WHAT TO SAY to get better machine

BlackSpinner wrote:

mcdover wrote:Caveat Emptor! The time for negotiating for a better machine, was BEFORE you walked out of the store with it. I'd be willing to bet that your RX said CPAP @ ? cmH20, humidifier, and mask.

The problem is that sleep deprived people often can't think straight or absorb new information easily.

Remember sleep deprivation is a torture technique used to break down resistance by creating confusion.

VERY VERY GOOD POINTS!!!!!!!! And very very very true.

Eric

BlackSpinner wrote:

mcdover wrote:Caveat Emptor! The time for negotiating for a better machine, was BEFORE you walked out of the store with it. I'd be willing to bet that your RX said CPAP @ ? cmH20, humidifier, and mask.

The problem is that sleep deprived people often can't think straight or absorb new information easily. I am a computer programmer and systems analyst but before I got my machine I was in such bad state that non of the information on this site made much sense. I was lucky in getting a good machine and adapting easily. Two weeks on the machine made a world of difference in my cognitive ability. Most DME's take advantage of this state of mind, most people expect service like they get at the pharmacy where the pharmacist will verify that what is prescribed is actually what you need and won't interact with other things and your allergies, my pharmacist will make sure I understand how to take the medication (in 2 languages) and its side effects. I expected the same quality of service from my DME and I didn't get it.

Remember sleep deprivation is a torture technique used to break down resistance by creating confusion.

this is an excellent post and I agree with everything in it and except for my very first DME which was excellent, mirrors to a T what I have experienced with DMEs, particularly when I was not doing well recently.

Eric

mcdover wrote:Apparently, you don't know the difference in "cost" vs. "price". Just because the price is closer, doesn't mean the cost is. I see that you don't run a business, evident by the fact that this concept is lost on you. Also, before mudding up the water with claims of illegal activity, it would behoove you to keep your incorrect thoughts to yourself.

Get a grip. I know more about suppliers than you might think. You have no clue what I may or may not know and your telling me that I am incorrect and I should shut up because I disagree with you. BS. It simply will not happen.

Upgrade fees to Medicare patients are indeed illegal if you bill Medicare at all. Participating Medicare providers have even more stringent rules.

Now I can add rude, hateful, arrogant and a donkey's behind to the list of reasons why I wouldn't want to do business with you.

Pugsy wrote:

kentoboo wrote:I had to pay an extra $159 to upgrade to a data capable machine. I probably was hosed ( no pun intended) but sometimes it is just easier to switch than fight!

It may have been a legit fee, just depends on the insurance (like HMO or PPO thing). Straight Medicare though? That is fraud.

But sometimes "peace of mind" costs are well worth it. If it didn't take food off the table and paying the extra helped your stress level by not having to go to battle, then peace of mind cost is not so bad. I bought out of pocket so I didn't have to fight with anyone. Gave me peace of mind knowing I got what I wanted and I didn't have to battle for it.
Overall the cost was probably a wash after deductible and co pays. I had the cash, didn't take food off the table so worth it to me not to fight that battle.

You could not be more wrong about Medicare. Yet again, a post from someone who has no idea what they are talking about.

The code for CPAP is E0601. If a DME puts out the same machine to ALL customers, it is perfectly legal to "upcharge" for a more expensive machine. Two years ago, Medicare slashed reimbursement by 10%. Do you think the manufacturers cut their prices too? Not hardly. The S9 and PR System One were introduced at about 10-15% more than the previous platform. Now, Competitive Bidding is here. 34% cut in reimbursement in the first round and the second round bidding is about to start. Care to guess who gets these Medicare contracts? That's right, SmartGuy, the lowest bidders. So do you really think Medicare recipients are going to get the best, top-of-the-line CPAP available without an upcharge? Medicare knows this. People don't want the bottom of the barrel anything, much less a CPAP, so what a better way to get out of paying altogether. Cut the reimbursement down to near cost, force over burdening regulation, tickle the payments out over 13 months, and make the DME prove the patient is using the machine AND seeing their doctor AND the doctor is writing the correct notes. That's the current rules that I deal with NOW!

