CPAP Racket

I should clarify my post. I don't think Sleep Study tests are overprescribed as I do the other tests I mentioned. I do think the business is a racket, in so much as the exhoribitant prices charged customers, billed insurance companies etc, all in the name of greed for individuals and companies. But this issue is not specific to CPAP DMEs, it is pervasive in the entire medical community and why the USA needs massive health care reform. And now I will get off my soapbox.

BeanMeScot wrote:We were arguing about this in another forum. A couple of guys were diagnosed with OSA but didn't believe it because they said EVERYONE who does a sleep test gets diagnosed with OSA and it is therefore a racket. My argument was that you don't do a sleep study because you are feeling great and don't have a problem in the world. You do it because something is wrong. You snore or you are excessively tired, etc. Therefore, it is more likely that you will be diagnosed with a sleep problem than not.

My doctor had no relationship to the sleep doctor or the sleep center or the DME in any way, shape or form. The DME had no relationship to the sleep center or the sleep doctor. But people start to feel like they are being shafted when there is a relationship between some of these people. I can see their point but that doesn't mean they don't have OSA.

Exactly!

On the other hand, I think too many doctors overlook some things (like in my case) where a visit to an ENT would have also been of great benefit.

Den

I was a bit more blunt. I came right out and asked by physician if it was a racket. He told me, first, if it was a racket, do you think I'd tell you. And second, to you feel better since you started using it, and I had to answer "yes". And he replied, so I guess its not a racket. I guess this all came about because I'm self pay and luckily I was able to get what I needed from this site, instead of getting hosed by Apria. And then, there are those with 100% insurance on everything, and they just move from doctor to doctor to fix then next thing

Gads! I HATE sticking up for local DME suppliers - BUT - we DO have to take into account the extreme costs of dealing w/multiple insurances! That means AT LEAST one staff member MUST be an "insurance expert". Insurance "coding" is another "specialty" required on staff. The paperwork is astronomical. PLUS they need to pay upfront for quite a bit of equipment that reimbursement comes in by dribbles and drabs monthly over an extended period of time. The online DME suppliers do NOT have these upfront expenses. Yes, they have to pay upfront for their inventory - BUT - they are reimbursed in full w/some profit IMMEDIATELY at time of sale rather than the monthly trickle. Grrr! There are times I HATE being "fair" to local DME suppliers but in all fairness we have to give the devil some of his due.

Slinky wrote:Gads! I HATE sticking up for local DME suppliers - BUT - we DO have to take into account the extreme costs of dealing w/multiple insurances! That means AT LEAST one staff member MUST be an "insurance expert". Insurance "coding" is another "specialty" required on staff.

LOL, are you kidding me? My DME "insurance expert" told me I only had to pay 10% (or $170), with 90% coverage by insurance, so I went ahead and purchased my equipment. Then the insurance came back, and with my expected coinsurance, only paid $1300 for a bill that was $2800, not $1700. That's right, they told me the equipment cost $1700, then went ahead and billed the insurance for $2800. This left me holding a $1500 tab. When I complained to the DME that I wouldn't have purchased the equipment had their "expert" not misinformed me about my cost and the insurance coverage, she fired back "Its not our responsibility to know what the insurance covers, its yours". So frankly, I have little sympathy for the "extreme cost" DME's must incur to employ "experts".

Jason S. wrote:LOL, are you kidding me? My DME "insurance expert" told me I only had to pay 10% (or $170), with 90% coverage by insurance, so I went ahead and purchased my equipment. Then the insurance came back, and with my expected coinsurance, only paid $1300 for a bill that was $2800, not $1700. That's right, they told me the equipment cost $1700, then went ahead and billed the insurance for $2800. This left me holding a $1500 tab. When I complained to the DME that I wouldn't have purchased the equipment had their "expert" not misinformed me about my cost and the insurance coverage, she fired back "Its not our responsibility to know what the insurance covers, its yours". So frankly, I have little sympathy for the "extreme cost" DME's must incur to employ "experts".

You have no idea how many times I've read posts on the forum where the "insured" party tried to find out from their insurance provider just how much they would pay for this stuff.......and the insurance folks couldn't/wouldn't tell them for various reasons.......mainly because they didn't know how much the DME was going to bill for it.
Talk about people being caught in a "catch-22"!

