How Much Did You Pay For Your Machine and Mask?

wading thru the muck! · Post by **wading thru the muck!** » Wed Oct 19, 2005 2:39 pm

Gee, $4200 for a $350 cpap and $384 for a $179 hunidifier... no wonder SSI/Medicare is going broke.

What I would like to know is what the DMEs do with all this money? They must have to carry it out in wheelbarrows.

Severeena · Post by **Severeena** » Wed Oct 19, 2005 5:54 pm

I know Tom and I talked about this, while resting and he said the insurance companies are the ones causing this.

Go figure.

Jan in Colo. · Post by **Jan in Colo.** » Wed Oct 19, 2005 9:00 pm

"Gee, $4200 for a $350 cpap and $384 for a $179 hunidifier... no wonder SSI/Medicare is going broke.

What I would like to know is what the DMEs do with all this money? They must have to carry it out in wheelbarrows.

One thing I don't see taken into consideration in these discussions is that just because insurance/Medicare is billed an amount....doesn't mean it PAYS that amount. At least I know that to be the case on doctor's charges and that kind of stuff, so I assume it to be true on medical equipment. Medicare especially only pays 20% or less on a bill. That's pretty much the whole reason medical bills are so expensive...insurance never pays what it is charged, so the charges go up and up until the reimbursement is at a reasonable amount. No way in hell is Medicare going to pay X amount just because it was BILLED X amount. They pay just a percentage of the bill. And all other insurances base their payment schedules on what Medicare is doing.....

Jan in Colo.

wading thru the muck! · Post by **wading thru the muck!** » Wed Oct 19, 2005 9:20 pm

Jan,

Sev's EOB will tell her what Medicare is actually paying for her machine. I'll bet you it is WAY more than 20% of the $4200. But to humor you, even if it was only 20% of the billed amount that would still be $840 for a machine that cpap.com sells for $349.

Severeena · Post by **Severeena** » Thu Oct 20, 2005 5:25 pm

Medicare is paying $175.00 a month per my contract I have in my hand.

If 24 X $175.00 doesn't = $4,200.00 I am not multiplying correctly?

Yes the contrat is for 2 years= 24 months times $175.00= $4,200.00

I should know what I am talking about Jan.

Thanks Wading for your support and help in this.

regisb50 · Post by **regisb50** » Thu Oct 20, 2005 10:40 pm

We are a little off topic here. Most people who read this thread are interested in how much it is going to cost to live with CPAP. How often should the masks be replaced?...

So please keep posting that kind of information.

Now to the topic of all that money. We are seeing the result of bureaucracy building. Insurance companies are trying to protect their funds, by creating an organization to monitor claims - they are profit motivated. Every dollar they don't pay in claims goes to the profit side of the equation. They may have spent $10 in administration to keep that $1 but this is usually impossible to prove.

The medical supply companies are in business to make a profit by selling material goods. They have had to create an organization to manage the billing and collection from both the insurance companies and the end user. This has been a survival decision. Insurance companies rarely pay in less than 3 months, and often create multiple approval steps that delay payment for over 9 months. If the medical supply companies do not get paid for something they delivered to you , the will probably try to collect from the patient, but very likely it will end up being a bad debt.

I have seen statistics that show that the dollars going to medical bills incur a 30% to 60% organizational overhead.

There has never been a bureaucracy that has effectively reduced its own size.

I am sure no one would ever agree to it, but it would be interesting if there was a law passed for all medical groups including the hospitals that only 10% of funds can go to administrative costs, and that any insurance payment later than 45 days incurs a significant penalty, maybe we can put tens of thousands of clerical people out of work.

Jan in Colo. · Post by **Jan in Colo.** » Thu Oct 20, 2005 11:08 pm

Geez, Severeena and Wading...

I wasn't trying to argue with you guys at all. Or dispute what you were saying. Not at all. Sorry if it came off that way. I was just bringing up part of the numbers game that insurances and DME's play....maybe it had been brought up and I hadn't seen it. Shoot maybe it wasn't even a relevant point.

Anyway, my sincere apologies.

Jan in Colo.

NOzsnAZ · Post by **NOzsnAZ** » Thu Oct 20, 2005 11:31 pm

Well...back to our regularly scheduled programming....

I purchased a PB 420E w/ HH and a Ultra Mirage FF mask = CPAP.com price ~ $943.00

My insurance is BCBS and the charges went like this:

BMI.com "billed" BCBS = $2,836.00
BCBS "allowed" = $1,381.16 of which
BCBS "paid" BMI = $1,243.06
and I paid = $138.10

(Since I had already met my $300 deductable, I was responsible for 10%)

So I got an auto machine that would have cost me $943.00 for $138.00 - that is why I pay those large premiums every month...

