Who's up for more DME Bashing???? Updated

[jaybee72]

Well, I just got the call from the DME after having my doc send them a new order for a replacement flow generator. The new script says auto with a range... Anyway, they wanted to make sure I was OK with the $200 upgrade fee since that machine is considered "premium" and they won't make enough money on it.

Quick call to insurance company: confirmed they are in network and under contract to supply it with no money out of pocket to me... "Do not pay them a dime; you have 100% coverage not subject to deductible! They cannot charge you at all."

So, call another DME. This one says they charge a $150 upgrade fee, but if the titration shows we couldn't reach a definite pressure setting then they could get it out of United instead of having to charge me. I said it's been 5 years since the titration, the whole point is to NOT have to do another. She said that she thought that would work, so I asked the doc office to fax everything over there...

Ugg!! I hate dealing with these people!!!

[greatunclebill]

this is clearly between your insurance company and the dme. the dme is attempting to violate the terms of their agreement with the insurance company. you should be speaking to managers that wear suits, not phone operators, rt's or receptionists.

[jnk]

Some of us have found that our insurance will reimburse us completely if we buy online, at least once insurance understands how much money they will save by letting us do that.

As our hosts explain:

Will my insurance company reimburse my online cash purchase?

Yes, in most cases. However, reimbursement is an agreement between you and your insurance company. If you are planning on attempting to collect reimbursement, be sure to check with your insurance company first!

CPAP.com is a cash based, high volume, direct to patient business model. We avoid dealing directly with insurance companies and pass the resulting savings to our customers.

However, we do provide our customers with an insurance compliant, itemized invoice that contains applicable insurance billing code(s) for each item purchased.

Additionally, CPAPtalk.com is a good resource for those with questions about reimbursement as many CPAPtalk.com users regularly purchase from cpap.com and obtain reimbursement from their private insurance companies.

https://www.cpap.com/cpap-faq/Insurance.html

I have no connection with our hosts other than occasional purchases from them. Be sure to check other sites for prices, but give CPAP.com the opportunity to price-match, if you feel like it, since they will do that, I think.

For some of us, going out of network costs us money, so it isn't always worth it. But if you can give your insurance a specific price over the phone and explain that you can send in an insurance-compiant invoice, you may find a way to keep from dealing with the crooks who use the "we charge extra for anything but the bottom-of-the-line stripped down machine" liars. Calling a machine "premium" does not make it so in reality anywhere but in the twisted DME's head. It is the DME's job to stip you of us much money as it can get. It is your job to make sure they aren't successful at their little dishonest games.

If you are bored and would like some light reading , here is a discussion posted by someone who explained those games very (and disturbingly) clearly:

viewtopic/t73476/Lets-clear-up-some-misinformation.html

[chunkyfrog]

--and what are my chances for getting Medicare to reimburse me for online purchases?
I do NOT think this will be covered at the DME-sponsored "user group" meeting next month!

[Gerryk]

Some DME's really suck. It only takes a small percentage 1 out of 100 to make them all look bad. This happens everywhere not just with DME's. 1 teenager is a bad driver the other 99 must be too and so on.

I guess all we can do is post when we do have a good experience with a DME. Of course cpap.com has always done a good job but some of us have to go to a regular DME for insurance reasons.

Gerry

[jnk]

In my opinion, the bad 99 make the 1 good one look bad.

I have met DME owners whom I respect and whom I believe do a good job. They are NOT the ones who call their cheapest machine "standard" and everything else "deluxe." They are the ones who only provide efficacy-data machines and who provide APAPs whenever asked for by the doc or patient, since APAPs are the exact same insurance code as CPAPs.

[jaybee72]

Just spoke to the manager of the DME (I think the head of the company) to get the low down on the $200 upgrade charge. Here are is the key point that still makes me laugh. Make sure you all get this juicy inside info:

An auto CPAP costs 2 to 3 times as much as a regular CPAP

I bet ya'll didn't know that. I started laughing and pointed out it's a $50 difference online; someone should clue them in before they go out of business! That opened the door for my real tirade - he quickly jumped onto the huge difference in service that he provides versus the total lack of service you get online. So, I took that opportunity to blast him about my $150 mask fitting last month that didn't even involve hooking up to machine to fit at pressure. That's some service they provide! He did agree that was not an ideal fitting...

