More DME antics

Guest · Post by **Guest** » Sat Dec 30, 2006 9:05 pm

DME Dan,

Not to pick on you, just to ask you to clarify things from "your" side of the issue: my DME is not the worst I've heard/read about, but they aren't particularly good either. Like upfront honesty: "I don't know", "We can't, that is up to the doctor" would be nice, instead of "it can't be done", "that's not possible", "the machine doesn't have that capability" when it "can" be done, when it "is" possible and when the machine "does" have that capability.

We see, for instance, the Swift nasal pillow sold online with headgear, interface and 3 sizes of nasal pillows. Too many times we see the Swift sold by B&M DMEs as 2 separate items: headgear one price, interface w/ONE size nasal pillow for yet another price. We never see those other 2 sizes of pillows. They are then later SOLD]to some one else.

Another instance: the ComfortLite 2 sold in 2 different packages: headgear, interface, with two sizes of either the Direct Seal or the Pillows Cushion, and two sizes of the Simple Cushion. Yet when we buy from a B&M DME we are billed for headgear and interface but given EITHER 2 sizes of nasal cushion OR 2 sizes of nasal pillows OR 2 sizes of nasal seals. I've read of some even being given just ONE size of pillows, seals, or cushion.

They are billing for the entire package but not giving the entire package. They are holding back some seals, cushions or pillows to SELL later as extra cushions, seals or pillows. Medicare will pay for 2 nasal cushions every 30 days or 2 pairs of nasal pillows every 30 days.

dataq1 · Post by **dataq1** » Sat Dec 30, 2006 9:12 pm

I just discovered this (my fault for not exploring it before):
Cpap.com's sister company Billmyinsurance.com is a BlueCross/blueshield participating PPO DME provider.
Check it out.

BTW, I don't work for either of the .coms nor do I work for a DME (either the evil ones or the good ones)

neversleeps · Post by **neversleeps** » Sat Dec 30, 2006 9:20 pm

DME Dan wrote:It is threads like this that give this site a bad name in the DME world. Confusing patients is dangerous and should be avoided whenever possible. Why upset people needlessly with all this detail? Sure, DMEs make a few bucks on occasion. We know our stuff and earn it. Can you imagine trying to explain all this stuff to patients every day? Gives me a headache just thinking about it.

ROTFL!!!!!!!

Methinks someone is poking fun at DMEs with this brilliant bit of sarcasm.

(At least, mehopes so...)

jules · Post by **jules** » Sat Dec 30, 2006 9:20 pm

Anonymous wrote:
We see, for instance, the Swift nasal pillow sold online with headgear, interface and 3 sizes of nasal pillows. Too many times we see the Swift sold by B&M DMEs as 2 separate items: headgear one price, interface w/ONE size nasal pillow for yet another price. We never see those other 2 sizes of pillows. They are then later SOLD]to some one else.

Another instance: the ComfortLite 2 sold in 2 different packages: headgear, interface, with two sizes of either the Direct Seal or the Pillows Cushion, and two sizes of the Simple Cushion. Yet when we buy from a B&M DME we are billed for headgear and interface but given EITHER 2 sizes of nasal cushion OR 2 sizes of nasal pillows OR 2 sizes of nasal seals. I've read of some even being given just ONE size of pillows, seals, or cushion.

They are billing for the entire package but not giving the entire package. They are holding back some seals, cushions or pillows to SELL later as extra cushions, seals or pillows. Medicare will pay for 2 nasal cushions every 30 days or 2 pairs of nasal pillows every 30 days.

At least you got a pillow as part of the Swift - I didn't - separate billing of "3" items - last I knew you couldn't use the Swift without a nasal pillow but they billed for the mask and pillow separately (and headgear was the 3rd item). Yes the DME is making a killing on insurance money and Medicare for the broken down packages.

This would all be viewed differently if they actually gave the extra parts to a person in need or were to include double the right size in a package (for the Swift I knew my size) instead of all the sizes without the extra bill for even one nasal pillow.

I expect if I had gotten the CL2 from the local DME I would have been billed for EACH interface and size in addition to the mask and headgear.

jules · Post by **jules** » Sat Dec 30, 2006 9:22 pm

neversleeps wrote:
DME Dan wrote:It is threads like this that give this site a bad name in the DME world. Confusing patients is dangerous and should be avoided whenever possible. Why upset people needlessly with all this detail? Sure, DMEs make a few bucks on occasion. We know our stuff and earn it. Can you imagine trying to explain all this stuff to patients every day? Gives me a headache just thinking about it.
ROTFL!!!!!!!

Methinks someone is poking fun at DMEs with this brilliant bit of sarcasm.

(At least, mehopes so...)

i also hope so but what if this is for REAL !!!!!!!!!!

SCARY

dataq1 · Post by **dataq1** » Sat Dec 30, 2006 9:27 pm

Hey Slinky,
Good questions for DME Dan and mattman.
I'd really like to understand what appears to be double dipping.

