Walmart and personal control

I went to the local Walmart a few months ago. I had a needed a physical photo in a bit of a rush on the weekend, so I printed it using their online service and chose the option to have it printed and kept at the local store. A bit later I get their notification that it's ready, so I go down there with my printed notification in hand.

When I get to the photo store counter, the employee takes a quick glance at the notification, tells me that I can collect it at the back of the store (seems strange I mention, but to no effect), and asks one of the employees across the aisle to take me there. That employee finishes up what he was doing, then leads me towards the back of the store. About 3/4 of the way, we meet another (more senior) employee who looks at the notification and says that my photo won't be at the back of the store, it will be at the photo store counter (where I was originally), so we all walk back there and indeed that's where it is.

However, it doesn't have a price affixed. Trying to be helpful I show my notification again and point out where the price is 19 cents + 2 cents tax = 21 cents. Employee tries to charge me 23 cents (= 21 cents + 2 cents more tax). When I explained I didn't want to pay double tax (once is enough), she quickly charged me only 21 cents.

Overall, all but the first employee who sent me on the wild goose chase were helpful and nice, but the whole experience leaves me with a pretty negative impression. Fortunately, there's lots of competition to choose from.

I still say "something "ain't" kosher w/this situation. It may well have something to do w/the fact that you've been on CPAP for 5 years (w/most insurances you could be eligible for a new, more up to date, CPAP after 5 years) and haven't had reported contact w/a sleep doctor in 5 years and your insurance wants a current verification of your therapy status, i.e. contact w/a sleep professional or even a new titration study to verify you still need CPAP.

I think the root of the problem is that the DME's customer is not the sick person, it's the medical/insurance system. And the same probably applies to a whole variety of medical services. We're just another "human resource".

It's a nice convenience to have the DME automatically bill the insurance and just have us make a "small" copayment, but I think it introduces a huge number of distortions that are actually detrimental in the long term. For instance, none of us can consider the final cost of a DME's services when choosing a DME, since we have no idea what they even are. So, the insurance pays whatever and all our rates go up.

While I'm at it, two other gripes with the system. First, all the different rates charged by a provider for exactly the same service, and the hassles they have trying to be paid by the insurance. Why is the cash price for a doctor's visit so astronomical compared to the insurance rate for exactly the same thing? Given the hassles and delayed payments they have from the insurance companies, it should be the other way around.

Second, I hate the idea of employer paid insurance. You get sick, you lose your job, you lose your insurance. You get sick, you change jobs, your new insurance won't pay because it's a pre-existing condition. I had a work colleague who needed urgent surgery to correct a pre-existing condition that took a turn for the worse shortly after he started a new job. Tough luck for him: insurance won't pay. Now he's an invalid for the rest of his life because of that. He has been continually "covered" by so called health insurance all his life.

JointPain wrote:Fortunately, there's lots of competition to choose from.

A local journalist in a small Colorado town documented
the rise of Walmart and the demise of all the small
businesses in the downtown.
In 18mths, all of the small business were gone.
At which point, Walmart raised all their prices.

I do not shop at Walmart.
If that is the only place to get it,
I don't need it.

Keep it up and soon Walmart will be the
only place to shop....at their prices.

Why do you have to have a prescription in the first place? I can never recall a headline that stated " Death by CPAP". Having to obtain a prescription automatically raises the price of the machine and accessories 3 to 4 times.

The people on this forum are way more informed on this subject than any DME or tech. I ever talked to.

kempo wrote:Why do you have to have a prescription in the first place? I can never recall a headline that stated " Death by CPAP". Having to obtain a prescription automatically raises the price of the machine and accessories 3 to 4 times.

The people on this forum are way more informed on this subject than any DME or tech. I ever talked to.

Government and special interest lobbyists make it this way. I am a diabetic who uses novolog and lantus insulin. I am also a doctor, but can't write prescriptions for myself. I contacted the FDA to ask why novolog and lantus were rx, and other insulins like lente and regular were OTC. Their reply was basically that you could kill yourself with novolog or lantus, but that you couldn't with lente and regular. That was one of the biggest pieces of bs that I ever heard. The real reason is that novolog and lantus are newer insulins and far more profitable than the older lente and regular. Big Pharma lobbyists, wanting to maintain maximum profitablility, made sure that novolog and lantus stayed on rx. The farther away from the free market you can keep a product with government protection, the more money you can make on that product. Works the same way with CPAP machines and supplies.

