dme provider prices?

sleeplessinnorcal · Post by **sleeplessinnorcal** » Thu Oct 22, 2009 12:11 pm

i just ordered a new mask through my dme (pulmonary soulutions). mask headgear $65.00. mask paykel forma large $410.00. ff cushion and foam $105.00. total $580.00. through insurance i am on an 80 percent and 20 percent. so my total is 96.01. i can get the mask by myself for $120.00. why do provider dme inflate their cost so much? When i called the dme to reorder i asked them several times what the price is and she did not tell me. if i would have know the price would be $580.00 i would have said no way. if i go through with a non-provider i have to pay 65%.

tonycog · Post by **tonycog** » Thu Oct 22, 2009 12:29 pm

https://www.cpap.com/productpage/fisher ... -mask.html

65% of $103.95 is less out-of-pocket for you and gives your gouging DME provider one less customer. $500+ is beyond outrageous and offensive. They should be run out of business for that. You should call them on this nonsense. Ask them to justify doing this to you. Don't expect a positive response, though.

Best wishes,
Tony

cinco777 · Post by **cinco777** » Thu Oct 22, 2009 12:37 pm

Have you noticed that the Economy is still "tanked"? Your DME is just trying to make ends meet - what is wrong with that?

Since they often are the only game in town and are sometimes partnered (officially or "under the table") with the local sleep clinics/Drs, they can pretty much do what they please, especially when most of their sleep-deprived clients are uninformed and trusting. Don't be surprised that they are raising their already exorbitant prices to "insane" levels.

My DME-provided mask was charged at a price over $300. My copay (20%) was over $60. The online price was about $110. Within a month, I picked up a backup mask (new, original packaging, same brand/model) from CPAPAuction for $45 including S&H. I don't see my local B&M DME getting more of my business - I wonder if they are still hoping to hear from me.

sleeplessinnorcal · Post by **sleeplessinnorcal** » Thu Oct 22, 2009 1:05 pm

their are only 2 dme's in town. other dme does not have respironics cpap's. so if they are partnered with my doctor i wonder how much she makes on the deal. when i origianlly got my cpap i only had to pay 290.00 for cpap and mask. so i think i did good on that deal because they made a deal with my insurance. but for now i think they are trying to make their money back. i am returning equipment back and looking elsewhere.

potholerepairman · Post by **potholerepairman** » Thu Oct 22, 2009 1:14 pm

Don't know your insurance but mine United Healtcare does not pay anywhere near those prices, so your 20 % might be a lot lower once you find out how much your insurance company cuts down those high prices.I may be a rookie but do try to know what goes out the wallet.Buying thru my dme only when it makes financial sence is the only way I would use em.

Autopapdude · Post by **Autopapdude** » Thu Oct 22, 2009 1:18 pm

Dmes are in the business of making money--in that case, it seems like a lot of money. Obviously, you can get the equipment online (this is a very nice online DME, our host), and self-pay. Run the numbers both ways and see how it goes for you. In/re setup advice, you can get plenty of that here, and it isn't all that complicated. People are very glad to help.

mattman · Post by **mattman** » Thu Oct 22, 2009 5:53 pm

The price is set by the insurance company. They will determine a price and then pay a percentage of that.

The first price you see is (usually) the submitted amount. That's the total price the insurance company tells the DME to put down.

The second price will be the allowable. This is (usually) 40% or 60% of the submitted amount. This is what the insurance company will actually pay.

The DME company is not allowed to charge a lower price to a cash customer than the price the insurance company has set for that HCPC code.

This is why the company that runs this site has a seperate company set up for when he bills insurance. Unfortunately, DME companies can't do this so when you want to pay cash you get stuck having to pay the higher insurance prices.

Guest · Post by **Guest** » Thu Oct 22, 2009 9:44 pm

you clueless wonders forget that the "price" of medical equipment includes your RIGHT as a patient to demand RT service at any point throughout your treatment years. It includes the cost to bill insurance. It includes the cost to deliver stuff and communicate with your doctor. It includes a lot. There is no "fair" price for this stuff. The only reason it's somewhat cheaper online is because the online stores don't provide any freaking service other than answering the phone and giving virtual advice. It's opportunists making money. This is fine for the 2% of people out there that rely on internet stores. That's why all of this stuff is eventually going to be on the shelf at Walgreens at rock-bottom prices - then we'll see where the internet guys are. It will be due to people like you assuming that DMEs don't deserve to get paid for the service component. When manufacturers wake up and begin charging online companies $90 for a mask, things will change for the better.

