2006 1:32 pm

Mattman and DME Dan,
Please review my posts in this topic. Pehaps I didn't express myself clearly.

My DME admits to removing the headgear from the manufacturer's mask package. They admit to charging my insurance for the entirety (including the headgear) of the manufacturer's package. They admit they later charge another customer (or his insurance co) for the headgear that was removed.That sounds like getting paid for the headgear TWICE. That's what I'd term double dipping.
The DME rationalizes this by saying that if they provided the entire manufacturer's mask package every time a user was authorized to a new mask that they would be violating the insurance company policy that states the user is entitled to a new mask every three months. The user is entitled to new headgear every six months.
The DME goes on to explain, we are just doing what the insurance company allows. We are operating within the scope of their rules, so don't blame us if we get paid for the headgear twice!

IMHO that begs the issue:
IS IT RIGHT? IS IT HONEST?

IS IN THE PATIENTS BEST INTERESTS?

On the flaws of the insurance companies, sure their flawed. Does that excuse a DME of taking advantage of the flaws?

Are there DMEs that are of the highest integrity? I'm sure there are. I'm looking for one!

Are there DMEs that give lip service to world class service and respect, but are driven by the bottom line. I'm sure there are.

I do get the impression that you guys are trying to defend the entire industry. You just can't do it, there will always be some rotten apples.

A question for those who work for DMEs. Do you charge full price (or even the insurance allowance) for people who do not have insurance? Or do you provide equipment and services at no cost to some people. If you choose to provide services gratis, then are those expenses borne by the profit center or being passed on the insurance companies by double-charging?

When I give to a charitable cause, it comes out of my pocket, not out of my neighbor's.

DME Dan · Post by **DME Dan** » Sun Dec 31, 2006 7:48 pm

Billing for a headgear that was not provided is fraud. Mistakes do happen but this sounds systematic and intended.

SuxBeingU · Post by **SuxBeingU** » Sun Dec 31, 2006 9:02 pm

Dan how can you justify, with good conscience, selling a machine that retail for 255.00 for 1695.00 dollars? My insurances part is 1017.00 and they expect me to pay the balance.

Other than selling thing to gov't I don't how you get away with making a 1450.00 profit OVER a competors retail price. Who knows what actual cost is.
I certainly can't do this in my business, I will lose every customer within a month.

Guest · Post by **Guest** » Mon Jan 01, 2007 2:16 am

DMEDan, what is a Heated Breathing Circuit [A4604]?? My DME charged a selling price of $70 for one. Then crossed the item out - but left the charges on in the total.

I'm waiting for my Medicare and secondary insurance statements to arrive to see what was actually billed, what was actually allowed and what was actually paid by both. Currently all I have is the Delivery Receipt I was required to sign.

Wulfman · Post by **Wulfman** » Mon Jan 01, 2007 9:35 am

Well, they DID manage to catch a few of the crooked ones.
I just KNOW you're gonna be shocked by these news items.
Who said "Greed is good"?????

Den

From the current HME NewsWire:

RT faces discipline
Brief
01.2007

DAVENPORT, Iowa - A state licensing board has charged a former Apria respiratory therapist with re-selling breathing machines for between $125 and $225 after patients were done using them. Tammara Lutz, 43, and another woman, Kassie Beth Dierks, pleaded guilty last year to re-selling the machines--which were taken from Apria, where Lutz worked at the time--and pocketing the money. Lutz, who has a hearing before the Iowa Board of Respiratory Care Examiners Jan. 22, faces disciplinary action. The managers at Apria's Davenport branch, Deborah Magedanz and Sharon Arthur, have asked the board not to allow Lutz to practice respiratory therapy again.

Fraud wrap-up
Brief
01.2007

The owner of Angel Care Medical Supply in San Antonio has pled guilty to charges that she bilked Medicare and Medicaid out of more than $4.4 million. Mary Lou Hernandez, 59, allegedly induced "runners" at San Antonio doctors' offices to sign off on fraudulent documentation for the equipment.
She faces up to 10 years in prison...

A U.S. district judge has sentenced the owner of V&A Services to two years and three months in prison due in connection with a wheelchair fraud scheme.

