I'm in the wrong business

I just found out my ins was paying $135/mo. for an S8 Compact. Rent to own over 13 mo.

$1755 when the equivalent is $330 online @ cpap.com.



No wonder my co. is on corporate welfare.

quite a little racket, is it not!

We just finished our 13mo rental and Medicare & Supplemental paid DME $195/mo=$2500.

Will your online source deliver it--same day--to your house, set it up, show you how to operate it, adjust your mask, provide personalized follow-up service, answer your questions, immediately provide a replacement if it breaks...and if you don't like it, take it back before you've paid for it?

Sure they make a profit. Would you expect that for free?

LinkC wrote:Will your online source deliver it--same day--to your house, set it up, show you how to operate it, adjust your mask, provide personalized follow-up service, answer your questions, immediately provide a replacement if it breaks...and if you don't like it, take it back before you've paid for it?

Sure they make a profit. Would you expect that for free?

My local DME provider did none of those things either. Wait. They did one of those things: they made a profit.

LinkC wrote:Will your online source deliver it--same day--to your house, set it up, show you how to operate it, adjust your mask, provide personalized follow-up service, answer your questions, immediately provide a replacement if it breaks...and if you don't like it, take it back before you've paid for it?

No, but neither would my DME. I wouldn't tar them all with the same brush, but my DME made me wait a couple weeks for an appointment to go to their location, did no measurements before handing me the one choice of mask (then billed me for a Quattro after giving me an UltraMirage and, when I questioned it, told me they were "exactly the same" anyway), "followed up" by calling to see if I wanted to buy any more supplies, refused to take it back until I was able to prove they had given me the wrong machine in the first place (not the one prescribed), threatened to tell my doctor I was noncompliant when I insisted on returning it, and continued to bill my insurance and me for several months after it was returned.

I just completed my 13 month contract with Apria...regardless of what they charged, Medicare paid them $61 month.
13 months = $793.

Whoa! Medicare's 80% reimbursement is now $61 a month!!!!! In 2006 Medicare's 80% was $59.97 a month in our area. The copay was $14.99 for a grand total of $74.96 for 13 months.

John Dozer if you have had that Compact for less than 30 days - 45 days maximum - TAKE IT BACK and INSIST on a Resmed S8 Elite II w/EPR. Call your insurance and see if you have the option of more than just this one local DME CPAP provider. Having the option of more than one provider gives you more bargaining/negotiating room to get a fully data capable CPAP.

LinkC wrote

Will your online source deliver it--same day--to your house, set it up, show you how to operate it, adjust your mask, provide personalized follow-up service, answer your questions, immediately provide a replacement if it breaks...and if you don't like it, take it back before you've paid for it?

Sure they make a profit. Would you expect that for free?

The B&M DME, for my Insurance provided machine, did the following:
1) Called me Saturday, two days after the order was e-mailed to them from the Sleep Drs office, to ask me to pre-approve the copay on my charge card,
2) When I asked which machine I was pre-approving, I was told a different machine (Auto w/C-Flex) than was ordered for me (Auto w/A-Flex),
3) When I told the caller (a shipping clerk) the correct machine model #, he said he had that model# in stock and would ship one to me,
4) He said there would be a shipment delay as the RT would need to set it up before he could ship it,
5) 5 days later (Thursday) I received my machine. Per the shipping label, he had shipped it the day before from their local office, 20 miles distant,
6) My machine, an Auto, arrived with a pressure range setting of 4 - 20 cmH2O, and with AHI and Leak reporting turned off. The Provider instructions had been removed from the box (standard policy for B&M DMEs).

B&M DME "submitted" price for machine was $1180 and my copay (20%) was $236.

During this week of interactions (sorry, should be interaction since I only had one) with the local B&M DME, they made no offer to set up my machine, show me how to operate it, or fit/adjust my mask. They did, however, as mentioned above, call me on a Saturday morning to ensure that they would receive my copay amount. In the seven months since receiving my machine, the local B&M DME ("A") has provided no follow-up service, nor do I expect them to as they did, in early April, receive the $$$ from me and, therefore, had/have no further need to communicate with me.

