Dissatisfied with my clinic and DME vendor in Brooklyn NY

I got my sleep test just over a month ago. While the clinic did a professional job of diagnosing and titrating me, they did not have a large selection of masks to try -- mostly very basic models. Also, my DME vendor is associated with the clinic -- they are not exactly the same company but I went to the sleep clinic to meet the DME vendor's rep to pick up my machine, and when they wanted to give me a mask that I had rejected during my sleep study because of the agonizing pain it induced just below my nose, he got the sleep clinic to give him one of their masks to give me.

The thing is, the DME vendor is ripping me off. They provided me with a CPAP machine, a generic passover humidifier, and the above mentioned mask, but the machine is a rental and they are charging me (or rather, my insurance company) $130.00 per month, although they did say something along the lines of the machine becoming mine and fully paid for after I have paid them $1,800.00. The kicker is that the machine they are renting me is a Respironics RemStar Lite, which retails for $256.50 on cpap.com.

I would love to just buy a machine and tell them to stick their $130.00 per month where the sun don't shine, but the joke is that it is cheaper for me to sit back and take this, because of my medical insurance. If I buy a machine from an out of network provider, like cpap.com, my insurance will reimburse me just 80%, and that only after I have met my deductible, which I haven't. This DME provider is in network so it is covered 100% with no deductible, subject to a cap of $1,500.00 per calendar year. Since I started on CPAP in May, I will end up with less than $1,500.00 in charges for the machine this calendar year and the next. The only reason I might have to buy a machine is to save (most of) my $1,500.00 in case I happen to need some other DME this year.

What I would really like is the names and phone numbers of a sleep clinic and DME provider in Brooklyn, NY who are in Oxford's Freedom network and charge reasonable prices for reasonable equipment. My current provider gave me the cheapest mask and machine he could get and is charging sky high prices.
--
mikebomb

RemStar Lite at 17 cm H20
Passive humidifier
Fisher & Paykel FlexiFit HC405

Mike, this is how DMEs work, almost all of them. They charge price A to the insurance, pricing each hose, each filter, each part of the mask, the machine and the humidifier. Doesn't matter what the actual cost of the mask, machine or humidifier (passover or heated) is, they charge the same. Their profit comes from what the insurance pay on the difference of their actual cost. BUT the insurance pays price B by contract with the DME. They don't ever pay what the DME charges.

Insurance companies will rent the first few months because they don't want to buy you a machine you will not use. The first few months is to make sure you comply with usage and why you have to take your machine back in for reading every few weeks the first month or so. Then they will pay the difference between their coverage, minus any deductibles and your co-pay and what they have already paid in rental.

If you buy out of network, these same conditions apply. They take out the deductible, anything they have already paid on rental--because they will not let you buy your own machine until you have rented one and proved complince. What you will be reimbursed is this amount.

Most insurance companies will also pay for a new mask every 3-6 months. Many nasal masks at least need the seals replaced that often, and nasal pillows should be replaced so often also as they lose their resiliancy.

Janelle wrote:Insurance companies will rent the first few months because they don't want to buy you a machine you will not use. The first few months is to make sure you comply with usage and why you have to take your machine back in for reading every few weeks the first month or so. Then they will pay the difference between their coverage, minus any deductibles and your co-pay and what they have already paid in rental.

If you buy out of network, these same conditions apply. They take out the deductible, anything they have already paid on rental--because they will not let you buy your own machine until you have rented one and proved complince. What you will be reimbursed is this amount.

Mine does not work this way. The machine they gave me is a REMStar Lite - it does not keep compliance information past how many nights it was used for 4 or more hours. I have had the machine for almost a month and I have never been asked to take it back for a reading. I could buy a machine at any time and will be reimbursed for 80%, after my deductible, subject to the $1,500.00 per year cap. When I got the machine, the DME vendor reminded me about the cap and told me that if my insurance stopped paying them the $130.00 per month for the rented $256.50 machine, I would be obligated to pay it.
--
mikebomb

is to speak to cpap.com. Ask for good auto paps, recommendations, differences, etc. They are very knowledgeable and helpful. I got stuck with the DME ''blues'' too, but then I went ahead and ordered my second set thru cpap.com. NO problems. THey are very helpful, knowledgeable and you can always check their main website for various machines, masks, etc.
My DME was going to give me some bomb off the dusty moldy oldy shelf, and I insisted on the 420E. Much discussions, phoning, etc. They finally relented when Isaid I'd go elsewhere, and got it. POint it, advocate for yourself and tell the DME what YOU want, not what ole pc of machine they can't give away on an unsuspecting patient who does not have the knowledge, you will learn on this board. I knew zip, am no expert now, but do know more than the DME who came and knew nothing had to read a ''how to'' from the sales rep for PB on my machine.

