Overcharged for machine?
Overcharged for machine?
So, when I got my S8 Compact I agreed to 13 payments of $60 and the machine is mine. Apparently my insurance company picks up half. $60X13 is $780 and double that is $1560. I did a quick seatch and saw this unit being sold for $800 or so. I called the provider and they gave me some babble about the insurance company dictating how much they sell it for. He said the plus side was that if the machine didn't work out I wouldn't be stuck with it. Does this sound right to anyone? You'd think if the machine retails for $850 for example, I'd be responsible for $425 or payments of roughly $32 a month.
pat, if you check https://www.cpap.com/printable_pricelist.php they have a list of retail prices from cpap.com. You'll notice you can pick up some rather excellent bundles (XPAP, heated humidifier, software, etc) for less than what you'd be paying out of pocket!
Read a few posts about "evil DMEs" and you'll see one of the major complaints by most of the folks here is that DMEs generally charge double the price of online stores. Now, the secret is.....they negotiate with insurance companies as to the "real" price for the machine (what the insurance companies end up really paying), but don't let you in on the actual retail price.
The vast majority of folks who have dealt with cpap.com for an XPAP purchase have been very satisfied, including myself. You might want to check out whether or not your insurance company and cpap.com will work together. There's a link on the toolbar sometimes for that.
Good luck and watch your wallet!!!
Kajun
Read a few posts about "evil DMEs" and you'll see one of the major complaints by most of the folks here is that DMEs generally charge double the price of online stores. Now, the secret is.....they negotiate with insurance companies as to the "real" price for the machine (what the insurance companies end up really paying), but don't let you in on the actual retail price.
The vast majority of folks who have dealt with cpap.com for an XPAP purchase have been very satisfied, including myself. You might want to check out whether or not your insurance company and cpap.com will work together. There's a link on the toolbar sometimes for that.
Good luck and watch your wallet!!!
Kajun
_________________
| Mask: Ultra Mirage™ Full Face CPAP Mask with Headgear |
| Additional Comments: APAP, 8-14 cm H2O. |
This therapy WORKS!!!
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hayeswildrick
- Posts: 130
- Joined: Wed Feb 21, 2007 3:41 pm
- Location: New Jersey
He's actually not giving you a line. Your insuance company has pre-negotiated prices for various equipment and services. Because all CPAP machines have the same billing code, your insurance company pays the same price, whatever machine you get.
Supposedly, this is a "discount" price. You've probably seen that your doctor will bill the insurance one amount, then they'll agree to pay a lower amonut, and you pay a portion of that. The same thing is here.
But, what is unusual is that with CPAP machines, you can get the same equipment "internet retail" at about 1/2 the price that your insurance company has "negotiated" with the local brick-and-morter supply company to pay!
Why do the local medical equipment companies get more money?
They would argue that it's because they not only supply the machines, but also give customer care and service. They fit your mask. They adjust the machine. They sometimes accept returns.
In my case, even though the machine cost more from the local supply company, after insurance my expense was still less than buying it on my own. And, being a newbie, I wanted the service they provided.
On the other hand, if I'd had to pay out of pocket, I'd have bought from CPAP.com (which is what I did when I bought my most recent mask).
I hope this makes the muddy waters a little bit clearer!
Jeff
Supposedly, this is a "discount" price. You've probably seen that your doctor will bill the insurance one amount, then they'll agree to pay a lower amonut, and you pay a portion of that. The same thing is here.
But, what is unusual is that with CPAP machines, you can get the same equipment "internet retail" at about 1/2 the price that your insurance company has "negotiated" with the local brick-and-morter supply company to pay!
Why do the local medical equipment companies get more money?
They would argue that it's because they not only supply the machines, but also give customer care and service. They fit your mask. They adjust the machine. They sometimes accept returns.
In my case, even though the machine cost more from the local supply company, after insurance my expense was still less than buying it on my own. And, being a newbie, I wanted the service they provided.
On the other hand, if I'd had to pay out of pocket, I'd have bought from CPAP.com (which is what I did when I bought my most recent mask).
I hope this makes the muddy waters a little bit clearer!
Jeff
Insurance dictates pricing for everything. When you see a charge and have insurance remember that it is the insurance company that set the charge, not the doctors office, hospital, DME company, etc. This is true for all of medicine.
Also keep in mind that with the cost of the machine comes follow-up care from your DME company. Or at least it should. All DME companies that are worth anything should follow-up with their patients on a regular basis.
Also keep in mind that with the cost of the machine comes follow-up care from your DME company. Or at least it should. All DME companies that are worth anything should follow-up with their patients on a regular basis.
DP
RPSGT
RPSGT
I got the same sticker chock this morning when calling my insurance... My RemSTAR M series PRO and humidifier will run for about $1800... (hose, mask, filters etc. are extra...) "Thankfully", I have already maxed out my deductible (2 sleep studies, one of them the titration, $2,225 a pop, will do that to you!) so I'll pay only 20%... I understand that part of the expense is the "care" you receive with the equipment... Haven't seen a lot of care so far, but I am still hoping... (On that note, you guys have given me better care than my sleep doctor and DME... Perhaps you should get a cut of the money!!!)
