Damn DMEs

I just had to vent tonight as I opened my bill from the DME. For my Autoset Spirit AutoPap, humidifier and two masks, the insurance company paid those bastards $2900. I still owe them $360.

One of the masks was lousy and one was the wrong size! I could have bought the whole thing for less than $1000 at cpap.com, and I'm sure the folks there aren't going hungry.

If I'd known then what I know now I 'd never have let them order me the machine. I'd have bought it online and billed the insurance myself, saving us both a lot of money.

bottom feeders, imho.
You've learned the DME dance of the thieves.
We've all been there, heard that, see it all, and done that. They are a necessary evil. I bought additional equip. from CPAP.com. Best ever.
My DME I doubt I will hear from anymore, which is ok by me.

SleepyGuy wrote:I just had to vent tonight as I opened my bill from the DME. For my Autoset Spirit AutoPap, humidifier and two masks, the insurance company paid those bastards $2900. I still owe them $360.

One of the masks was lousy and one was the wrong size! I could have bought the whole thing for less than $1000 at cpap.com, and I'm sure the folks there aren't going hungry.

If I'd known then what I know now I 'd never have let them order me the machine. I'd have bought it online and billed the insurance myself, saving us both a lot of money.

What you have is a typical DME experience . Can't say we haven't been warned if you spend any time at all reading this forum. All the references to Jimmy Hoffa and the MOB and witness protection program. Sure they were jokes but now you know what we were getting at. The DME references and links to Cpap.com prices to compare to. Funny how some think it wont happen to them... But you got your insurance to "pay out"..LOL

Some lessons hurt more than others. At least your insurance was holding the bag and not you.

Don't feel bad. There are alot of us in the boat with you. Now we know better also.

Chris

If we want to keep down medical costs, DMEs would be a great place to start.

Those are some rough words. I'm not here to say that every dme is great. All I can say is what I know. Let me give a hypothetical situation...

Say for example a dme pays $450 for your cpap unit with heated humidity and the tubing.. Then the dme pays about $100 to $150 for the mask that we give you.

A typical insurance company will reimburse about $700 for the machine. They might reimburse $25 for tubing and $200 for the mask. (if we're lucky) So total reimbursement is $925. Minus the $450 of course... and the $100 for the mask.

Now the dme has made a profit of $375. This is not bad. But don't forget they paid a respiratory therapist to go out to your home and spend an hour plus with you. Not to mention the continuing follow up that they do. (a good dme will do I should say) The mileage and expenses involved in the company vehicle that is used to get out there....blah blah blah.

In the end a dme is making only a few hundred dollars if that per new cpap patient. This may seem not too shabby but trust me when I say that there are several other indirect expenses involved.

Not all dme's are evil. Not all of them are good. Do your homework and do not accept sub par treatment!!! There really are companies out there who care about you and your treatment, not just profit!!

Melissa

MelMel1 wrote:Say for example a dme pays $450 for your cpap unit with heated humidity and the tubing.. Then the dme pays about $100 to $150 for the mask that we give you.

Well, yes, but your numbers are really off. You're quoting CPAP.COM prices.

I don't know about other states, but here in NH, that $450 CPAP unit with humidity and tubing sells from DMEs for $1800. The "discount" price "negotiated" by the insurance company is about $1200. The mask (and by the way, they can't be $100 to $150, if CPAP.COM can sell them for that and make any money at all) runs more like $250 or more. Hoses are NOT included... Nor is the humidifier.

All totalled, my price from the DME is $1850, for equipment that I could get from CPAP.COM for about $800.

So even assuming the DME purchased the equipment FROM cpap.com, and therefore their cost was $800, that's over $1000 pure profit. Now, I've spent some time with my provider fitting masks, perhaps 2 hours of total time. So basically, your argument is that her time is worth $500/hour?

And remember, these are negotiated DISCOUNT prices. If I bought it from them WITHOUT my insurance, the total cost would be in the neighborhood of $2500. $1700 of profit.

That's not "fair margin", that's gouging.

Liam, who doesn't begrudge someone FAIR profit, but thinks profiteering on the health needs of others is scummy at best.

You're quote, "if we're lucky" eerily sounds like you are a DME. If you are, it's a tough way to make a living, but if all the DME's are worried about is profitability what about the dictate, "WHERE IS THE SERVICE IN CUSTOMER SERVICE"?. We are educated consumers, expect to be treated fairly, not have our INSURANCE COMPANIES BILKED, causing the out of sight insurance prem's we all must endure. Thank GOD for the 'net where we have learned what's real, what isn't and all the BS in between.

Sign me: Glad my DME's day are done with me.

MelMel1 wrote:Those are some rough words. I'm not here to say that every dme is great. All I can say is what I know. Let me give a hypothetical situation...

Say for example a dme pays $450 for your cpap unit with heated humidity and the tubing.. Then the dme pays about $100 to $150 for the mask that we give you.

A typical insurance company will reimburse about $700 for the machine. They might reimburse $25 for tubing and $200 for the mask. (if we're lucky) So total reimbursement is $925. Minus the $450 of course... and the $100 for the mask.

Now the dme has made a profit of $375. This is not bad. But don't forget they paid a respiratory therapist to go out to your home and spend an hour plus with you. Not to mention the continuing follow up that they do. (a good dme will do I should say) The mileage and expenses involved in the company vehicle that is used to get out there....blah blah blah.

In the end a dme is making only a few hundred dollars if that per new cpap patient. This may seem not too shabby but trust me when I say that there are several other indirect expenses involved.

