Another Evil DME

[dankazoo]

In December, I cracked my Remstar heated humidifier water chamber. I figured that I needed a replacement and a spare. So I called Gentiva CareCentrix to see about another one as my deductible was maxed out for the year. I also ordered one myself from CPAP.com since I knew I couldn't get a second one out of CareCentrix also. Lo and behold, my water chamber from CPAP.com was $28 with a $7 shipping fee.

The very same unit from the DME was billed out to CIGNA at $153.76 and my co-payment is $30.75. While I no longer have CIGNA (I now have Anthem), I'm sure any of my new experiences with the new DME (don't know who it will be) will get more scrutiny in advance.


Dan-A slow learner but still able to tell the difference between $35 and $153.

[wading thru the muck!]

Hi Dan,

Another great DME story. Those situations always seem to work out that way. Just when you think, "it's just a little plastic container, they can't charge that much" the DMEs come back and suprise you. How do these guys sleep at night. What is their mark-up? cost x 8?

Nice to see you on the forum.

[Mikesus]

Actually they got $183... $30 from you, and $153 from your insurance... Funny part is they used the code that MelMel called the kiss of death, AND got reimbursed....

My take on this is, if it takes them ANY effort to get reimbursed, they will tell you its not covered. Regardless of what your insurance company tells you.

[Liam1965]

Actually they got $183... $30 from you, and $153 from your insurance... Funny part is they used the code that MelMel called the kiss of death, AND got reimbursed....

My take on this is, if it takes them ANY effort to get reimbursed, they will tell you its not covered. Regardless of what your insurance company tells you.

No, I think they got $153. The statement wasn't "The Insurance paid $153", the statement was "It was billed to the insurance at $153". The insurance probably paid $123, saying the copay amount was $30.

At least, that's how my insurance works.

Liam, who may not LIKE insurance, but at least he knows how his works.

[MelMel]

Just proves they weren't too quick anyway. The humidifier chamber has its own billing code... Pricing sounds high for chamber only.

Anyway don't even get me started about Gentiva.... In our area they won't even do cpap set ups. They fed ex cpaps with an instructional video. Uggghhh. Although I think maybe a video would be helpful to some of the patients I've seen. I know we've covered this on other posts...but a box and a video doesn't work for everyone. I can see it with some but not for all. Sends shivers down one dme's back.

MelMel

[dankazoo]

Hey MelMel-
I also have the insurance billing when I got the original CPAP equipment to begin with. The Heated Humidifier unit then (E0562) was billed at $310.50.
I did not see an RT on set up, just a manual to do it myself. It would have been nice to have a professional like you, not those bozos.

Liam the insurance whiz-you had that one down.

[MelMel]

That is the way Gentiva works... and you know what is even worse?? In my area they are "not accepting other providers into their network". So whatever happened to patient choice??? I have no idea. If you have/had an hmo with no out of network benefits then they strictly limit which dme you can go to. Then of course there are no quality controls on that dme...the insurance company contracts with the lowest bidder or whatever dme that insurance company might have some type of financial interest in. Grrrr, I digress.

MelMel

[firemarshal]

I just had to chime in on this after reading so many post about DMEs. I am getting my equipment through a local company. I live in a small town so they the only one. They have been the only ones to seem to care if I get this done in a timely manner. The sleep clinic and doctor did not get back to my gp for almost six weeks. And then my dr. had no idea of what to put on script even though I argued for about 15 min. then gave up. Took script to DME and they have taken care of everything and have called and kept me informed as to the status. I went into the office and requested auto with flex and that is what they are getting me. I have made many phone calls to sleep dr. and regular dr. and did not get calls back everytime I call DME they get back to me, even if to say they don't have any info and will call back when they do. I know that many people out there have bad experinces and I know that does happen. At first I did not want to go to DME after reading all the horror stories on the forum but I did and I believe will be happy with that choice. I did talk to my insurace about buying off the internet and how much money they could save and they said that they have proceedures that must be followed and could not change. Was given a thank you by person talking to for trying to save company money but that is as far as it went. This experience of trying to get some sleep is about as much fun as a sharp stick to the eye.

[53now]

DME quickie !!

March 22, 2004
DME -------"Praxair"
1 Cpap Mask Mirage Activa STD ..............$222.50
1 Simple Strap Headgear .......................$41.90
1 6 ft tubing..........................................$63.00

Hummmmm That's $327.40 Unreal

They had the nerve to charge "Extra" for the headgear !! Hummm I'm wondering why the extra 50 cents tacked onto the $222 for the mask ???

Rich

[G00fy217]

It must have been for the Velcro they use on the masks!!

[MelMel]

DME Quickie #2

Why do they charge for the headgear???? Because they can....! Billing codes. When the mask is billed to the insurance 1 mask = 3 separate billing codes. You can thank the government for that. There is not one code to bill for the mask including the headgear. It is basically broken down to the frame, cushion and headgear. As far as pricing I would say that is on the high side of average in the industry.(so far as I've seen anyway)

And get this.... we once had an insurance company tell us we weren't charging enough for the equipment we were billing for. They told us we had to increase what we charged for oxygen and bipap. As much as our company would like to make more money it seemed crazy even to us!

MelMel