Outrageous prices

My DME sent me the usual postcard to remind me it was time to get new gear.

So I called and ordered a new cushion ( or so I thought ).

Instead I get a whole new mask and headgear and hose.

They included a price list that they charged. I suppose it was by accident because they didn't include that before.

Highway robbery!!!

These prices are for Resmed Activa mask and headgear and filters and hose.

Mask - Standard $152.88 ( not too bad )

Headgear - $65.00 ( for those flimsy little straps !! )

Filters (2)- $14.02 ( wow for two little pieces of filter material )

Hose - $53.33 ( Medicare got hosed all right )

Total of $285.23 Great Googledeemooogledee

Instead of a $30 cushion they gouge Medicare and my secondary insurance for this.

That's our government for you.

Remember - we don't get to set those prices. It's all determined by Medicare.

If you used our hosts site the charges would be exactly the same.

It's insane. They will set 1 price at 200% above retail and then set another at 50% below cost.

It's a lovely little system isn't it?

Can you tell I don't like Medicares fee schedule?

mattman

I think you are putting your finger on what is wrong with the health care and insurance industries, and in fact, most of American industry these days:

Price gouging the customer for the sake of unfair profit.

My dad was a sales engineer for years and said one thing that sticks with me regarding making a fair profit:

"If any company marks up their goods and services from their suppliers more than 15%, then they are ripping off the customer."

I try to abide by this rule in my own business. There is nothing wrong with making a fair profit on re-selling goods and services if you can add some value to them. The problem is when prices are jacked up too high, services are cut, and excessive profit goes to pay for over-inflated CEO salaries.

It's a vicious circle in today's business climate, unfortunately, the customer loses by paying more for fewer services.

telly wrote:I think you are putting your finger on what is wrong with the health care and insurance industries, and in fact, most of American industry these days:

Price gouging the customer for the sake of unfair profit.

My dad was a sales engineer for years and said one thing that sticks with me regarding making a fair profit:

"If any company marks up their goods and services from their suppliers more than 15%, then they are ripping off the customer."

I try to abide by this rule in my own business. There is nothing wrong with making a fair profit on re-selling goods and services if you can add some value to them. The problem is when prices are jacked up too high, services are cut, and excessive profit goes to pay for over-inflated CEO salaries.

It's a vicious circle in today's business climate, unfortunately, the customer loses by paying more for fewer services.

You can always cut prices with cheaper labor, We just need people to work cheaper than they do in China. Jim

"If any company marks up their goods and services from their suppliers more than 15%, then they are ripping off the customer."

I think it depends upon the industry and how much customer service is provided. I used to work for a mom and pop TV & appliance dealer. Markup on TVs and appliances was a minimum of 40%; parts and accessories had at least a 100% markup. This markup was normal and not unfair. The price included some wiggle room for haggling or for free delivery and setup. We also included quite a bit of hand holding for those who needed it.

I think a major point was missed here.

Willie asked for a single cushion and got a bunch of other stuff he did not ask for just so the DME could rake the cash in on their over-priced products.

GREED was at the root of this transaction!

I had already found this wonderful site when I was diagnosed. I asked my insurance company if I could buy my machine online and get reimbursed and save them 50% at least of the cost of the machine. Their answer was No, if I got it from the DME, it would be 100% covered, if I got it anywhere else, I would get nothing because of the deductable. In other words, they don't care about saving money, they scratch each others back.

I ended up going through the DME, and I must say that I got great service, they spent quite a long time finding exactly the right mask for me. I couldn't however get an auto, which I wanted, they would only give me a Remstar Plus with cflex, and the humidifier. Of course, no card available. I bought my auto online from cpap.com and use the humidifier that I got from the DME, so I now have a backup machine just in case I have problems.

Prices billed and collected are very different animals.
A dme may bill anything they like, but will be paid a contracted amt.

Most consumers always thing they are being robbed.]

In an earlier life when I owned a neighborhood pharmacy for 18 years, I would occasionally be confronted by a customer who thought s/he was being robbed.

I would ask them if they thought I was entitled to a profit and most agreed, then I would ask them how much and they clammed up.

Some I would ask them what business they were in and ask if they would rather me use their prifit margin instead of mine. Silence!

I would then tell them exact;y what the drugs cost me and asked them to tell me what a fair price should be and I would charge them this amt.
Nobody ever answered.

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mattman wrote:That's our government for you.

Remember - we don't get to set those prices. It's all determined by Medicare.

If you used our hosts site the charges would be exactly the same.

It's insane. They will set 1 price at 200% above retail and then set another at 50% below cost.

It's a lovely little system isn't it?

Can you tell I don't like Medicares fee schedule?

mattman

LOL last time you said it was the insurance company fault for those high prices, now it is the Government's fault? You can't seem to make up your mind to justify those ripoff prices. Are you sure it is not the DME? the one charging the fee?

I think the government should make it illegal for insurance company to dictate where you can buy your medical supplies from and force them to reimburse patients if they find the item scripted for a lower cost elsewhere.

If you are allowed 3 masks per year and they pay $150ea, then you have $450 per year mask budget to spend on masks. If you the patient can buy them for $100 each then you can get 4.5 masks per year. If they did that it will still be cheaper than the stupid way they are doing it now.

mattman wrote:That's our government for you.