Udo Udo Ekpo Jr., 64, of Stone Mountain, Ga., must also pay $164,590 in restitution. Ekpo allegedly bilked Medicare by submitting claims for wheelchairs and accessories that were never provided to beneficiaries.

arthuranxious · Post by **arthuranxious** » Mon Jan 01, 2007 2:34 pm

My experience with bandits running DMEs has been typical, I was prescribed an autopap and they delivered a CPAP and told me it was an autopap. When I suspected something was not right, and after buying a card reader etc. for the Remstar Pro, I checked the serial number with Rspironics and discovered it was a fixed CPAP. they agreed to switch it for an auto. They said I would have to wait a week because they need to change ti for another Remstar so I shouldn't hjave to get accustommed to new equipment manufacturer. I waited, their therapist "Got lost" he didn't know which way was uptown and which way was downtown and his GPA system took him miles away... I finally was issued a Resmed. It is fine anyway, and I am not switching back to Remstar.
But, the reason why the insurance is paying is because they foist on all of us a system where we get a house call (I don't want it, don't need it, found it a massive pain to stay home from work for 2 hours). House-call, personal delivery, expert counselling and guidance from the DME is what they are billing and insurance is paying. I, for one, would much rather have a nice service counter at my sleep lab where I could pick up what I need, get card read and printed out... etc. but they haven't yet figured that out.
I suspect that frail elderly people who are diasbaled by their health problems like the respiratory therapist coming to the hosue, 99% of the rest of us don't.

snoregirl · Post by **snoregirl** » Mon Jan 01, 2007 8:02 pm

I agree with arthuranxious.

I do not want some person coming to my house and delivering stuff. He also can't possibly have the full range of stuff in a car or truck.

I also agree waiting at home is not fun. Bad enough I have to do it for the furnace guy, a/c guy, etc.

Slinky · Post by **Slinky** » Mon Jan 01, 2007 8:34 pm

Home delivery???? NOT my DME!!!! YOU make an APPOINTMENT to see their RT who gives a brief explanation, fitting, equipment and out the door. 1/2 hour tops, hopefully (for them) less.

Mail in the data card? Uh uh. BRING it in to them, just leave it. They'll mail you a copy of the printout - if you ask for and want it. But it won't be done whilst you are there.

Fitting a mask at your pressure to check for leaks? Uh uh. Bare bones machine can't check for leaks. Check mask fit in various sleeping positions? Uh uh. Unless you wanna lay on the floor.

The list goes on. But why bother? Most of you have encountered as bad or worse.

dataq1 · Post by **dataq1** » Tue Jan 02, 2007 4:05 pm

Cross posted:

dataq1 wrote:Was just told by DME that they are no longer providing the Hybrid mask because insurance companies are denying claims. Allegedly the issue is that the manufacturer is providing the headgear with the mask. The insurance companies want the headgear broken out and sold as a separate unit.
I guess I'd check with your insurance before purchasing this mask if you intend to have a claim filed.

_

blarg · Post by **blarg** » Wed Jan 03, 2007 4:39 am

mattman wrote:The DME companies are not "ripping people off" or "abusing people".

I have the same problem with this statement that I have with other broad sweeping generalizations, such as:

"The DME companies are ripping people off."
"Higher pressure is better."

etc.

You're usually very careful about qualifying your statements with "the companies I work with" etc, so I'm guessing this was just an oversight. I appreciate that, but anyone defending an entire industry saying that companies are not "ripping people off", be it medical, software, tourism, ANYTHING is bound to be mistaken, simply because we all admit there are bad apples.

I do wish that the forum in general could approach your posts with less skepticism (Me included. We might even learn something!), just as I wish you could approach criticism of other DMEs with less skepticism. DMEs abuse people, and people abuse DMEs. It happens. I really do want to hear what you have to say, so please, let's be as precise as possible so that the messages come through without misunderstanding and/or an emotional charge. It's difficult to objectively read through something when the wording itself seems to indicate a bias that I'm sure you didn't intend.

