Switching DME during rental period?

chunkyfrog wrote:I would hate to be cut down to some POS brick.

chunkyfrog wrote:I just called my DME, and they said that my machine would be grandfathered.
There is some talk that competitive bidding is being postponed, or even abandoned completely.
Good news if true. Very good news.

Janknitz wrote:

My DME just delivered my heated hose last week. The charge was $79, compared to the cpap.com price of $40. Looks to me like a couple of years of supplies are going to be pretty lucrative for the DME, too. And if they do a good job, you'll still be there down the road when it's time for the next machine.

I used to think this way too, but consider . . .

The charge was $79, but if you have insurance, what will ultimately be paid between your insurer and your co-pay or deductible? (and if you don't have insurance, why would you pay $79 out of pocket if you knew you could get it for $40???). My guess is that once insurance kicks in plus your share they will get close to the $40, perhaps even less. But a whole lot of paperwork will transpire before they get paid a cent. So when you pay for their billing department and their negotiation runarounds with the insurer, their liabilities, their rent and inventory, on-staff respiratory therapist, they probably make $5 or $10 profit on the hose, while cpap.com with its cash basis is probably making $20. So just how lucrative is it for the DME to sell supplies???

The behavior of the DME's tells the story. Some DME's flat outright refuse to order things like a single replacement cushion, because they are in the red by the time they do all the documentation, ordering, delivery, etc. So they probably are much happier when we DON'T order supplies from them, unless it's a bigger order of multiple items (hose, humidifier chamber, filters, and a new mask that can be parted out).

And will THEY be around by the time it's time for us to order a new machine. In the current climate--thanks to Medicare competitive billing--possibly not. So they could care less about making us happy, and it shows in the lousy way most DME's treat us "valued customers".

chunkyfrog wrote:On a slightly different tack, I am on Medicare and 3 weeks into my capped rental of my new machine.
Competitive bidding is coming up, effective next year. Will my lovely new machine and awesome DME
be grandfathered, if the bid goes to some clip joint? I would hate to be cut down to some POS brick.

This is not always the case though. I just found out this morning that my current DME had billed my insurance $595.65 for some supplies I ordered last week. That seemed like WAY TOO MUCH $$ so I called my insurance to find out what they had billed for and what the insurance allows for the items. Here's what I found out.

Resmed P10 headgear: DME billed $94.17 and insurance allows $29.96
Resmed Filters (2/pk): DME billed $27.84 and insurance allows $8.14
Nasal applicator (assuming this is the P10 mask frame): DME billed $319.00 and insurance allows $88.70
Nasal pillows: DME billed $154 and insurance allows $42.85

So the DME billed a total of $595.65 and the insurance company allows $169.65 (which is what the DME will get paid by the insurance company as my out of pocket has been met). I could have gotten all of these supplies for about $105 from cpap.com. So the DME is getting about $64 more for the items, which should more than make up for the little bit of extra time it took to bill my insurance.

Janknitz wrote:

This is not always the case though. I just found out this morning that my current DME had billed my insurance $595.65 for some supplies I ordered last week. That seemed like WAY TOO MUCH $$ so I called my insurance to find out what they had billed for and what the insurance allows for the items. Here's what I found out.

Resmed P10 headgear: DME billed $94.17 and insurance allows $29.96
Resmed Filters (2/pk): DME billed $27.84 and insurance allows $8.14
Nasal applicator (assuming this is the P10 mask frame): DME billed $319.00 and insurance allows $88.70
Nasal pillows: DME billed $154 and insurance allows $42.85

So the DME billed a total of $595.65 and the insurance company allows $169.65 (which is what the DME will get paid by the insurance company as my out of pocket has been met). I could have gotten all of these supplies for about $105 from cpap.com. So the DME is getting about $64 more for the items, which should more than make up for the little bit of extra time it took to bill my insurance.

Yes, that is my point. The amount the DME bills is PURE FANTASY. The amount the insurer will pay is going to be less. I didn't mean to imply it's always less than the retail price for the same supplies--sometimes it is and sometimes it isn't. So when someone says that the "DME billed my insurance $79 for a heated hose"--it doesn't mean the insurance will pay $79. We're on the same page here.