This whole topic is like the classic good news/bad news. On the one hand it's almost comforting to realize that a lot of people are in the same boat I am with DME's. The bad news is that a lot of people are in the same boat I've been in etc., etc., etc. I was so clueless when I started with CPAP 5 years ago & the DME I started out with was no help at all. Problem was my insurance carrier at that time dictated what DME I had to use. I'm sure it was the one they'd negotiated the best price with.
Result was that, like so many others who've posted on this forum, my CPAP wound up in the closet getting dusty. Then at the end of last year I was so shocked at the death of Reggie White, the brilliant 13X NFL all-pro at the age of 43, attributed in part to OSA, I decided I'd better get serious about CPAP!
What a difference 5 years makes. Now I've discovered CPAP.com & this forum & life is so much more pleasant.
Problem is, I'm also on home oxygen therapy & haven't been able to find a CPAP.com for O2 supplies, so I'm still pretty much at the mercy of one of those DMEs from Hell. I'm switching to the DME dept of our little local hospital next week & I know most of those guys already, so hopefully I'll be able to work with them. In fact, I'm currently fighting with the DME I "fired" 18 months ago & told to pick up their supplies. You guessed it. They've never picked up the stuff & now they're claiming I owe them megabucks for past-due rental invoices. They haven't serviced the equipment, refilled O2 bottles, or even invoiced me in at least the last 18 months. Just talked to them again today & told them their equipment will be out in my front yard after Mon if they don't pick it up - then I asked them where I should send the invoices for storage fees.
eBay used to be a source of supplies if you really knew what you were looking for, but it looks like they'll probably do the same thing with oxygen supplies they did at the end of last year with all things CPAP & prohibit any items that might require a prescription.
Like I said, good news/bad news. Thanks for your patience & letting me rant. You know, it actually feels better just getting it off my chest to fellow sufferers I know will understand....
Another Evil DME Story...Don't let this Happen to you!
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Janelle
I've had a lot of dealing with insurance companies and providers over the last 36 years. These are the things I have learned:
1. The provider (DME in this case) can charge whatever they want.
2. Each insurance company had a "reasonable and customary fee" over which they will not pay, no matter what the provider charges
3. Be sure to look in the column that says What You Owe on the EOB. If it says $0.00 you owe the provider absolutely NOTHING. They cannot make you pay. If they do, copy the EOB (Explanation of Benefits) and send it to them.
4. In order to be listed as a Preferred Provider, these providers (doctors, labs, DMEs, etc) agree to accept the reasonable and customary maximum allowable. That means you do not owe more than a copay which is part of that maximum allowable.
For instance, your insurance pays 80% of the maximum allowable. you are only liable for the other 20% of the maximum allowable, NOT WHAT THEY BILLED THE INSURANCE COMPANY
1. The provider (DME in this case) can charge whatever they want.
2. Each insurance company had a "reasonable and customary fee" over which they will not pay, no matter what the provider charges
3. Be sure to look in the column that says What You Owe on the EOB. If it says $0.00 you owe the provider absolutely NOTHING. They cannot make you pay. If they do, copy the EOB (Explanation of Benefits) and send it to them.
4. In order to be listed as a Preferred Provider, these providers (doctors, labs, DMEs, etc) agree to accept the reasonable and customary maximum allowable. That means you do not owe more than a copay which is part of that maximum allowable.
For instance, your insurance pays 80% of the maximum allowable. you are only liable for the other 20% of the maximum allowable, NOT WHAT THEY BILLED THE INSURANCE COMPANY
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ballast949
- Posts: 61
- Joined: Wed Apr 13, 2005 6:10 pm
- Location: Portland, OR
I haven't gotten the 1st bill from my DME yet, but I can look up my claims online with my insurance. So far, here is what they have paid the DME for.
------------------------Billed----Payable-----My CoPay----Cost on CPAP.COM
Humidifier ---------$323.00-----257.54-----$28.62--------$160.00
Water Chamber-----$32.40------26.24--------2.92----------19.99
Now, they have sold me the humidifier, so it should have come with the water chamber, but they have billed it separately. If they had rented me the humidifier, then they could have justified selling the water chamber separately. And, since they are not renting the humidifier to me, if I return their 'rental' bipap machine, unless I buy a compatible machine, I am out that money - and will the insurance buy me another if I do?
And to top it all off, I can buy the BiPAP complete with Humidifer (and water chamber) for $1310.00 at cpap.com. Now I haven't seen the charge for renting the actual BiPAP machine yet, but the equipment slip that came with my paperwork said the monthly rental was $420. Even assuming the insurance will knock that down to $ 350, Between the Insurance company and my copay, I could own it free and clear in 3 months if purchased outright. ($1310 cost - 259.54 - 26.24 - 28.62 - 2.92 = a balance of $947 and that divided by $350/month .... less than 3 months)
So Monday I start with the insurance company to see what I need to do to purchase it outright and save them and myself some money.