I do not want you to "go away and die", I want to be able to discuss ideas with you without it becoming an "is not" "is too" kind of situation, and because of my own bias, I know I'm quick to jump the gun. My guess is that others here are too.

blarg · Post by **blarg** » Wed Jan 03, 2007 4:45 am

snoregirl wrote:I do not want some person coming to my house and delivering stuff. He also can't possibly have the full range of stuff in a car or truck.

The guy that came to my house to set me up originally had more masks with him than they do in the "mask refitting room" at that very DME. If I ever see that tech again I'm asking him why.

Guest · Post by **Guest** » Wed Jan 03, 2007 9:47 am

When I go to a patients home to set up a CPAP machine I take everything I have. First, I don't want to have to disturb the patient twice. I don't carry everything in the house at once, that can be very over whelming, but I certainly have everything possible with me. Also, to comment on home delivery-- Alot of patients DO NOT want someone in their home. I always offer, but 85-90% of the patients do not take me up on the offer. I am not sure I would want a stranger in my home either. More commonly I have dropped off replacement supplies for them at work or home. I also DO NOT charge for any of my services. Maybe I am the idiot for not charging. I never bill insurance for anything other than supplies that the patient gets. I guess I am nieve, but I honestly never thought to open a mask that I paid one price for and bill the patient for two or three different items. The only thing that I do is on the initial setup is split the cost of the mask out to include mask and headgear. (I do this by subtracting the cost of the headgear from the cost of the mask so that the patient only is charged the dollar amount of the mask for all the "Parts") I do this so that the insurance companies see that the patient did get everything they need to use cpap correctly. After that if the patient got a mask, they were charged for a mask- not separately for each part.
I am almost overwhelmed by all the topics brought up on the forum, but I can say I know for a fact that some DME companies take parts out of masks and resell them to other patients. I know it happens. I have called a few companies onto the carpet about it. I spend a good part of my day with other companies patients ( FOR FREE) discussing their practices and billing procedures and such. And then providing them with only the products that they need at a reasonable charge. One so called service the other guys in town practice is making the patient get all replacement supplies instead of just a seal or just a filter. They get the patients to believe that the insurance will not cover just a filter, that they have to replace all their supplies. One patient showed me a bill for $800 for replacement supplies. I told the patient that even if I gave him two of everything possible I could not come within half that price. I did want to clarify that there is a HUGE difference between a truly local DME and a chain DME (Such as Ap*** or Lin****).
These same companies brag about their service. I have yet to have one of their patients even know where the filter is on their machine, much less how to change it. Is this wrong? I am not sure. I am sure that there are customers that get their equipment from cpap.com that don't know where the filter is and how to change it.( I am not dissing cpap.com.I am not familiar with order from them. I just know people and I am sure that some people don't listen or care about their own treatment) For that matter I am sure that I have a patient that doesn't know where their filter is or how to change it. What I can say in my heart that for my patient it is not for lack of trying.
I have fallen into mainstream as well a little bit. I used to call my patients every month to see how they were doing. I still do for about 3-4 months. Not to push selling supplies, but to ask how they felt, to make sure that they didn't have questions. After that if you have a patient with virtually no leak, 100% compliance(by that I mean all hours of sleep, not at least 4 hours of use a night) it almost felt like I was stalking them. I backed off on people like that and now I call them every 6 months or so.
I don't have all the answers to the big B&M DME vs internet debate. I have a different view because my day job is at a B&M DME, but my true passion is at a music store that I own and operate and over the past few years have seen the internet take it's toll on my whole family. The internet is a wonderful thing and serves its purpose well, it also takes away the local family owned shops ability to survive. A small company can't compete with a huge mail order/internet company.

KansasRT · Post by **KansasRT** » Wed Jan 03, 2007 9:50 am

Sorry- that was me- I guess I took too long and was logged out.
KansasRT

snoregirl · Post by **snoregirl** » Wed Jan 03, 2007 11:55 am

Kansas,

I understand your frustartion at the internet stores and small local businesses. But the Big Box stores, which are brick and mortar, do the same thing to small businesses as the internet retailers do.

In the DME and insurance world, at least in my experience, we seem to be forced towards the DME version of the big box store (national chains) due to the requirements of insurace companies.