The call to the DME regarding an APAP vs CPAP (today)

[Bingo]

Bottom line for DMEs is that they make the same profit for cpap or apap. Which do YOU think they will recocmmend???
....
After you have the machine in your possesion, then you can thumb your nose at the DME, well maybe just smile knowingly at them....
Good luck.

Two things here that I think are extremely important to note.

The first comment that an equipment provider will make the same profit off either item could not be more incorrect.

To say that both an Auto-PAP and a CPAP have the same HCPC code is a slight misconception. What is happening is that there is in fact 1 HCPC code - this is E0601. This code is defined as: "CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE". The reimbursement is fixed for this item and will vary based on a patients insurance. Typically, they will reimburse around $600 - $800.00. Note that this is ALL an equipment provider will be reimbursed for this unit. If a patients prescription changes 2 years later - a provider will generally not be able to be paid anything further for a different machine (Say, switching from a CPAP to a CFLEX unit, etc).

Since an Auto-PAP does not actually have it's own seperate HCPC code, the only way to get reimbursed for it is to bill it as a CPAP.

It does not take much to realize that if you are being paid $700.00 and your machine costs you $800.00, that you are going to lose out.

Now, before anyone goes leaping to quote prices, it also has to be understood a provider can NOT provide a $600.00 machine at a $700.00 reimbursement level and make a profit.

I completely understand that this site, being owned and operated by someone who also owns an internet retailer and also owns an insurance billing agency and also owns a marketing business selling CPAPs is not going to particularly like a traditional equipment provider. However, I think it is very unfair not to provide balanced and accurate information to those who ask for it.

Also, I just wanted to point out that when people suggest trying to work with an equipment provider yet also suggest "thumbing your nose at them" - you may find that if you treat them with friendship and respect that you will get a LOT farther than treating them like dirt. Just food for thought.

B

[NightHawkeye]

The S-8 Vantage is a good machine. Some folks here swear by it. It doesn't have C-flex, but that may or may not be important to you. Lots of folks do just fine without C-flex. (Some of us don't even like it.) Here's a link to it.
https://www.cpap.com/productpage/resmed ... p-h3i.html

Regards,
Bill

[Rastaman]

Anyone got a clue why they caved? All I did was offer to pay the DIFFERENCE between the machines. Now, they want $35 for the "water chamber" and I'm ok with that And then I asked how much for the switch-out and she said "Don't worry about it."

Tomorrow I will be there with bells on my toes. It sounds like this unit even has a EPR mode but that probably doesn't work in Auto mode knowing my luck. Hehe. Well, I am having pretty good luck as long as this IS NOT a used unit.

Do these DME offices attempt to sell used units at full price to the insurance? That's a curiosity of mine. This just seems too good to be true. All my efforts seem to have paid off.

[Bingo]

Anyone got a clue why they caved? All I did was offer to pay the DIFFERENCE between the machines. Now, they want $35 for the "water chamber" and I'm ok with that And then I asked how much for the switch-out and she said "Don't worry about it."
...
Do these DME offices attempt to sell used units at full price to the insurance? That's a curiosity of mine. This just seems too good to be true. All my efforts seem to have paid off.

I know this is very, very hard for a lot of people around this site to believe, but most of the time an Equipment Provider really is interested in working with people. Believe it or not, they hate the way insurance companies work too! Wwhen a patient was willing to meet someone halfway, AND was understanding about things and treated someone like the partner they are - I have rarely seen a case where a healthcare provider wasn't willing to bend over backwards for someone.

Also, in answer to your question - no. Equipment providers cannot give used equipment to a patient and then bill for new equipment.

Now - this is NOT to be confused with situations like most XPAP cases where the equipment rents for 3 months to ensure compliance and THEN flips over to a purchase. Those cases are handled by the payment structure of the specific contract.

There are a few very rare cases where a patient can be sold used equipment and the insurance billed - but honestly the insurance companies require such obscene documentation that it simply isn't feasible for a company (Things like complete purchase history of the unit along with all servicing documentation for the previous lifetime [Or 5 years]. 6 month PM check logs for lifetime of equipment, tracking of the patient for the lifetime of the equipment and so forth.)

Bingo

[Rastaman]

Sounds reasonable. I guess I'm not so dismayed now. You can understand my point of view though can't you? It would seem I was told one thing this morning and another this afternoon, which was practically the direct opposite. Why? Any suggestions? I'm very happy with their decision. The more I read about the unit I'm getting the more pleased I am.

Now, I'm left wondering if 6.5 hours per night is complying with the insurance? Surely it is right? And if I'm complying THAT much I would think it's obvious to the insurance that I need the DME.

[DME_Guy]

Bingo's post are accurate and informative. Sometimes I think some people on the forum are under the impression that DMEs get paid thousands of dollars for CPAPs and are just being greedy for not wanting to put out top of the line equipment.

The only thing I would add is that insurance companies aren't the speediest payors. It costs a lot of money to collect what is due to DMEs.

From my experience, the Remstar Auto costs $300 more than a basic CPAP and the S8 Vantage costs $200 more.

