What value does a DME provide?

[grahasc]

As a relatively new user of a CPAP machine (around 6 months so far), I'm very confused about my DME continuing to bill my insurance for rental of a machine that I could buy for around $400 from CPAP.com. I don't have all my bills handy, but, I think every month or every other month, they're billing my insurance company something on the order of $422 (that's what this latest bill indicates - it also indicates that the actual payment received from the insurance is around $95).

Is this a scam, or is there some value the DME provides that I'm missing? They call every other month or so wanting my compliance numbers, but I really don't need any threats from them to use the machine. It works, and I'm happy (I haven't missed a night since I got the machine). I just don't understand why I need the DME anymore. It would seem to me that its stuff like this that is driving our healthcare system broke.

Am I missing something? If I'm not, what should I do? Complain to my doctor?

[archangle]

Yes, it's a scam, known as the American medical system. No point complaining to your doctor. That's the way it's done, and your doctor is part of the medical mafia. He's either happy with the status quo or he's as disgusted with the system as you are and powerless to do anything about it.

It might be worth complaining to your elected public officials, but they're even more corrupt than the medical system.

DMEs do, in theory, provide some value. Most people aren't smart enough or willing to go to the effort to figure out their own equipment. They need someone to show them how to use the equipment, fit them for the correct mask, etc. DMEs should give you the option of trying a few different masks. Insurance often requires you buy from a local DME to get insurance coverage.

Unfortunately, lots of DMEs do a terrible job of the services they should be providing to their customers.

[TalonNYC]

The DME is *supposed* to exist so that multiple doctors can all leverage one warehouse and billing/shipping/maintenance system. The problem is that - as with everything else in our medical system here in the US - cash is king. The DME will provide you with the cheapest thing they can, and for as much money as they can get.

I'm not against folks making money, but sometimes DME's forget that their penny pinching kills.

[nanwilson]

I have not seen or heard from my DME since the day they sold me my machine and mask.....and that was 1 year and a half ago. I do not have insurance so had to pay up front for my equipment. I figured they would call to see how I am doing...at least I knew I needed further supplies.....nope not a word. I have since bought another machine, extra hose, filters for both machines and I have gone through 8 masks.(all on my own)..........and its thanks to the folks on this site, if it wasn't for them I would be in a big hole in the ground by now. So as you can see, I didn't need the DME (thanks to them) it is now up to you to make the decision if going through insurance is the best for you or buying your gear online at cpap.com or other dealer.
Good luck
Nan

[JohnBFisher]

... I have not seen or heard from my DME since the day they sold me my machine and mask... ...

Nan, it's great to hear you continue to do well. And your experience, sadly, is not all that unusual. 20 years ago that was my experience with a DME. I switched to an internet provider as soon as I could. I'm back to using a DME, but not by choice. My insurance does not allow me to purchase products via the internet for reimbursement. Frankly, they loose a LOT of money that way.

I spent a couple months interviewing DMEs before I found this one. I've definitely been on xPAP therapy longer than most of the DMEs have been in business. I am not a difficult patient, but I do insist on quality service. This one does provide it. Though I find compliance questions funny (after 20 years I would either be complaint or I would not be using them!), they actually do call and check to see how I am doing. They are the first DME that has done that.

So, to the original poster, good DMEs are out there. Sadly, too many are not all that good. You need to take the time to find the "right one" for your needs.

[apneawho]

After my experience with a local DME, in network for my insurance, I am convinced they are in it for the money and don't give two shakes about the patient.

[JohnBFisher]

After my experience with a local DME, in network for my insurance, I am convinced they are in it for the money and don't give two shakes about the patient.

I have no problem with someone making money, if they ALSO place patient satisfaction / care first. A good DME will make a lot more money by providing good service at a reasonable cost.

Sadly, this lack of customer / quality focus is not limited to the medical industry. Providing customer/quality focus is a basic business strategy. I know it works, because I spent years practicing that approach. As a trouble shooter for my company, I would wander into VERY difficult situations and end up (a) solving the problem and (b) wondering out with a huge sale (literally around a million dollars) to address the real need. I did that year after year, so I know the strategy works. The effort to deliver good quality service is *always* rewarded.

Too many people only focus on the short term profit, without remembering that we all purchase based on the relationship which we build with one another. If you trust someone, you will spend more money with them (in the long run). If you do not trust them, you will find someone else you do trust with whom you will do business.

[jnk]

The good ones have knowledgeable and helpful staff.

So I hear.

The problem with the DME arrangement is that some idiots somewhere assumed that if patients' insurance companies paid extra for the machines, that would then somehow motivate the DMEs to be helpful to patients. Stupid, stupid, stupid idea. It just ain't workin'.