One of the clerks at my DME told me that they take the headgear out of the bags that contain the mask from the manufacturers. Then they provide the remainder (mask etc, but less headgear) to the user, and charge the insurance the price as if it contained the headgear.
Then they provide the headgear and charge for that as if it were replacement parts. According to this clerk, they have piles of hundreds of headgear that represent pure profit. She told me this because she thought that she could "liberate" one for me.... afterall I and my insurance had paid for it when I got the mask, minus the headgear.

UNBELIEVABLE !

Wulfman · Post by **Wulfman** » Sat Dec 30, 2006 9:43 pm

When I was checking out the local DMEs around here, one of them quoted me $255 for the Ultramirage Full Face mask.....and then another $60 for the headgear. That was when CPAP.COM's price was still $139 for the mask AND headgear. (I won't go into the prices of the machines but they were comparable to what's been listed in some of these posts) Anyway, it didn't take me long to "do the math" and figure out who was going to try to screw my insurance (and ME).
I just can't imagine why anybody would buy ANYTHING from a local DME.

Den

neversleeps · Post by **neversleeps** » Sat Dec 30, 2006 9:56 pm

jules wrote:
neversleeps wrote:
DME Dan wrote:It is threads like this that give this site a bad name in the DME world. Confusing patients is dangerous and should be avoided whenever possible. Why upset people needlessly with all this detail? Sure, DMEs make a few bucks on occasion. We know our stuff and earn it. Can you imagine trying to explain all this stuff to patients every day? Gives me a headache just thinking about it.
ROTFL!!!!!!!

Methinks someone is poking fun at DMEs with this brilliant bit of sarcasm.

(At least, mehopes so...)
i also hope so but what if this is for REAL !!!!!!!!!!

SCARY

LOL!! If it was for real that would be scary!!

Brick and mortar DMEs are an expensive and unnecessary middleman. The advent of internet retailing exposed this fact and more and more people are figuring it out every day. Thanks to forums like this one, the public is being made aware of exactly what's going on. (Those pesky details that needlessly upset and confuse the patient!) The secret's out!

DME Dan · Post by **DME Dan** » Sat Dec 30, 2006 9:57 pm

Wulfman, imagine that some have less intellect than yourself. Now can you imagine why patients buy from DMEs? They need us. We need them.

Some of the posts on this thread indicate acts of theft and fraud by my competitors. Those acts are wrong.. Charging more than internet rates is not theft. It is not wrong.

neversleeps · Post by **neversleeps** » Sat Dec 30, 2006 10:02 pm

DME Dan wrote:Wulfman, imagine that some have less intellect than yourself. Now can you imagine why patients buy from DMEs? They need us. We need them.

So the brick and mortar DMEs are counting on patients of lower intelligence to keep them in business. Sounds like a perfect match!

DME Dan · Post by **DME Dan** » Sat Dec 30, 2006 10:12 pm

Yes, basically it is a good match. Before sites like this and dealers on line, we had the smart ones too. Fortunately for us, you are in the minority and business is good. Don't be too hard on us. We have patients that can't remember which part of the mask goes up...Nope, not kidding. Not many of those patients are likely to surf the net anytime soon.

neversleeps · Post by **neversleeps** » Sat Dec 30, 2006 10:24 pm

ROTFL!!!!! DME Dan, you crack me up!!!!

I guess brick and mortar DMEs do have their special niche.

Good luck with your clients. Since you'll be busy with them, if you run across any smart ones be sure to send them our way.

Wulfman · Post by **Wulfman** » Sat Dec 30, 2006 10:59 pm

DME Dan wrote:Wulfman, imagine that some have less intellect than yourself. Now can you imagine why patients buy from DMEs? They need us. We need them.

Some of the posts on this thread indicate acts of theft and fraud by my competitors. Those acts are wrong.. Charging more than internet rates is not theft. It is not wrong.

Dan,

I agree with SOME of what you say. There are SOME CPAPers that just aren't "into" the intricacies of this therapy. (I know several) SOME of them are getting along with their therapy (but don't really know how well they're doing).....SOME give up......and SOME find their way here (or the forums in general).

Theft and fraud seem to have been "epidemic" for a number of years now in many, many sectors of business (does the word Enron ring a bell?). Also, some of the big DME chains HAVE been caught (recently) in fraudulent schemes, too. Unfortunately, it's human nature.

The down-side of the high prices in the whole medical category is it's driving up the insurance rates so that even the folks on group insurance are being seriously squeezed. Small businesses are getting priced out. And for individuals?......forget it.
Our lawsuit-happy culture is partly to blame. Negligent practitioners are partly to blame. Our lawmakers are partly to blame. Insurance providers are partly to blame. AND, we're (probably) partly to blame.

I don't know what's in store for the future, but I'm not optimistic that it's going to get better.

