Let's clear up some misinformation

nanwilson wrote:Not all prescriptions state exactly which machine to dispense.

They do if you insist on it.

DoriC wrote: . . . jaw-dropping . . .

I agree. The scariest thing is that the poster actually seems to think he or she is making sense and seems sincerely delusional and unable to see how the arguments made come across to customers/patients like us.

I believe that the OP also does not realize how many manufacturers and doctors follow this forum and will read the DME-think posited here and see right through the double-speak and will see clearly the full implications of what is being said. Manufacturers don't like their more useful machines being withheld from patients, I don't think. I really think it is GREAT that this is documented. It proves exactly what has been said in this forum for so many years. That's why my thanks to the OP is sincere. Thank you for proving the point so well.

The saddest thing is that manufacturers (the other half of the PAP cartel) have at times made the lame argument that brick-and-mortar DMEs, as opposed to online companies, are motivated to be more helpful to patients because DMEs can overcharge for the equipment and then (out of the 'goodness' of the DME's heart, apparently) use part of that profit to pay for trained employees to spend phone and face time with patients to be helpful to them. The OP has proven what a load of whatever that argument is. DMEs, as the OP has made so clear, are motivated only to maximize profit, not help. Since it would be even more expensive for a DME to pay trained employees to solve problems for patients than it is for the DME to provide AHI-data machines, why would any profit-centric DME provide either one? If machines that give useful info are being called "deluxe" to maximize profit, obviously actually being helpful in other ways would be considered bad business too, to a profit-centric DME anyway. So, what's next? Maybe: 'I'll tell you how to be comfortable using your machine if you pay me under the table'?!

I have read disturbing words from DME people before. But the arguments made here about how to "maximize profits" strike me as just this side of evil. Barely.

It would be nice if some decent DME owners would post in this thread to refute the drivel offered up to us here--that only the cheapest machine is ever paid for by insurance and that patients should have to pay extra out of their own pocket for any machine other than the cheapest the DME has.

If any DME people are out there who see things differently, as in 'actually caring about patients,' post here and say so. Please. Don't let us think that all of you think like the OP in this thread!!!

My impression is that the OP is angry with insurance companies, and resents that we are constantly blaming DMEs instead of the insurance companies who she/he feels are rightfully to blame. I think some of our anger (note I said SOME and don't anyone misquote me as saying ALL!) is misplaced, and perhaps we are somewhat ignorant of some of the rules and terminology that DMEs operate under. I think this can all be succinctly summarized by saying that we're getting the shaft from the insurance companies, as well as many (but not all) DMEs who obviously didn't go into the field to be of particular help to sick people.

My insurance company is direct. They don't lie to me. They paid $2205. for my machine. The DME argued against me 'needing' that machine and had to give in when I insisted. When I mentioned downloading the data they told me my warranty with Resmed for the machine would be voided if I downloaded the data. They have lied to me many times. They once brought out a bagged "new" mask for me to try. The mask and head gear were from two different companies.

My latest DME brought out a mask that was opened and had a part MISSING.
The previous one tried to sell me a cushion coded as a mask without headgear.
They also coded the front part of my Swift FX as TUBING so they could get more from my insurance.
I am amazed they actually included all three sizes of pillows, as many do not.

Elle wrote:My insurance company is direct. They don't lie to me. They paid $2205. for my machine. The DME argued against me 'needing' that machine and had to give in when I insisted. When I mentioned downloading the data they told me my warranty with Resmed for the machine would be voided if I downloaded the data. They have lied to me many times. They once brought out a bagged "new" mask for me to try. The mask and head gear were from two different companies.

And none of that contradicts what I wrote. Believe me, I've had my share of negative experiences with DMEs.

Keep in mind that the OP told you what you can do about it (i.e., contact the accrediting body), and that was some great advice.

Robespierre wrote:So, LTTS, does this mean that every time a doc prescribes an AutoPAP and the DME fills the prescription, the system is such that the DME loses money because insurance will only pay for a brick?

If DME buys an apap at $550-600 cost and collects $800-900 for it, is that losing money?

Granted, if they get you a brick that costs them $350 and still collect $800-900 from insurance, that is a LOT better... for THEM.

LTTS has told us that insurance only covers a basic cpap (or "brick"), but that statement is based upon the DME marking up their cost on the machine by 125% or more... if they provide you with an apap that they mark up only 30-35%, it does not mean they are losing money (in my opinion). In many businesses that buy at wholesale and sell at retail the markup is an average of 30-40%.

Basically, LTTS is telling us that a DME's business model is to earn 125% or more in profit on ONE CUSTOMER'S cpap machine. If they don't earn that much then they are losing money... according to LTTS.

rocklin wrote:

nanwilson wrote:Not all prescriptions state exactly which machine to dispense.

They do if you insist on it.

And that is exactly my point!! It's true that some folks don't come here or do any research first (I didn't either... just got really lucky), but as more and more people get educated, they will simply tell their doctors what machine they want (hopefully knowing in advance whether they will be paying for it or if their insurance company will). At that point, the only involvement the DME will have is to follow orders, which they must do! After that, you will only need the DME for supplies... and if you don't like one, you go to another, or purchase on line.

Until the situation changes and machines can be purchased at your local pharmacy, and until the insurance industry changes , it's imperative you know what's going on. Yes, the insurance companies do the pricing... most of you know that... right?