Here's the way all of this is going to end if something doesn't change. The only CPAP offered to you by your DME company, is going to be the most basic bottom of the barrel CPAP manufactured. Medicare, Blue Cross, and all other private insurance. HMO's have been doing this for years now. Just ask any United Healthcare policy holder what his "in-network" DME offers as a covered CPAP. If you want something better, you are going to have to reach a lot deeper into YOUR pocket for it. So instead of bitching about what the evil DME is charging, maybe you should confront the true cause of the problem and complain about what the insurance is paying. For some unknown reason, people don't see a problem with paying more for bigger motor in their car, or the leather seats, or the nice stereo system, but tell them the CPAP they WANT costs more than what their insurance will pay for, and just step back and watch the fireworks.

I've been told by several local doctors that they are not excepting any new Medicare patients. Not because they don't like treating seniors, but because they can't practice for free. When your costs are more than the reimbursement, it doesn't take an Einstein to figure out what the next step is.

So, all that being said, my original advice still holds. You have to do your homework BEFORE signing all the paperwork and walking out with the machine. I can't compete like a traditional business and have sales, reduce prices, etc. All I can do is offer superior equipment and better customer service. That's why I only put out high end machines. Every customer gets an auto and given a choice between manufacturers. Most DME's don't run this way and take the different approach of putting out the bare minimum. Usually these companies are financially affiliated with a sleep lab or doctor, so they have a built in referral source. The poor patients not only get mid-level to very basic equipment, they also usually get poor customer service. When the patient finds out they made a mistake by using that company, it's too late. Medicare pays 13 months of rental.....PERIOD! If you went to a crappy DME and got your machine and now want to swap companies, you are usually SOL. If you have had the machine for 4 months, Medicare is only going to pay 9 more months of rental....TO ANYBODY. So, the very best thing you can do, is do your homework first. If your doctor is pushing a particular company, you had better ask why. Is there ANY kind of financial relationship? I'm not accusing anybody of a kickback, but if I get a check from a company, isn't it in my best interest if that company succeeds? Also, I would NEVER recommend a company that is owned by a hospital or has some sort of joint -venture relationship. If I know that I will have a steady stream of new customers EVERY month, what's my incentive to treat them right and give good service? Sure they'll get pissed off and go somewhere else after I've filed the claim a got the money, but good 'ol partner sleep lab will just send me another batch of new patients next month.

EricinNC wrote:

mcdover wrote:Caveat Emptor! The time for negotiating for a better machine, was BEFORE you walked out of the store with it. I'd be willing to bet that your RX said CPAP @ ? cmH20, humidifier, and mask. If it does, then you are SOL and you are dependent on the charity of the DME if you do get an upgraded machine. As far as the advice to threaten to write letters to various state agencies, remember extortion is illegal, and if you actually do write those letters, I would consult an attorney first. Nothing like having to defend yourself against a libel suit.

With the exception of one or two, you have been given some terrible advice here. As a DME owner who only puts out the high end machines, here's what I suggest to get what you want. First the difference in cost between an Escape and Elite is somewhere around $150-$200. Knowing that, I would suggest that you go into the office and ASK for an upgraded machine. If they won't do an even swap, offer to compensate them for the difference. Remind the manager that you plan on being a long term customer and the periodic replacement of supplies (masks, tubing, filter, etc..) have to come from somewhere. Contrary to popular belief on this site, DME's are not making a killing on selling CPAP's. With the increased regulation, tax increases, increased cost of doing business, and the increased games insurance companies are playing to keep from paying claims, there have not been a darker day for DME companies. That being said, more and more companies are going to the less featured CPAPs in order to keep costs down, because reimbursement rates have consistently dropped while cost of goods have risen. If you want a upgrade, be prepared to pay extra on top of what insurance pays.

