So.... 2 DMEs walk into a bar....

[Lizistired]

It's just so tiring to have to play this game. I know, I know.... I've been a hose head almost 20 years. I should be used to it. It just frosts me that we HAVE to be "used to it".

I won't give in though. Heck, I've already been dead. Doing this stuff is easy by comparison.

That's why they make it a PITA, in hopes that you will just roll over.

[Janknitz]

Most people don't have a clue they are getting rooked, so the DMEs get away with it all the time. Why stop???

[idamtnboy]

Anyone have an idea how Medicare reimbursement allowances compare to cpap.com prices? My stuff is charged directly to Medicare, who then pass the claim on to BCBS who pay the deductible. I have no out of pocket cost, except for a healthy premium per month for the BCBS insurance, so I have no particular incentive to buy my stuff from anyone other than the local DME and so have not done any real price shopping. They have given me decent, but not necessarily stellar, service.

[ameriken]

Most people don't have a clue they are getting rooked, so the DMEs get away with it all the time. Why stop???

I beleive this is why medical costs are so high...it's the providers themselves trying to jack the insurance companies and the government.

If insurance would go to a major med plan where patients had to take care of these kinds of costs, I'd bet that almost everything would be priced far lower. Most consumers don't care when someone else is paying for it and so these companies can get away with it.

We all end up paying for it one way or the other.

[chunkyfrog]

I already share my online resources (this forum, too) with my friends and co-workers.
I will also help them with the paperwork to get the best deals and have insurance apply the deductible.
I, for one intend to be a strong, silent pain in somebody's glutes.

[Janknitz]

Medicare pays a lot more than the online price. Around $100 per month for the machine plus outright purchase of the humidifier for a few hundred dollars. The extra Medicare pays is supposed to be for "service"

[Muse-Inc]

Medicare requires that they meet certain documentation requirements subject to periodic audits and to maintain those records for I think it's like 10 yrs or something like that. Sure jacks the cost up to do that even if it's in one of the acceptable electronic forms.

[idamtnboy]

Most people don't have a clue they are getting rooked, so the DMEs get away with it all the time. Why stop???

That's actually the case in all areas of life where consumers don't have the information, inclination, knowledge, expertise, or whatever is required to make a truly informed buying decision. That's why heating & air conditioning contractors get by providing shoddy service and installs for an unfair price, or why car buyers get rooked so often. Same thing when it comes to buying retirement investment plans, or life insurance, or the services of a lawyer. Years ago the funeral industry was notorious for its rip off tactics.

But no, consumers don't need protection by regulators. The free market will provide it. That's why the Repubs won't let the President appoint a head of the consumer protection agency for financial services.

[yardbird]

Well... I got my response from my insurance company.
The DME is absolutely NOT allowed to balance bill me.

This assumes the machine I want is billed as E0601. It's a Resmed S9 Autoset so.... as far as I know that's E0601.

Anyone seen it billed under any OTHER billing code?

My coverage is 100% for in-plan DME (and they ARE in-plan... I checked that first). No co-pay.

I would LIKE to get on a regular schedule of replacements for masks, pillows, filters, etc, through my insurance. I have no problem dealing with a DME that's right next door to my sleep doc as long as we all understand that while I am perfectly agreeable to them making a profit and staying in business, I won't stand for being bullied, scammed or lied to.

I can't afford to buy a new machine out of pocket again. I've purchased my last 2 machines from our host and while I love them dearly, my employment (or lack thereof) and insurance situation just won't let me do that again..... for now. If this local DME reinforces all the bad experiences I've had with local DMEs in the past, then I'll continue to get my supplies from our host and pay out of pocket. I would much rather reward GOOD behavior than bad behavior even if it costs me a few bucks.

[Sheriff Buford]

want to borrow my taser?

[yardbird]

want to borrow my taser?

Is it an AUTOSET?

Like... it'll go up to whatever voltage is needed to maintain an open DME?

[Lizistired]

Most people don't have a clue they are getting rooked, so the DMEs get away with it all the time. Why stop???

