Damn DMEs

When I got my equipment almost 2 years ago, I did the research online and knew what "retail" costs were. My HMO contracts with a home health agency, who charged the HMO (BCBS) separate monthly rental fees for the CPAP and the humidifier. They were paying out over $300 per month in rental fees. (Masks and supplies were charged out when supplied)

After a few months of seeing the bills being paid, I called the HMO and was told "we pay rental fees up to the purchase price--then stop; at that point you "own" the equipment." When I asked them what the used for "purchase price," they told me $3000!!!

Sure enough, after about 9-10 months, they stopped paying and the home health folks stopped billing. Go Figure!!

Hoping to sleep tonight...

Sean,

One big difference you may be experiencing in the DMES department is that you are from CANADA.

In the USA, the DMES are crooks and they try to fast food you right out of their office. I have learned more on this forum than I ever did from any DMES.

I am a little partial to Canada in that you guys have some excellent MD's. I know because that is where my MD is from and he is awesome!!

So, please keep your beef and send your MDs down here!!!!!!

Signed: A Beef Farmer's Wife

you hit the nail on the head, of the DME argument, to feel sorry while they "wait'' for their ""insurance payments" GIVE ME A DOUBLE BIG BREAK. Don't worry they got the overhead, and costs, and salaries, all figured in, before you even make one phone call to them. No one is arguing fair profitability, its the gouging and then our being made to feel ''guilty'' or worse ''uninformed"". As to the DME's who do go the mile, ISN"T THIS THEIR JOB ANYHOW?

I'm tired of talking about my bad experiences with the Do not much-to-nothing DME's, and exactly the best quote is, TAKE CARE OF YOURSELF. The DME's are in it for the ''da-- money experience"....how's that for a nickname

LDuyer wrote:

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.

Grant I wrote:When I asked them what the used for "purchase price," they told me $3000!!!

And we wonder why our insurance premiums are so high. $3000 for $800 worth of equipment.

Like we used to say in the air force. Nuke the Piss Ants


Fly Guy

Well there you go . If all the DMEs are crooks shopping around won't help much. Now that we have the internet and good people like cpap.com and cpapplus.com there shouldn't be any more price gouging right... LOL .. People trust them just like they trust their Doc or pharmacist. They dont know any better. Who thinks of buying medical equipment on the internet. My father doesn't own a PC . Never heard of a .com . To him a keyboard is part of a piano or organ. What about them. They are victims waiting to happen.

Beware of the DME.

Not you christine.

Chers,

Chris

Well, that is it then. I am going to open up a DME and make my fortune! Anyone care to invest?

I still wish that the DME functions were provided by a doctor. As I've said before, when I need an antibiotic to kill off that rare, resistant strain of chlamydia, my DOCTOR (and I) decide which one to try, my DOCTOR decides how much to take, and when to take it, and how to determine if it's working properly. If I see no results, I go back to my DOCTOR to change things around.

So why, with this medical condition, does my DOCTOR say "Well, you have it. Go talk to this third party about taking care of it."?

Medical insurance covers the doctor's time, which (IMO) should not count under the DME limitations of your insurance policy. Then the DME supplier becomes just a different form of pharmacy, charging a fair price and not claiming huge amounts of overhead for customer service which is (according to most stories on here) woefully under served.

And does anyone know if there's even any licensing requirements? We know our doctors have to go through years of training and licensing in order to be doctors. (It doesn't mean they all know a lot, but it DOES mean that on average they seem to).

We get an awful lot of anecdotal evidence that many DMEs don't know their ass from a hole in the ground.

Liam, who really thinks the whole system is corrupt.

Liam1965 wrote:Liam, who really thinks the whole system is corrupt.

Whoops, I got too involved in the e-mail, and lost the signoff I'd planned to use, which was:

Liam, who doesn't really have chlamydia.... the syphilis killed it off.

Also, it appears my post was not clear. My wife, who arguably understands me best of anyone in the world, didn't get what I was trying to say.

My point is that the mask fitting and stuff should be handled by the doctor. Not the providing of equipment. The doctor should work with the patient to determine what's needed, and then write a prescription (or a list for you of what you together decided for you to buy)....

I just don't see why this particular part of the medical profession is farmed out to people who are often poorly trained and seem to have little interest in helping solve your problem or even helping you remain compliant.

Sure, there are good DMEs. Mine (other than the price gouging) is pretty good. Well, my DME rep is, my DME company is the price gouger. But it sounds like there's no real regulation of them, so the fact that I got a really good one was a crap shoot.

My wife suggests we start a letter writing campaign to the various state attys general or insurance commissions and newspapers, complaining about the price fixing.

Liam, who prefers his prices broken.