If you were my DME supplier and you gave me a cheap machine, I could guarantee Id get a high end data compatible machine out of you. I am glad to hear darker days are here for DME companies, as most DMEs do not treat their customers well, like most insurance plans do not treat their customers well. I have no sympathy for you.


Eric

You are a fool as proven by your many profanity laced posts. Thought you weren't going to post anymore?

The only thing that really works is some sort of underlying threat, as in "dont mess with this customer he has pull." Or buy out of pocket. Or a direct doctor order (which I have gotten several times because of my personality. I never had any trouble getting high end machines and much of it has to do with my personality type. Being super super nice and polite =rugmat.

Eric

mcdover wrote:

EricinNC wrote:

mcdover wrote:Caveat Emptor! The time for negotiating for a better machine, was BEFORE you walked out of the store with it. I'd be willing to bet that your RX said CPAP @ ? cmH20, humidifier, and mask. If it does, then you are SOL and you are dependent on the charity of the DME if you do get an upgraded machine. As far as the advice to threaten to write letters to various state agencies, remember extortion is illegal, and if you actually do write those letters, I would consult an attorney first. Nothing like having to defend yourself against a libel suit.

With the exception of one or two, you have been given some terrible advice here. As a DME owner who only puts out the high end machines, here's what I suggest to get what you want. First the difference in cost between an Escape and Elite is somewhere around $150-$200. Knowing that, I would suggest that you go into the office and ASK for an upgraded machine. If they won't do an even swap, offer to compensate them for the difference. Remind the manager that you plan on being a long term customer and the periodic replacement of supplies (masks, tubing, filter, etc..) have to come from somewhere. Contrary to popular belief on this site, DME's are not making a killing on selling CPAP's. With the increased regulation, tax increases, increased cost of doing business, and the increased games insurance companies are playing to keep from paying claims, there have not been a darker day for DME companies. That being said, more and more companies are going to the less featured CPAPs in order to keep costs down, because reimbursement rates have consistently dropped while cost of goods have risen. If you want a upgrade, be prepared to pay extra on top of what insurance pays.

If you were my DME supplier and you gave me a cheap machine, I could guarantee Id get a high end data compatible machine out of you. I am glad to hear darker days are here for DME companies, as most DMEs do not treat their customers well, like most insurance plans do not treat their customers well. I have no sympathy for you.


Eric

You are a fool as proven by your many profanity laced posts. Thought you weren't going to post anymore?

Im a fool? Well how did I get so many high end, data compatible APAPs from DME people like yourself? HUH? Answer that, DME. If you were my DME IRL, Id eat you for breakfeast.

Eric

mcdover wrote:The code for CPAP is E0601. If a DME puts out the same machine to ALL customers, it is perfectly legal to "upcharge" for a more expensive machine.

Oh, so sorry, I guess that since you can screw everyone that makes it okay to screw the Medicare patients.
I didn't realize that made it okay.

BTW what do you charge for the S9 Autoset (before the ins write off adjustment)? Is it anywhere near the $2300 that I was quoted for a ResMed Escape from a brick and mortar DME? And again where are you? I want to make sure I avoid your place of business. It is very apparent we would not get along.

Pugsy wrote:

mcdover wrote:Apparently, you don't know the difference in "cost" vs. "price". Just because the price is closer, doesn't mean the cost is. I see that you don't run a business, evident by the fact that this concept is lost on you. Also, before mudding up the water with claims of illegal activity, it would behoove you to keep your incorrect thoughts to yourself.

Get a grip. I know more about suppliers than you might think. You have no clue what I may or may not know and your telling me that I am incorrect and I should shut up because I disagree with you. BS. It simply will not happen.

Upgrade fees to Medicare patients are indeed illegal if you bill Medicare at all. Participating Medicare providers have even more stringent rules.

Now I can add rude, hateful, arrogant and a donkey's behind to the list of reasons why I wouldn't want to do business with you.

Keep clutching your erroneous beliefs tightly. I'm just offering you years of experience in dealing with Medicare and private insurance on a daily basis. If you don't think I KNOW what is allowed and not allowed by law, you are as disillusioned as that Eric nutjob who brags about making girls cry.

