Why Do DME's Charge So Much?

Jeff,
Reference your comment on copays. Yes I have been paying them for the past two years.

curtcurt46 wrote:Jeff,
Reference your comment on copays. Yes I have been paying them for the past two years.

Ok, thanks. I have not paid, nor been asked to make a copay for anything related to CPAP. I thinks that's odd. I do pay a quarterly payment for my Tricare Prime coverage though.

Jeff

I have Blue Cross Blue Shield - they don't pay the full amount that my DME provider bills them. For example, the Swift nasal pillows are billed at 50.85, but they only pay 40.20. For the rental of the machine, they bill 316 but BCBS only pays 95.05.

However, I just discovered that my insurance limits DME benefits to $1500 per calendar year and I reached that limit in September. Ouch - My DME will bill me at the rate that BCBS actually pays, not what they bill them, but now I'm faced with paying for all the supplies they sent me (I told them not to send anymore this year, and I'll return what I haven't opened).

I started CPAP in March so I have two more rental payments in this calendar year and then I'll suposedly own the machine. BCBS told me that I could write to their Grievances & Appeals department and they might be willing to push the remaining rental claims into the next calendar year.

Just wondering - does everyone follow all the recommendations for replacing supplies. I clean mine regularly and they look fairly pristine by the time I throw them out (I've actually been saving the hoses - maybe I'll find some non-medical use for them). The DME sends me stuff on a regular schedule, but I wonder if I really need so much, especially if I have to pay for some of it!

Allen

albelk wrote:does everyone follow all the recommendations for replacing supplies.

Allen,

I doubt it.
You didn't list all of your equipment, but in any case.....
I'm still using my original mask, seals, hose and (washable) filters after 18 months and everything's still in good shape. I didn't use a local DME (bought all of my stuff from CPAP.COM) and so have not had to succomb to the Determined Money Extractors gimmicks of selling "stuff".
If you push this contract into the next (fiscal) year, your deductibles may kick in again and it'll cost you even more.

Good luck,

Den

albelk wrote: [...]
Just wondering - does everyone follow all the recommendations for replacing supplies. I clean mine regularly and they look fairly pristine by the time I throw them out (I've actually been saving the hoses - maybe I'll find some non-medical use for them). The DME sends me stuff on a regular schedule, but I wonder if I really need so much, especially if I have to pay for some of it!

Allen

Allen, I don't toss my stuff either. I keep using it as long as it still works. If my insurance would automatically pay for masks, supplies, etc., every few weeks or months, I'd probably take them up on it but it still wouldn't make a lot of sense to me.

OCO

My DME charges my insurance company $2500.00 for my machine.

The exact same machine can be bought at CPAP.com for $516.00!

https://www.cpap.com/productpage-bundle ... undle.html

'nuff said, wouldn't you say?

Just wondering - does everyone follow all the recommendations for replacing supplies. I clean mine regularly and they look fairly pristine by the time I throw them out (I've actually been saving the hoses - maybe I'll find some non-medical use for them). The DME sends me stuff on a regular schedule, but I wonder if I really need so much, especially if I have to pay for some of it!

Allen

I think non-cat owners sell their extra stuff on eBay and yahoo. However, the cat owners need all the extra stuff they can get..