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Re: cpap.com vs dme

Posted: Tue Feb 06, 2007 1:11 am
by Patrick A
[quote="jackr"]Well, I told my mother that I was going to buy my equipment online. She told me that her DME can give me a great deal.

After spending 20 minutes on the phone with the guy this is what I learned.

cpap.com is selling below cost and will be out of business soon.

You cant buy smart card readers.

Smart card readers are for doctors only.

There is terminoligy in the data that patients cant understand.

Changing your own pressure is illegal.


I could probably go on but I started tuning him out. I can imagine if I never found this forum I may have bought into all that BS.


Posted: Tue Feb 06, 2007 8:47 am
by dataq1
mattman wrote:We (traditional Brick and Mortar DMEs) are under a world of contractual, supplier, local, state and federal regulations that an online retailer such as this one don't even begin to have to deal with.
Since I have no evidence to dispute this, I must accept your statement as a possibility. So I will stand corrected, and modify my previous comment that DMEs can either elect to sell card readers or not.

Regardless, the statement of logic remains true. DMEs do (and can) sell smart card readers. That is my angst over your prior assertion that DMEs cannot sell smart card readers. I guess that had you said that certain DMEs cannot sell card readers, I would have not called you on it.

Just in case you and other readers may think this discussion as pointless, you have now suggested an important point that is useful to our community. What I've learned from this discussion is that, possibly, and quite plausibily, Online DMEs are not restricted by the same regulations as a B&M DME. That suggests that the online DME may have more latitude to conduct business than the B&M DME.

Consequently, the user of DME services, really should, at mininum, check with on-line services for gear, as the latitude to conduct business may work well for the buyer.

Thanks to your suggestion, I can understand better the possible differences between the B&M and online DME supplier.


Posted: Tue Feb 06, 2007 4:10 pm
by wnbresn
Sorry Mattman but DME's such as your self are going to go the way of the dinosaurs in time. Why should I waste my time with getting incorrect or biased info from DME's such as yourselves when with a little effort I can find all the info I need and much better service on the web? So far my DME (American Homepatient) has been nothing but a total failure when it comes to knowledge or service. They insisted on a nasal mask when I told them I was a mouth breather. They then told me I needed a doctors script just to get a chinstrap and it took 6 months and repeated calls to get them to stop billing me because they thought I was renting my equipment even though I had paid in full for it. Telling me I can't change my pressures or monitor my readings is like telling me I can't rip off that little tab on mattresses that says" Illegal to remove" it makes no sense and is basicly unenforcable . When I need a new mask in a few months I will get it on the web without a docs script. When I need a new hose I will do the same thing. If I want to eventually monitor my readings all the time I will get a reader and software from whomever gives me the best price and DME be dammed. If I have questions about equipment or readings I will come to forums like this and then weigh all the answers to my questions and make my best decison again with no help or hinderance from a DME. You brick and mortar DME's can either wise up or get out of our way.


Posted: Tue Feb 06, 2007 4:18 pm
by Rabid1
[quote="wnbresn"]Sorry Mattman but DME's such as your self are going to go the way of the dinosaurs in time. Why should I waste my time with getting incorrect or biased info from DME's such as yourselves when with a little effort I can find all the info I need and much better service on the web? So far my DME (American Homepatient) has been nothing but a total failure when it comes to knowledge or service. They insisted on a nasal mask when I told them I was a mouth breather. They then told me I needed a doctors script just to get a chinstrap and it took 6 months and repeated calls to get them to stop billing me because they thought I was renting my equipment even though I had paid in full for it. Telling me I can't change my pressures or monitor my readings is like telling me I can't rip off that little tab on mattresses that says" Illegal to remove" it makes no sense and is basicly unenforcable . When I need a new mask in a few months I will get it on the web without a docs script. When I need a new hose I will do the same thing. If I want to eventually monitor my readings all the time I will get a reader and software from whomever gives me the best price and DME be dammed. If I have questions about equipment or readings I will come to forums like this and then weigh all the answers to my questions and make my best decison again with no help or hinderance from a DME. You brick and mortar DME's can either wise up or get out of our way.