Good luck!

Anonymous wrote:

Janelle wrote:Insurance companies will rent the first few months because they don't want to buy you a machine you will not use. The first few months is to make sure you comply with usage and why you have to take your machine back in for reading every few weeks the first month or so. Then they will pay the difference between their coverage, minus any deductibles and your co-pay and what they have already paid in rental.

If you buy out of network, these same conditions apply. They take out the deductible, anything they have already paid on rental--because they will not let you buy your own machine until you have rented one and proved complince. What you will be reimbursed is this amount.

Mine does not work this way. The machine they gave me is a REMStar Lite - it does not keep compliance information past how many nights it was used for 4 or more hours. I have had the machine for almost a month and I have never been asked to take it back for a reading. I could buy a machine at any time and will be reimbursed for 80%, after my deductible, subject to the $1,500.00 per year cap. When I got the machine, the DME vendor reminded me about the cap and told me that if my insurance stopped paying them the $130.00 per month for the rented $256.50 machine, I would be obligated to pay it.
--
mikebomb

I honestly believe if I had to do it over again, I would order from Cpap.com or other good internet sight and take the 80 percent insurance money and eat the loss of the 20 percent,which because I would not be paying DME prices would not be a huge amount anyway, and have what I want. I also hated my DME experience.

Mike,

I am from LI. I don't know if they are participating, or if they would ocme out to you, but they are great to work with - they are CHS Home Support Services in Hauppauge. They are affiliated with Mercy in Nassau Cty and it is kinf of near you - you may want to give them a try.

I read so many posts about the evil DMS's and insurance hassles, I decided to just avoid most of it. I ordered directly from cpap.com. Now, I'll submit the charges to my miserable insurance co. (Aet-NO!) and wait for their negative response. If they pay out of network rates of 70%, fine, if they do not, fine. I got the machine and mask I wanted, have been using for for 3 days so far, and seems to be going pretty well.

I'm going about 6 hrs a night, which is about the same amount of sleep I got before therapy, but I am seeing slight improvements in the way I feel, from day to day.

I'll just be making payments on my credit card, rather than rental payments to the evil DME, and much lower payments, I might add.

Boomer

DME is now a registered user of cpaptalk.com. I feel I needed to represent the NOT evil DME company.

I could not believe boomers comments about a DME. He actually never even dealt with one and calls them evil. My job is to infuelence the other side to DME. It can be a postive experience especially for the first time users.

DME you will find a lot of unhappiness with DME's on this and any other forum as most are worthless. If you actually care about your patient instead of how much you can bilk the insurance and since you are in my state, I would like to get to know you. Where in Texas are you?

Rock and Roll, I am located in Houston. Our company has several locations throughout the States.

I am just north of Houston.

I wouid love to know who you are as I might use you to buy suppies and have you do the insuranced instead of me and make life easier. If you care to PM me....

It can be a postive experience especially for the first time users.

Could be, but too often is not - especially for the first time users who post to the message boards. Perhaps other first time users are getting such a positive experience at the hands of most DMEs that the people have no need to try to find a message board to help them deal with the problems their DMEs can't (or won't) help them with. Or maybe the people just quietly drop out of treatment.

Perhaps the company you work for gives the new users a much better experience than a lot of the ones who post on the message boards have reported.

"DME", I was reading another topic:
Jun 13, 2005 subject: Has anyone used these masks?

In that, you wrote:
"DCTom, I do not use a mask, but I have fit over 1000 patients who do."

I know that it depends on each individual, and depends on what you think will work well for the person - and maybe what your employer stocks. But I'm curious... what mask do most of the first time users you fit walk out of the store with?

I hope you and Rock and Roll will make contact.

Mikebomb,
I live in NYC and I've been using a sleep lab on the upper west side for the past few years. They have not been great.
I recently got a second opinion from the NYU Sleep Disorders Center in Manhattan, 212-263-8423. They offered me a mask fitting service I wasn't offered at the other center. They seem to have every mask and interface available and allow you to lie down and try them out. You then order the winner from your DME. (of course, I discover this service AFTER I've been slowly trying different masks and interfaces over the years, some paid for out of pocket...)
This center seemed very good, but I also know alot more now and can ask more questions than before. Doing some research on forums like this is very helpful and is critical in the face of so many under-informed medical pros.
I'm stuck with the DME my insurance has: Apria. Not good.
I either wait, wait ,wait with Apria and have my insurance cover all or most of it, or buy it fast on the net. Waiting is frustrating when it's your health and life at stake...