So, when a DME files an insurance claim for a ridiculous amount,
and the insurance company pays the contracted amount;
does the DME claim the difference as a LOSS on their taxes?
It seems that a little 'financial creativity' could be just too tempting not to do.

chunkyfrog wrote:So, when a DME files an insurance claim for a ridiculous amount,
and the insurance company pays the contracted amount;
does the DME claim the difference as a LOSS on their taxes?
It seems that a little 'financial creativity' could be just too tempting not to do.

You know what... you nor I can do a damn thing about it. Things like that go on all the time. Of course it's not right, but hopefully at some point, prob long after you and I are gone, they will come up with a better solution, including not having to hire the OP to do their bidding.

In the meantime, you must be your own advocate... which I realize more every day, and that's really all the power we have.

Looked at another way, isn't it wonderful what happens to the free market when government mandated regulators step in and make decisions for you?

For the free market to work there has to be freedom for both the producers and consumers to strike their own deal. But when someone with a gun and the power to take everything you have steps between you and your supplier, or you and your customer, and dictates the terms of the deal, then you have the situation that lead to this wonderful interchange.

For myself, I shortcircuted the system and bought the machine I wanted out of pocket.

A pox on them all, I say!

chunkyfrog wrote:So, when a DME files an insurance claim for a ridiculous amount,
and the insurance company pays the contracted amount;
does the DME claim the difference as a LOSS on their taxes?
It seems that a little 'financial creativity' could be just too tempting not to do.

Some of the difference goes to cover the ridiculously low amount that they get from medicare patients.

It does not make it right, it is just a symptom of the problems with the insurance system here in the US.

chunkyfrog wrote:So, when a DME files an insurance claim for a ridiculous amount,
and the insurance company pays the contracted amount;
does the DME claim the difference as a LOSS on their taxes?
It seems that a little 'financial creativity' could be just too tempting not to do.

No, they can't do that. Profit or loss is the difference between cost to buy and price to sell. If cost is higher than sale price, then there is a loss. But all gross profits and losses get aggregated together at the end of the year so the numbers on a specific single transaction or product mean very little at the end of the year. Business accounting is based on what the business did earn or lose, not on what it could have earned or lost.

I think one reason the DMEs, and all medical providers, charge a seemingly ridiculous amount is two fold. The contract amount varies with every payer and trying to bill each payer the contract amount only would be an accounting nightmare they happily let the payer shoulder. It's easier just to bill every payer the same amount and then adjust their number on their books when they get the payment. Also, it provides a number they can use to tell the self paying patient, "This is what we always charge." As we all know, what they charge, and what they accept as payment, are two different numbers and much of time don't make any sense whatever.

If DMEs are complaining about reimbursements being only 50% to 60% of the charged amount they should just be happy they aren't selling flu shots, B-12 shots, or doing lab blood tests. My Medicare statements often show those contract amounts as low as 10% of the billed amount.

The people on this forum are the best. I was lucky to find this forum before I had my sleep test and with the good advice from this forum I knew exactly what to expect. I got the machine I wanted and found a DME I could do business with.

If you ever wonder why so many have trouble with their DME they are probably getting advice from the OP or someone like her.

I understand why we all need a sleep study to find out if we have OSA. But I don't understand why we need a prescription to buy a cpap or cpap supplies. I hope during my lifetime I will be able to walk into Wally World or WalGreens and buy what I want right off the shelf. By pass insurance and DMEs. You would be able to buy the so called "DELUXE MODEL" for 60 to 70 percent less than they cost now. Mask, hose, headgear, same way. Does it not piss off anyone but me that cpaper's have to have a prescription to buy a mask? As long as you have to have prescrpition for these things it will cost 4-5 times more than they should.

Anyways, I hope everyone has a great week.

LTTS mentioned that Medicare will be instituting competitive bidding in something like 90 more regions in the next few months, and that that has already been done in 10 regions. She also mentioned that Medicare reimbursements will drop some more and the DMEs will really be strapped for profit margins. There're problems with her complaint. If prices drop significantly that means either one, the prices have been higher than necessary for a DME to make a decent profit, or two, there are a bunch of idiot business operators out there who don't know how to bid a price high enough to make a decent profit. I suspect the latter will be the more likely case. There are many small business operators who aren't smart enough to know they need to make money to stay in business. They make it hard for everyone. But, that's the free market capitalist way. Another problem with her complaint is that all the free marketers keep saying the Gov't should buy more stuff with open market bidding. When you do that price becomes the all important driver. Customer service gets tossed overboard.

Remember 30 years ago when airlines were regulated? Flying was not cheap, but it was dependable, you didn't have airlines going belly up every few months, you got good service when you flew, and you could fly to every major city in the country. After deregulation you have cheap air fares, airlines going broke, cramped seating, no food, baggage fees, and smaller cities being left out of the service map.

30 years ago when MCI was allowed to sell long distance phone service at rates far below Ma Bell, Uncle decided the phone system should be deregulated. That's when phone service started going downhill. Rural phone rates for land lines skyrocketed. Home phones became cheap and you had to buy them. They lasted about 3 to 5 years. The old bell system phones that were part of the phone charge were built to last 40 years. They never broke. We have unregulated cell phone service. Get away from populated areas and you don't have service. Phones are good for only 2 to 3 years. Phone charges easily run up to $100/month. And in many cases the service is crappy. Remember who was prez 30 years ago?