Posted: Tue Feb 06, 2007 6:12 pm
by mattman
wnbresn wrote:Sorry Mattman but DME's such as your self are going to go the way of the dinosaurs in time. Why should I waste my time with getting incorrect or biased info from DME's such as yourselves when with a little effort I can find all the info I need and much better service on the web?
...
You brick and mortar DME's can either wise up or get out of our way.
A couple of things to respond to here.

1) It is your opinion that my statements have been "incorrect or biased" when in fact they have been neither. You are most assuredly welcome to your opinion but please refrain from attempting to state it as fact.

2) The fact that you obviously had an unpleasant experience with your particular DME provider has absolutely ZERO bearing on my business nor the hundreds and hundreds (If not thousands by now) patients whom I have provided care that most rate as "exceptional or better.". Now, you can choose to either believe that or not but don't you DARE try and state as fact that I have ever provided otherwise when you use phrases like 'DMEs such as yourself'. Thank you.

3) I will never argue with the fact that many users, and you are obviously one of them, would be much better served by the system by being able to purchase your equipment online as a cash sale and avoid all the hassles of insurance and without the hands-on care available through most traditional DME providers. In fact, since the first day I've ever come to these boards I've advocated a system that allows and accounts for both types of patients so I again tell you that I take extreme issue with those (yourself included) that try to claim as fact that I am biased. I am nothing of the sort.

4) Your assertion by Am. Hmpt that you need a prescription for a chin strap is absolutely correct if you want it to go through insurance and is technically correct if you wanted to pay cash for it. You may think it's a stupid law. I happen to agree wholeheartedly that it's a stupid law. However, disagreeing with the law DOES NOT change the fact that it's correct. A lot of people here love to take something they disagree with and hold it up as an example of DME stupidity. I'm sorry, but that just isn't the case and in my opinion, shows the bias of the poster, NOT the DME company.

5) Again, something else I've said from day 1 - poor care (such as taking 6 months to provide an item) IS NOT ACCEPTABLE. However, individual cases of poor customer service do not equate to an entire industry failing it's customers. No one here likes to remember this but guys - even if you take all the pissed off people here... even if you DON'T remove the cases of misunderstandings or just disagreements (like our chin strap case above) this still only equates to a tiny fraction of the total DME business out there and an even smaller fraction of patient interactions. And it's always been my opinion that by it's very nature websites such as these are going to attract those who are unhappy with thier care so the picture is even further out of whack.

6) We aren't going to go anywhere anytime soon. To be sure there will be changes. There always have been and there always will be. I wouldn't be supprised to eventually see a system like I mentioned above that allows for both types of patient interaction. What you forget though is that CPAPs and supplies are only a small aspect of the care that a DME company provides. Everything from rehab equipment, custom mobility products, premie/infant/child medical care, physical therapy care, IV therapy, Respiratory products, allergy products, oxygen, aids to daily living, skin care, wound care, ostomy products, nutritional care, diabetic and insulin therapy. and many more.

I would NEVER, EVER wish on anyone the sort of life-altering experiences that so often bring someone to us. Most patients who end up dealing with a DME company have just had one of the most horrible, life changing and often life ending experiences before they see us. We are an unusual business in that we tend to meet people when they are at thier worst - very often at a simply horrific time. It is those patients who make up the vast bulk of our business. And it is with those patients for whom our type of business shines. Where our ability to provide very specialized, very hands on care is so much more needed, desired, and effective than with the types of patients that frequent here. Those who know what they want, how they want it and don't want any interference from anyone else.

We aren't going away, and I really honestly hope that you never have the sort of needs to find out for yourself first-hand why that statement is so true.

It has nothing to do with the oft-repeated "legal prey" or "legal license to steal" that is so regularly repeated here. Again while no one likes to accept it the simple fact is that when taken as a big picture - reimbursements are not all that great. People can make a profit, of course. There isn't anything wrong with making a profit. There is something wrong with a crappy provider, yes. That doesn't equate to an entire industry doing something awful.

