No deals with the local DME

[Wulfman]

Damn, Sorry, let me jump off my soapbox

Yeah, I get the same way......
Makes ya just wanna SMACK somebody upside of the head!

Best wishes,

Den

[DreamStalker]

Damn, Sorry, let me jump off my soapbox

Yea, but then some low paid workers would have to loose their jobs and corporate CEOs would have to lower their annual salary increases from 300% down to 200% and so on .... and so ... you know, that trickle up economics effect

[Slinky]

Well, for one thing these insurance companies NEVER pay the amount they are billed. They all have an agreed upon, set amount, negotiated w/the DME when they contract w/them. When you check your statement from your insurance you should find the billing amount, the "allowed" amount, the amount you "may" be billed (your co-pay), etc. This amount "has" to be high enough to cover the more expensive xPAP machines as well as the bare-bones machines the DMEs prefer to provide if your doctor doesn't specifically script or insist on one of the higher end machines.

So we "do" have to take a good look at our statements and see what our insurance "really" paid for our equipment. Unfortunately, that is usually 2=3 months "after the fact".

Or we can try asking our insurance companies what they will "allow" for each piece of equipment. And that can differ between the various DMEs they are contracted with and also for "out of network" DMEs.

[mattman]

The problem is as I've mentioned before that we don't see the larger picture.

This isn't to say the insurance companies aren't screwed up - because they are (On a massive scale in fact). They just aren't screwed up the way people here think they are.

The Insurance companies don't really care about the price they pay for CPAPs because they have contracted rates with the DME companies. They don't care because they are saving MASSIVE amounts of money by going through the DME companies. Amounts you can't even begin to believe. Billions of dollars. Which all goes right into the pockets of the insurance companies.

I think it was Aetna that had a very short Ad campaign a few years back. I only saw the commercial twice I think. One of thier selling points was that they had billions of dollars in assets available. I think they pretty quickly realized that saying you have billions of dollars available when asking people for more of thier money was not the brightest way to go at things.

Again, the issue is the big picture. Right now CPAP/BiPAP/APAP whatever is the darling child. It's the product you can make a profit on. Which is nice since so many of the other things you can't make a profit with. Between reimbursement that is either below cost or in many cases nonexistant along with the massive amount of work involved in just getting paid you are lucky to find an item you can make a profit on.

So what happens is that the playing field is skewed. The people who just want to pay cash for a CPAP and go on with life are stuck.

Insurance needs to be changed to provide fair and level reimbursement across the board. Instead of having 1 item you make a large profit on and another that you take a huge loss on it should be changed to make a fair profit on both items.

Instead of paying $1,500.00 for a CPAP that costs $700 but then only paying $28.00 for a $900.00 tracheotomy supply there should be a straight percentage over cost or something similar.
How is it fair that insurance pays $250.00 every 3 months for a mask that most likely isn't even needed but the same policy won't pay ANYTHING at all for the oxygen tanks that we deliver each and every week to the person who is on oxygen 24 hours a day/7 days a week??

I can tell you very honestly we have patients we lose THOUSANDS of dollars a year on but we are required to provide service for and we are required to eat the cost. We aren't alone. This is why I see cries of DME people being thieves that are screwing insurance companies and screwing America I continue to try and explain that it simply isn't the case.

So yeah, when you can look beyond just the CPAP equipment the insurance companies are saving hundreds of millions if not billions of dollars by working with DME companies and it's not going to change until we force the issue.

It NEEDS to be changed if the uninsured or other cash customers are ever going to see fair pricing.

mattman

[Wulfman]

One of the other things that we have to keep in mind is that to the insurance providers, this therapy is such a VERY, VERY, VERY SMALL portion of their expenses. A couple of thousand here and there is "nothing" compared to the hundreds of thousands of dollars spent on individuals (which adds up to many millions or billions) for other surgical and medical procedures in the hospitals.
If we try to save them a thousand dollars here and there, it's "chunk change" to them......they'll make up for it (spending for overpriced DME products) in your increased premiums next year. It's inevitable.....how many times have you seen your premiums go DOWN??? One way or another, YOU are going to pay the cost......NOT the insurance provider......they're not going to lose money.

Personally, I have the satisfaction of knowing that I DID save them SOME money.

Den

[Guest]

they'll make up for it (spending for overpriced DME products) in your increased premiums next year.

But as I just said - they DON'T make up for it in overpriced DME items since the DME items AREN'T overpriced when you look at the whole picture.

mattman

[KansasRT]

I agree that you have to take hit on some items and can really make a big profit on other items. But if you didn't charge $250 or more for a mask, insurance wouldn't have to pay that much every three months for a mask. Likewise, if you didn't charge $1500 for a cpap that cost $700 insurance wouldn't have to pay that much. I understand that a profit needs to be made to pay the bills, but if the charge was not so much, insurance wouldn't have to pay as much. I know what I pay for my equipment and I also know that I purchase on a much smaller scale and bigger companies get better deals than I do and charge twice as much. The average patient that I supply CPAP to, barring any $2500 deductable or strange insurance rules wakes away with what ever CPAP they want and all supplies ( I don't bother to order machines that are not downloadable or cool humidifiers) for around $150- $400 total after insurance. I can say that even after that I can guarentee that I made a profit.
I disagree that you don't get paid anything at all for oxygen patients. You are paid a monthly fee to provide a service. You are making a profit on oxygen patients in the long run, or you would not be providing the service. You also are making a profit in the long run on tracheostomy supply patients, or else you would not continue to provide that service. There are patients that you do tend to lose money on, but the profit usually out weighs the loss.