Somnos balance billed us over 400 clams to get my hubby into a S9 Autoset.
Best $400 were were ever gypped out of.
Mine came from CPAP.com.

mcdover wrote:Keep clutching your erroneous beliefs tightly. I'm just offering you years of experience in dealing with Medicare and private insurance on a daily basis. If you don't think I KNOW what is allowed and not allowed by law, you are as disillusioned as that Eric nutjob who brags about making girls cry.

I also had years in the medical service profession and I also dealt with Medicare on a daily basis. Probably more years than you. Just because you want to be an ass doesn't make what you do right. There is no need to be hateful, snide and uppity. People like you are the ones that give DMEs a bad taste in people's mouths. I won't lower myself to respond to your insults any more. Neither will I bother reading your comments. Not worth my time. I suggest you feel free to add me to your Foe list so you won't be bothered reading mine. I am not going to get into a pissing contest with you anymore than I have already done.

Pugsy wrote:

mcdover wrote:The code for CPAP is E0601. If a DME puts out the same machine to ALL customers, it is perfectly legal to "upcharge" for a more expensive machine.

Oh, so sorry, I guess that since you can screw everyone that makes it okay to screw the Medicare patients.
I didn't realize that made it okay.

BTW what do you charge for the S9 Autoset (before the ins write off adjustment)? Is it anywhere near the $2300 that I was quoted for a ResMed Escape from a brick and mortar DME? And again where are you? I want to make sure I avoid your place of business. It is very apparent we would not get along.

I did not say that is what I did. I simply told you that you were WRONG, and that it is legal and this is how you do it.

Like I have stated many times, I only put out high-end machines.

I put out S9 Autosets at the insurance allowable. Blue Cross just cut reimbursement by 50% and I'm still putting out autos at the allowable. Same with Medicare. Now, if Medicare goes through with competitive bidding for the round 2 areas, I won't be able to do that anymore. Cost vs. reimbursement will be to the points where it is not feasible anymore. Care to guess who ultimately suffers? My example of how it is legal to "upcharge" is about to be 100% reality IF the competitive bidding law is not repealed.

Pugsy wrote:

mcdover wrote:Keep clutching your erroneous beliefs tightly. I'm just offering you years of experience in dealing with Medicare and private insurance on a daily basis. If you don't think I KNOW what is allowed and not allowed by law, you are as disillusioned as that Eric nutjob who brags about making girls cry.

I also had years in the medical service profession and I also dealt with Medicare on a daily basis. Probably more years than you. Just because you want to be an ass doesn't make what you do right. There is no need to be hateful, snide and uppity. People like you are the ones that give DMEs a bad taste in people's mouths. I won't lower myself to respond to your insults any more. Neither will I bother reading your comments. Not worth my time. I suggest you feel free to add me to your Foe list so you won't be bothered reading mine. I am not going to get into a pissing contest with you anymore than I have already done.

You hurl insults, then accuse me me of being hateful. Well, I'm beginning to think that you've had too many years of oxygen-deprived sleep to be deemed rational and lucid.

chunkyfrog wrote:Somnos balance billed us over 400 clams to get my hubby into a S9 Autoset.
Best $400 were were ever gypped out of.
Mine came from CPAP.com.

Were you required by your insurance to use the DME that upcharged you the $400?

The real, and possibly only, key here is persistence.

For the most part, DMEs don't get paid by the specific machine. They get paid for treatment. The tendency, therefore, is to use one standard, not very expensive, machine for as many patients as possible.

My personal solution was just to give up and pay for what I wanted using an out-of-network benefit for which I (theoretically) get reimbursed for 70%. I have not gotten any reimbursement yet, but fortunately could afford to pay the full cost out of pocket if needed. Most people can't, and must use in-network benefits to get treatment.

Try all of the advice above, but persist. If you can convince your physician to help fight this, it might help. Be warned that when money is involved nobody is terribly interested in what your doctor thinks you need.