tonycog · Post by **tonycog** » Thu Oct 22, 2009 9:55 pm

Cowardly Guest wrote:you clueless wonders forget that the "price" of medical equipment includes your RIGHT as a patient to demand RT service at any point throughout your treatment years. It includes the cost to bill insurance. It includes the cost to deliver stuff and communicate with your doctor. It includes a lot. There is no "fair" price for this stuff. The only reason it's somewhat cheaper online is because the online stores don't provide any freaking service other than answering the phone and giving virtual advice. It's opportunists making money. This is fine for the 2% of people out there that rely on internet stores. That's why all of this stuff is eventually going to be on the shelf at Walgreens at rock-bottom prices - then we'll see where the internet guys are. It will be due to people like you assuming that DMEs don't deserve to get paid for the service component. When manufacturers wake up and begin charging online companies $90 for a mask, things will change for the better.

When I "demanded RT service" at a particular point in my treatment years - 3 weeks in - I was told "I don't know how to help you avoid mask leaks. You just need to call your doctor". My DME provider's RT was the only 'clueless wonder' in my Bi-PAP journey so far. The cost of billing my insurance is fair, I guess. It was the only thing they did correctly.

Also, please feel free to 1): log in and identify yourself rather than being an anonymous trolling coward and 2) justify a $580 price tag for a mask. At $580 I certainly do see an "opportunist making money."

Tony

cinco777 · Post by **cinco777** » Thu Oct 22, 2009 11:26 pm

cowardly guest wrote

includes your RIGHT as a patient to demand RT service at any point throughout your treatment years

Please note that getting "helpful" service from an incompetent DME will be as successful as getting water from squeezing a rock.

cpapmask · Post by **cpapmask** » Fri Oct 23, 2009 2:47 am

I think I will add a little note to this subject this morning since I can not sleep. I am getting an auto cpap next week. I know my insurance pays 90% of the cost and I will have to pay the 10%. This is a replacement machine i am getting the first auto that i have tried. I got my script from my dr who does not care what brand i get. I did my home work and decided what brand and model I wanted this time. I went to my insurance companys web site, there I could do a print out of allowed DME that i could purchase from. I was able to do a print out of all allowed DME within a 20 miles radius of my zip, did that one and then did a 50 mile radius of my zip. I took the 20 mile print out and started calling to see what brands of cpap they carried, I found a lot do not even carry cpaps and I found out what brand some of them did carry. I even asked them if they could order the machine i wanted. a lot told me no. i even had some tell me that my insurance will only pay for one paticular brand and one paticular model. Now I have been on cpap for 10 or so yrs now..This is not the first machine i have had. I told the companys that did not have or would not order what i wanted to have a nice day and i hung up. I had one tell me that if they ordered the model and make i wanted that it would cost me the 10% that insurance would not pay and and additional 480.00 of course u know what i told them. I had one DME tell me that my ins would only cover a paticular machine and model that sales for 185.00 on the internet, and they were going to bill my insurance 1560.00 now i was told that i would have to pay 156.00 cash my 10%. Again you can guess what i told that co to. I ended in the 50 miles radius print out before i found a DME that i would shop with or become there customer. I felt they were honest before i got off the phone with them. As i did find a DME that would get waht i wanted but they wanted to charge me and my insurance over 1300.00 for the machine. But the honset DME i ordered from will have my new auto cpap with built in humidifier
will have my machine for me next week. I have 120.00 left to pay on my deductible for the year so the machine will cost me 120.00 deductible plus and additional 56.20 for a toat of 176.20 out of my pocket. So do the math the machine is actually costing me and my insurace co just under 800.00. They will not rip me and my insurance off as i will not shop with them. I am there customer and i have worked in retail mgnt for 35 yrs now.. I never ripped my customers off and I don't expect to get ripped off either in life... I will fight for 1.00 if I have to LOL. Well the way i got my family dr. to write me a script for an auto is another story for another day. Some may like they way and others may not. Will share that story later.