[greenham]

agree Mattman,

In the big picture maybe things are less fouled up. I just wish there was a program for those who have insurance w/ a major carrier in my case (BCBS) to have a way to use the benefits more efficiently and economically. For others who don't care or don't need to care, fine. Let biz go on as usual.

Maybe in a perfect world.

[Wulfman]

they'll make up for it (spending for overpriced DME products) in your increased premiums next year.

But as I just said - they DON'T make up for it in overpriced DME items since the DME items AREN'T overpriced when you look at the whole picture.

mattman

That all depends on the person's perspective.
I couldn't build and sell personal computers anymore for $2000 (or much, much more) like was done 20+ years ago.....nobody would buy them with them selling now for less than $1000. There's no "value added" ANYTHING that could justify those kinds of prices. Everybody's looking at the bottom line. There's still a NEED for local computer shops and "gurus", but nobody can make enough money at it to make a living. Look at what's happened to the computer manufacturers over the last 20 years and you'll see what's going to (probably) happen to the XPAP market......we're already seeing it NOW.......Hoffman Labs, AEIOmed......the mergers have always gone on and will keep continuing.
If the Asian/Chinese companies ever start making this stuff (either for somebody or start up their own companies), you'll be able to take your prescription to a Wal-Mart pharmacy and pick up your own XPAP for about $100 (or less). Don't laugh......stranger things have happened.

Den

[neversleeps]

they'll make up for it (spending for overpriced DME products) in your increased premiums next year.

But as I just said - they DON'T make up for it in overpriced DME items since the DME items AREN'T overpriced when you look at the whole picture.

I agree that you have to take hit on some items and can really make a big profit on other items. But if you didn't charge $250 or more for a mask, insurance wouldn't have to pay that much every three months for a mask. Likewise, if you didn't charge $1500 for a cpap that cost $700 insurance wouldn't have to pay that much. I understand that a profit needs to be made to pay the bills, but if the charge was not so much, insurance wouldn't have to pay as much. I know what I pay for my equipment and I also know that I purchase on a much smaller scale and bigger companies get better deals than I do and charge twice as much.

So, in fact, those DMEs are overpricing their items when you look at the whole picture.

Thanks for the clarification, KansasRT. How I wish there were more out there like YOU!

[mattman]

So, in fact, those DMEs are overpricing their items when you look at the whole picture.

Thanks for the clarification, KansasRT. How I wish there were more out there like YOU!

Neversleeps, have you ever READ any of the stuff I've written? I genuinely don't know why you seem to feel that I'm a ripoff artist and you make a point of little comments like wishing there were more people like KansasRT in response to something I've said. I care more about this stuff than you can imagine. Why the hell do you think I'm constantly putting myself in front of the firing squad on this board? It's not because I enjoy getting kicked in the teeth, I can assure you.

I'll try one more time... Since we do not set the prices it's therefore catagorically impossible to ever state that WE overcharge for anything.

With that out of the way look at my whole post above. One of the first things I said was that getting paid $1500 for a CPAP is too much.
Please read that again. It's too much.

However, getting just as underpaid for other items is just as unacceptable. So in the larger scheme of things the money evens out.
THAT'S why the insurance companies don't care. It's not because they are getting ripped off. They simply aren't. In the big picture they are saving VAST amounts of money.

Are we getting close to being on the same page here?

mattman

[DreamStalker]

... Why the hell do you think I'm constantly putting myself in front of the firing squad on this board? It's not because I enjoy getting kicked in the teeth, I can assure you.

mattman

Uhhh ... perhaps it could be a lack of sunshine?

Wa wa wa wait a minute .. I got it! ... because there is respectful disagreement.

[pstuck]

I have worked in DME for approx. 10 years and I do deliveries, billing and ordering. Not all DME's are bad but all DME's need to make a profit, that is the nature of the game. We have a set mark up and all of our supplies are marked up that amount above what our cost is regardless of how much the insurance pays. Some items we make a profit, some we lose money on those items are quickly deleted from stock and not sold. We do not unbundle our CPAP supplies, if you order the swift you get all 3 sets of nasal pillows for the price of the mask. We are not trying to rip anyone off, some insurance companies (especially Medicare) make this hard. For example oxygen we pay less than 1000.00 for a concentrator but medicare (until just last year) refused to ever consider this purchased and in order to get cannulas, filters etc. covered for the patient the DME had to continue billing medicare a rental of over $200.00 a month essentially for the life of the patient with no purchase ever. With the new law we continue to bill for 3 years. There is always people out to rip you off but not everyone is a thief.

[DreamStalker]

I don’t think anyone said that ALL DME’s are bad or even crooked. The LARGER PICTURE is that when you mix large amounts of money with a broken healthcare system … fraud is not only prevalent but also inevitable.

[neversleeps]

Neversleeps, have you ever READ any of the stuff I've written?

Yes. In fact, I've read every post you've ever written. I read all your posts back when you were using the name Bingo and I've read all your posts as mattman.

I genuinely don't know why you seem to feel that I'm a ripoff artist and you make a point of little comments like wishing there were more people like KansasRT in response to something I've said.

Actually, I was responding to something KansasRT said. I do wish there were more out there like her. She lends a balanced viewpoint regarding the overpricing of equipment. You contend it doesn't exist; or, more accurately, you admit it exists, but contend DMEs have nothing to do with it. Yet, KansasRT wrote:

I know what I pay for my equipment and I also know that I purchase on a much smaller scale and bigger companies get better deals than I do and charge twice as much.

That's what I'd call overpricing.

Why the hell do you think I'm constantly putting myself in front of the firing squad on this board?

Honestly, that's a mystery to me, too.