Let's clear up some misinformation

[ltts]

It's a conspiracy. We all got together and said "Let's make up stories about DMEs"

I don't think you make up stories -- I think you made rules that don't exist, and make no sense. If you rent a car do you think you'd get very far if you demanded a new car that had never been driven before? Your insurance company only wants to pay for an economy car if you get in a wreck with your family auto. Is the rental care place ripping you have if they won't provide a cadillac for the price your insurance company is willing to pay?

In fact, insurance companies pay NOTHING for the service component and none that I know of require that you receive any service at all. So who is to blame when they set reimbursement rates based on the cost of the product, only? The DME or the insurance provider you or your company is paying $500 plus dollars to a month? I think you're mad at the wrong people in this equation.

No body "rents" a xpap machine. You rent to own - just like you LEASE a car to use your analogy. If you LEASE a machine that doesn't do what what was promised in the lease or has a warranty issue you get things replaced - with an apology. You also get a manual with that car by the way and fuel gauges and millage gauges. If you think it is safe to drive a car without those and modern safety equipment you are and idiot. In fact comparing DME's to used car salesmen is an insult to car sales men. They at least know what they are selling.

But you don't rent to own. There is no guarantee that the insurance will complete the payments to the purchase price. I hate to break it to you, but your insurance company makes the rules -- not the DME provider. If you don't like the rules you should complain to your insurance company. I am dead certain your DME provider would support you wholeheartedly.

[Elle]

You can't dispute that the DME inflates the prices. I would think my insurer is not unusual paying $2205. for a machine. They don't cost that much.

[ltts]

When I towed the DME line I spent 5 plus years at the wrong pressure (at least 5 points under).

Diagnosed in 2006 and basically starting to finally get treatment with newly acquired data capable machine a month ago.

It's unreasonble for a patient to expect a PAP device to main it's pressure without a problem for 5 years. That is why you should have it checked periodically. And unlike online suppliers, the DME provider that provided the machine will do that at no cost to you or your insurance company. All you have to do is make an appointment and bring it in to be tested. If you never had it tested you have no way of knowing how long it wasn't providing the correct pressure. You don't need a deluxe machine for that reason. Your deluxe machine will eventually have the same problem. But by all means, call your insurance company and complain to them and explain why you think they should pay for the feature rich machines instead of the basic model. Your DME provider will love you for that.

[ltts]

You can't dispute that the DME inflates the prices. I would think my insurer is not unusual paying $2205. for a machine. They don't cost that much.

Well the problem is that most patients do not understand how to read their estimation of benefits that they receive from their insurance company. I work all over the united states and the company I own does well over 1 million per month in billing for DME providers, and I have never seen a single insurance payer that paid anywhere near that amount for a CPAP device. You either have a Bilevel device with 2 pressure settings (a much more expensive device), or you are reading the submitted price which is the MSRP payers demand on a bill, and bears no relation to the actual fee schedule that is paid to the DME provider.

[jedimark]

Responding to a troll, but what the hell.. (@the original poster, I don't want to replicate their bullocks)

I have something I'd like to express to you and people like you.

Firstly, monitoring more than just data compliance has been found to be the KEY to getting a handle on CPAP treatment..

There are THOUSANDS of CPAP users who are willing to testify on this.. Not just on this site. Plenty of others.. If you learned how to use Google, you'd have more of a clue.

This fact alone totally defecates over useless studies which are performed with MUCH lower sample audience.. We don't just want data capable machines, we simply DEMAND them.

If you are too incompetent to realize how important it is to involve the patient in this treatment, you're both a fraud, and in the wrong business.

Being sold a non data capable machine is slap in the face of people already dealing with a crappy medical condition. The fact that you call being able to monitor this a luxury shows how out of touch you are with reality..

Now please post where your from so we can boycott your crappy organization..

All recent PAP devices are data capable. They ALL monitor usage. And you are correct that service component is important. And if your DME company is not providing the service you require you should seek another. But I am correct that no insurance company cares enough to pay for it. Nor do they care enough to pay for the deluxe features that many here seem to feel they are entitled to.

