RT Hoseheads face problems too

Vasily accidentally guested wrote:RG,

If I got a script that said
CPAP with A-flex
CPAP pressure 10 cmh2o

I would have to call the Doc who wrote it and have him verify if he meant APAP or CPAP. This is due to our Corporate policy, the policy states that it MUST state APAP AND MUST give a pressure range for it to be a valid APAP order. I've already expressed my feelings on that policy earlier so I don't think I need to repeat it.

Thanks, Vasily.

And by the way, thanks for all your posts. I always enjoy reading them. Your caring attitude toward people is very apparent.

Vasily accidentally guested wrote:
Snoredog,

I still stand by my claim that there is only 1 HCPCS code for an APAP.

I think Vasily is absolutely right.

greyhound accidentally guested wrote:Snoredog,

I appreciate all your contributions to this forum, but I think, in this case, you're being unfair to Vasily. After you stated that there was a unique billing code for an APAP, he simply asked you for the code. Instead of answering his good faith question, you responded with a personal attack.

Thank you for saying that, greyhound.

I haven't read the whole thread, but I'm going to jump in here and say:

How dare they say they won't pay for comfort? That is ludicrous. I guess I should wear a hairshirt with my auto-bipap tonight to make them happy?

It is well documented thru scientific study (see pubmed.com) that xpap'rs on autos are more likely to be COMPLIANT due to comfort issues: ie able to spend most of the night at a more comfortable lower pressure and have it go up when needing to take care of events.

CPAP compliance numbers are dismally low because it is so damn uncomfortable.

The insurance and the dme are always forgetting one important thing: WE ARE PAYING THEM. They aren't our masters, they are our servents and they are supposed to be doing what is BEST FOR US.

Stuff like this just pisses me off to no end.

Jen

Gads, given my experience w/my local CPAP DME supplier it almost makes me upchuck to say ANYTHING in their defense - but - here goes:

Medicare requires a 13 month capped rental before the CPAP becomes ours. At cpap.com a Respironics M Series Auto w/A-Flex runs $579. They have to make a profit on this auto or they wouldn't be selling it at this price. On the other hand they buy in HUGE volume from Respironics so you know darn well they are getting one heck of a good discount over what local DME suppliers pay for the same machine. So lets allow cpap.com their profit and the locals their higher purchase cost and say the locals PAY the same amount at cpap.com sells at retail.

In theory then, my local DME supplier is paying $579 for the Respironics M Series Auto w/A-Flex.
They then sell it to a Medicare patient via capped rental, billed at $135 a month for 13 months - BUT - Medicare only allows $74.96 a month rental and only pays $59.97 a month for the rental.
The patient or their secondary insurance must then pay the $14.99 difference so that the local DME is getting paid that $74.96 for the next 13 months for a total of $974.48.
A profit of $395.48 - UNTIL you consider there is SOME overhead, there is a portion of their RT's salary, and while they shelled out the full $579 in one month, it is going to be 13 months before they recoup the full amount, getting it piece meal for 13 months.

That doesn't excuse their shoddy service, their crappy attitude, their less than truths, or their ignorance. But they aren't making the killing that that billed amount of $135 x 13 months would have us think they do.

Frankly, I begrudge my local CPAP DME supplier every penny they collect on my CPAP.
On the other hand, my local 02 DME supplier is worth every penny they collect in my opinion. I don't begrudge them a penny.
Different company, different philosophy and customer service.
God bless the GOOD local DME suppliers.