Going to War with DME again This Morning

[ChicagoGranny]

I am not kidding that I am paying $420.00 a month for an oxygen concentrator because I am in my deductible period. I can buy one on-line for $795.00,

As the clock ticks I am getting more nervous for you. Why don't you buy one for $795???

I don't know how long your deductible period is, but you will go through it again next year if you still need the concentrator.

[Kate M]

As the clock ticks I am getting more nervous for you. Why don't you buy one for $795???

I don't know how long your deductible period is, but you will go through it again next year if you still need the concentrator.

Funny you should ask that, Granny! No need to get nervous for me, although I appreciate your concern!

I have only recently needed the oxygen , and only at night, following a hospitalization for respiratory failure due to pneumonia. I had an appointment with my new pulmonologist (right after I got out of the hospital I changed jobs and it was new insurance, new deductible, new doctors, etc. ... sigh) As I was asking for an Rx to buy a concentrator, he decided I needed a sleep study. The sleep study was done last week, and I was diagnosed with OSA. I am hoping to get my CPAP next week! (I am already assuming the insurance company and local DMEs will be too expensive to work with and have a very low threshold for going online!) I have two weeks left in the billing period for my concentrator, and when I get the CPAP, the concentrator is going away. Otherwise, I would have already bought it

[idamtnboy]

... whilst ... works in the supplies side...

This isn't usual American language. Where are you located, since it's not shown in your profile info, Australia, or UK, or are you an import into the US? If you aren't US then the relationships and payments by insurance companies may be vastly different than here. If you are referring to US pricing, then the great difference you are seeing is not what most of us see in relation to billed vs. paid cost vs Cpap.com price.

[Lugus]

I am a ten year import into the USA from the UK by reason of marriage and will update my profile when I remember.

[idamtnboy]

I do agree, that the insurance company very likely does not pay the exorbitant rates, but I am expected to if I am in my deductible period. The rental prices confuse me. I am not kidding that I am paying $420.00 a month for an oxygen concentrator because I am in my deductible period. I was told that after 36 months of rental ($15,120.00) I would own it! I can buy one on-line for $795.00, so if I spent $15,120.00 I could by 19 of them and open my own DME company! But my insurance won't give me credit towards my deductible unless I spend the money at one of their approved DMEs, but I am certain they don't give me the same price they give my insurance company, but of course my insurance co. won't tell me what that price is so that I can negotiate a better price for myself. Sigh.

Something doesn't add up here. If you are covered by insurance, and are still in the deductible period, your cost for the equipment will be the same as what the insurance company will pay. There is no way the insurance company is going to let you pay off your deductible at rates higher than what they pay. If the supplier is an approved DME with a contract with the insurance co. the price is the same whether you pay it, they pay it, or your uncle pays it.

Surely, you cannot be comparing the rental cost of $420/mo for 36 months for the same machine you are saying you could buy for $795.00. I don't doubt one bit an oxygen concentrator could cost $420/mo, and I don't doubt you could buy an OC online for $795 outright, but there is no way they are the same machine.

[Kate M]

Something doesn't add up here. If you are covered by insurance, and are still in the deductible period, your cost for the equipment will be the same as what the insurance company will pay. There is no way the insurance company is going to let you pay off your deductible at rates higher than what they pay. If the supplier is an approved DME with a contract with the insurance co. the price is the same whether you pay it, they pay it, or your uncle pays it.

Like I said, "The rental prices confuse me." I have no idea how this works, I would simply be shocked if my insurance company would pay such a ridiculously high monthly rental rate. If you say they do, then you must know more about it than I do, which doesn't set the bar very high

Surely, you cannot be comparing the rental cost of $420/mo for 36 months for the same machine you are saying you could buy for $795.00. I don't doubt one bit an oxygen concentrator could cost $420/mo, and I don't doubt you could buy an OC online for $795 outright, but there is no way they are the same machine.

It looks like the rental prices confuse you also. Here, I will strenuously disagree with you, as I am presenting the facts about what equipment I am renting and you are offering an opinion as if it were fact. They certainly are the same machine. I have gone to multiple online sites. The model of the Concentrator I am renting is the Perfecto2 V - model #IRC5PO2V I just looked online and the price is even lower than it was a couple weeks ago when I checked: 742.00 seems to be the most common price. Check yourself. Here's one link for you: http://www.activeforever.com/invacare-p ... ncentrator And stop calling me Shirley.