That's actually the case in all areas of life where consumers don't have the information, inclination, knowledge, expertise, or whatever is required to make a truly informed buying decision. That's why heating & air conditioning contractors get by providing shoddy service and installs for an unfair price, or why car buyers get rooked so often. Same thing when it comes to buying retirement investment plans, or life insurance, or the services of a lawyer. Years ago the funeral industry was notorious for its rip off tactics.

But no, consumers don't need protection by regulators. The free market will provide it. That's why the Repubs won't let the President appoint a head of the consumer protection agency for financial services.

We can always count on the free market to protect consumers. ....

[chunkyfrog]

Is there any law against helping others get a better deal?
Ombudman, concierge, or yentl.
My hubby has been helping Ukrainians with poor English skills get good deals on used cars since he was 10 years old.
The little interpreter who only translated the info that got the buyer a better deal.
His dad was a little perturbed when he found out what his kid was doing, but pleased about the several hundred dollars less he had to pay.

[imagep]

Most people don't have a clue they are getting rooked, so the DMEs get away with it all the time. Why stop???

I beleive this is why medical costs are so high...it's the providers themselves trying to jack the insurance companies and the government.

If insurance would go to a major med plan where patients had to take care of these kinds of costs, I'd bet that almost everything would be priced far lower. Most consumers don't care when someone else is paying for it and so these companies can get away with it.

We all end up paying for it one way or the other.

I'm a new member (actually just registered to respond to this post), so go lightly on me and don't run me off...

Yes, thats largely why medical costs are so high.

A while back I actually proposed to my congressman an alternative health care system, which would insure every single American ("universal" style) for less money than what our gov already spends on health care. I'm not going to go into all the details of it, and I am not trying to get political, but yes, it is actually possible for the gov to purchase a group policy for 308 million people (every American) for less than the gov already spends on healthcare - resulting in a $2,000 savings per citizen.

How? Well, largely by getting rid of insurance paying for normal medical expenses. Healthcare is one of the few industries which does not exists within a normal capitalistic system. The price of almost every other product is set by the market and kept reasonably low by the market. But since what most of us call insurance is not actually insurances (it's a prepaid health care plan), we don't bother to price shop. Since we don't bother to price shop, health care providers don't bother to be price competitive as they "stick it to" the insurance companies. And actually, the insurance companies like it. While the insurance co may occasionally complain that a health care provider is overcharging, they really arn't directing the complaint at the health care provider, they are directing the complaint at the patient and asking for the patient to pay more money to cover the overcharge. Insurance companies actually love and promote high health care prices. You see, the higher the price of health care, the more they can justify the existance of the insurance company, and the higher the price that they insurance company can charge for insurance. From the consumers point of view, if health care is so expensive that we can't afford it, and if we may literally die if we are not getting it, then we are willing to pay up to every dime that we have to acquire it. The only thing that keeps insurance rates partially in check is the fact that employers and individuals will occasionally shop for insurance and choose the lowest bidder or at least the best value.

Our national "health care crises" isn't actually caused by some people not being insured, it's caused by too many people being OVERINSURED. The purpose of having insurance is to financially protect ourselves in case we had a very expensive, yet unlikely medical bill. Paying $50 or $100 to go to the doctor isn't unlikely or expensive, and thus we don't really need our insurance to cover that type of care. Millions of people and families pay $500-$1000 each month, just to have the insurance company write a $100 check to the the doctors office, yet, somehow they think that is saving them money. Imagine what would happen if we all got "comprehensive" car insurance that covered every maintanence expense (including gas) for just a $20 co-pay, and got you a new car for just a $500 deductable if your old one was worn out. First of all, we wouldn't bother to take care of our cars as there would be no incentivie. Second, can you imagine filling up your car for just $20? Today it cost me about $75 in my gas hog suv and about $40 in my econo car and I have to fill up every couple of weeks in both cars. But if I could fill up for just a flat $20 copay, heck, I'd waste the heck out of some gas, and I wouldn't bother to price shop. It wouldn't matter to me if gas was $3/gallon or $300/gallon, and you can bet that some gas stations might just start charging $300 a gallon. So try $6,000 for a tank of gas!!! Naturally, the insurance company would have to price the insurance very high to cover the costs, and the higher the cost of insurance, the more gas stations could justify charging for gas, and the more insurance companies would have to charge...ad infiniteum It's a never ending cycle, at least up to the point that the insurance companies get every single penny that we make after taxes (and soon it will be like that with health insurance).