So, he basically admitted that United would not reinburse enough to cover the cost of the machine, so to stay in business he has to charge the $200 fee ("which is his actual cost difference") for an auto on United. I then asked him why didn't he work out a better deal, he obviously knew some percentage of patients would need an auto, and could have bid an appropriate amount to cover those occasionals. Or just not contract with them altogether if they cost him so much money...

He claims the upcharge is not balance billing. It's paying for extra options, such as leather seats in a car. It's perfectly legal beacuse there isn't a code to cover the difference...

[Gerryk]

I would contact your insurance provider and not a clerk. Tell them what is going on and ask what to do. If they are under contract then the DME is violating that contract. I do think it is time for a new DME.

[jnk]

His equating an APAP to leather seats is an expression of a medical opinion on the validity of a doctor's prescription. Some might view that as less than ethical coming out of the mouth of a medical-equipment provider. Same with asking for under-the-table money to get what insurance covers.

Therefore, I might use this sentence with the DME dude:

"After I tell my doc and my insurance what your expressed medical opinion is of my doc's prescription (that an APAP is like leather seats on a car), which DMEs in this area who are actually capable of filling doctor's prescriptions without offering medical opinions, or scamming patients, would you recommend that his patients, and others with my insurance, go to from now on?"

If he insists he will go out of business providing modern standard machines, say that you are perfectly willing to believe that if he is willing to open up his books to you for you to see for yourself what he pays for APAPs and what he gets from insurance so you can judge for yourself whether he makes enough with each sale. He can't say it if he is unwilling to prove it with cold, hard numbers he can back up.

[GumbyCT]

It's perfectly legal beacuse there isn't a code to cover the difference...

IF there isn't a code, HOW can he bill for it? That is under-the-table.

For the future readers - "Be sure to write a check AND get a receipt". It's for IRS deductions
Indicate on the check what it is for. IF they stammer and stutter when you ask for a receipt, give the machine back and get your money back then run away.

Send a copy of the receipt to your insurance.

[pratzert]

Well, I just got the call from the DME after having my doc send them a new order for a replacement flow generator. The new script says auto with a range... Anyway, they wanted to make sure I was OK with the $200 upgrade fee since that machine is considered "premium" and they won't make enough money on it.

Quick call to insurance company: confirmed they are in network and under contract to supply it with no money out of pocket to me... "Do not pay them a dime; you have 100% coverage not subject to deductible! They cannot charge you at all."

So, call another DME. This one says they charge a $150 upgrade fee, but if the titration shows we couldn't reach a definite pressure setting then they could get it out of United instead of having to charge me. I said it's been 5 years since the titration, the whole point is to NOT have to do another. She said that she thought that would work, so I asked the doc office to fax everything over there...

Ugg!! I hate dealing with these people!!!

jaybee72,

Please share who your DME company is, so we may add it to our personal list of the EVIL DME's.

Thanks

[pratzert]

Some of us have found that our insurance will reimburse us completely if we buy online, at least once insurance understands how much money they will save by letting us do that.

As our hosts explain:

Will my insurance company reimburse my online cash purchase?

Yes, in most cases. However, reimbursement is an agreement between you and your insurance company. If you are planning on attempting to collect reimbursement, be sure to check with your insurance company first!

CPAP.com is a cash based, high volume, direct to patient business model. We avoid dealing directly with insurance companies and pass the resulting savings to our customers.

However, we do provide our customers with an insurance compliant, itemized invoice that contains applicable insurance billing code(s) for each item purchased.

Additionally, CPAPtalk.com is a good resource for those with questions about reimbursement as many CPAPtalk.com users regularly purchase from cpap.com and obtain reimbursement from their private insurance companies.

https://www.cpap.com/cpap-faq/Insurance.html

I have no connection with our hosts other than occasional purchases from them. Be sure to check other sites for prices, but give CPAP.com the opportunity to price-match, if you feel like it, since they will do that, I think.

For some of us, going out of network costs us money, so it isn't always worth it. But if you can give your insurance a specific price over the phone and explain that you can send in an insurance-compiant invoice, you may find a way to keep from dealing with the crooks who use the "we charge extra for anything but the bottom-of-the-line stripped down machine" liars. Calling a machine "premium" does not make it so in reality anywhere but in the twisted DME's head. It is the DME's job to stip you of us much money as it can get. It is your job to make sure they aren't successful at their little dishonest games.