Stephen

Our current DME apparently needs our business--and they didn't even sell our machines!
(--We dropped THOSE crooks!)
They 'do' Medicare--I have a year to make sure our new supplier (them or somebody else)accepts the contracted price.
Of course, I am an inveterate name dropper; and can make my experiences (and recommendations) available to hundreds of co-workers.
I believe these folks may work out--if not, someone will.

beckah wrote:You might get your wish that Walmart will sell Cpap items and accessories. Looks like they already have some Cpap pillows and one mask for sell.

http://www.walmart.com/search/search-ng ... nstraint=0

WalMart has no CPAP masks for sale. What you are seeing is a listing for CNS Stores, a privately held company that is unrelated to WalMart.

CSN Stores is an e-commerce company based in Boston, Massachusetts. It has been growing rapidly since its inception in 2002 with over 200 online stores and over 800 employees.

Things would be much better if CPAP machines, masks, and supplies could be sold by WalMart and their competitors.

kempo wrote:Why do you have to have a prescription in the first place? I can never recall a headline that stated " Death by CPAP". Having to obtain a prescription automatically raises the price of the machine and accessories 3 to 4 times.

The people on this forum are way more informed on this subject than any DME or tech. I ever talked to.

I'm going to have to admit that there probably is sufficient reason to require a prescription for CPAP.

1) With our corrupt medical system, you probably wouldn't get reimbursed by your insurance if a prescription wasn't required. Yes, it's stupid that the system works that way, but that's the way it does work in many cases.

2) Many of the people on this board are way more informed than Joe Sixpack about what's needed for CPAP. I think we tend to underestimate the stupidity of the general public.

3) If it was "go to Walmart and get a CPAP off the shelf," a lot of people would never get it set right. While auto CPAP is a good thing, it's not (yet) good enough to always set a correct pressure without a smart user or good DME/doctor. Look at how many apparently smart people here on this board have terrible problems with mask leaks, mouth breathing, etc. and have to really work at it to get it right, even with the "help" of their medical professionals.

Joe Sixpack would probably end up with a dataless, manual CPAP machine with no humidifier, the wrong mask, no chin strap, etc.

4) Quite a few people would get a CPAP, ignore the instructions, not do it right, then decide "CPAP is not right for me," and not get the benefits of CPAP. CPAP does require a lot of effort.

5) How many hypochondriac soccer moms would put little Johnny on CPAP when he doesn't need it just because she's a nervous nellie?

6) Would we have computer generated Billy May clones in TV commercials pushing the amazing "Breathe-o-matic" for everyone who snores? Heck I've already seen commercials for miracle mouth guard things and sprays that "completely cure snoring."

7) A properly done sleep study will find quite a few things that won't be found by an auto-CPAP machine, no matter how smart it is. Especially if someone smart doesn't really take a good look at the data the CPAP records.

8) I'm not convinced that there aren't some risks of long term bad effects of CPAP. We know that improperly done ventilators and oxygen do bad things to newborn infants and premies. I think that even some adults suffer from being on "ventilators" for too long. Yes, CPAP is designed with these risks in mind, but who knows what the downside is of CPAP over 20 or 30 years on someone who doesn't really need it?

Yes, for those of us with apnea, the known risks of apnea far outweigh the potential risks of CPAP, but I'm not sure we're confident enough in CPAP to inflict it on someone without apnea.

9) You probably can hurt yourself with a CPAP machine if you don't clean it, get the CO2 vent clogged, etc.

Now those are what I consider to be some of the legitimate reasons to not make CPAP non-prescription. Whether it would really be worse to make CPAP available without a prescription, I don't know. I don't think we can just come out with and say it would be better to not require a prescription. Would the country as a whole be better off with OTC CPAP? I'm not that confident that it would.

Yes, I DO know that the medical mafia is falling down on doing its job on CPAP in terms of proper equipment, followup, and patient education.

I still don't think we can claim this is one of those things were it's only regulated because of our admittedly corrupt medical system.

archangle wrote:

kempo wrote:Why do you have to have a prescription in the first place? I can never recall a headline that stated " Death by CPAP". Having to obtain a prescription automatically raises the price of the machine and accessories 3 to 4 times.

The people on this forum are way more informed on this subject than any DME or tech. I ever talked to.

I'm going to have to admit that there probably is sufficient reason to require a prescription for CPAP.

1) With our corrupt medical system, you probably wouldn't get reimbursed by your insurance if a prescription wasn't required. Yes, it's stupid that the system works that way, but that's the way it does work in many cases.

2) Many of the people on this board are way more informed than Joe Sixpack about what's needed for CPAP. I think we tend to underestimate the stupidity of the general public.

3) If it was "go to Walmart and get a CPAP off the shelf," a lot of people would never get it set right. While auto CPAP is a good thing, it's not (yet) good enough to always set a correct pressure without a smart user or good DME/doctor. Look at how many apparently smart people here on this board have terrible problems with mask leaks, mouth breathing, etc. and have to really work at it to get it right, even with the "help" of their medical professionals.