------------------------Billed----Payable-----My CoPay----Cost on CPAP.COM
Humidifier ---------$323.00-----257.54-----$28.62--------$160.00
Water Chamber-----$32.40------26.24--------2.92----------19.99
Now, they have sold me the humidifier, so it should have come with the water chamber, but they have billed it separately. If they had rented me the humidifier, then they could have justified selling the water chamber separately. And, since they are not renting the humidifier to me, if I return their 'rental' bipap machine, unless I buy a compatible machine, I am out that money - and will the insurance buy me another if I do?
And to top it all off, I can buy the BiPAP complete with Humidifer (and water chamber) for $1310.00 at cpap.com. Now I haven't seen the charge for renting the actual BiPAP machine yet, but the equipment slip that came with my paperwork said the monthly rental was $420. Even assuming the insurance will knock that down to $ 350, Between the Insurance company and my copay, I could own it free and clear in 3 months if purchased outright. ($1310 cost - 259.54 - 26.24 - 28.62 - 2.92 = a balance of $947 and that divided by $350/month .... less than 3 months)
So Monday I start with the insurance company to see what I need to do to purchase it outright and save them and myself some money.
ballast949
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Respironics Bipap Pro2 at 20/17.5 with BiFlex at 2
& Heated Humidifier & Ultra Mirage Series 2 Full Face Mask - Encore Card reader & software
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Respironics Bipap Pro2 at 20/17.5 with BiFlex at 2
& Heated Humidifier & Ultra Mirage Series 2 Full Face Mask - Encore Card reader & software
Folks:
It seems that this is a common Scam amongst DME's. My brother was sold a Puritan bennet Goodnite 420 for 1000% of list ($3000 bucks!) because his insurance pays 100%......now all of a sudden he is getting invoices, from his insurance company showing that they have been paying a monthly rental fee for the machine.
It seems that DME's have found a weak link in insurance company regs, since many insurance companies suggest a rental for new users....so now they have found a loophole that allows the DME to charge 4-20X the list price of CPAP/BiPap machines.
It is no wonder why my health insurance premiums have gone up 275% in the past 3 years....
Boycott DME's!! It's just like buying goods from theives on the streetcorner. Even though insurance companies have let the wolves into the barn doesn't make it ethical.
_____________
It seems that this is a common Scam amongst DME's. My brother was sold a Puritan bennet Goodnite 420 for 1000% of list ($3000 bucks!) because his insurance pays 100%......now all of a sudden he is getting invoices, from his insurance company showing that they have been paying a monthly rental fee for the machine.
It seems that DME's have found a weak link in insurance company regs, since many insurance companies suggest a rental for new users....so now they have found a loophole that allows the DME to charge 4-20X the list price of CPAP/BiPap machines.
It is no wonder why my health insurance premiums have gone up 275% in the past 3 years....
Boycott DME's!! It's just like buying goods from theives on the streetcorner. Even though insurance companies have let the wolves into the barn doesn't make it ethical.
_____________
Folks:
It seems that this is a common Scam amongst DME's. My brother was sold a Puritan bennet Goodnite 420 for 1000% of list ($3000 bucks!) because his insurance pays 100%......now all of a sudden he is getting invoices, from his insurance company showing that they have been paying a monthly rental fee for the machine.
It seems that DME's have found a weak link in insurance company regs, since many insurance companies suggest a rental for new users....so now they have found a loophole that allows the DME to charge 4-20X the list price of CPAP/BiPap machines.
It is no wonder why my health insurance premiums have gone up 275% in the past 3 years....
Boycott DME's!! It's just like buying goods from theives on the streetcorner. Even though insurance companies have let the wolves into the barn doesn't make it ethical.
_____________
It seems that this is a common Scam amongst DME's. My brother was sold a Puritan bennet Goodnite 420 for 1000% of list ($3000 bucks!) because his insurance pays 100%......now all of a sudden he is getting invoices, from his insurance company showing that they have been paying a monthly rental fee for the machine.
It seems that DME's have found a weak link in insurance company regs, since many insurance companies suggest a rental for new users....so now they have found a loophole that allows the DME to charge 4-20X the list price of CPAP/BiPap machines.
It is no wonder why my health insurance premiums have gone up 275% in the past 3 years....
Boycott DME's!! It's just like buying goods from theives on the streetcorner. Even though insurance companies have let the wolves into the barn doesn't make it ethical.
_____________
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wading thru the muck!
- Posts: 2799
- Joined: Tue Oct 19, 2004 11:42 am
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ballast949
- Posts: 61
- Joined: Wed Apr 13, 2005 6:10 pm
- Location: Portland, OR
Contacted my DME billing this morning. They told me that if I return the rental BiPAP, they will refund the price of the heated humidifier (although the paperwork says only if returned in 30 days). When I asked why they had charged me for the Water Chamber separately when one is included with the humidifier, her response was "some humidifiers come without one, so they charge for it." I repeated that this model came with one and she gave me the same answer.
?? Anyone out there buy a humidifier that didn't come with a water chamber?
So I called the insurance company and asked about buying the unit outright. They told me 1. I had to rent it for at least 3 months before I could buy it. 2. If I buy it "out of system", my copay would be 20% instead of "10%" 3. They just pay for what they are billed according to they schedule of fees, so they didn't care about the extra billing for the Water Chamber.