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): DME

I still say "Beware of the Evil DME" You may not be one of the Evil Ones but the chances of a newbie getting a fair deal at most is slim to none.
You wouldn't pay 5 times as much for a car from the car dealer so why do it for medical supplies. Hell theres more markup on these cpaps than there is on cars.
You wouldn't buy a car if the tires , seats, spare tire were extra. Separating these items isn't just unethical, Its Criminal.

Why is there no industry organization to police the evil DMEs ? You could do much to promote good will by starting one. But that would probably be bad for business.

Just like in AA. The first step in treatment is admitting you ( the DME industry not you personally) have a problem.

Beware of the EVIL DME

Chris

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): newbie, DME

Hello,

I hope I can address the DME haters for a moment. Ive come across many comments condemning them as evil, etc and wanted to share some insight on the industry.

1) Prices are not determined by the DME company. Anyone in business would love to charge millions of dollars for something that cost one dollar but the market wont allow it. The insurance companies each determine their own allowed amounts for medical equipment. Then it is up to the local DME provider to decide if they will participate, or accept, those allowables.

2) It doesnt matter what a DME company bills your insurance co. Insurance co only pay the amount they allowed for the equipment minus your co pay, deductibles, etc.

3) Many of you make comments concerning the service EXPECTED from DME providers. Just a point of mention, DME cos are paid for the equipment they provide, not service. Your healthcare is provided by your Dr. not the DME co! Very few insurances actually have AND PAY for a "Respiratory Therapist Visit" code. Many DME companies cannot afford to hire a Respiratory Therapist (in my area salaries start at $50k a year full benefits expected). Just because they are clinically trained in respiratory therapy doesnt mean they are going to give you a treatment. They are used as a marketing tool for the DME company. There is nothing that a therapist can do regarding mask fitting, machine selection, etc, that a properly trained technician couldnt do!

4) Pricing on the internet is bottom of the barrel, basterdised pricing! Most websites that you find have sold equipment that is given to sleep labs for free! Or a sleep lab tech might offer himself a five finger discount and sell masks on his own. Manufacturers give their product away as samples to sleep labs. Just like your Dr receives sample mediciations. Imagine if employees could take those free meds and start a website and sell them online? What price would you expect to pay for your viagra? Its easy to drop prices when the product is free isnt it?

5) Most DME companies will tell you that internet pricing is below cost! I can verify this, and manufacturers are thankfully trying to correct this. Enjoy your discounted mask prices while they last, cause you can expect them to go up! Margins for legitimate companies trying to compete are non existant and even johnny goodman who apparantly owns this site has attested to that, thats why there is no mask return policy.

6) How much money does the evil DME company make? When look at your insurance EOBs, how much did your insurance pay the DME? Most likely your in the <$100 range for a rental. The rental period is capped, so that item becomes yours in 10 to 15 months, considering your particular policy.

Pause here and consider, how much does it cost to rent a car? $40 a day for a compact? is that ford focus worth the $1200 a month the rental company collects on it? Would you pay less that 1/4 that price if you bought it? Would your local car rental agency give you the car, let you own it, if you rented it for a year straight?

Consider a hotel room, $100 a night. How does your home compare in cost to a hotel room? Thats $3000 a month, could you do better buying a home?

DME companies get paid what the insurance dictates and takes a minimum of 60 days to an average of 120 days to collect their rental fees. Can you go to mcdonalds and eat a meal and pay for it 6 months later? Can you name ONE OTHER BUSINESS that will allow you to do this? Interest free??

And then you demand a Respiratory Therapist available at your beckoning? You expect someone to be on call to poo poo you when you have a complaint at midnight? What could that person do to satisfy you, run over to your home with a suitcase full of masks for you to select?

DOES YOUR DOCTOR COME SEE YOU AT HOME? ? ?

How many members here to go their Drs and dont even see them? How many are attended by Nurses or Physicians assistants?

How many of you can get a service man to come over and just LOOK at your refridgerator for less than $75?

Thats all a DME co gets paid, total, and you expect them to provide the service AND THE EQUIPMENT?

I say, if your that demanding, open your wallet and get it from this site, cash. You still dont get the service, cpap.com is not going to answer your question at midnight like you expect, lol. They wont even take your mask back! So, either lower your expectations to a more reasonable level or just deal with the fact that you are just a little too damn demanding.

PS if you dont know that your sleep lab got paid over $2500 for a TEST, compare that to the expectations of your DME provider who over the coarse of a YEAR might make half that amount, provide you with the equipment, and care, EVEN THOUGH YOU DONT THINK IT ENOUGH, and be on the hook to replace or repair your equipemnt during that period of time. Selfish bastards they are huh?