Questionable DME practices

[tee1971]

I've been treated for sleep apnea for almost a year now. There have been a few times I have questions about my DME's billing/business practices.

Originally, my machine came with a book and it listed what came with the machine. It says it included a hose, 2 reusable filters, and one disposable filter. I was billed for the machine, hose, and disposable filter all separately. Plus, I only received one of the reusable filters. The humidifier book said it came with two of the adapters that connect it to the machine. I only received one.

Later, I needed new head gear for a Resmed nasal gel mask. They said that mask was only sold complete and I couldn't buy just the headgear. I know this can't be true because I have seen the headgear only online.

I decided to try a new kind of mask. Yesterday, I got a Resmed Swift FX mask from them. I was billed in two parts. One for the mask and one for the headgear for a total of $198.00. I can buy the same thing online for $127.00. Once my insurance gets it they will probably reduce the charges per agreement with the DME but it still seems they are gouging me. Resmed's website shows it sold complete and that it should include 3 sizes of nasal pillows (S,M,L). The lady said I'm sure you won't need a large that I am probably a small but she sent the small and medium pillows. I am sure they kept the large pillows so they could sell it as a part to someone else.

I am going to check another DME's service but I just wanted opinions from some other people. Are they cheating me or is this all common practice? Thanks for any advice.

[Janknitz]

You are absolutely right about what they did but yes, it's common practice. All of the insurers permit the parting out of masks that are packaged as one.

The biggest issue was removing one of the nasal pillows and then reselling it to someone else. If they had given all three nasal pillows to you, you could have used the Great Nasal Pillow Exchange thread here to trade for the ones in your size. Now you and your insurer have to BUY another nasal pillow. They profit at your expense--even though you and your insurance didn't technically pay for 3 nasal pillows, neither did the DME, but they took advantage of it on your dime.

And yes, you can get the headgear separately, but only every 6 months per Medicare guidelines (which most private insurers follow as well). If it was time for new headgear, what your DME was telling you is that they don't make enough profit on the headgear to bother for you. You are not worth the effort to them. Not nice.

[chunkyfrog]

The insurance companies do NOT care!
I have reported two cases of fraudulent billing to BCBSNE,
but they maintain that nothing was wrong with what was done.
--And I provided PROOF!
Any insurance company that does not go along with this crap, please identify yourself.
We will be interested in hearing from you.

[greatunclebill]

if your fraud is in a government program, you can report it to the government agency thru the appropriate fraud , waste and abuse office. if that fails, you can write to your us senator about government waste. yes, senators get results.

[chunkyfrog]

Well, since I am a county employee, the contract is with a government entity.
Probably not.

[Janknitz]

None of this, unfortunately, is considered fraud. DME's claim Medicare intermediaries TELL them to part out the masks and CPAP accessories in billing. And technically, you and your insurer are only paying for one nasal pillow as it's billed, so there's nothing wrong with delivering only one (or two) instead of the three that came with the package.

It's lousy customer service but nobody cares except us. DME's and insurers have never learned the difference between what they CAN do and what they SHOULD do.

[chunkyfrog]

with the new regulations; will it get better or worse?

[MidnightOwl]

As long as insurance is footing the bill they are really the DME's client, not you. And they agreed to this. You are the insurance company's client (or your employer is). You can try to take it up with them (or your employer can).

[Conrad]

My DME did the same thing, except I did receive all three sizes of pillows for my FX.

Here's the breakdown from my DME bill.

Resperonics DS750HS (750P from the bottom of the machine?) Rental - $280.00
Resperonics 1056215 humidifier Purchase - $335.00
Resperonics 1032907 PAP Tubing 6ft Purchase - $44.96
Resperonics 1005964 PAP Filter non-dispos Purchase - $15.39
Resmed 61500 PAP Swift FX S&M&L Purchase - $129.40
Headgear Purchase - $43.73

[DiverCTHunter]

if your fraud is in a government program, you can report it to the government agency thru the appropriate fraud , waste and abuse office. if that fails, you can write to your us senator about government waste. yes, senators get results.

Well, since I am a county employee, the contract is with a government entity.
Probably not.

Chunky - find out who your Deficit Reduction Act compliance officer is.

[tee1971]

Thanks to everyone for your input. I checked with another local DME and told them the situation. They confirmed the billing as normal practice. They did say that if I were their client I would have gotten all the extra pieces I paid for.

On the plus side... I have been on CPAP for almost a year and have really struggled. I have tried quite a few masks and been really patient but I have struggled the whole time. I am ready to give up. This other DME actually has respiratory therapists that work for them (not just some person that hands you a mask and a bill). They assured me that if I switch to them they would really work with me to solve my problems. They helped renew my strength to keep trying.

Thanks again for your input.

[leejgbt]

None of this, unfortunately, is considered fraud. DME's claim Medicare intermediaries TELL them to part out the masks and CPAP accessories in billing. And technically, you and your insurer are only paying for one nasal pillow as it's billed, so there's nothing wrong with delivering only one (or two) instead of the three that came with the package.

It's lousy customer service but nobody cares except us. DME's and insurers have never learned the difference between what they CAN do and what they SHOULD do.

First, DME companies are not fans of either Medicare or insurance because of rules like those described here. Yes, the DME described here is a pitiful example. But, there are many DME companies that have learned what they can and what they should do. These are the companies that belong to their state associations. In the case mentioned above, what should have happened is either the whole mask (including headgear) should have been provided as the headgear usually lasts longer than the mask. Or, if the headgear is all that needed replaced, a headgear that is slightly used (usually from mask fitting kits) could have been provided as a courtesy to get them by until the entire mask was due to be replaced.

[lazer]

... I have been on CPAP for almost a year and have really struggled. I have tried quite a few masks and been really patient but I have struggled the whole time. I am ready to give up. ....

I encourage you to create an account (it's free) on this board and list your equipment in your profile [User Control Panel]

Start sharing your problems here and I am very confident you will get some great advise and solutions that will help you!

[chunkyfrog]

tee1971; I heartily encourage you to register.
Your experience is not unusual; but no reason to give up.
I used a horrible mask for the first 4 months, until I could afford to get another, better fitting mask.
There are numerous strategies to make that the techs may not have told you about.
Mask liners, like Pad-a-Cheek and Remzzz's can maximize your comfort.
Also bear in mind, that if you have excessively high deductible/co-pays;
purchasing masks and parts online may be advantageous.

[torontoCPAPguy]

I have not, nor do I know of anyone who has had a great experience with a DME/supplier. I was gouged to the point of it being criminal. I have never returned to ANY storefront for my CPAP nor other supplies and buy EVERYTHING online. It can be 1/3 of the price you pay to those thieves. I have bought a bunch from our sponsor here and have always been pleased with the service and the prices are more than fair. I am able to find equipment online even cheaper than from our host, but choose to buy much from my host(s) as a matter of courtesy.

Just bought replacement cushions for my Quattro's and paid an average of $15-$18 for them as opposed to up to $60 from online storefronts and brick storefronts. I bought six of them and figure I save myself about $250 give or take.

Know what you are buying and what the fair market price is; then decide from whom you are going to buy. I ensure I buy from folks that back up their products as well based on their feedback ratings. Have had a problem here and there over the years but always taken care of with great speed and efficiency.

Caveat Emptor!