(I also purchased the software - but that was out-of-pocket (not covered by insurance) so total cost out of pocket was $237.00)

NOzsnAZ

Severeena · Post by **Severeena** » Fri Oct 21, 2005 1:24 pm

Jan, sorry I took it the wrong way. This is one of the hardest things with a computer, we cannot see any of the facial expressions when a person is typing.

wading thru the muck! · Post by **wading thru the muck!** » Fri Oct 21, 2005 3:23 pm

Jan in Colo. wrote:Geez, Severeena and Wading...

I wasn't trying to argue with you guys at all. Or dispute what you were saying. Not at all. Sorry if it came off that way. I was just bringing up part of the numbers game that insurances and DME's play....maybe it had been brought up and I hadn't seen it. Shoot maybe it wasn't even a relevant point.

Anyway, my sincere apologies.

Jan in Colo.

Jan,

Sorry to have seemingly snapped back at you. As you can see I am passionate about this issue.

My point was that the amount that is often billed is so huge that even if the providers receive only a small percentage of what they bill they are sill making massive profits.

The cost of buying health insurance has increased astronomically and this is the reason.

christinequilts · Post by **christinequilts** » Fri Oct 21, 2005 7:22 pm

Severeena wrote:I cannot believe it.
American Home Patient is bilking Medicare for my ResMed S7Lightweight for a 2 year contract of $175.00 plus Tubing 8 feet smooth bore 51.28NA is says on the contract, Humid Air II $384.00 now if my multiplication is correct this is attrotious.

American Home Patient is billing Medicare $4,200for the two years?

Do you have regular Medicare or are you in a managed care plan? Regular Medicare pays $94-111 rental for CPAP- capped at up to 15 months (capped rental), with the first 3 months is 100%, next 12 months is 75% of allowable. CPAP hose allowable is $34-41, nasal mask-$99-117, ect. If you want to see more, Puritan Bennett has a chart for the main products used for OSA: Medicare Payment Guidelines

At least CPAPs are capped- BiPAP ST are in the 'Frequently Serviced' catergory, so they are rental forever & ever...and at $550-700 per month that means every year they pay more then twice what CPAP.com charges for it- and this goes on until the person no longer needs it, which is typically until the person dies or needs an invasive ventilator. Now they do include mask & supplies in the monthly rental, but they don't add up to that much...even at Medicare allowables. Considering I'm 33, if I live a typical life span, Medicare could eaisly end up paying out nearly 1/4 million dollars at todays prices & dollar. They do replace the BiPAP ST if needed, but typically not less then every 5 years so that would be about $30,000, add in $500 per year for accessories they provide ($15,000) and that brings their 'cost', at cpap.com prices, to $45,000...and a potential profit of over $200,000 for my DME. What is even worse with Medicare is if you don't have another insurance to pick up the 20% co-pay for the BiPAP ST- at $125 per month/$1500 per year, you could buy a new BiPAP ST every 2 years. Thankfully regular BiPAP are capped rental, like CPAPs, so most people with apnea don't have to worry about this.

THier · Post by **THier** » Fri Oct 21, 2005 8:01 pm

THier wrote:Well newby here and to the whole cpap thing,,, but I guess I am lucky, I have good insurance, and paid nothing,
Just received
Breas pv10 cpap,
Resperonics H2 humidifier,
and an IQ mask.

I am fighting for a different mask, I used a Profile Lite to start my study, and finished with a Comfort Classic.

Tom

Well just swapped out machines today,
Remstar Pro2
Humidifier
ComfortClassic mask
I have a Spare mask and hose now

Still fully covered.

Tom

Severeena · Post by **Severeena** » Fri Oct 21, 2005 9:30 pm

I was reading my contract when I posted about Medicare.

I have a 2 year contract.

I have Medicare Part A and Part B.

Boomer · Post by **Boomer** » Sat Oct 22, 2005 8:44 am

I got my Rx from the doc and ordered here. Paid just over 1127.98, for my Remstar Auto, Activa mask, heated humidifier, extra filters, chin strap, software and card reader. Submitted the bill to my insurance, they paid 80% of all of it.

Have since ordered a Breeze, a swift, more filters, 10ft. hose, and the coupling that goes between the machine and humidifier, from cpap.com. Wouldn't do it any other way.

About the coupling between the machine and humidifier, mine was leaking and did not have a replacement. I called the DME that does contract with my insurance, Apria, as they have a local store here. They would not sell me just the coupling, said they would only sell me a new humidifier, for 285.00, and I would have to have a prescription for that. So I just ordered them here, had them in 3 days. I did order a few extras, as well.

Boomer

Severeena · Post by **Severeena** » Sat Oct 22, 2005 2:41 pm

I am not really going to push to much about the Auto Spirit I bought out of pocket because in December I am going to be asking for a new powerchair.

Talk about an expense.

Mask

Mask

Mask

Mask

How Much Did You Pay For Your Machine and Mask?

Where is the money going?