If you used our hosts site the charges would be exactly the same.


mattman

I don't understand why you say if we use the hosts site--cpap.com the prices would be the same...
What I see on their site is that an activa mask cost $135.00
hose $9.99
filters $13.99 for 6!! for my respironics machine

Cindy

I guess I will add to this thread.

After two months of being on CPAP, I get both my doctor and my insurance to agree that an outright purchase of my machine makes the most sense for everyone involved. My insurance says if the claim is over $700.00 they will agree to an outright purchase. My doc is on my side and will agree as well, based on my 100% compliance.

My wife and I start calling my DME to make sure they take care of the billing the correct way to make this happen. They take over 3 weeks to even return any of our calls. The reply on my answering machine was "I don't understand what you are asking for. We have to submit this for 10 months of rental, this is the only way any / all insurance works, and we won't do it any other way"

Needless to say, the anger gear kicked in over reason, and we dropped the machine in their lap and told them what orifice they could put it in. pps:

I've already ordered a new machine from cpap.com (and it even shipped today!) Of course now for my stupidity I get to suffer for the next 3 -4 days, and risk my health.

On the other hand I got to order an APAP in place of my CPAP.

While I'm not sure that my DME motive was purely greed, the way it would have worked out with my deductible it would give the DME much more than what my insurance would have paid me.

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap.com, CPAP, DME, APAP

mattman wrote:Remember - we don't get to set those prices. It's all determined by Medicare.
mattman

Hello again Mattman!
Three things that perhaps you can explain to me:
1) Three different DMEs quote "providers charges" for the exact same mask $216.00, $175.00 and $390.00. Who sets those charges?

2) Again the same mask, with exactly the same insurance coverage, the insurance allowables are 173.00, 103.00, and $217.00. (I must admitt I don't have any medicare allowance information) Who sets these allowances?
These are all for the same mask, for the same patient, in the same location, same insurance, same coinsurance, same deductable, just different DMEs.

I'd really like to understand, because it makes no sense to me at all. Are you saying that medicare determines these charges? Or does Medicare determine the allowances for all insurance companies.
BTW, do medicare allowances vary by state or region?





Thanks,

Anonymous wrote: LOL last time you said it was the insurance company fault for those high prices, now it is the Government's fault? You can't seem to make up your mind to justify those ripoff prices. Are you sure it is not the DME? the one charging the fee?

Oh come on man. Please stop just trying to find stuff to attack people on. READ the post - they are specifically referencing Medicare. Medicare is adminstered by the Government - not insurance companies.

mattman

preemiern wrote: I don't understand why you say if we use the hosts site--cpap.com the prices would be the same...
What I see on their site is that an activa mask cost $135.00
hose $9.99
filters $13.99 for 6!! for my respironics machine

Because the initial post was referencing going through Medicare and not paying Cash. Our hosts sites for billing Medicare and Insurance will have the same reibursement that we will - whatever those payors have determined.
Which, on a random side note is - I suspect - why they are all setup as different companies even though they are all owned by the same individual. The same thing I've argued against since day 1: The fact that we are forced by Medicare and Insurance companies to charge the same for cash customers as the prices they have set. Since he uses different companies he's able to get around that. We aren't sadly, and our indigent/cash customers pay the price because of it.

mattman

dataq1 wrote: Hello again Mattman!
Three things that perhaps you can explain to me:
1) Three different DMEs quote "providers charges" for the exact same mask $216.00, $175.00 and $390.00. Who sets those charges?

As far as how the "submitted" amount goes I'm not sure how anyone else really does it. Most of the outfits I've worked with just use the MSRP. Since it really doesn't apply to anything it's a good a number as any to use.

dataq1 wrote: 2) Again the same mask, with exactly the same insurance coverage, the insurance allowables are 173.00, 103.00, and $217.00. (I must admitt I don't have any medicare allowance information) Who sets these allowances?
These are all for the same mask, for the same patient, in the same location, same insurance, same coinsurance, same deductable, just different DMEs.

This I don't get at all myself. The only thing I can possibly think of is that somehow they are going down as different HCPC codes though if it's the same mask it shouldn't. There will always some variance between different Insurance Companies and even plans within the same Insurance but typically not that dramatic - and you say it's the same insurance anyways. So the only thing I can think of is that if one mask was considered a Full Face Mask, the other maybe a nasal mask and the third a Pillow system. Other than that, I'm stumped!!

dataq1 wrote: I'd really like to understand, because it makes no sense to me at all. Are you saying that medicare determines these charges? Or does Medicare determine the allowances for all insurance companies.

Well remember - you have 2 different numbers. The 'submitted' amount is what's sent in by a provider. This number really is essentially meaningless. The 'allowable' is the amount the payor has determined to be the actual price paid for an item. This amount IS determined by the payor.
MOST Insurance companies will tend to follow Medicare Guidelines for both coverage and payment. They aren't always followed exactly, but nearly everything is based in part on those criteria and payment amounts. For example, we might see an Insurance Plan that follows the coverage criteria from Medicare Guidelines and then pay 80% of Medicare Allowables. Or another that might follow both exactly.

dataq1 wrote: BTW, do medicare allowances vary by state or region?

They vary by state. Each state is different though what you really see for the most part is that the amounts stay the same within a general "region" of the country. Example - most payments for Georgia are the same as for Florida but not the same as say, Wisconsin. They are based on state though so you really do have to watch out when you are figuring payments as some are different!

Hope that helps -

mattman