Den

Hey, Jason. I've had a doctor's office give me the same "spiel". Have you EVER had to make an initial office call w/a new doctor where they would even BEGIN to discuss an appointment time w/o ASKING if you had insurance and if so, what insurance company, etc.?? I refused to pay the bill. And got away w/it. I could give a rat's rear what they about my knowing what my insurance will and won't cover, if they want to get paid THEY will know BEFORE I am offered that "service". Of course, one of their ways around that is having you sign that you will be responsible for any amounts over and above what your insurance will pay. But if you want to really push the issue, if they want to get paid, they share the responsibility of knowing whether they are contracted w/that insurance or not and what your coverage is.

And look good at your EOB for services. The billed amount is NOT the allowed (contracted) amount your insurance agreed to and IF that DME supplier, doctor, etc. is contracted w/that insurance they cannot charge you more than your copay of the ALLOWED amount, not the billed amount.

BeanMeScot wrote:We were arguing about this in another forum. A couple of guys were diagnosed with OSA but didn't believe it because they said EVERYONE who does a sleep test gets diagnosed with OSA

I would have to agree the results are skewed, at least here, the sleep lab is so overwhelmed, it doesn't what to test anyone who doesn't have a sleep disorder. My PCP did not even think he could get my referral to the sleep lab accepted, he expected the sleep lab to come back with a list of other tests they wanted to be run first. My sleep study was put off for a couple of months because they didn't think I had OSA (from the information supplied by my PCP) and therefore I was not a priority case. They darn near freaked out when they discovered I did have OSA.

[/quote]

Is your out-of-pocket more with an auto? I had straight CPAP at first and my out of pocket was about $85 plus monthly rental of $13. Now I'm getting an auto and I'm told it's an additional $250 plus the same monthly rental of $13. Does that sound reasonable to others? I feel like someone is always sticking their hands in my pockets whenever I deal with anyone in this industry.[/quote]

There should be NO "additional" charges for a higher-end model of CPAP. They bill the insurance providers with the very same code E0601.
If several months had gone by since starting (and then switching machines), that might be a slightly different story, but if you're "starting" therapy and tell your DME that you want a better machine, they should not be charging you more.

Den[/quote]

I confirmed with my insurance company that it is the same code and they will pay the same amount whether it's straight CPAP or auto. The DME agrees but said they charge the patient $250 out of pocket because the machine costs them more and they get paid the same. Should I switch DMEs or will I get the same response from other DMEs and I should just pay the extra $250 out of pocket. I can't tell you how financially raped I feel dealing with this shady industry.

ericthomas wrote:I confirmed with my insurance company that it is the same code and they will pay the same amount whether it's straight CPAP or auto. The DME agrees but said they charge the patient $250 out of pocket because the machine costs them more and they get paid the same. Should I switch DMEs or will I get the same response from other DMEs and I should just pay the extra $250 out of pocket. I can't tell you how financially raped I feel dealing with this shady industry.

Do the math.
Personally, I'd either take my business elsewhere (do some DME shopping) or purchase online from CPAP.COM. (which is what I did)

Make certain that you have your CPAP prescription.
You can purchase an APAP online with a CPAP prescription and there's probably not $250 difference.....depending on which models you're comparing them to. On the other hand, I consider "data-capability" much higher on the priority list than "Auto/APAP" functions (although all Autos have data-capability).

Den

If you've had your current straight CPAP and it is not a fully data capable CPAP, 30 days or less I would take it back. If you have had it MORE than 30 days you MAY have difficulty getting another of the local DME suppliers contracted w/your insurance to do business w/you OR you will have to pay the extra months' full rental. Your insurance is only going to pay X amount of dollars for a CPAP so you would have to make up out of pocket for any "extra" months.

ericthomas wrote:

gbuskirk wrote:This was resolved to my satisfaction. Rather than call me, the DME owner told them to issue me the Auto. They will bill it the same way, as you all knew and said. Thanks for your help.

Is your out-of-pocket more with an auto? I had straight CPAP at first and my out of pocket was about $85 plus monthly rental of $13. Now I'm getting an auto and I'm told it's an additional $250 plus the same monthly rental of $13. Does that sound reasonable to others? I feel like someone is always sticking their hands in my pockets whenever I deal with anyone in this industry.

Check with your insurance company and find out if the DME can charge you that 250.00...I'm betting no.