Most DME companies feel that there just is not enough money in CPAP given the amount of time you often times have to spend with a patient. Try and make sure that the person actually providing you the machine and educating you on it is a registered respiratory therapist or a registered sleep technologist.
If you are not happy tell your doctor not to use them anymore and then find a new one if you can. Unfortunately some insurances have exclusive contracts with DME companies which means you are stuck. Apria, for example, has an exclusive contract with CIGNA. No competition usually means poor service.
If you are not happy tell your doctor not to use them anymore and then find a new one if you can. Unfortunately some insurances have exclusive contracts with DME companies which means you are stuck. Apria, for example, has an exclusive contract with CIGNA. No competition usually means poor service.
DP
RPSGT
RPSGT
Since you say your insurance company only picks up half, you are a prime candidate for ignoring your insurance and buying cash online.
At that low level of reimbursement as well as the low end machine you are getting you can get a much nicer (even auto) machine for less.
At 20% copay it paid me to use insurance, somewhere between 30 and 40% or so it no longer does.
BUT if you decide to go online, get rid of that rental now before you sink another $60 into it.
Your prescription is good for another machine. Order now, then take that thing back in a couple of days when you cash machine arrives.
I have bought (back up machine) and many other items from CPAP.com and they are wonderful to deal with.
At that low level of reimbursement as well as the low end machine you are getting you can get a much nicer (even auto) machine for less.
At 20% copay it paid me to use insurance, somewhere between 30 and 40% or so it no longer does.
BUT if you decide to go online, get rid of that rental now before you sink another $60 into it.
Your prescription is good for another machine. Order now, then take that thing back in a couple of days when you cash machine arrives.
I have bought (back up machine) and many other items from CPAP.com and they are wonderful to deal with.
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georgev747
- Posts: 13
- Joined: Tue Apr 24, 2007 10:14 am
- Contact:
apria lawsuit
DMS apria does things like this and lies, I just filed lawsuit against them
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hayeswildrick
- Posts: 130
- Joined: Wed Feb 21, 2007 3:41 pm
- Location: New Jersey
I'm convinced that the answer to that question is "Through your doctor." The vast majority of patients that the DMEs work with come to them through their doctors. If the doctor likes a DME, that DME will get lots of business. If the doctor has repeated problems with a DME, they'll start referring their patients to someone else.Do you have any ideas about how to get the local DME's to be more responsive to us.
So, if you can get your doctor to be an advocate for you with the DME, you'll almost certainly get results.
Jeff
I'm in the process of getting my first machine. I called the DME that my sleep clinic sent my prescription to and told them exactly what I wanted (REMstar Auto C-flex with humidifier, software and card reader). I emailed them a link to cpap.com's bundled package/price. The DME told me that there's no way they could "match that price".
Of course, they were going to try to stick me with a lesser machine, kind of like moving the cattle herd though the "process". I told them if they can't get what I want, I'll go elsewhere. A couple of days later she called me back and said she spoke with her Respironics Rep and they could order what I wanted. The cost? She told me the insurance company has no billing code for an APAP, so she was billing them the $1200 "retail price" of the standard CPAP and I'd be paying 20% of that and that they will "give me the software and card reader free". Good enough for me because, being a noob to all this, I wanted some place local in case I have problems or questions.
Just thought I'd toss my experience in.
Of course, they were going to try to stick me with a lesser machine, kind of like moving the cattle herd though the "process". I told them if they can't get what I want, I'll go elsewhere. A couple of days later she called me back and said she spoke with her Respironics Rep and they could order what I wanted. The cost? She told me the insurance company has no billing code for an APAP, so she was billing them the $1200 "retail price" of the standard CPAP and I'd be paying 20% of that and that they will "give me the software and card reader free". Good enough for me because, being a noob to all this, I wanted some place local in case I have problems or questions.
Just thought I'd toss my experience in.
_________________
| Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear |
| Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control |
yeah you won't be stuck with it as long as you "give" it back to them and forfeit everything you have paid, they will still charge your insurance until the end of the term for it and resell it to some other sucker.
its all about the math, if you have a 50% deductible, you are crazy to go through the insurance suggested DME like Apria, you will get ripped off every time. You will end up with a sub-$300 machine with no features and be charged for the Cadillac of machines.
Shop around yourself, just like buying a car or TV, you are better off just buying the machine you "want" outright and be done with it. Your chances for therapy success are much greater with an autopap that has reporting capabilities where you can monitor your own therapy.
If your pressure is really high like 15cm and higher than you may need a Bipap, or if you have a lot of centrals you may need a adapt SV machine. But you know what, that is what the doctors "should be doing" as part of their job to "guide" you towards the treatment that is best for you over the long run, not what is best for their revenue. Since not many doctors know how to do that yet, you are stuck doing your own research and asking questions of those that have been on therapy for a few years or more.