Not all dme's are evil. Not all of them are good. Do your homework and do not accept sub par treatment!!! There really are companies out there who care about you and your treatment, not just profit!!

Melissa

SleepyGuy wrote:I just had to vent tonight as I opened my bill from the DME. For my Autoset Spirit AutoPap, humidifier and two masks, the insurance company paid those bastards $2900. I still owe them $360.

One of the masks was lousy and one was the wrong size! I could have bought the whole thing for less than $1000 at cpap.com, and I'm sure the folks there aren't going hungry.

If I'd known then what I know now I 'd never have let them order me the machine. I'd have bought it online and billed the insurance myself, saving us both a lot of money.

Strange part bout that is that the insurance companies don't seem that interested in doing that...

As for the mask, at least it was the right style wrong size, my sleep study even indicated LARGE FULL FACE MASK as required and when I went to the DME they had a small nasal all ready...

(It was flattering in a way, no one has ever considered my nose small )

Now that I am losing my insurance, I asked my DME company how much it would cost me to buy the equipment I have been using,..$1695! I have been using it for about 2 months now and am using a Resmed S6 (which is almost impossible to find anymore, seeing how the S7 is out and the S8 is due out any day). I also have the HC150 humidifier.

I have no problem with the DME's service, they treated me great. But the prices? There outta be a law!

I have a wonderful local DME- they do everything to get my medical equipment from monthly home deliveries & multiple shipments of supplies from the central warehouse. Even when I didn't have insurance to cover all the stuff I needed for my multiple medical problems they went above and beyond to provide me with everything I needed and never charged me a penny- they were probably writing off $200-300+ of rentals & supplies per month. When I started BiPAP ST there was a problem getting my heated humidfier covered by Medicare so they wrote off the $250 instead of making me pay. I know some of it comes down to time is money with DME's and the amount of time it would have taken their claims specialist to appeal the decision would have cost more then what they paid for the heated humidfier wholesale.

DME's don't just have to service us as a customer but they also have to service the insurance companies that ultimately pay for a vast majority of medical supplies. It is really hard to serve two masters who have very different agendas- I was in a similar situation as a workers comp case manager years ago. As patients we only see one side of the DME but there is a lot more going on then just getting us our equipment and cashing a check from your insurance company. DME's have to make sure the script is correctly worded and signed by the doctor along with verifying supporting medical documentation before they can even summit a claim to an insurance company. It might go through but it might be bounced back....there's no garuntee the insurance company won't change the rules and make the DME jump through more hoops just to get reimbursed. It is an unfortunet aspect of our society in the US that medical businesses need to have just as many insurance claims specialist as they do medical professionals to deal with all the issurance red tape.

While you have your new xPAP and related equipment the DME is out the $$$ until the insurance company pays which could take a couple months- would you want to work today if your boss told you that you wouldn't be paid for it for 90 days? This part of the reason on-line DME's can charge less- they don't have to wait for payment as you pay before you get the equipment. If an individual can get their insurance to pay for an xPAP from an online DME the individual has to come up with the money first and then play the insurance game...a lot of people cannot afford to do that so they must rely on local DME's that are willing to work with their insurance.

Do I think there are bad local DME's out there? I know there are- I dealt with a couple before I found my current one. It is like everything else- there are good and bad. We should not assume that all local DME's are bad and that all internet DME's are good. Each person needs to find the right provider for themselves. I've used cpap.com for some items I wanted that I knew would be difficult to get through my local DME- I'm glad I have the option.

MelMel 1, They aren't ment to be rough. They are ment to be a WARNING to future cpap equipment purchasers.
Cpap.com makes money selling at a fair price. So , if you sold it at double you would make a profit. But no, you guys sell at 3, 4, 5, 6 times cpap.com retail, and then don't really have a clue how the stuff works.

The last 3 cpaps I purchased included the tubing . No extra cost . You DMEs disassemble the package and price each piece individually. Not to mention removing the Clinician manual to sell on Ebay.

Jimmy Hoffa isn't buried in New Jersey he's running a DME somewhere near you.

Warning to all readers. Visit your local DME at your own risk.

Except you Christine, your nice

Cheers,

Chris

Yes I agree Chris, Gailzee, the DMEs have a con game going. They bilk their customers when they are the most vulnerable. Tired weak, confused unknowing of whats in store for them. The patients trust them and get robbed.

Waverly

As I understand it the RT provides service as well as a product. In my case he spent a very long time, in educating me, answering all me question, (and still answering them to date), and being truly attentive to my needs. Yes his prices are more than CPAP.com but if I count the hours of trained and experienced service, I do not begrudge his compensation be in the form of a surcharge over his wholesale price. The problem is systemic and the DMEs worth their salt should not be blamed automatically.

In the end, what seems to be a requirement, is that it is OUR responsibility to take responsibility for SELF, and not give this up to others. Inevitably, this means more work on your part to educate your self thoroughly and be prepared in discussions with doctors, DMEs and the Insurance people. Knowledge and assertion in the belief that you may know a bit helps.

It seems really easy to first establish blame instead of doing a little bit of critical thinking.

What I find about this community of cpaptalk is a confirmation of the adage that "No one is as smart as all of us..."

I agree seanconnery. That said. BEWARE OF THE EVIL DME.

Except Christine. She's a nice one.

Ionizer

seanconnery wrote:In the end, what seems to be a requirement, is that it is OUR responsibility to take responsibility for SELF, and not give this up to others.

Words to live by. I think I shall paste a copy of this somewhere where I can stare at it and be reminded......for I need to be reminded. Thanks.