Why do insurance companies allow this?

andyomega · Post by **andyomega** » Thu Jul 12, 2007 11:58 am

Why do insurance companies allow doctors and DMEs to charge them SOO MUCH MONEY ???
Don't they look into the amounts they are being charged?
Last year I went to a neurologist and he asked me a few questions, did a 30 second exam, told me I dont have a sleep disorder im just depressed and charged my insurance company 200 dollars.
What about the monthly rental fees DME suppliers get for the machines?
It doesnt make sense.

Slinky · Post by **Slinky** » Thu Jul 12, 2007 12:21 pm

Don't confuse BILLED amounts w/the amounts actually allowed and paid.

Coastal_ZZs · Post by **Coastal_ZZs** » Thu Jul 12, 2007 1:12 pm

What a post!! What a POST!! DANG IT!! THANK YOU FOR POSTING AHEAD OF ME!!

I am sitting here going through my bills and freakin'!

and Slinky, I hear 'ya, but I AM looking at amount paid and STILL trippin'

This month, with my invoicing, I am going to try to triple or quadrouple my bill and when the client pays what he considers to be an allowable amount, I'll just write off the rest! Somehow I don't think it is gonna work the same.

These "Insurance write offs" have to be used somehow, for "tax" purposes or something, don't they??

2 nights of sleep study -
$5490.00 charged
$1674.00 allowed
$3816.00 - "insurance writeoff" cough, gag, gasp, choke!!

... and my sleep doctor WORKS for these people?? conflict of interest maaaybe?!? - okay, I'll hold that for another post...

I hope someone can help with this because I am considering going to the Attorney General. I have already printed a grievance review form for my insurance and am looking at it right now. This would primarily be around my machine issues and the fact that it was rented for 2 months, but was "purchased" after 1 month. They have effectively roped me into this piddly machine that they gave me since as they said "An A-flex machine costs at LEAST $5000.00 and IS NOT for patients but for diagnostic use by professionals only".

My insurance billing department was tripping when I got her to go online to cpap.com. She insisted that the machine I had was very expensive. I told her they had PAID for the machine with the 2 month rental.

ohhh Micheal Moore, is this what you were talking about?!?! (I haven't seen the movie).
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Slinky · Post by **Slinky** » Thu Jul 12, 2007 2:16 pm

Save your breath w/the Attorney General. Those amounts are pretty much determined by Medicare (our federal government) and those that accept Medicare can not (except in some rare specified instances) charge less than the Medicare allowed amount.

Medicare could reduce "their" costs considerably by reducing the capped rental length of time from 13 months.

One of the things we don't see that local DME suppliers run into that online DME suppliers don't is the local place a LOT of xPAPs w/people who then don't comply w/usage and return the xPAP. That leaves them w/a used machine they can't sell as new. When you consider that between 30% and 50% of new xPAP users don't comply and return the xPAP .... that does add to their cost vs the online DMEs.

Of course, IF the sleep doctors and DME suppliers were more diligent in seeing to it that the patients got plenty of support, adequate fittings of masks and more opportunitites to try and find the right mask ......

I'm not bleeding for the local DME suppliers by any means .... !!!! Nor particularly sympathetic to them (my local CPAP DME supplier is lousy) but sometimes like it or not you gotta give the devil his due.

TXKajun · Post by **TXKajun** » Thu Jul 12, 2007 2:44 pm

This may have been answered before, but just what DO the brick and mortar DMEs do with returned machines? Pawn them off as new if possible or sell at discounted prices or just return to manufacturer??

Kajun

Coastal_ZZs · Post by **Coastal_ZZs** » Thu Jul 12, 2007 3:59 pm

I feel with my DME already like I have with my car dealership in the past. Great folks until you walk off the lot with the car. WHen you return, you had better not ask questions unless you have your wallet ready as well ...

Let me state:
1) All businesses must make money and I am in no way denying my DME that (or my car dealership). I am proud to live in a democratic, capitalist run country. Free market economy helps a lot of things (until the government becomes too involved).
2) I should be able to get the same exceptional service/ personal contact that I got in the beginning of the process.
3) The DME and car dealership deserve money in the future as well for services/ equipment rendered - I am not denying that.
4) My life/ quality of life is worth more than the $2000 - $5000 or whatever amount charged for the sleep study.
5) I do not know what market price is for these studies, but if my insurance standard is less than $2000 and I am charged $5000, it tends to raise my eyebrows as I try to understand it.

What do they do with the used machines? Try to pawn them off on people like me when I report that I have problems with the first machine they gave me... got no problem with a used machine though, don't get me wrong.