I don't know why they changed their mind. My guess is you were polite and they're willing to work with you. You insurance company may pay a higher than average rate for CPAPs and that makes it easier for the DME to absorb the costs.

[Rastaman]

Well, I certainly don't want the company that diagnosed my sleep apnea to go under by any means. I don't want them to take a big loss on it either. I like the c-flex feature on the Remstar Plus but hope to enjoy the versatility of this exchanged unit. And I certainly hope that they are able to "move" this Remstar and make something on that.

I try to be polite. My grandmother always said you'll catch more flies with sugar than with vinegar. I still haven't figured out why we need to catch flies in the first place but you know......

[Bonnie]

Then can you explain why Apria billed my insurance company just over $500,00 for a Swift, a cpap hose (which I didn't order) and 2 packages of filters? And my insurance company paying it? Seems the profit margins are a bit high? And insurance premiums off the charts?

And the commemts are right.....being polite is the right way to be. But when one is relegated to spending hours of time and phone calls dealing with less than caring people who do not have your best interest at heart.....I seem to have read many more posts here regarding inept, terrible service, bad advice from DMEs compared to the few that people have had success with them. People who see a DME after diagnosis go with their script in hand and are not given options or choices based on the patients needs. It is generally through research or a forum one learns what all this new lingo in the world of OSA is about. Then make intelligent choices what would be best for them. Other wise why would people visit a forum? The information given by people who actually use the equipment? The advise to help make the transition easier? This you don't get from a company who is is business to make money. Perhaps if Apria hadn't rushed me out the door after 5 minutes of instruction on how to clean my machine, not returning my phone calls for a few days when I had questions or problems, telling me I am wrong for questioning their expertise, etc. etc. I might have a different opinion of them.


And Bingo, "thumbing your nose" and "treating them like dirt" are two very different actions.

[Rastaman]

That seems ridiculous on the billing aspect. These masks are $125 or so. The hose shouldn't be anymore than $15. And filters should be just a few dollars also. Up $150 tops?

[Bonnie]

Should read $500.00 not $500,000....

[Rastaman]

That's how I read it anyway but even so. Times 4 the price?

[Lyn]

It does not take much to realize that if you are being paid $700.00 and your machine costs you $800.00, that you are going to lose out.

Now, before anyone goes leaping to quote prices, it also has to be understood a provider can NOT provide a $600.00 machine at a $700.00 reimbursement level and make a profit.

I completely understand that this site, being owned and operated by someone who also owns an internet retailer and also owns an insurance billing agency and also owns a marketing business selling CPAPs is not going to particularly like a traditional equipment provider. However, I think it is very unfair not to provide balanced and accurate information to those who ask for it.

For a ResMed S7 Lightweight, hose, O2 hose connector & Activa mask & headgear the DME charged my insurance co $1880.00. Just to compare, these items would total approx $414.00 thru cpap.com. The ins co approved & paid $1420.78. I wanted a ResMed S8 Vantage ($766.00 at cpap.com for Resmed S8 Vantage EPR Auto CPAP and H3i Humidifier Combo with hose) so I had to pay the DME another $100.00 out of my pocket. So you'll have to excuse me if I don't have much sympathy for the DME that's only making $655.00 to $1007.00 profit.

As far as the S8 Vantage itself, it's a great little machine. You are correct that the EPR can only be used in cpap mode. My pressure runs around 10.8, so I've never needed to try it.

Lyn

[neversleeps]

I completely understand that this site, being owned and operated by someone who also owns an internet retailer and also owns an insurance billing agency and also owns a marketing business selling CPAPs is not going to particularly like a traditional equipment provider. However, I think it is very unfair not to provide balanced and accurate information to those who ask for it.

First off, show me ANY case where an insurance claim has been "double or more" what anyone has paid online.

Here we have some balanced and accurate information for those who asked for it:

Price using a traditional DME: $2232.65
Price of identical equipment using online DME (cpap.com):$718.75

(see: viewtopic.php?p=36815#36815)



Price using a traditional DME: $1200.00
Price of identical equipment using online DME (cpap.com):$199.00

(see: viewtopic.php?p=36811#36811)



Price using a traditional DME: $2900.00
Price of identical equipment using online DME(cpap.com):$1000.00

(see: viewtopic.php?p=8449#8449)



Price using a traditional DME: $1850.00
Price of identical equipment using online DME (cpap.com): $800.00

(see: viewtopic.php?p=8564#8564)



Price using a traditional DME: $2500.00
Price of identical equipment using online DME (cpap.com): $325.00

(see: viewtopic.php?p=9294#9294)



Price using a traditional DME: $2500.00
Price of identical equipment using online DME (cpap.com): $650.00

(see: viewtopic.php?p=78986#78986)



Price using a traditional DME: $3400.00
Price of identical equipment using online DME(cpap.com):$1569.00

(see: viewtopic.php?p=79010#79010)

By the way, although no one brings it up, our very host here ALSO gets paid those same amounts. No one refers to him as "evil" either.

I wonder why...

[Darth Vader Look]

Excellent rebuttal neversleeps. Bingo ------- balls in your court and in play.

[ozij]

neversleeps - always vigilant. And factual!

O.