To illustrate - I have another question. Why doesn't anyone ever get this irate over this forums owner being paid the the same amount I do for CPAP equipment? Everyone is fine with it when he gets those amounts. Yet when I do, I'm "preying on the innocent". Why the double standard? To me, the answer is because you are happy with the service from him. Okay, great. So then is the issue is NOT the money involved but the customer serivce? Remember before you answer that I've constantly stated my position that CPAP reimbursement is currently too high. However, it NEEDS to be high to help offset the crappy reimbursement for other items (Hence the 'big picture' comment I made above - it evens out). I think it should be even across the board without having to have spikes in certain areas to account for dips in others.

Very Respectfully,

mattman

Posted: Tue Feb 06, 2007 6:42 pm
by Slinky
MattMan, I only wish I "could" rely on my DME's RT. I wish I had a DME like you. My sleep pulmo is great but he has even less time than you and is much less available to answer my questions, etc. It would be so great to have a DME I could go to or call and be able to RELY on his/her answers or suggestions. As it is, thank God for this forum. And thank you for contributing.


Posted: Tue Feb 06, 2007 6:56 pm
by Guest
I can't say one way or another whether DMEs are evil, but trying to keep an open mind: My DME is charging the insurance company for the product, but there are a lot of services that go with it, they sent me home with two masks, but will only charge for the one I keep, so I can try two over the long run. They offered to drive to my house to pick up my card so they could print a report for my Doc next week. I don't blame them for bundling the service cost with the device. And for the vast majority of patients, their services will be all the difference, they have made follow up calls, they have an RT on call 24 hours a day I can talk to, etc.

That said, a proactive well informed patient would probably save the health care system bundles by going through an online DME. I have learned a thousand times more from this site than from the DME. But what about people without the internet? What about people not competent to read Pub Med study abstracts to gather their info?

I think a good system requires both, Brick and Mortar DMEs and for the more computer literate and self motivated patient card readers and online support. Any way, in my case my sleep doctor and I will be figuring it all out together anyway since I am atypical all round. Do I know more about UARS than the RTs? Yup. Do they know things about the system and how to use the equipment than me? Yup. It's not an either or situation.


Posted: Tue Feb 06, 2007 7:04 pm
by dataq1
mattman wrote:To illustrate - I have another question. Why doesn't anyone ever get this irate over this forums owner being paid the the same amount I do for CPAP equipment?
I don't get irate over the amount being paid to the owner of this forum BECAUSE he doesn't get paid the same amount of money.
Cpap.com will be paid 175.00 for a Universal Hybrid. Between my insurance company and myself my local DME is paid 299.00 for the same product.

That makes me slightly irritated at my DME.

BTW, my service on this product was: “Come pick up your box on Saturday”


Posted: Tue Feb 06, 2007 7:24 pm
by mattman
dataq1 wrote:
mattman wrote:To illustrate - I have another question. Why doesn't anyone ever get this irate over this forums owner being paid the the same amount I do for CPAP equipment?
I don't get irate over the amount being paid to the owner of this forum BECAUSE he doesn't get paid the same amount of money.
Cpap.com will be paid 175.00 for a Universal Hybrid. Between my insurance company and myself my local DME is paid 299.00 for the same product.

That makes me slightly irritated at my DME.

BTW, my service on this product was: “Come pick up your box on Saturday”
When they go through insurance he is paid the same amount we are. Just like when we go through insurance.

The problem comes when people are trying to compare paying cash online against billing insurance through a DME. It's apples and oranges. It's further compounded when they use that comparison to fuel thier hatred.

When you compare apples to apples and both are billed using insurance this forums owner is paid the exact same amounts we are.

The difference is that those prices are set by the insurance companies and not by us and we are legally obligated to charge cash customers those same amounts but online retailers do not have the same requirements (Hence the different companies).

mattman

Posted: Tue Feb 06, 2007 8:47 pm
by NightHawkeye
Mattman, I gotta give you credit. Ya not only come here and provide useful info, you've also learned to effectively deal with the resentment, frustration, and even outright hostility many here have with their DME's. To the extent you've incorporated what you've learned here into your own customer relations, you are to be commended.
mattman wrote:To illustrate - I have another question. Why doesn't anyone ever get this irate over this forums owner being paid the the same amount I do for CPAP equipment? Everyone is fine with it when he gets those amounts. Yet when I do, I'm "preying on the innocent". Why the double standard?
Since I've not dealt with a local DME, I can't offer a comparison, but I can state that I've found CPAP.com to be straightforward in their dealings. They openly state their prices and policies - no tricks, no gimmicks. When I decided to buy my Remstar-auto I found a slightly lower price at another website, but ordered from CPAP.com anyway. Since CPAP.com had a price matching policy, I simply entered the competing website and price in the comments field and didn't really worry too much about whether they'd honor it or not. The next day when the machine arrived, it was at the lower price. It makes me a happy camper, and a repeat customer.