DreamStalker · Post by **DreamStalker** » Thu Jul 12, 2007 4:13 pm

Well you know, it sure would be nice if I had the same option the insurance companies have to be able to choose from the billed amount, allowed amount, and payed amount for all of my bills ... I'd have more money for more PAP equipment

darthlucy · Post by **darthlucy** » Thu Jul 12, 2007 7:28 pm

TXKajun wrote:This may have been answered before, but just what DO the brick and mortar DMEs do with returned machines? Pawn them off as new if possible or sell at discounted prices or just return to manufacturer??

Kajun

When my DME was giving me the run around (trying to give me a lesser machine because they didn't have my S8 Elite in stock, then telling me I couldn't return the lesser machine when my Elite came in), I asked this very same question.

"So you're telling me you can't take returns. Then what do you do when someone has a rental machine that they return when they are no longer using it?"
"We use those as loaners."
"Great, then give me a loaner until my Elite comes in."

Done. I now have my Elite, and they have their loaner back!

Guest · Post by **Guest** » Thu Jul 12, 2007 7:55 pm

Yes most DME's use the returned CPAP's from patients (weither they returned them for non-compliance or for other reasons) as loaner machines. The DME I work for will return any machine as long as it is still on rental, once the insurance converts it to a purchase we will not return it. Unless it is part of a recall or it is broken, we will then give them a loaner until it is fixed and returned.

Comparing CPAP.com or many other online suppliers to B&M DME prices (atleast the one I work for) is like comparing apples and oranges.

Example: Our cost from Respironics for a Remstar BiPAP ST WITHOUT Humidifier is $350 MORE than the cost of a Respironics Remstar BiPAP ST WITH a humidifier at CPAP.com. So it would even be cheaper for us as a B&M DME to purchase the machine from CPAP.com!!!

Oh and most insurance companies follow Medicare allowable billing amounts, however like I said a couple of weeks ago in another thread. Medicare does not pay for portable O2, so the DME's writeoff the total cost for any portable O2 provided to Medicare patients. So in return they give larger allowables for other items, believe me Medicare is saving money in the end with this agreement, it may not seem like it on the surface, but they are.

RosemaryB · Post by **RosemaryB** » Thu Jul 12, 2007 7:55 pm

darthlucy wrote:
TXKajun wrote:This may have been answered before, but just what DO the brick and mortar DMEs do with returned machines? Pawn them off as new if possible or sell at discounted prices or just return to manufacturer??

Kajun
When my DME was giving me the run around (trying to give me a lesser machine because they didn't have my S8 Elite in stock, then telling me I couldn't return the lesser machine when my Elite came in), I asked this very same question.

"So you're telling me you can't take returns. Then what do you do when someone has a rental machine that they return when they are no longer using it?"
"We use those as loaners."
"Great, then give me a loaner until my Elite comes in."

Done. I now have my Elite, and they have their loaner back!

Coastal_ZZs · Post by **Coastal_ZZs** » Fri Jul 13, 2007 5:21 am

[quote="Anonymous"]
Comparing CPAP.com or many other online suppliers to B&M DME prices (atleast the one I work for) is like comparing apples and oranges.
Please explain this further. I do not understand. The company you work for operates no differently than the rest of capitalist society. If the owners of these DMEs were being charged 50% - 100% more for product "just because", they would do one of 2 things 1) sue the manufacturer or 2) close their doors.

Example: Our cost from Respironics for a Remstar BiPAP ST WITHOUT Humidifier is $350 MORE than the cost of a Respironics Remstar BiPAP ST WITH a humidifier at CPAP.com. So it would even be cheaper for us as a B&M DME to purchase the machine from CPAP.com!!!
Sorry, I can't believe this either. If so, your company NEEDS to purchase from cpap.com, add 15% to it and still get it to the consumer for less that what is being charged. Are you telling me that a car dealership gets charged more for an auto from the manufacturer from dealer to dealer? I don't think so other than transport costs due to location and volume discounts. Now that I said that, Walmart has changed the US a lot because of volume discount and the way it affects other companies and some of that has been in a bad way. But when you keep selling a Ford as a Ferrari, someone is going to call BS! Walmart never called it at Ferrari, neither did cpap.com.

Oh and most insurance companies follow Medicare allowable billing amounts, however like I said a couple of weeks ago in another thread. Medicare does not pay for portable O2, so the DME's writeoff the total cost for any portable O2 provided to Medicare patients. So in return they give larger allowables for other items, believe me Medicare is saving money in the end with this agreement, it may not seem like it on the surface, but they are.
Highway robbery is highway robbery, doesn't matter if you rob Peter to pay Paul. I don't use O2, why should I pay more for my product because of this.

I give very little creedance to a DME employee who posts as a guest. Kinda like a fox in the henhouse if you ask me. Please post under your registered name, it doesn't take long to log in. I appreciate you monitoring this forum, I think it is a good idea for DMEs to see what the general public thinks about things.

... my name is Peter, my money is in Paul's pocket - go talk to him!

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, bipap, humidifier, cpap.com, medicare, DME, auto

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