The two main things a newbie patient should ask for:
1. Copy of all PSG reports that come from the lab. Doctor won't give you that, tell them to take a hike and sue them.
2. If cpap is suggested, obtain and keep a copy of your script, make sure it has DX: OSA (backed up by your PSG report), RX: CPAP, Heated Humidifier & Mask. If there is a pressure found during the titration, it should state that pressure. OSA is a life-long disorder until they come up with a cure. Your cpap script never expires.
3. Shop around, ask questions, again long-term therapy you cannot beat an autopap don't care what any doctor says. Remove the financial gain aspect from your sleep doctor bias and they will also suggest an autopap. It is only those that want you to come back every 3 months, have 2 PSG's per year dictate how you breathe at night and basically baby-sit you along the way so they can rake in the reimbursements. Go to any medical website, they will have a Reimbursement section showing the doctor how they can make more money. That is why they make these cheap plain jane machines, they are money makers for the doctors and HME's.
With insurance changing every year you are almost guaranteed you will be paying more and getting less over the next foreseeable years, you should obtain the machine/therapy that carries you at least 5 years down the road.
Ask anyone, today you have medical coverage, tomorrow you may not. Once that coverage is gone do you want to be "stuck" with a 10-month rental? Why do you think insurance and DME's love that rental so much? The numbers show 40-50% patients give up on therapy. If they can cancel that therapy in 6 months, hey they save money. That is why they allow the DME to charge high prices for rent-to-own. Rent-to-own is the most expensive way to purchase anything. But you don't have much choice in the matter.
There are some Insurance plans you can get without DME coverage, it can sometimes lower your premium by $100 month (BC/BS for example), that is $1200 a year savings, you can buy a new machine every year with those savings, if you are buying your own masks you'll find you can go 6 months or a year with the same mask easy.
I recently bought a new 420e and humidifier, doing some google searches I found it for $549 complete shipped to my door. I already had the software and cable, so I was good to go. If it only lasts me 1 year I'll still be money ahead than paying extra for DME coverage.
its all about the math, if you have a 50% deductible, you are crazy to go through the insurance suggested DME like Apria, you will get ripped off every time. You will end up with a sub-$300 machine with no features and be charged for the Cadillac of machines.
Shop around yourself, just like buying a car or TV, you are better off just buying the machine you "want" outright and be done with it. Your chances for therapy success are much greater with an autopap that has reporting capabilities where you can monitor your own therapy.
If your pressure is really high like 15cm and higher than you may need a Bipap, or if you have a lot of centrals you may need a adapt SV machine. But you know what, that is what the doctors "should be doing" as part of their job to "guide" you towards the treatment that is best for you over the long run, not what is best for their revenue. Since not many doctors know how to do that yet, you are stuck doing your own research and asking questions of those that have been on therapy for a few years or more.
The two main things a newbie patient should ask for:
1. Copy of all PSG reports that come from the lab. Doctor won't give you that, tell them to take a hike and sue them.
2. If cpap is suggested, obtain and keep a copy of your script, make sure it has DX: OSA (backed up by your PSG report), RX: CPAP, Heated Humidifier & Mask. If there is a pressure found during the titration, it should state that pressure. OSA is a life-long disorder until they come up with a cure. Your cpap script never expires.
3. Shop around, ask questions, again long-term therapy you cannot beat an autopap don't care what any doctor says. Remove the financial gain aspect from your sleep doctor bias and they will also suggest an autopap. It is only those that want you to come back every 3 months, have 2 PSG's per year dictate how you breathe at night and basically baby-sit you along the way so they can rake in the reimbursements. Go to any medical website, they will have a Reimbursement section showing the doctor how they can make more money. That is why they make these cheap plain jane machines, they are money makers for the doctors and HME's.
With insurance changing every year you are almost guaranteed you will be paying more and getting less over the next foreseeable years, you should obtain the machine/therapy that carries you at least 5 years down the road.
Ask anyone, today you have medical coverage, tomorrow you may not. Once that coverage is gone do you want to be "stuck" with a 10-month rental? Why do you think insurance and DME's love that rental so much? The numbers show 40-50% patients give up on therapy. If they can cancel that therapy in 6 months, hey they save money. That is why they allow the DME to charge high prices for rent-to-own. Rent-to-own is the most expensive way to purchase anything. But you don't have much choice in the matter.
There are some Insurance plans you can get without DME coverage, it can sometimes lower your premium by $100 month (BC/BS for example), that is $1200 a year savings, you can buy a new machine every year with those savings, if you are buying your own masks you'll find you can go 6 months or a year with the same mask easy.
I recently bought a new 420e and humidifier, doing some google searches I found it for $549 complete shipped to my door. I already had the software and cable, so I was good to go. If it only lasts me 1 year I'll still be money ahead than paying extra for DME coverage.
someday science will catch up to what I'm saying...
So the S8 Compact is a low end machine? They told me I was getting the best available when I talked to them. I think I might take some advice and look for one online and then return this thing. It's OK but I want more for my money. Some people are mentioning things like smart card, software, etc. I feel like I am missing out on better treatment.