[idamtnboy]

And stop calling me Shirley.

Yes, dear! (spoken with 47+ years of practice!)

[idamtnboy]

Something doesn't add up here. If you are covered by insurance, and are still in the deductible period, your cost for the equipment will be the same as what the insurance company will pay. There is no way the insurance company is going to let you pay off your deductible at rates higher than what they pay. If the supplier is an approved DME with a contract with the insurance co. the price is the same whether you pay it, they pay it, or your uncle pays it.

Like I said, "The rental prices confuse me." I have no idea how this works, I would simply be shocked if my insurance company would pay such a ridiculously high monthly rental rate. If you say they do, then you must know more about it than I do, which doesn't set the bar very high

Surely, you cannot be comparing the rental cost of $420/mo for 36 months for the same machine you are saying you could buy for $795.00. I don't doubt one bit an oxygen concentrator could cost $420/mo, and I don't doubt you could buy an OC online for $795 outright, but there is no way they are the same machine.

It looks like the rental prices confuse you also. Here, I will strenuously disagree with you, as I am presenting the facts about what equipment I am renting and you are offering an opinion as if it were fact. They certainly are the same machine. I have gone to multiple online sites. The model of the Concentrator I am renting is the Perfecto2 V - model #IRC5PO2V I just looked online and the price is even lower than it was a couple weeks ago when I checked: 742.00 seems to be the most common price. Check yourself. Here's one link for you: http://www.activeforever.com/invacare-p ... ncentrator And stop calling me Shirley.

Even before checking that link I found prices in the range of $600 to $1800. Medicare rental rate in 2010 for an oxygen concentrator was $173/mo, and as you said, 36 months max.

Here is what Medicare expects to get for their money, which is more than you get when you buy a machine outright yourself.

Medicare payment for oxygen and oxygen equipment is made on a monthly basis. One bundled monthly payment amount is made for all covered stationary equipment, stationary and portable contents, and all accessories used in conjunction with the oxygen equipment. An add-on payment may also be made for those beneficiaries who require portable oxygen. Per the MIPPA of 2008, effective January 1, 2009, Medicare payment for oxygen equipment may not continue beyond 36 months of continuous use. . After the 36 month rental cap, Medicare will continue to make monthly rental payments for oxygen contents. In addition, payment for in-home maintenance and servicing of supplier-owned oxygen concentrators and transfilling equipment will be made every 6 months, beginning 6 months after the rental cap, for any period of medical need for the remainder of the reasonable useful lifetime of the equipment. Payment is made on a monthly basis for oxygen contents for beneficiaries who own liquid or gaseous oxygen equipment.

Most insurance companies use Medicare pricing as a guideline, so if your insurance company is willing to pay $420/month for something Medicare pays only $173, something is rotten somewhere. The difference between 36 months x $173/month and the current price for O2 concentrators may be the result of two factors - continual drop in technology prices and slowness in Medicare's ability to readjust pricing to reflect new market prices. I'll bet O2 concentrators did cost $4000 plus 5 to 10 years ago. Of course DMEs will buy the cheapest equipment available that fits in the HCPCS code. That must be what we are seeing here. It'll be interesting to see what the new Medicare payment is under the competitive bidding pricing structure.

Just another example of how convoluted the medical delivery system really is.

[Kate M]

Most insurance companies use Medicare pricing as a guideline, so if your insurance company is willing to pay $420/month for something Medicare pays only $173, something is rotten somewhere. The difference between 36 months x $173/month and the current price for O2 concentrators may be the result of two factors - continual drop in technology prices and slowness in Medicare's ability to readjust pricing to reflect new market prices. I'll bet O2 concentrators did cost $4000 plus 5 to 10 years ago. Of course DMEs will buy the cheapest equipment available that fits in the HCPCS code. That must be what we are seeing here. It'll be interesting to see what the new Medicare payment is under the competitive bidding pricing structure.

Just another example of how convoluted the medical delivery system really is.

Thanks for providing that price reference (wherever do you find things like that!?) This is why I believe that I personally may be getting ripped off and that my insurance company would never pay this much! This confirmation of what I expected does give me some ammo to use when I go back to them and question it though. It could be the DME company is simply overcharging me and I am paying more than the insurance company would allow them to bill me. I'll share this info with my husband and see what he can find out. The concentrator I am using had not much more than 0 hours on it ( <3? ) when they delivered it, so I am guessing they recently purchased it.