Joe Sixpack would probably end up with a dataless, manual CPAP machine with no humidifier, the wrong mask, no chin strap, etc.

4) Quite a few people would get a CPAP, ignore the instructions, not do it right, then decide "CPAP is not right for me," and not get the benefits of CPAP. CPAP does require a lot of effort.

5) How many hypochondriac soccer moms would put little Johnny on CPAP when he doesn't need it just because she's a nervous nellie?

6) Would we have computer generated Billy May clones in TV commercials pushing the amazing "Breathe-o-matic" for everyone who snores? Heck I've already seen commercials for miracle mouth guard things and sprays that "completely cure snoring."

7) A properly done sleep study will find quite a few things that won't be found by an auto-CPAP machine, no matter how smart it is. Especially if someone smart doesn't really take a good look at the data the CPAP records.

I'm not convinced that there aren't some risks of long term bad effects of CPAP. We know that improperly done ventilators and oxygen do bad things to newborn infants and premies. I think that even some adults suffer from being on "ventilators" for too long. Yes, CPAP is designed with these risks in mind, but who knows what the downside is of CPAP over 20 or 30 years on someone who doesn't really need it?

Yes, for those of us with apnea, the known risks of apnea far outweigh the potential risks of CPAP, but I'm not sure we're confident enough in CPAP to inflict it on someone without apnea.

9) You probably can hurt yourself with a CPAP machine if you don't clean it, get the CO2 vent clogged, etc.

Now those are what I consider to be some of the legitimate reasons to not make CPAP non-prescription. Whether it would really be worse to make CPAP available without a prescription, I don't know. I don't think we can just come out with and say it would be better to not require a prescription. Would the country as a whole be better off with OTC CPAP? I'm not that confident that it would.

Yes, I DO know that the medical mafia is falling down on doing its job on CPAP in terms of proper equipment, followup, and patient education.

I still don't think we can claim this is one of those things were it's only regulated because of our admittedly corrupt medical system.

Joe six pack is smarter than you think. If you can go buy a flat screen LED 1080P flat screen TV and hook it up to your cable or dish box along with a blueray DVD and make it work, you can do the same with a cpap machine with your eyes closed. This is not rocket science!

kempo wrote:Joe six pack is smarter than you think. If you can go buy a flat screen LED 1080P flat screen TV and hook it up to your cable or dish box along with a blueray DVD and make it work, you can do the same with a cpap machine with your eyes closed. This is not rocket science!

I've helped Joe Sixpack set up their TV before. You're overestimating his skill. No one gets hurt when he sets up the TV wrong. His health doesn't suffer if he decides to discontinue it. He's also going to be able to find a buddy like me who can fix it for him in exchange for a six pack if he can't figure it out. He also doesn't have to wait a few weeks to tell if it's working or not.

CPAP isn't as simple as you seem to think.

Exactly which mask are you looking for? Someone on Croupier's Mask Roulette thread might be able to help you if they are willing to provide a mask and NOT trade, since I am sure no one wants your old mask. I have a few extra masks, some with and some without headgears- so maybe I have something you can use for the price of postage, provided you live in the USA, that might be in better shape than yours--though the ones I have are also used gently.....If you want to send me a PM, maybe I can help you. I think you can buy headgears without RX if u want one of the ones I have, that doesn't already have one. I would hate to see you go without your CPAP because of red tape.

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Often WalMart partners with independent providers who locate in their store. I know of medical clinic, hearing aid service, and banks.

Even selling a few things helps keep specialist suppliers sharp. And WalMart employees often refer customers to specialty stores.

As for the debate of socio-economic politics herein, WalMart takes its chances in the free market protected by a justice system - people can avoid shopping there (as many did when it recently changed its product mix and pushed environmentalism). OTOH, socialism is based on central control. (Sure, advocates talk of spontaneous community processes, but reality is that it always becomes controlling. A big problem is failure to judge quality, which is rooted in a view of humans as incapable and untrustworthy, thus must be controlled by some magically omniscient collective.)

The problem many people herein are having with providers/suppliers comes from bureaucracy, be it government (as in the Canada-UK etc. system of direct government health care) or insurance companies and doctors who are operating under many government rules (such as gyrations of payment with Medicare patients). I find that doctor offices are staffed by bureaucrats who have not had a help-the-customer focus instilled in them as nurses and doctors have. And quality varies – some doctors don’t know how to measure blood pressure accurately, even a large hospital did not (they violate AMA/CMA guidelines). Ability to walk away is the best mechanism for quality improvement. (Those who are dishonest will find they are shunned by providers and customers – choice does not provide a free lunch.)