It's the insurance payers you should be trying to convince. DME providers would love to convince them of that as well. I've been in meetings between insurance payers and DME providers making exactly the case you are stating here, but guess what? They don't care.

But I wonder if you go to McD's and demand a big Mac for the price of a cheeseburger. Or go to the Ford dealer and insist they give you a loaded car with a navi system for the price of a basic escort? You wouldn't even dream of it, right? So why, pray tell, do you think a DME provider should give you a high end device when your insurance will only pay for a basic model?

That's the mystery.

Wow.. You really are out of touch with reality.

Yes, no insurance companies give a crap, they are purely about dollars and numbers..

But if all current machines are now data capable, we would not be seeing this issue at all.

Why are they still off-loading crappy old machines on people then?

Insurance companies are only half the blame.. Idiot marketing droids from the manufacturers are responsible for the other half of it. (Philips and their recent IQ model comes to mind.. May whoever invented that crappy idea be given a free permanent transfer to Sol.)

Each of these manufacturers builds these new machines on the SAME FREAKING HARDWARE PLATFORM, the main difference between models is software.

Your analogy fails supremely in this instance. The ingredients are there.. It's all in the "special sauce".. (and yes, I do have a clue about how software/firmware is designed)

[Elle]

My machine was being checked. I would make the trip in for them to say to me: "Yep. Looks like you have been using it. See you next year". It recorded hours of use.

My pressure was set at 8 all those years and now with the auto it hovers around 14.

[Elle]

The complaints appear to be universal. We can't all be idiots.

[ltts]

Several months ago there was a thread about administrative pricing for DME goods. Here is what I wrote back then. Take particular note of my last sentence.

The comments by others about the DMEs need to get their own house in order first is right on. How can politicians and the public not believe that DMEs are getting fat off taxpayer money when we look around at the entire medical industry and see marble palace hospitals being built, physician practices setting up expensive MRI and DNA labs, medical groups practicing in fancy brick high rise office buildings in the priciest parts of the city, and on and on? And we look at the EOBs from every medical provider and see them accepting as full payment reimbursements as low as 15% of the billed amount. Who's gouging who? Are reimbursers gouging the providers, or do providers gouge the poor souls who have to pay their own medical bill? The medical industry has a serious image problem, and DMEs are caught up in it, rightfully or not.

We have many problems related to health care in this country, and like you I have seen the palaces that are medical groups and hospitals. But I travel over 125K miles a year to work with DME providers, and I can't think of a single palace associated with a DME. It's easy enough to look up the profits that even so called "not for profit" health insurers are bringing in (and paying 50-100 million to their CEOs per year). You don't have to guess who is doing the gouging.

[ltts]

The complaints appear to be universal. We can't all be idiots.

The complaints are far, far from universal. Medicare approved DMEs are required to collect patient satisfaction surveys. I see them every day. And they aren't faked because they are coming in envelopes sent by patients. It is highly, highly unusual for a DME to fall below a 90% satisfaction rating. Most have a satisfaction rating exceeding 95% on 8 different indicators.

If this is your universe of complaints then of course you are not satisfied. Because you have been misinformed to believe that DMEs are somehow obligated to pay for features and services that insurance payers, including almost every private insurance payer, Medicare, and Medicaid refuse to pay for.

The average independently owned DME makes a profit of 6%. Is that too much?

[Elle]

I was satisfied with mine until I educated myself.

They lie and there are gullible people out there who want to keep it simple. There are also a lot of people who want their thinking done for them and the DME is happy to accommodate.

[Elle]

My brother in law has been on cpap for many many years and got a new machine every 5 years. He was happy with his latest "new" machine. I asked to see it. I laughed. It must have gone out of production 15 years ago. He knew no better and was still happy to sit with it instead of learning that he could do better.

[ltts]

My machine was being checked. I would make the trip in for them to say to me: "Yep. Looks like you have been using it. See you next year". It recorded hours of use.

My pressure was set at 8 all those years and now with the auto it hovers around 14.

Then something changed about your condition that required a higher pressure. Perhaps you gained weight, took up drinking alcohol, any number of things. I agree, autoset systems are better when patients experience weight or lifestyle changes that could change the pressure they require to keep their airway patent. You should lobby your insurance payer to cover them instead of the basic model. There is a 100% chance your DME provider would support you in that.