Of course the higher prices cycle is just one of the many ways we get scammed by low copay low deductable insurance. We get scammed every time we turn around. Just off the top of my head...

1) we are taught not to price shop for health care. And the health care industry promotes this by not allowing price advertising.

2) we are told that PPO's save the patient money because the PPO's give special discounts to insurance companies. Thats not really the way it works. PPO's save insurance companies money, but not the patients. Until last year I had been going to a doc office that is owned by one of our two local hospital systems. I rarely visit the doctor and typically only went twice a year, once every six months to get my blood presure Rx renued. the next to the last time that I went to that doc, it cost me $125 for no examination other than the 2 minutes that the nurse spent checking my weight and blood pressure (which I can do for free at Walmart), about a two minute conversation with a doc, and 30 seconds of her time to write the script. Then my wife went, and I noticed that she got a 30% discount for not having insurance. So the next time I went, they asked me to update my insurance information, so instead of admitting that I have a high deductable policy, I simply told them that I no longer had insurance. I got a 30% discount. I asked the payment lady how they could afford to give non-insured patients a 30% discount and she explained that ultimately, they give almost everyone a 30% discount because they give a 30% discount "negotiated" rate to insurance companies, but that discount just doesn't happen to show up on the patients bill. I was like "wow, you have been ripping me off for all these years by not giving me that same 30% discount". Then I started checking into that policy a little more. Seems that they do this in the approval of insurance companies because it makes the patients think that they are getting a better value from the insurance companies than they really are. So the patient gets a bill for $125 but only has to pay maybe $25 of it due to their copay. So the patient "saved" $100 right? Wrong, remember the bill was jacked up to begin with. If the patient didn't have insurance the bill would have only been $87.50 so the patient only saved $62.50.

3) An extention of the scam I labled as "2", is the fact that if the patient didn't have insurance, and wasn't brainwashed into thinking that he couldn't price negotiate or price shop, he would have utilized a cheaper service. After I discovered how I had been getting overcharged just because I had insurance on file with the doctors office, I decided that I would do some price comparisons. I ended up finding a doc who has a standard visit rate of just $50 per visit. Now this doc is a graduate of a very prestigious medical school (Vanderbilt) and she seems to offer most every type of care that your typical family physician would, with the excepting that they do not do "pain management". that doesn't mean that if you needed some stitches they wouldn't give you pain medication, that just means that they don't give out long term scripts for serious pain meds. Anyhow, they litterally have a price sheet posted on the wall. I know exactly how much everything costs before I get it done. So I asked her how they can be so much cheaper. She says that since she doesn't accept insurance, she doesn't have the expense of having to deal with insurance companies, and since she doesn't do "pain management" her malpractice insurance is lower, and since she is self employed and doesn't have to spend half her time in meetings, or expaining why she did what to some manager/beaurocrat that she can spend her time treating patients. Now do the math, $50 per visit, she does 6 visits per hour, and the office is only open 5 hours per day. Thats $375,000 per year. Even if her overhead and small staff (two parttime people) costs her $175,000 a year, she is still making $80,000 a year more than the average family physician, and she works LESS! Anyhow, if you didn't catch it, the scam is that when you have a PPO or HMO you are actually prohibited from price shopping because your insurance company requires that you only use certain providers (or else you pay more), so you are letting the insurance company make decisions for you. That reduces your freedom of choice.

4) etc, I could talk about the cons of our current medical system all day.

[Janknitz]

Resmed S9 Autoset's billing code is E0601.

Prepare a letter to the DME that you understand, after checking with your insurance company, that the DME is not permitted to balance bill. You also understand that the billing code for the machine your doctor has ordered, a ResMed S9 Autoset, is E0601 and that your insurance covers the cost at 100%. You expect them to provide the machine requested, and if they attempt to bill you for more than the contracted insurance price you will be filing complaints with your insurer and with the appropriate state regulatory agencies. Fax or mail it to them and tell them what time and day you will be coming in to pick up your S9 Autoset.

If and when they do provide you with a machine, check and double check to be certain that it's really the Autoset, not an Escape Auto--odds are 50:50 that they'll try that trick.