DMEs are not rewarded financially for being helpful to patients, so they have zero motivation for that.

They can't bill insurance for time spent being helpful to patients, so they don't do it.

Competition might help to correct for that stupid idea, but there is no real competition fostered either. People have no way to shop around when they are kept in the dark about what they need or should expect. When it is the people making the money who are deciding how the money is to be made, customers lose.

The shame of it is that companies such as ResMed are dumb enough to act like the arrangement is presently working and actively say idiotic things in an attempt to keep it in place, since the DMEs are the primary customers of the manufacturers in this little underhanded cartel.

See for yourself if this isn't the dumbest load of stupidity ever put to print: http://www.resmed.com/us/dealers/intern ... ients.html

[Janknitz]

Interesting that ResMed chooses to malign Internet suppliers when the biggest problem lies with the b&m DMEs whom they regard as their customers.

But their suggestion was a good one. If you are unhappy with a DME, comPlain loudly (and in writing) to your doctor. DMEs regard the doctors (not you) to be their customers and if they get a "make my patient happy if you ever want another referral from me" call the DME will bend over backwards to accommodate. The trick is getting your doctor to take 5 minutes to do this, but it is a fast track to better treatment by the DME.

[TalonNYC]

DMEs regard the doctors (not you) to be their customers

Alas, in most major metro areas, this is no longer the case. The DME's become exclusive providers for one or more insurance companies, so no matter which doctor you use, they HAVE to go through a particular DME for your insurance.

Though, I am learning that if you become a polite pain in their ass, they suddenly do what you want in order to keep you from calling in 5x/day =)
If you don't swear, yell or become rude, they cannot just hang up on you, so they do the next best thing. "Yes, here, take it, just STOP CALLING US FOR A WEEK!"

[jnk]

I hereby declare Mike "No Longer a Newbie," despite his sig.

Although the whole "polite" thing has me wondering where he is REALLY from!

[Pugsy]

I'm very confused about my DME continuing to bill my insurance for rental of a machine that I could buy for around $400 from CPAP.com.

The others have pretty much covered the usefulness (or not of DME).
Regarding the monthly billing.. Your insurance probably does a monthly capped rental. That is why DME calls for monthly usage numbers.. to satisfy insurance requirements. What is first billed per month is just a fantasy amount and the amount allowed is the real number. You might check with your insurance company as to how long this goes on before they no longer pay and the machine is considered yours. The time will vary depending on insurance company.
Medicare uses the 13 month capped rental. Many other insurance companies mimic Medicare and some simply have their own requirements.

And yes, doing it this way often results in the insurance company paying much more than what we could have purchased the same machine for from an online supplier that they wouldn't reimburse us for if we had. Just another reason for higher insurance premiums. Not a very cost effective way to do business.

BTW if your insurance company does a monthly capped rental and that rental extends to January 1... and you have a calendar year deductible to meet... guess what happens? You get to meet the deductible again. More out of pocket for you but at least it helps meet the deductible for further medical expenses should you have them.

[BlackSpinner]

Interesting that ResMed chooses to malign Internet suppliers when the biggest problem lies with the b&m DMEs whom they regard as their customers.

But their suggestion was a good one. If you are unhappy with a DME, comPlain loudly (and in writing) to your doctor. DMEs regard the doctors (not you) to be their customers and if they get a "make my patient happy if you ever want another referral from me" call the DME will bend over backwards to accommodate. The trick is getting your doctor to take 5 minutes to do this, but it is a fast track to better treatment by the DME.

No it is not the doctors responsibility. Anymore than it is their responsibility to monitor a pharmacies activities.
My doctor handed me a photo copy of a bunch of DME business cards and Yellow pages adds and told me to take my pick. He was not allowed to make recommendations. I chose the one nearest my home.

The Resmed statement is a bunch of crap.

The only value the DME provides is to their shareholders.

[TalonNYC]

I hereby declare Mike "No Longer a Newbie," despite his sig.

Although the whole "polite" thing has me wondering where he is REALLY from!

When you live here, you learn to be exceptionally obnoxious WITHOUT swearing or being impolite. Mind you, being able to let loose a stream of horrific and unimaginable obscenity is also a great skill to master when you are in NYC. I can do both.

[apneawho]

DMEs regard the doctors (not you) to be their customers

Alas, in most major metro areas, this is no longer the case. The DME's become exclusive providers for one or more insurance companies, so no matter which doctor you use, they HAVE to go through a particular DME for your insurance.

Though, I am learning that if you become a polite pain in their ass, they suddenly do what you want in order to keep you from calling in 5x/day =)
If you don't swear, yell or become rude, they cannot just hang up on you, so they do the next best thing. "Yes, here, take it, just STOP CALLING US FOR A WEEK!"

This is so true.