A $2500 Auto CPAP???

beneyw · Post by **beneyw** » Tue May 09, 2006 4:14 pm

To cut to the chase...saw doc today and he agreed to do another titration study so I got a Remstar Auto with smart card from DME for several days and DME charged me $75 for the study. He then said, the auto machine sold new for, now get this, $2500 and after Medicare reimbursement I can have the machine for another $900 cash if I decide to change machines from my originally prescribed Remstar plus.

Unless I am a fool, I find the same machine online for approx. $700 +- with heated humidifier. What am I missing?

Before I report this 'alleged liar' I want to make sure I am not incorrect on my assessment. Please someone help me with this dilemma..
Thanks..

Linda3032 · Post by **Linda3032** » Tue May 09, 2006 4:21 pm

The DME must think you are ignorant and will take his word at face value. Print out your cpap.com price and take it to him. See what he says then.

If he won't back down on his price, see if your insurance will let you deal with cpap.com or contact billmyinsurance.

Otherwise, find another DME.

johnnygoodman · Post by **johnnygoodman** » Tue May 09, 2006 4:22 pm

Welcome to CPAPtalk,

As is often heard around the boards, "beware the evil DME".

As you are a man who cuts to the chase, I'll do the same.

#1. It is the same machine.

#2. Your doctor and CPAP provider live in the insurance world. The prices you see on cpap.com are cash prices. Cash involves much less paperwork (only a valid Rx), hence the discount.

You are no fool. You are in the right place to learn how the CPAP game is played and how to make the best of it. Welcome!

Johnny

Wulfman · Post by **Wulfman** » Tue May 09, 2006 4:26 pm

beneyw,

You're not missing anything.......
You're just experiencing the (somewhat) typical DME "rip-off" routine.
Did they tell you if that included everything or are they willing to throw in a heated humidifier for another $400....hose for $60.....mask for $300, etc., etc.?

Welcome to the party.......buy what you need/want at CPAP.COM. You won't regret it.

Best wishes,

Den

Sleepy Dog Lover · Post by **Sleepy Dog Lover** » Tue May 09, 2006 6:03 pm

I will stick up just a tiny bit about the DME's before I start bashing them again. Part of it is the contract that they have through insurance and the full staff they have to keep. They also pay a respiratory therapist to show you how to use the machine and to help you choose a mask. I know when I went the RT spent over an hour with me trying masks on and showing me everything. So there is some value you get from the mark-up, the very first time you order a CPAP. That being said, for the most part, the prices and what you have to go through to get the machine that you need is a total rip-off. There are many stories on here about a doctor prescribing a specific machine, such as an autopap, and the DME just about refusing to provide it.

beneyw · Post by **beneyw** » Tue May 09, 2006 6:44 pm

I am not opposed to someone selling an item and making a few bucks profit to stay in business...BUT, when someone tells me an item sells NEW for $2500.00 and he is going to get 1500 from Medicare and I am getting a bargain at an additional cost of 900....someone has to scream...baloney!!

mdkohm · Post by **mdkohm** » Tue May 09, 2006 7:22 pm

I think they should bill for the RT's time - not jack up the prices 300%.

I have been having trouble with my DME. Today the brought me a USED RemStar Auto C-FLEX. The only manual was a photo copy of a non C-FLEX model and the filter looked very used and they weren't going to supply a new filter.

This was to replace my 40 hour old ResMed S8. This seemed like a huge downgrade especially since it was used and did not even have a manual.

I told her to pack it up and keep it. I still don't know what I am going to do, maybe change to another DME or just deal direct with cpap.com.

pratzert · Post by **pratzert** » Tue May 09, 2006 7:30 pm

[quote="Sleepy Dog Lover"]I will stick up just a tiny bit about the DME's before I start bashing them again. Part of it is the contract that they have through insurance and the full staff they have to keep. They also pay a respiratory therapist to show you how to use the machine and to help you choose a mask. I know when I went the RT spent over an hour with me trying masks on and showing me everything. So there is some value you get from the mark-up, the very first time you order a CPAP. That being said, for the most part, the prices and what you have to go through to get the machine that you need is a total rip-off. There are many stories on here about a doctor prescribing a specific machine, such as an autopap, and the DME just about refusing to provide it.

Well... let's make it perfectly clear.... you say that the DME send is better because they will send out a RT to show you how to use the machine.