Stick around and keep posting. Register as a user......there are several others in your line of work here. It's always good to hear from y'all.
(just make sure to wear your flak jacket)

Happy New Year.

Den

Slinky · Post by **Slinky** » Sun Dec 31, 2006 10:08 am

You know, I can understand that the patient is most likely not going to use all 3 sizes of cushion or pillows that come w/their mask. I can even understand the DME keeping those sizes not needed or used by the patient.

What I don't understand is WHY when they keep these extra sizes they then CHARGE the next patient who needs one of those extra sizes for them. Well, I DO understand why, but I do consider it fraudulent since they've already been paid for them.

I can understand their purchasing the entire "package" and dismantling the package for the separate parts that they must sell to customers whe needed since it is cheaper (even for them) to buy by the package than by the individual parts.

But what I consider fraudulent is their selling a "package" as individual parts to a patient needing the entire package sans the size or sizes they don't need.

These are the practices that leave a bad taste in my mouth for local B&M DMEs.

Also, altho the B&M DMEs need to keep an RT on hand for fitting, etc. for new and return patients way too many DME RTs aren't particularly truthful w/thei patients, nor are the particularly adept at fitting masks nor giving instructions.

As an example: cpap.com's mask fitting guide or video. Anyone have a B&M DME's RT be 'that' conscientious in fitting and suggesting a mask to a new or returning patient?

Another example: my B&M DME's RT, sat me in a chair, suggested and tried a couple of masks and sent me on my way. Of course, it wasn't a particularly good fit. Instead of returning to my DME for help in fitting and adjustment I went back to my sleep lab. The sleep lab MANAGER took me into a room, helped w/fitting the mask, turned a PAP machine on to "my" titrated pressure, had me lay down on the bed, checked the PAP machine's leak data, made a few more adjustments to the fit, again checked the leak rate, had me roll to a side sleeping position, again checked leak rate, made an adjustment or two, had me roll to the other side, again checked leak rate ..... heck, the DME didn't even have a bed or anything to have me lay on nor a machine that could check leak rate!!!!!!!

Who had more to benefit from my remaining compliant w/PAP therapy? The sleep lab or the B&M DME??? Yet who was more conscientious about fitting and assisting the patient??

I'm sure there a good B&M DMEs and DME RTs out there. I've read of a few in the forums. BUT - they definitely seem to be in the VAST MINORITY!

I can also understand the frustration, even boredom, of patient after patient who has little interest in their therapy. BUT, many of those patients are just overwhelmed and confused w/so much to take in and absorb so fast. Are they encouraged to contact the DME's RT w/any problems and questions? I sure wasn't! AND when and if a patient DOES come back w/questions or assistance w/a problem is the DME's RT responsive, honest and truthful, share more information w/the patient, answer the patient's questions and volunteer helpful suggestions, providing as much info as the patient wants and asks for at that point?? NOT MY DME's RT!!!!

Frankly, I appreciate and respect those B&M DME RTs, owners or staff who actually take the time and interest in taking part in these forums to help inform us from the B&M DME's side of the equation. And it is very true they have to be pretty thick-skinned AND caring to continue taking part and responding to various posts. We sometimes beat them up pretty bad. But hopefully they will also LEARN from us and improve their patient care just as hopefully we become a little more understanding of their issues.

mattman · Post by **mattman** » Sun Dec 31, 2006 11:37 am

Slinky wrote:You know, I can understand that the patient is most likely not going to use all 3 sizes of cushion or pillows that come w/their mask. I can even understand the DME keeping those sizes not needed or used by the patient.

What I don't understand is WHY when they keep these extra sizes they then CHARGE the next patient who needs one of those extra sizes for them. Well, I DO understand why, but I do consider it fraudulent since they've already been paid for them.

You are assuming they do. Virtually every company I know that does this does exactly the opposite. The REASON they keep the extras is to give them away to the people who need them but are unable to get insurance to pay for them (Either they have no insurance or it's overutilization). Show me a specific instance of a provider who you KNOW (not assume) is selling extra sets of pillows.

Slinky wrote: I'm sure there a good B&M DMEs and DME RTs out there. I've read of a few in the forums. BUT - they definitely seem to be in the VAST MINORITY!

Again, this is an assumption. Remember, an internet message board is about the absolute worst measuring stick one can find. Toss in the fact that the majority of the people coming here are doing so specifically to find something they felt they didn't get - and it just compounds the problem. I've said it time and again - the people on this website are the overwhelming minority of CPAP users.

I know it's somewhat fruitless to keep pointing this out as a large number of the regular users on this board do wish we DME folks would all just die and go away but it's true. If you can remove yourself enough from the anger and hatred to see the larger picture and be objective it becomes clear.

The DME companies are not "ripping people off" or "abusing people".

Both internet retailers and tradional outlets have thier place. They are both useful and they are both needed.

The real solution is to revamp insurance. Not just kill off the DME folks. Of course I keep pointing that out but a lot the most vocal folks here refuse to see that.

mattman