Contrast this with my online experience in purchasing my "backup" machine (same Model#):
1) Called online DME (880 miles distant) late Tuesday afternoon (two days prior to my Sleep Drs office emailing their order to the local B&M DME) and ordered my "backup" machine,
2) Was told machine was in stock and would ship next day (morning) and that I would receive it in two business days,
3) On Wednesday morning, received an e-mail with UPS tracking#, and found a lower online price for my machine,
4) Called and was given the lower price because of their price matching policy,
5) Received my "backup" machine on Friday morning,
6) Opened the box which included the Provider's instructions and set up the machine - set up pressure range, 7 - 12, and turned on AHI and Leak reporting,
7) Used it that afternoon for a nap.

My out-of-pocket price for machine was $526.

B&M DME "submitted" price was 2 1/4 times greater than the online DME price although I received much better service (interactions/communications/instructions/etc.) from the online DME. Go figure!

The thought that my B&M DME would "deliver it--same day--to your house, set it up, show you how to operate it, adjust your mask, provide personalized follow-up service, answer your questions, immediately provide a replacement if it breaks...and if you don't like it, take it back before you've paid for it?" had me ROTFL for a few minutes before I regained my senses and could post this response.

I have read the rare postings of members that received such awesome service from their local B&M DME and I am Envious. My B&M DME is awesome Only in obtaining $$$ from me.

Shame on you for accepting less than your money's worth.

But I've heard there's one born every minute...

My turn to volley.

Actually there is more than one intelligent person born every minute. However, only intelligent people know this fact.

An "intelligent person" would have realized there's only a 1 in 4 chance I was talking to them.

Your turn...

I have a few comments about this thread:

The Medicare allowable for CPAP (E0601) is $85.94 to $101.10 depending on what region you live in. The maximum Medicare will pay is 80% of this amount or $68.75 to $80.88. This is only for the first three months then the allowable drops another 7.5% for the next ten months.

DoriC your numbers cannot be correct. This is probably what your DME billed but it is not what was paid. If your Medicare supplement insurance is truly a supplement then it will follow the Medicare allowable and pay the 20% co-pay of the allowable.

If you did not get the quality of service this allowable pays for then that DME should not be in this business line. As of Aug 2009 over 29,000 are no longer Medicare providers. Hopefully yours is one of these. By the way, this equates to well over 150,000 jobs lost.

Yup, B&M DME's charge more for PAP's and supplies, always have always will, it has been discussed many times ovr the years on this forum so i won't get into that. However I would like to say that, if you are running a B&M DME AND are a Medicare provider, you feel like you are running a gauntlet every time that you bill for a PAP, or any other equipment you provide for that matter.

For example, last Thursday Medicare came by for an inspection due to a patient complaint. They investigated the patients clinical and billing file along with 4 other patients files that were not involved in a complaint. They found nothing wrong with any of the files, everything great right, nope wrong. It appears that JACHO had sent the wrong documentation concerning our accreditation to Medicare (Now mind you this is not paperwork that WE can provide Medicare nor do we even have a copy of this paperwork, it is done privately between JACHO and Medicare), so all of our billing since the middle of Sept. has to be refunded to Medicare and our provider number has been suspended until the correct paperwork is sent from JACHO to Medicare. We have been informed that this will take 60 days at a minimum. So what does that mean for us? Without a provider number we cannot bill anything to Medicare, this compromises 73% of our revenue, if we were a Mom & Pop DME we would go under.


DoriC: Please check you paperwork again, DME's cannot "balance bill" Medicare patients. The DME can only bill to your secondary insurance your copay from Medicare's allowable. If your DME billed the complete balance above Medicare's allowable they are doing so fraudulently.

My copay was $890 for a dumb ResMed Escape -- what a rip off.

Lee and akcpapguy, the whole medicare billing is so screwed up, it's a wonder anyone can make any sense of it. and it undermines what we hoseheads not on medicare have to pay for equipment.