That RT is NOT Included in the price of the machine that the DME charges the insurance company for.

It's a SEPARATE and ADDITIONAL charge. (AT least on MY insurance plan)

I am buying my AutoPAP from cpap.com and my insurance company will pay for ANY RT I WANT as long as they are in my insurance network. They exclusively use Apria for the DME stuff. And yes, Apria will be more than glad to send a RT to my house and make even more money.

But I'm not letting them have ANY of my insurance money. Machine from cpap.com and RT from somewhere else too !

The ONLY way to hurt the EVIL DME is in the pocket book. Maybe someday they will stop ripping people off.

Tim

NightHawkeye · Post by **NightHawkeye** » Tue May 09, 2006 7:40 pm

mdkohm wrote:I have been having trouble with my DME. Today the brought me a USED RemStar Auto C-FLEX . . . I told her to pack it up and keep it.

Name of DME please - you promised.

mdkohm · Post by **mdkohm** » Tue May 09, 2006 7:53 pm

As promised.

American Home Patient is the DME.

I just looked into how they have been billing my insurance company and they are billing under both American Home Patient and Ancillary Care. It looks like they billed over $700 for my rent to own S8 and 1 Ultra Mirage FF on the day I picked it up and about $90 a month since then.

They submitted several sperate invoices for the same day. Two of them were duplicates (2 for 76.54 and 108.34). Scam artists.

My insurance pays 100% of the inflated cost through the DME, but will only pay 60% after $500 deductible if I go out of network (like cpap.com).

NightHawkeye · Post by **NightHawkeye** » Tue May 09, 2006 8:04 pm

mdkohm wrote:My insurance pays 100% of the inflated cost through the DME, but will only pay 60% after $500 deductible if I go out of network (like cpap.com).

I got the 60% story from BC/BS as well, but I wasn't convinced and didn't care anyway, so I ordered from our online benefactor here and received 100% reimbursement. There are other similar stories about how submitting the bill yourself qualifies you as in-network.

All I have to go is my own experience, of course.

Regards,
Bill

Midnight Son · Post by **Midnight Son** » Tue May 09, 2006 8:09 pm

Bottom line: Despite having 50% insurance coverage it was significantly cheaper for me to purchase my Auto Cflex machine without any insurance. My 50% co-pay with the DME was significantly higher than paying CPAP.com price without insurance.

Midnight Son
ps. good for you for doing your homework, No wonder insurance rates are rising 8-11% per year.

Guest · Post by **Guest** » Tue May 09, 2006 9:10 pm

To me, it's amazing that insurance companies would pay a DME a price that's HIGHER than the cost of a much more sophisticated machine that my DOCTOR has prescribed and I can buy cheaper elsewhere. Why aren't they interested in saving money.... maybe they could lower my premiums. HA !

Even more absurd, is that "MY" insurance carrier (CIGNA) does NOT rent the machine like some others... they BUY it.

They WILL cover the cost of an AUTOPAP but ONLY if I use a standard CPAP for three weeks. THEN, and only then, will they cover the cost. In the meantime, they have already purchased the first machine.

Now, I could see it if I truly only wanted a "better" machine, but my DOCTOR has PRESCRIBED an APAP machine based on the info gathered during the titration study.

So, it would save them a ton of money if they just reimbursed me for the APAP machine in the first place. It's a win-win situation all around.

The Insurance company SAVES MONEY, I am happy, my Doctor is Happy, and I get the PROPER prescribed treatment I should have right from the beginning.

And what's up with these slimey DME's trying to palm off USED equipment on people who should be getting Brand New machines? PLUS, they steal the manuals out of the box and sell them elsewhere (ebay).

I should have been on CPAP therapy two weeks ago instead of having nightmares about Apria.

I wish we could get this on 60 minutes or Nightline or some big-time Television reporting show. THAT might make the DME's treat patients with honesty, and decency and compassion.... Oh Hold it.... I must be dreaming again......

NightHawkeye · Post by **NightHawkeye** » Tue May 09, 2006 9:18 pm

Guest wrote:I wish we could get this on 60 minutes or Nightline or some big-time Television reporting show.

Objective reporting from the big three networks . . ., that is such a quaint idea . . .

DME_Guy · Post by **DME_Guy** » Tue May 09, 2006 10:51 pm

$2500! I think what the DME is saying is they don't want your business.

Humidifier

Humidifier