BiPap St Cost $$$$$

[tsduke]

They deal with medicare. I'm only saying she only used the words "insurance companies" and we didn't discuss medicare specifically. They get out of the a life of gear replacements too if I don't complete this first purchase. I'm going to follow up with insurance, but I don't think the DME was lying. I really don't. Because she even encouraged me to compare prices for gear outside the office and said money can be saved. Especially for those that don't use much medical outside cpap gear in most years.

I'm not saying your wrong I'm just suggesting things may have changed.

[Pugsy]

Things can change sometimes but not normally the fact that most DMEs are bold face liars.
Unfortunate but true the majority of the time.

People get machines all the time from other sources and have their insurance pay for the other stuff.

See what your insurance says.

[tsduke]

Just curious...How long has it been since insurance forced the rent to own model first up front paying for them.

[Pugsy]

Not sure I understand your question.

How insurance handles the purchase whether a total up front purchase without any rent to own thing or the whatever rent to own time frame and then its yours has been around since cpap was brand new to medicine.

Even today some insurance don't do the rent to own thing...some don't even have any compliance requirements to meet.

Insurance plans can vary though...even among the same insurance company. BCBS is notorious for having different requirements for anything in different plans but all within the same parent company.

Some companies pay in total the first month...some take 3 months...some take 6 months...some take 10 months...and some mimic Medicare which is 13 months. Some have compliance requirements...some don't give a rat's behind.

It's why I always tell people to call up their insurance company because plans and companies can vary widely on how they handle things....
and DMEs can't possibly know every little thing about every little plan out there...impossible.

[tsduke]

I was asking how long the rental thing has been around. I got the impression it was a shift in recent years so they could monitor compliance first.

[Pugsy]

Rent to own has been around at least the 10 years that I have been doing this stuff...probably a lot longer.
It's nothing new at all.

And this "compliance" thing isn't always the insurance company's requirement either.
DMEs (and doctors) will often make up their own in house standards or protocols and then blame the insurance company for them.

DMEs are well known to tell some big whoppers and blame it on the insurance company for any number of situations.
If they told me the sun rose in the East and set in the West I would go outside and look for myself.

We had a thread some time ago listing some of the whoppers people had been told and later found out simply were bold face lies...quite a thread.

[tsduke]

So far my inquiries with insurance support your statement Pugsy. I've only talked with first level rep, but she could not find anything support the DME comments. She has requested a specialist looking into to be sure though and will call me back.

I also called Nucara, which is anothe provider in the my area. The rep therapist there said she has never had issue with gear being covered for a person that provide there own maching through whatever means they wished. Even said she's had fair amount of people get maching from family for friends that stopped using them never bought/rent any months through insurance. There gear was still covered by insurance.

I don't like to be lied to and I will seek different avenues for my supplies just on principe if DME was in fact lying to me. Waiting for call back from insurance and she said their is a good chance they would call the DME. My DME is same ownership/family of hospitals and clinics as my sleep doctor works for. Not same facilities but all Mercy One, formally known as Wheaton Franciscon/Covenant.

[Pugsy]

Your DME is getting greedy and seeing those big bucks coming in every month for that high dollar machine or future high dollar machine.
Trying to strong arm you into using them and not taking your business elsewhere.

Now maybe the person you talked to there simply was relaying what she was told or trained to say but to me that is simply no excuse for telling whoppers.
I will respect any place of business deciding to set their own in house rules for whatever but tell me the truth about it and don't go putting the blame on the insurance and lying about it. Funny how those in house rules always seem to benefit the DMEs bottom line cash flow though....in every situation I have see that has been the end result....every single time.

[tsduke]

While still wrong telling me it's the policy is one thing and entirely different. Blaming the policy on insurance is a lie and wrong.

[Pugsy]

That's always been my main bone of contention when any business adopts whatever in house policy and instead of simply saying "this is our policy" they say "this is your insurance company's policy".
They are free to adopt any in house rules they wish...just be honest about it. That's all I ask.
Then I get to decide if those in house rules are something I want to live with or not.

I always have this little thing in the back of my mind "if they are dishonest about this fact...what else are they dishonest about?"
Maybe nothing else but that little gnawing thought is always there eating on me.
I rarely give someone a chance to lie to me twice. Just the way I am. Too many other businesses out there who will be glad to have my business.

[slowriter]

The rent-to-own practice has its annoyance. But when I recently failed CPAP and could simply return the machine and move on to a bilevel, I was seeing the advantage.

[TropicalDiver]

Learned today that I can't go out and buy a machine on my own and still have insurance cover replacemnent cushions, masks, hoses, etc. I have to "complete" a purchase through insurance first. So if I want my gear to be covered for life I have to first complete the 10 month rent to own. DME said all insurance they work with is the same way.

Not true at all. Insurers typically want you to demonstrate usage of a machine (compliance) for some period of time.

Plus the amount they are charging extra on the machine would cover a ton of consumables.....

[TropicalDiver]

In understanding the interactions, it is often useful to think about financial interests of each party.

The DME wants to sell you as much stuff as possible. They would like to be paid the highest amount for providing the stuff. Insurers would like to limit the number of items they pay for, and pay as little as possible. As an insurer, you are very happy if someone gets a CPAP without the insurer paying for it.

So what is the insurer likely looking for? Evidence of medical necessity and script. If you have a CPAP, evidence of compliance before continuing to provide supplies. If you need a CPAP, paying for the lowest category of machine that meets medical needs. If they are paying for a CPAP, some sort of lease/purchase (with the goal of not paying the full cost for clients who are non-compliant -- while not paying too much of a premium when machine are ultimately owned). Demanding low rates from DME providers -- and the insurer is fine if folks opt to buy the goods without insurance.

Here is what the DME is trying to sell you: I know you have a perfectly good oxygen concentrator that you got from your mom when she died and you are just asking us to sell you the mask and tubing. The insurer actually requires us to rent you an concentrator at above market rates (and they will pay most of that) or they will never pay for a mask for the rest of your life. Does that sound like the insurer would actually do that?

[palerider]

Or, to put it more simply...

DMEs LIE

[hairfallingout]

They sure do, DME's LIE, I feel like I am reading all my own frustration a month ago here. I wish I could say it will get better but I got fed up and bought my own machine. Best thing i ever did, getting more rest every night now. These prices are outrageous, Bottom line whatever you decide you need to being using some kinda machine to have a better life. I wish I wasn't so ignorant to get a sleep study done years sooner.