But why blame the DME provider? How would they know something changed about your situation that meant that the originally prescribed pressure was no longer sufficient? They made sure your machine was set on the pressure your physician prescribed. Did you ask your physician about it when it seemed to be no longer working for you? If you had the physician could have ordered a repeat study to retitrate you.

[Elle]

My insurer who paid $2205. for this machine is the same one who paid approx. the same price for what the DME told me I needed over 5 years ago (when I was ignorant). The DME was not pleased that they would not make as high a profit this time but had no choice.

Counting on the public remaining ignorant will always give you good stats.

Anyway, I am sure you are determined to keep the blinders on but with the internet gaining ground the party is about to end.

goodnight.

[ltts]

My brother in law has been on cpap for many many years and got a new machine every 5 years. He was happy with his latest "new" machine. I asked to see it. I laughed. It must have gone out of production 15 years ago. He knew no better and was still happy to sit with it instead of learning that he could do better.

Well you should feel very lucky that you found a DME provider that would absorb the cost of a deluxe machine without asking you to pay the difference between that an what the insurance company pays for.

To be perfectly honest, that is what bothers me about the posts here. Many of you are getting things that DME providers are under absolutely no obligation to provide for no extra charge, and instead of being grateful for it, you are complaining about the DMEs who don't. Instead of being happy that many DMEs go the extra mile for you even when your insurance company says they won't pay for those features, you think DMEs that won't do it for free are ripping you off. For some reason people have developed this entitlement mentality that makes them believe that DME providers are obligated to provide them with the most deluxe machine made when the insurance company barely wants to pay above the actual cost of providing the product.

And by the way, there are no patients receiving machines that went out of production 15 years ago. Anywhere. I doubt there are patients receiving machines that went out of production even 3 years ago. The blowers seldom last that long, and the machines cost more to be repaired than the cost of a new machine. The manufactuers make sure of that.

[idamtnboy]

All recent PAP devices are data capable.

Please define data capable. To us CPAP patients, data capable means a hell of lot more than hours of use. If you are suggesting that all machines will provide data such as pressure and details of AHI, you are dead wrong.

Nor do they care enough to pay for the deluxe features that many here seem to feel they are entitled to.

but guess what? They don't care.

So why, pray tell, do you think a DME provider should give you a high end device when your insurance will only pay for a basic model?

That's the mystery.

We strike out in frustration at the one we can reach, the DME supplier. We aren't getting the support from the medical community we need when it comes to determining the absolute best therapy for our condition, and as a group we are pissed. If the DMEs don't like the idea of a Resmed S9 Autoset being in the same code as an S9 Escape, then don't sell it. The insurance company pays by the code, and the code includes the Autoset.

We don't see getting a fully data capable machine as an entitlement. We see it as a necessity. When the insurance company says, "We will pay for a PAP machine, and this is what we will pay, and these are the machines this payment will cover," then why the hell shouldn't we demand the best machine in the offering? Especially when many doctors, like mine, know the basic CPAP doesn't provide all the information necessary and so prescribe the Autoset. And we know that the insurance company expects that machine to be used for the next five years. With a planned life span at least that long no way is any knowledgeable patient going to want anything less than a new machine. There's just no mystery there. If you make a contract with BK to pay them $4.00 for a hamburger, and the selection of hamburgers includes a double meat Whopper as well as the Whopper Jr., then any person who is covered by that contract has a right to ask for the big one.

Your comment about the Medicare ABN doesn't jibe with my reading of the provision. It applies to a situation where a patient wants to voluntarily upgrade to something like a VPAP or BiPAP machine when a CPAP has been prescribed. They are in entirely different codes. The ABN does not apply to machines within the same code.

As one of the other posters said, welcome to the real world of patients. I for one am glad you are here. I don't expect you to agree with our viewpoint, but I do hope you can at least understand a little bit where we as CPAP patients are coming from. As the old adage says, "S*** rolls downhill," and we feel like we are at the bottom of the hill!