Kiralynx · Post by **Kiralynx** » Fri Oct 23, 2009 8:37 am

Cowardly Guest wrote:you clueless wonders forget that the "price" of medical equipment includes your RIGHT as a patient to demand RT service at any point throughout your treatment years. It includes the cost to bill insurance. It includes the cost to deliver stuff and communicate with your doctor. It includes a lot. There is no "fair" price for this stuff. The only reason it's somewhat cheaper online is because the online stores don't provide any freaking service other than answering the phone and giving virtual advice. It's opportunists making money. This is fine for the 2% of people out there that rely on internet stores. That's why all of this stuff is eventually going to be on the shelf at Walgreens at rock-bottom prices - then we'll see where the internet guys are. It will be due to people like you assuming that DMEs don't deserve to get paid for the service component. When manufacturers wake up and begin charging online companies $90 for a mask, things will change for the better.

Oh. Really? That's nice to know. The RT at my B&M DME got me the right machine. But never has service been provided in person. The only time I've seen her in person was the day I picked up my machine and signed all the papers.

No masks in stock. Everything has to be ordered, and it takes 5-7 working days to get anything -- although sometimes it takes 3-4 weeks "because that's a special order." DME staff so incompetent they ship replacement pillows in a manila envelope and blame me when it arrives crushed and unusable. DME staff who refuse to issue a return receipt when I returned the manged set of nasal pillows. (Well, heck, they'd already billed my insurance for them: did they think I was going to let them bill my insurance for the replacement set, too?) Refusal to honor a prescription from my doctor for a full face mask as an extra mask because I was only allowed 2 masks a year, despite the fact that my insurance said that they would pay for whatever the doctor prescribed.

Hmm, how much does it cost to send a fax? That's how they communicated with my doctor. I'll grant you: they're VERY good at communicating with my insurance company.

Yes, indeedie. The B&M DME provides GREAT service.

Without this Forum, I would be a CPAP failure, probably still struggling, because I wouldn't even know what questions to ask. Now I can order any equipment I want on-line and have it within two working days. If the brick-and-mortar DME provided the level of service my on-line DME does, I'd be delighted. But they don't.

leejgbt · Post by **leejgbt** » Fri Oct 23, 2009 9:13 am

I am the manager of a DME and these prices quoted are waaaaaaaaaay outside the norm. Yes, if you do give good RT service and good follow up it is worth the extra money. Yes, the cost of billing is built in to these costs. Also, a stat from the AASM, compliance from patients using DME companies is 60% while patient compliance using on-line companies is 3%. I think this 3% is the people on this website. You are the 3% that have the brain power and a little bit of luck to still be successful.

I know that there are some very poor DME providers but I would like to think that most do it right. I wonder if you compared the "mom and pops" to the "nationals" who would be rated higher?

carbonman · Post by **carbonman** » Fri Oct 23, 2009 9:15 am

Guest wrote:you clueless wonders

Yet another shining example of why DME's are worthless.

ScrappinMom · Post by **ScrappinMom** » Fri Oct 23, 2009 10:14 am

leejgbt wrote:I wonder if you compared the "mom and pops" to the "nationals" who would be rated higher?

Well, let's see. I know there is a lot of bad experience with Apria, a national company. Here's my experience with a "mom and pop", in business here for many years. When I went in to pick up my machine (took a week to get an appt) the "RT" gave me a Swift LT, told me if I didn't like that one, that I wouldn't like anything else any better. "Eyeballed" fitting the pillows to me, sent me one other size just in case those didn't work. When I asked her about the Nasal Aire II, she looked at me like I had 2 heads. Said they carried them "a long time ago" but they're not any good, so they quit. Really...

Said she would call me that Friday, in another 2 weeks, and again in a month. Never called me even once.

She gave me an Escape II piece of junk, (but I didn't know better at the time) no discussion about any other alternatives.
She spent a total of 15 minutes with me, including the time to fill out the paper work.

3 weeks in, after I further educating myself on this forum, I called to speak with the RT about changing machines. I had to leave a voicemail message, and she never returned my call. I called again a week later, explained the RT never called me back, and was put on the phone with ???, probably some sales person. Anyway, she argued with me about the differences between the Escape and the Elite. She then called ResMed, called me back and said I was right about the efficacy data. HOWEVER, there was NO WAY patients can get ANY info from even the Elite, and that was straight from ResMed. She finally said she would order it if I would pay $175 EXTRA, on top of my co-insurance. I said no thank you, I will bring this back.

Now, how's THAT for service???

Guest, if you don't have the guts to identify yourself and be civil, please go away. There is no need for hatefulness here. We are doing just fine without you and your kind.

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