I'm visiting the DME - help!

snoregirl wrote:I don't know what he was quoting for his aprox $800 to $1200 range, but I suspect he was talking machine, which again is misleading since you need the humidifier too and they aren't giving that away free.

I was not trying to mislead anyone. I was referring to a complete setup - CPAP, Humidifier if ordered and a mask.

mattman

snoregirl wrote:Back to the machine costs. I really don't think most DMEs want you to know. I called 3 before accepting stuff from one and all three I had to pull teeth to get a straight answer as to the total cost of the machine. They REALLY wanted to just tell me my monthly rental. But I wasn't interested in that, I wanted the whole picture to make my cash vs. Insurance decision.

The more likely reason (from my own experience) is that most everyone will be reluctant to get into specific dollar amounts for 3 reasons:

1) It is damn near impossible to decipher all the insurance hurdles and therefore be able to determine what exactly the price is going to be. There are just too many variables not the least of which is the most basic 'Does the patient actually qualify?'. You can have a box full of valid prescriptions but if the insurance determines you don't qualify they don't mean a thing. So suddenly your 15 dollar copay turns into a $900 charge. Believe me, those phone calls are anything but pleasant. I'll give you 100 bucks if you can show me one instance of this happening where the first thing we hear isn't 'I was told I only have to pay x dollars and I'm not paying you damn people 1 cent more'. (Random side bar - This situation is EXACTLY so many times a DME provider takes a week or more to deliver and keeps saying things about waiting for information from the Doctor. Yes we have a prescription but we are trying to get the documentation the insurance company requires to prove the patient qualifies).

2) The price can vary wildly based on the prescription that actually comes through. This is often very different from what we are being told on the phone either based on a doctor changing the order just prior to faxing it or the person on the phone not understanding what is actually written (A perfect example might be an Rx written as: CPAP 4-16 in a doctors handwriting can VERY easily be confused as: CPAP @16. H-U-G-E potential for a difference in cost).

3) God help you if you tell someone a dollar figure (Even if you say 'This is a guess/approximate/etc 482 times during a 60 second phone call) and what's actually billed is different. I hear this more often than I care to even think about. Seriously. So yeah, a lot of people in this business are extraordinarily reluctant about quoting prices due to the large variance in what the final cost will be.

It has nothing to do with trying to mislead people or rip people off or lie to people or anything. It's because it's just too damn hard to know for sure and we get burned every day for it already.

Oye, I just went back and looked at this post. Sorry to get so far off topic and into such length.

mattman

On the comment with the complete setup I said "IT IS misleading" not that YOU were trying to mislead anyone.

You didn't specify what setup you were talking about and IN MY EXPERIENCE I know what I was charged and what they paid and it was significantly higher than your number. Maybe in your area of the country, or the insurance companies you deal with it is lower, but mine wasn't an I have met a lot of people here whose numbers look an awfully lot like mine. I chose to give my numbers and point out that they were greater than yours.


On the estimating and lack of effort of the DMEs I contacted.... I understand that it is difficult with many insurances, however, I gave them the EXACT machine I wanted (I didn't care what the doc ordered, I wanted prices on what I wanted so I could compare, I wasn't buying anything else). I gave them my exact insurance and said ASSUME THAT I QUALIFY what would you be charging?

I live in an area dominated by a large company. I would guess that MUCH of their business comes from people with the exact same insurance I have.
At the time I started this I had NO idea if it was $500 or $5000. I had to get past that first.

My kid's orthodontist can submit a preapproval form and tell me aprox how much before I agree to his cementing stuff in her mouth. Why not with CPAP?
There are contract rates for this, someone has to have the charts or contracts, if not how do the billing people know that they are getting the correct payment from the insurance companies, blind trust?

It is impossible for a person in a billing office processing tons of claims to have no idea whatsoever the general costs, much less not be able to come pretty close knowing my real numbers when provided with the exact insurance and exact machine. I didn't want a committment that they would give me this, I wanted to know ASSUMING I AM APPROVED what I would be paying. How can anyone shop without these numbers?

Given my exact insurance which is far from obscure, and the exact machine I wanted (which by the way you know as well as I do makes NO difference to the numbers, only to the insurance company approving it), there is no reason a reasonable estimate of cost can't be arrived at.

I used to work for an HMO (10 YEARS). There's a little-known deductible benefit many health insurers use that MAY benefit you and others with high medical or DME costs. Especially if you are fairly healthy and don't usually seek medical care.

Call your insurance company and find out if they credit whatever deductible credits you've met in the last 3 months of the calendar year to the next deductible calendar year. For instance, if you didn't have any medical bills in 2006 until after October 1st (for a January 1-December 31 plan year), your insurance company may deem that you have satisfied your deductible for 2007. If you have satisfied a portion but not all of your 2006 deductible in the last 3 months of 2006, whatever portion of your deductible satisfied in the last 3 months of 2006 MAY be applied to satisfaction of your 2007 deductible.

If one plans well, one can see where if this is the case, some elective healthcare issues could be bunched up in the last 3 months of the year, every other year, giving you, in effect, a free year's deductible, if you stay well and don't need to use it for the first nine months of the year every other year. I always try to work this specific benefit to my advantage, or used to, til I got really sick. But, in effect, a healthy person can go on 2 years health coverage paying only one deductible doing things this way. As your office visit copays don't count toward your deductible anyhow, you can still receive check-ups (generally speaking) and meds checks and such, in your 9 months every second year when trying to avoid paying toward your deductible.

I know this sounds complicated, but I'll field questions if someone needs help with this one.

girlsaylor

Hello All. I'm a newcomer to CPAP, and find this site amazingly informative and populated by incredibly helpful people. I have a rather odd question...

First, some background info. I'm renting a Resmed S8 Elite, which works fine. The only problem is that it emits a faint but persistent high-pitched sound which I find extremely annoying. The background "whooshing" noise of moving air is no problem, in fact it's rather soothing, but that high-pitched sound... I have a very low pressure requirement (only 6 cm H2O), so I don't need an elaborate machine. My main concern is noise. I would like to test out a number of machines, but I live in Ireland, which has a small population and therefore rather limited choices in terms of available CPAP machines and suppliers.

I would rather avoid the laborious process of renting multiple machines just to find out which one suits me best in terms of noise. What I really need to do is to go into a quiet room, and plug my mask into a variety of machines, and find the one which is quietest in terms of extraneous noises.

I'll be in the CT/NY area in May. Does anyone know of a DME supplier in those areas which would let me try out various machines on their premises? If I find the right one I'd buy it for cash, so there'd be no insurance issues.

Thanks!

Mike