Of course, I also like the service Johnny provides us with cpaptalk.

Regards,
Bill


Posted: Tue Feb 06, 2007 9:57 pm
by Sleepy Dog Lover
I have to say that, while I have bought some things on cpap.com, I loved my DME experience. The RT spent a lot of time with me trying on every mask made at pressure to find the right one for me. I ended up with an Aura Headrest, now an Aura Twilight NP, and I still love it to this day. I bought the hybrid from cpap.com out of pocket because I wanted a full face mask for those nights with a cold or congestion, and I bought the software and reader from cpap.com. I called my DME when it was time for a new mask and they sent me what I asked for, along with a new hose, and a new humidifier chamber because mine had cracked. If I had wanted to go in for another appointment with the RT to try on additional masks, I could have, and would not have been charged for it.

From some of the stories on here, I feel lucky to have found my DME. One thing that I was sure of, I didn't want to deal with Apria, so I looked through my choices and found another DME that worked with my insurance. I would hope that Mattman would be more like the DME that I am using rather than Apria, but none of us can know unless we are using him as a DME. I have found that there is room for both brick and morter DME's and online DME's, I know that I would have been lost and spending a lot of money finding the right mask for me, and trying to fit the straps, etc when I had never used CPAP before. My experience with the Brick & Mortar DME was that is was a value added service, I not only got the mask and xpap, but I got the service of an RT that was willing to spend 1 1/2 hours with me showing me how to use the machine and trying on and fitting masks at pressure.


Posted: Wed Feb 07, 2007 8:15 am
by Guest
Mattman---thank you for having, and operating, a REAL business and REAL DME.


Posted: Wed Feb 07, 2007 8:54 am
by jackr
I surely didnt mean to start a fury!

Anyway, there is no way the DMEs are going to go the way of the dinosaur anytime soon.

If I didnt do a ton of research online or have the time to do it, it could be quite overwhelming. Having someone come out and actually set you up and take the time to show you how to use something, make sure the fit is correct and have an instant replacement for you to use in case of trouble is quite valueable.

Personally for me the learning curve that I (and all of us) have to bear is not worth the additional money to me. I feel confident in my abilitities to learn something or at least know where to go to get the info.

I was just personally insulted when I was told that I (as a patient) could not understand the data the cpap would put out. I dont feel that doctors are smarter then me. They just have different knowledge.


Posted: Wed Feb 07, 2007 10:25 am
by Sleepy Dog Lover
JackR,
I think that sometimes we do know more than the docs, we know better how we are feeling with the treatment, we know how certain things affect us, and we definitely have a vested interest in monitoring our treatment. If you are working mostly with a primary care physician, there is an even greater chance that we know more than the physician unless they are educated.

Having said that, I think that the board members are much more knowledgable than most people on CPAP. Unfortunately, these days, if you don't take charge of your own healthcare problems, you get lost somewhere in the system. I think there are a lot of docs out there underestimate our ability to understand and manage our own care.


Posted: Wed Feb 07, 2007 8:58 pm
by dataq1
mattman wrote: Why doesn't anyone ever get this irate over this forums owner being paid the the same amount I do for CPAP equipment? Everyone is fine with it when he gets those amounts.
Sorry Mattman but I can't let this statement go unchallenged.

You did not qualify you original statement as to the source of the payment

Your statement is still incorrect as it stands. Furthermore, I got a quote from Billmyinsurance who contacted my insurance company and determined their allowable for the hybrid mask. If I used my insurance to pay for a mask through the insurance arm of cpap.com they would be paid 103.00.

To summarize:
With Insurance:
Local DME is being paid 299.00
Billmyinsurance.com would be paid 103.00

Cash:
Cpap.com would be paid 175.00

I just can't see your statement that "this forums owner being paid the the same amount I do for CPAP equipment" is valid.