CPAP equipment up in price or reimbursements down?

[taberge]

I just visited my sleep clinic for my annual and found out they no longer carry the original mask they provided me 3 years ago. I have ordered a replacement for the last 3 years annually. It was a sorry sir, we no longer carry that model because costs have gone up and we would lose money if we offered that model. They even steered me to CPAP.com if I still wanted that model. Have the costs increased that much while reimbursements have stayed flat? Or have reimbursements fallen in value? I am left to wonder after reading a few posts that some insurance plans are not offering CPAP supply coverage that the industry is setting aside sleep medicine like they did years back for chiropractors?

[Slinky]

I can't speak for other insurances but Medicare reimbursement has gone down annually since 2006 when I started. As I understand it most insurances reimburse less than Medicare. Medicare recently started a competitive bidding process in several "districts" in the country and I'd be willing to guess that the successful bidders have cut back on what they are willing to supply for the reimbursement they get under their successful bid.

[xyz]

> I'd be willing to guess that the successful bidders have cut back on what they
> are willing to supply for the reimbursement they get under their successful bid.

Is that legal?
A prescription is required for a (new) mask.
Say that the doctor checks the "no substitute" box.
The DME has to do what the prescription says.

This is nothing more than the _old scam_ that newbies encounter every time.

A doctor writes a prescription for their first machine. It has data capability and a heated humidifier. The DME substitutes a different, CHEAPER machine and lies to the patient about it (if the doctor did not check the do not substutite box).

"Trust me. It's just as good."
Translation: We make a bigger profit this way. Your therapy will be worse though.

"We don't carry that model".
Translation: We could order it, but it would mean that we would make less profit. So we just carry these bottom of the line models in stock to give to new people who don't know better (yet).

It's just the same old, same old.

[Goofproof]

What do you expect, our country prints more money every year, lots more, with no value to back it. Prices go up, buying power goes down, you wanted change, it was changing before... Now, we will soon be checking in the sofa, looking for change. Tighten your seat belt, you are now driving the socialist road.

The good news if you use your own money to buy what you need, you get to chose what you buy and where you buy it. The people that overcharge and won't supply what you want can be removed from business, if you vote with your wallet. Jim

[archangle]

> I'd be willing to guess that the successful bidders have cut back on what they
> are willing to supply for the reimbursement they get under their successful bid.

Is that legal?
A prescription is required for a (new) mask.
Say that the doctor checks the "no substitute" box.
The DME has to do what the prescription says.

This is nothing more than the _old scam_ that newbies encounter every time.

A doctor writes a prescription for their first machine. It has data capability and a heated humidifier. The DME substitutes a different, CHEAPER machine and lies to the patient about it (if the doctor did not check the do not substutite box).

"Trust me. It's just as good."
Translation: We make a bigger profit this way. Your therapy will be worse though.

"We don't carry that model".
Translation: We could order it, but it would mean that we would make less profit. So we just carry these bottom of the line models in stock to give to new people who don't know better (yet).

It's just the same old, same old.

The DME has the option to say "we can't/won't fill the prescription as written. You can buy elsewhere or get the doctor to change the prescription." It might be illegal to dispense a machine that doesn't conform to the "do not substitute" box.

If the DME has a contract with the insurance company, they may not have the option to refuse to dispense a particular CPAP machine.

Taberge, document everything carefully. Call your insurance, if you have it, and see if they have a contract with the DME that requires them to provide the mask you want. Also see if there are other local DMEs who are in network for your insurance.

[LSAT]

There are definitely good and bad DME's. Many try to sell their most profitable items, but, in many cases they lose money on the items they supply us. For example...the item I use the most is the cushion and clip for my Quattro. I change it about every 3 months. The retail price that the DME charges is $70. Cpap.com...our host...sells it for $54. My DME is reimbursed $29 which includes insurance and my co-pay. The DME says that Resmed items are the worst and she refuses to stock many of their items. She does special order...usually 5-7 days.

[Janknitz]

I looked at the Medicare Allowables for CPAP masks in January of 2010 and January of 2011, and it's true, the reimbursement did go down. A whopping 11 CENTS. ($0.11).

In January of 2010, the allowable amount for an A7034 (Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap) was a minimum of $90.49 and a maximum of $106.46, depending on what state you live in. In 2011, the minimum was $90.40, and the maximum was $106.35.

So I looked at the change in fees for monthly capped rental on E0601 machines: In 2010, the fee was $85.94 to $101.10, in 2011 $85.85 to $101.00. Gee, those Medicare cuts are just killer!!!! Over the 13 month capped rental period, the DME is going to lose a up to a whole $1.43.

Admittedly, I don't know if there was a significant increase in wholesale prices of masks and machines, but I haven't noticed it reflected in CPAP.com prices.

By limiting their inventory to certain masks, DME's can probably negotiate better volume wholesale pricing, giving them a better profit margin. So it's good for the DME's, not necessarily for you, since savings will not get passed on to the customer the way reimbursement works. But they gotta make up that 11 cents somewhere!

[Alshain]

Keep in mind also that a 3+ year old mask may have been deprecated by another model or discontinued entirely causing the cost for THAT item to go up. Supply and demand.