I explained that based on the rental charge on the BiPAP, the DME was planning to charge $4200 for a machine I could buy for $1400 and had already charged me $300 for a humidifier I could have purchased for $160. She did check what I would have to do to buy the equipment and be reimbursed - the answer after a 10 minute hold was, lots of paperwork and all the things she told me before.
The insurance company really doesn't care. I have had connections to the auto glass industry for a few years and the insurance companies there are much the same. Until a few years ago, autoglass companies regularly charged the insurance company $1000 for a windshield they paid $100 or less for. Then one of the autoglass companies approached the insurance companies and said, 'if you give me all your business, I will sell you the glass at a 50% discount. The insurance companies went for it, and the industry as a whole was forced to lower their prices. Now they only charge 2 or 3 times what it costs them.
_____________
?? Anyone out there buy a humidifier that didn't come with a water chamber?
So I called the insurance company and asked about buying the unit outright. They told me 1. I had to rent it for at least 3 months before I could buy it. 2. If I buy it "out of system", my copay would be 20% instead of "10%" 3. They just pay for what they are billed according to they schedule of fees, so they didn't care about the extra billing for the Water Chamber.
I explained that based on the rental charge on the BiPAP, the DME was planning to charge $4200 for a machine I could buy for $1400 and had already charged me $300 for a humidifier I could have purchased for $160. She did check what I would have to do to buy the equipment and be reimbursed - the answer after a 10 minute hold was, lots of paperwork and all the things she told me before.
The insurance company really doesn't care. I have had connections to the auto glass industry for a few years and the insurance companies there are much the same. Until a few years ago, autoglass companies regularly charged the insurance company $1000 for a windshield they paid $100 or less for. Then one of the autoglass companies approached the insurance companies and said, 'if you give me all your business, I will sell you the glass at a 50% discount. The insurance companies went for it, and the industry as a whole was forced to lower their prices. Now they only charge 2 or 3 times what it costs them.
_____________
ballast949
------------
Respironics Bipap Pro2 at 20/17.5 with BiFlex at 2
& Heated Humidifier & Ultra Mirage Series 2 Full Face Mask - Encore Card reader & software
------------
Respironics Bipap Pro2 at 20/17.5 with BiFlex at 2
& Heated Humidifier & Ultra Mirage Series 2 Full Face Mask - Encore Card reader & software
Ballast:
While your auto glass story is valid.....If we as consumers don't stand up for ourselves, the result is higher premiums for all. There is no practical reason for insurance companies to get ripped off, because in the long run they will put their hands in your pocket to compensate for unethical practices.
To all:
Stand up now or pay later....If we don't fight....health insurance will be something only the rich will afford. What I have seen is that insurance companies charge more....and give you less. They have to make a living like anyone else. It is like if stores don't protect themselves from shoplifters, eventually they need to factor in a standard loss onto the price of the goods....so in a way you are helping shoplifters indirectly, by buying the goods they steal.
My doctor hit my insurance company 900 bucks to read my sleep study...a total of 10 minutes worth of work! I know that because I was positive it was the first time he read the darn thing is when I was in his office!
My insurance company said...here you get 197 bucks...he didn't even flinch and ate the remainder of the fee....who can complain when you make $1200 bucks and hour! Now if the insurance company paid the 900 bucks my premium would be 500 bucks a month and deductable $2000.
It's gotta come from some where! Boycott DME's! Use in network providers, anything you can do to save insurance companies money you get back in lower premiums. Buy CPAP supplies and Prescription drugs from the net or mail order. If you don't help...you don't have a right to bitch!
While your auto glass story is valid.....If we as consumers don't stand up for ourselves, the result is higher premiums for all. There is no practical reason for insurance companies to get ripped off, because in the long run they will put their hands in your pocket to compensate for unethical practices.
To all:
Stand up now or pay later....If we don't fight....health insurance will be something only the rich will afford. What I have seen is that insurance companies charge more....and give you less. They have to make a living like anyone else. It is like if stores don't protect themselves from shoplifters, eventually they need to factor in a standard loss onto the price of the goods....so in a way you are helping shoplifters indirectly, by buying the goods they steal.
My doctor hit my insurance company 900 bucks to read my sleep study...a total of 10 minutes worth of work! I know that because I was positive it was the first time he read the darn thing is when I was in his office!
My insurance company said...here you get 197 bucks...he didn't even flinch and ate the remainder of the fee....who can complain when you make $1200 bucks and hour! Now if the insurance company paid the 900 bucks my premium would be 500 bucks a month and deductable $2000.
It's gotta come from some where! Boycott DME's! Use in network providers, anything you can do to save insurance companies money you get back in lower premiums. Buy CPAP supplies and Prescription drugs from the net or mail order. If you don't help...you don't have a right to bitch!
Well said Joe. But , But , But, I pay for my insurance and I'm sure gonna get my moneys worth. Some even ask if insurance will pay for the distilled water. No wonder it costs so much. Then they go without (insurance) and end up in the ER and we all get to pay for it . AGAIN !
You know who you are out there.
You know who you are out there.
Last edited by chrisp on Wed May 25, 2005 3:19 pm, edited 1 time in total.