My DME service was so bad I called the HQ and made a complaint. First they were going to come to my house 45 minutes away. Never made an appointment. I had to call them. "Oh, we don't do that anymore. Can you come in next week at so-and-so?" Well, what are my options? Got there and said i'm a side sleeper so I guess I'll need something like a nasal pillow> They brought out a breeze, half-way adjusted it on my face, said "IT's yours", you can't have another one for 6 months". Told them I traveled a lot and they ssaid they would have me a PB 420E when I came back in two weeks with the Spirit to download the data. Showed me how to hook up the humidifier, threw out the ring that came with it as she said she'd never found a use for it (instructions were on the first page of the instruction booklet which I guess she never read). Took the stuff home, all was well, except I really didn't like the Breeze. Kept having to adjust the straps, the length, the nose piece all night long to keep a seal. Went back in 2 weeks, no RT, someone else downloaded the data, said 10 minutes it was 45, I asked for my new machine and it "hadn't been ordered yet", probably be 2 weeks or so". They said they had to order it from the manufacturer (now don't tell me they paid CPAP prices to the manufacturer). Told them I could have had it from CPAP.com overnight. They said , "Gee we wish we could do that but we have to order from the manufacturer."
Got my PB420E two weeks later. Couldn't get the sensor line to reach the unit from the humidifier. RT says pull it out until it does. Well, then the line was 4" into the other end and it appeared I wasn't getting good pressure readouts. I pushed it back in until the tube came out the other end more like originally, elevated the unit so the sensor tube didn't have to go so far (why couldn't he have suggested that?).

Since the script for my equipment said APAP, hose, mask, headgear, heated humidifier, hose, everything was priced separately. Now the hose comes with the CPAP and the headgear usually comes with the mask, unless it is a replacement, and the humidifier hose comes with the humidifier, so why are these all specified separately? And the headgear for the Breeze was about $75 and the Breeze unit the same. I know insurance won't pay but up to a certain amount, but this does still seem like price gouging to me.

When I asked to try a different mask I was told they couldn't do that, because they couldn't take the old mask back, because they couldn't sterilize them. Huh? they do it at the sleep labs all the time, they do it at Awake America all the time.

Well, after my complaint, the HQ called me and discussed my problems. They then called the head RT at the local office and talked to him and he called me. Turns out my RT had been there about a year and he agreed she was not well educated on the various units. He said if I needed anything more to contact him. I asked most recently about purchasing the integrated humidifier for the 420E and he said he would switch out my FP humidifier for the new one when it came in. It's in, and I'm going in this a.m. to get it.

So, so far, I've made something like 6 trips to my DME, several of them basically fruitless. Not one dime has been spent on their end driving out to where I live. Of those 6 times, I've seen an RT 3. one time they tried to give me another humidifier because their records showed I didn't have one.

When I called my insurance company about a month into treatment and asked if I could purchase online, I was told that the DME had never filed for insurance coverage on what I already had. One month of the DME not filing, one month sooner they could have had their money. To this day, I've still not received an Explanation of Benefits from the insurance that was paid to the DME. And it has now been two months.

I figure the purchase price of equipment from the manufacturer is about 1/2 or less of the amount charged on CPAP.com. And, yes, I agree the markup is about 4 times or more. If the insurance company is paying, it will pay about 3 times the markup. If a patient has to pay, it will be the full mark-up. Why can't the DME charge a patient without insurance the same as it would get from the insurance or even less, since they don't have to go through all the paperwork trail of filing? Makes sense to me.

Forgot to mention that when I started having runaway pressures on my 420E that I immediately called my RT, who had not a clue what was causing it and said she would find out. Three days later, no response, I called again, left a messaage, still no reply. Another three days, another message left and still n reply. This is when I called the HQ. When I took my machine in for the last download the head RT took it back for the 10 minutes (hah) 45 minutes later brought it back, no mention of fixing it so the pressures wouldn't runaway.

Now, I had found out on the board how to change the 1FL to 0 and that had done the trick, but when I took the machine in I changed it back to the default of 1. When I got home it was on 0 again. Hmmm.

Janelle
It was 3 months before I received a bill from my medical supplier showing what the insurance paid and what my co-pay was.I asked why I didn't receive one each month,and they said they send it when the insurance pays.
You know how slow they are in paying,right?


Also how do you do a quote when you post a reply.I tried but the whole message came up,not just the section I wanted.

Thanks for any help I can get.

Marie

wading thru the muck! wrote:

Grant I wrote:When I asked them what the used for "purchase price," they told me $3000!!!

And we wonder why our insurance premiums are so high. $3000 for $800 worth of equipment.

$800? are you kidding? It was prolly a fisher roadkil err Paykil with the cheapest mask available... Total DME outlay $450...

Liam1965 wrote: My point is that the mask fitting and stuff should be handled by the doctor. Not the providing of equipment. The doctor should work with the patient to determine what's needed, and then write a prescription (or a list for you of what you together decided for you to buy)....

There are a lot of sleep doctors who don't keep up with the equipment in detail. They are paid to know about the disease but not to understand all the fine tuned details of each machine and mask. At least in today's medical system.

You could sit with most sleep doctors and they wouldn't have a clue as to which mask would work better on your face than any other.

They're not around during your sleep study to see how you react to a given mask that was tried, etc.

And many patients never even see the sleep specialist -- they get referred by their GP or primary doc and he/she just does what the sleep specialist recommends and then never follows up with you.

It is important in today's managed healthcare world that we be responsible and manage our own healthcare (to the best of our ability). For that reason, it's a good idea for cpaptalk.com to exist and for cpap.com to offer alternatives to local DME companies.



There are lots of faults everywhere in our medical system, I agree.