(I'm suddenly feeling like I hi-jacked this thread! Sorry! )

[ChicagoGranny]

Thanks for providing that price reference (wherever do you find things like that!?) This is why I believe that I personally may be getting ripped off and that my insurance company would never pay this much! This confirmation of what I expected does give me some ammo to use when I go back to them and question it though.

Call your insurance company and discuss the prices. I found on a few occasions that the insurance company can be helpful with stating their contract prices and ensuring that you pay no more than this. I would not trust employees at the DME to be competent in doing this.

right after I got out of the hospital I changed jobs and it was new insurance, new deductible, new doctors, etc. ... sigh

This is an example of how our tax code screws us. Premiums paid by companies are 100% deductible and premiums paid by individuals are subject to various deductibility ranging from 100% down to zero. The code needs to be simplified so that both are treated the same.

We need to move to a system where each individual has his own insurance and when changing jobs you don't run into this problem.

[hyperlexis]

Thanks for providing that price reference (wherever do you find things like that!?) This is why I believe that I personally may be getting ripped off and that my insurance company would never pay this much! This confirmation of what I expected does give me some ammo to use when I go back to them and question it though.

Call your insurance company and discuss the prices. I found on a few occasions that the insurance company can be helpful with stating their contract prices and ensuring that you pay no more than this. I would not trust employees at the DME to be competent in doing this.

right after I got out of the hospital I changed jobs and it was new insurance, new deductible, new doctors, etc. ... sigh

This is an example of how our tax code screws us. Premiums paid by companies are 100% deductible and premiums paid by individuals are subject to various deductibility ranging from 100% down to zero. The code needs to be simplified so that both are treated the same.

We need to move to a system where each individual has his own insurance and when changing jobs you don't run into this problem.

Well under the Affordable Care Act, that has happened to an extent -- "self-employed" individuals are right now (and going forward) permitted to deduct the annual premiums they pay for health insurance from their federal taxes, just like companies. I discovered that on my 2011 tax return. Alas, it's not a credit, but it's better than nothing. (Although you still can't deduct the premiums from your FICA portion, but that may change for 2012). And people who are employed already get their health insurance as a tax-free benefit of employment, in lieu of taxed cash. Far better to have the insurance, even with deductibles and copays.....

Plus, under the ACA, people will eventually be able to obtain health insurance coverage under the exchanges even if they do become unemployed or switch to a job that offers no insurance. Right now, if the worst happens, they can go on the existing COBRA system (ughhhh!!!!) or possibly one of the cheaper, state high-risk pool plans, but alas, unless you live in Massachusetts or Hawaii, the nationwide ACA health exchanges don't open up for business until 1-1-14.

[DannyPh]

well. I contacted the Branch Office this morning in Regards to them giving me a used machine instead of a New machine and I caught the Resp. Therapist in a Lie when she tried to tell me that the Machine was New and only Had three run hours on it from Office testing. When I told her that I checked the Total Run Hours and it was 499 Run Hours with 129 of those hours being mine leaving 375 run hours on the machine when it was delivered. There was silence on the phone and when they returned it was the Branch Manager who tried to tell me that Per Medicare guide lines they were not required to issue a New Machine and that it was a rental ( which Might be true ). I then politely told him that I was contacting his supervisor at the Corporate Office for Further assistance. I contacted the Corporate office and they Kinda agreed with me that a New Machine should have been delivered and that they were contacting the Branch. Office to see what they could do. So, I am waiting for the corp. Office to call me back. My Next recourse will be to return the Machine ( Being it is a Rental ) and look at possibly buying online or finding another DME willing to get me a NEW Machine.

[idamtnboy]

We need to move to a system where each individual has his own insurance and when changing jobs you don't run into this problem.

Like a universal coverage, single payer system?

[Drowsy Dancer]

<snip> I caught the Resp. Therapist in a Lie when she tried to tell me that the Machine was New and only Had three run hours on it from Office testing. When I told her that I checked the Total Run Hours and it was 499 Run Hours with 129 of those hours being mine leaving 375 run hours on the machine when it was delivered. There was silence on the phone and when they returned it was the Branch Manager ...<snip>

Good grief.

[ChicagoGranny]

We need to move to a system where each individual has his own insurance and when changing jobs you don't run into this problem.

Like a universal coverage, single payer system?

I know what disasters are created when "someone else is paying". Apparently you don't and won't.