If you are bored and would like some light reading , here is a discussion posted by someone who explained those games very (and disturbingly) clearly:

viewtopic/t73476/Lets-clear-up-some-misinformation.html

Hi jnk,

Can you tell me which insurance companies will reimburse for the full cost of an out of network purchse of the machine ?

I have CIGNA, and when I bought my machine out of pocket, I put in for reimbursement directly and they made me pay my deductable and then they paid me my reimbursement percentage of 60% fo teh balance remaining afte rthe deductable.

It cost me... but I did get the machine my sleep Doc prescribed and what I wanted.

I have read some stories in the past about people who were able to convince their insurance carrier it save them money to let patients buy their own machines and get reimbursed. Our Host, CPAP.Com, sell stheir machines at a much, mich lower price than the DME's charge the insurance companies. So the insurance company saves, the patient is happy, the Sleep Doc is happier since his patient has the proper equipment to respond the the Doc's prescribed therapy.

But that arguement didn't work for me when I tried it with CIGNA.

[pratzert]

Some DME's really suck. It only takes a small percentage 1 out of 100 to make them all look bad. This happens everywhere not just with DME's. 1 teenager is a bad driver the other 99 must be too and so on.

I guess all we can do is post when we do have a good experience with a DME. Of course cpap.com has always done a good job but some of us have to go to a regular DME for insurance reasons.

Gerry

I've been waiting 5 1/2 years to be able to post a "good" DME experience..... I haven't come across one yet.

I break into a sweat when it gets close to the time to order a new mask.... I H A T E dealing with Crapria.

[pratzert]

Just spoke to the manager of the DME (I think the head of the company) to get the low down on the $200 upgrade charge. Here are is the key point that still makes me laugh. Make sure you all get this juicy inside info:

An auto CPAP costs 2 to 3 times as much as a regular CPAP

I bet ya'll didn't know that. I started laughing and pointed out it's a $50 difference online; someone should clue them in before they go out of business! That opened the door for my real tirade - he quickly jumped onto the huge difference in service that he provides versus the total lack of service you get online. So, I took that opportunity to blast him about my $150 mask fitting last month that didn't even involve hooking up to machine to fit at pressure. That's some service they provide! He did agree that was not an ideal fitting...

So, he basically admitted that United would not reinburse enough to cover the cost of the machine, so to stay in business he has to charge the $200 fee ("which is his actual cost difference") for an auto on United. I then asked him why didn't he work out a better deal, he obviously knew some percentage of patients would need an auto, and could have bid an appropriate amount to cover those occasionals. Or just not contract with them altogether if they cost him so much money...

He claims the upcharge is not balance billing. It's paying for extra options, such as leather seats in a car. It's perfectly legal beacuse there isn't a code to cover the difference...

As far as I am aware, there is usually a specific prohibition against a contracted provider billing the patient for any amount above and beyond the negotiated rate between the provider and the insurance company.

I'd say that you need to pursue this with your insurance company. Maybe you can set up a three-way conference call between you, the DME and your insurance company. See what the DME says while the insurance company is on the line.

Or in lieu of that, write a nicely composed letter explaining all that the DME told you, and send it certified to your insurance company with a copy to the DME and your State Insurance Regulators office.

I can't guarantee it will get you the machine you have been prescribed, but for sure it will get some attentions AND make you feel more in control. As you drop it in the mail... I bet you'll have a smile on your face.

[kempo]

Well, I just got the call from the DME after having my doc send them a new order for a replacement flow generator. The new script says auto with a range... Anyway, they wanted to make sure I was OK with the $200 upgrade fee since that machine is considered "premium" and they won't make enough money on it.

Quick call to insurance company: confirmed they are in network and under contract to supply it with no money out of pocket to me... "Do not pay them a dime; you have 100% coverage not subject to deductible! They cannot charge you at all."

So, call another DME. This one says they charge a $150 upgrade fee, but if the titration shows we couldn't reach a definite pressure setting then they could get it out of United instead of having to charge me. I said it's been 5 years since the titration, the whole point is to NOT have to do another. She said that she thought that would work, so I asked the doc office to fax everything over there...

Ugg!! I hate dealing with these people!!!

That DME is a flat out thief.