I'm in the wrong business

I don't have the paperwork in front of me, but what my DME PAID for my CPAP was not that much more than I could have purchased it online if I had paid out of pocket (I didn't purhcase online, though, because I had insurance at the time). What they were CHARGED by the insurance company was a lot more, but they didn't pay that. Medical providers/companies have a different contractual agreement with different insurance providers, and that's what they pay--not what is charged. Sometimes it's a huge difference; sometimes a small one. Every doctor/facility I've ever dealt with, if I had insurance at the time, their bills showed what they charge for the product/service, show an insurance contractual write-off and then what the insurance will pay after the write-off, and then what I owe.

My DME is probably a bit above average. Although they've never come to my house, they did extensively go over the setup, etc., when I went there to pick it up. They called a few times the first six months, but not since. But, if I call them, the service is great. If I order something through them, they send by UPS or FedEx and I usually get it the next day. When I had to go through my PCP for an overnight pulse-ox because I tried for two weeks to get my sleep doc to call me back about it and he wouldn't, the DME offered to try to call the sleep doc themselves, if I wanted them to (I elected not, since my PCP had already faxed the DME the order). Received the stuff the next day, with detailed instructions, and I got to keep it for a two-night study instead of one. They had a FedEx pickup time scheduled and all I had to do was repackage it and have it ready for pickup at my house.

My husband's DME is similar, although he has not had to order anything from them since his study earlier this year. They have called several times checking on his progress and when I was talking with her, she was very helpful and supportive with some issues I was having with him and his therapy!!

Thankls, Leejgbt and AKCPAPGuy, for the Medicare information. I appreciate your input!!!

And thanks, WearyOne, for sharing your and your hubby's local DME experiences.

WearyOne wrote:I don't have the paperwork in front of me, but what my DME PAID for my CPAP was not that much more than I could have purchased it online if I had paid out of pocket (I didn't purhcase online, though, because I had insurance at the time). What they were CHARGED by the insurance company was a lot more, but they didn't pay that. Medical providers/companies have a different contractual agreement with different insurance providers, and that's what they pay--not what is charged. Sometimes it's a huge difference; sometimes a small one. Every doctor/facility I've ever dealt with, if I had insurance at the time, their bills showed what they charge for the product/service, show an insurance contractual write-off and then what the insurance will pay after the write-off, and then what I owe.

I realize there's a kickback involved at some point.

However, my company is switching to a High Deductible HSA plan. I would be paying that rental fee without the kickback until I maxed out my deductible which is $1300 because I'm single. Married folks have $2600 deductible regardless if the fees are from just 1 person or everyone combined.

I've since found out I'm stuck with the same DME supplier despite the fact the purpose of this plan is to be "Consumer Driven". How can I "drive cost" if I can't choose my DME supplier?

Not really complaining about my plan's numbers but I am complaining about being stuck with this DME like I suspected. The question is if I do go outside to buy a machine can I get credit towards my deductible and its quite likely no.

Oops, sorry, I was doing this from memory, wrong! For the 1st 3months DME billed $295, Medicare paid $80.08, Union paid $20.02 ($100.10). After 3 months DME still billed $295, Medicare paid $60.06,Union paid 15.02($75.08).

John_Dozer,

I am having a hard time believing that your insurance contracts with only onwe DME supplier. I would ask for as different DME company. Also, if you do use an out of network provider there is a separate deductible, lower allowable and greater out of pocket for you. Most insurances will post on line the providers that are in network.

leejgbt wrote:...Most insurances will post on line the providers that are in network.

Not a single online provider on my plan.

Muse-Inc wrote:

leejgbt wrote:...Most insurances will post on line the providers that are in network.

Not a single online provider on my plan.

I think leejgbt meant, in other words, that the insurance company posts on their website the listing of in-network providers.

ScrappinMom wrote:...I think leejgbt meant, in other words, that the insurance company posts on their website the listing of in-network providers.

Oops! Even so, not a single one of the vendors shown on https://www.cpap.com is shown in my insurance company's online list of in or out of network providers. Took me hrs to get a list of 25 from them and not a single one of those DMEs handles CPAP equipment...means I gotta call, spend hrs on the phone and see if any of the ones listed by our host are in-network. Any wonder I hate insurance companies?

ScrappinMom wrote:

Muse-Inc wrote:

leejgbt wrote:...Most insurances will post on line the providers that are in network.

Not a single online provider on my plan.

I think leejgbt meant, in other words, that the insurance company posts on their website the listing of in-network providers.

I have one DME provider and they don't even have an online presence. Telephone only.

I'm sorry that so many people have had such a bad experience with their DME companies. I am proud to say I'm a Lincare rep and we do everything that one poster said:

"Will your online source deliver it--same day--to your house, set it up, show you how to operate it, adjust your mask, provide personalized follow-up service, answer your questions, immediately provide a replacement if it breaks...and if you don't like it, take it back before you've paid for it?"

I know a lot of other companies mail their CPAPs or have the patient come to the office to have a group set-up. Lincare does none of these things. We pride ourselves in personal service. With over 1,000 centers in 48 states, why do docs even use these other horrible DME companies? It makes folks like you not want to use their machines.

Call Lincare and switch your service and I promise you, you'll be happy!

Good for you!! Not to worry about the set-up or follow up service. It doesn't exit..I am a Respiratory Therpaist and worked for a dme for a very long time ..And they would make us do everything by the phone and if you had questions you have to drive to our office and it was a nation wide DME !!! We would put whatever we could in the mail in efforts to not go see the pts. But thats what our managers wanted..As RT's we knew we were doing a diservice to pt. Thats why I left.

DMErep,

Are you kidding me. The Lincare reputation is one of the reasons people are using CPAP.com. Who sets up the CPAP and fits the mask? Out of the many, many masks available which ones do you bring to fit? Is it not true that Lincare has contracts with ONE manufacturer for CPAP (told this by the sales rep who did not have the contract)? Do RT's do the fittings or possibly do you use nurses with no training in this field (supervised by the lone RT on staff)?

If this is the model to follow count me out.

The reason Medicare stretches the rental to 13 months is so they can hit you up for another co-pay. I feel there is nothing I can do but eventually buy the machine I need and keep theirs for a standby. By the time you get educated on what is going on and what you need it too late to do anything else.

leejgbt wrote:John_Dozer,

I am having a hard time believing that your insurance contracts with only onwe DME supplier. I would ask for as different DME company. Also, if you do use an out of network provider there is a separate deductible, lower allowable and greater out of pocket for you. Most insurances will post on line the providers that are in network.

Does Cigna ring a bell??

Apria won't either then.