Let's clear up some misinformation

Itts, are you a bot? You don't seem to be reading the responses.

My DME did not absorb anything. My insurer paid $2205 for a machine that likely cost the DME 1/3 of that.

Elle wrote:My insurer who paid $2205. for this machine is the same one who paid approx. the same price for what the DME told me I needed over 5 years ago (when I was ignorant). The DME was not pleased that they would not make as high a profit this time but had no choice.

Counting on the public remaining ignorant will always give you good stats.

Anyway, I am sure you are determined to keep the blinders on but with the internet gaining ground the party is about to end.

goodnight.

Baloney. Who is your insurance payer? will check the fee schedule. If I had a nickel for every patient who thought the insurance paid the submitted amount I would be rich. Your insurance company is in the business of making you believe they paid much more than they did, and that is why they make the EOBs so confusing. Even with a humidifer, mask, tubing, headgear, filter, etc. they did not pay that much.

In addition, the DME does not determine what you need -- your physician does, with the prescription they write. If your physician writes for an autoset the DME will provide it if they value more referrals from that physician. But your insurance company is not going to pay one dime extra for the fancy machine, and the DME is under no obligation to provide it. If they did, they did you a favor, and made next to nothing on your business. Obviously you don't appreciate it.

When you head to MacDonald's tomorrow tell them you want an extra large coffee for the price of a small. Maybe they will do it if you bring a note from your doctor.

ltts wrote:

Elle wrote:My brother in law has been on cpap for many many years and got a new machine every 5 years. He was happy with his latest "new" machine. I asked to see it. I laughed. It must have gone out of production 15 years ago. He knew no better and was still happy to sit with it instead of learning that he could do better.

Well you should feel very lucky that you found a DME provider that would absorb the cost of a deluxe machine without asking you to pay the difference between that an what the insurance company pays for.

To be perfectly honest, that is what bothers me about the posts here. Many of you are getting things that DME providers are under absolutely no obligation to provide for no extra charge, and instead of being grateful for it, you are complaining about the DMEs who don't. Instead of being happy that many DMEs go the extra mile for you even when your insurance company says they won't pay for those features, you think DMEs that won't do it for free are ripping you off. For some reason people have developed this entitlement mentality that makes them believe that DME providers are obligated to provide them with the most deluxe machine made when the insurance company barely wants to pay above the actual cost of providing the product.

And by the way, there are no patients receiving machines that went out of production 15 years ago. Anywhere. I doubt there are patients receiving machines that went out of production even 3 years ago. The blowers seldom last that long, and the machines cost more to be repaired than the cost of a new machine. The manufactuers make sure of that.

Do you sell cars on the side too. I'd like to buy one that doesn't run with no brakes and steering, it must be at least 10 years old, preferably used high mileage, I be willing to pay full new price for it, kind of like a DME would charge for a XPAP. Jim

ltts wrote:For some reason people have developed this entitlement mentality that makes them believe that DME providers are obligated to provide them with the most deluxe machine made when the insurance company barely wants to pay above the actual cost of providing the product.

Excuse me, but since when has the agreed upon contract price between the insurance company and the DME supplier been the patient's problem? The Resmed S9 Escape, Escape Auto, Elite, and Autoset all are in the HCPCS code E0601. I read that in Resmed's official Product List. When Medicare and Blue Cross tell me they will pay for a machine in code E0601 then I don't see why you believe you have a right to belly ache about me asking for the Autoset when the DME wants to give me an Escape. I'm sorry, but we as patients have no responsibility nor authority to mediate contract pricing between DMEs and insurance companies, nor to prop up the DME's bottom line if he has chosen to sell a machine for a miniscule profit margin.

idamtnboy wrote:

ltts wrote:All recent PAP devices are data capable.

Please define data capable. To us CPAP patients, data capable means a hell of lot more than hours of use. If you are suggesting that all machines will provide data such as pressure and details of AHI, you are dead wrong.

Nor do they care enough to pay for the deluxe features that many here seem to feel they are entitled to.

but guess what? They don't care.

So why, pray tell, do you think a DME provider should give you a high end device when your insurance will only pay for a basic model?

That's the mystery.

We strike out in frustration at the one we can reach, the DME supplier. We aren't getting the support from the medical community we need when it comes to determining the absolute best therapy for our condition, and as a group we are pissed. If the DMEs don't like the idea of a Resmed S9 Autoset being in the same code as an S9 Escape, then don't sell it. The insurance company pays by the code, and the code includes the Autoset.

We don't see getting a fully data capable machine as an entitlement. We see it as a necessity. When the insurance company says, "We will pay for a PAP machine, and this is what we will pay, and these are the machines this payment will cover," then why the hell shouldn't we demand the best machine in the offering? Especially when many doctors, like mine, know the basic CPAP doesn't provide all the information necessary and so prescribe the Autoset. And we know that the insurance company expects that machine to be used for the next five years. With a planned life span at least that long no way is any knowledgeable patient going to want anything less than a new machine. There's just no mystery there. If you make a contract with BK to pay them $4.00 for a hamburger, and the selection of hamburgers includes a double meat Whopper as well as the Whopper Jr., then any person who is covered by that contract has a right to ask for the big one.

Your comment about the Medicare ABN doesn't jibe with my reading of the provision. It applies to a situation where a patient wants to voluntarily upgrade to something like a VPAP or BiPAP machine when a CPAP has been prescribed. They are in entirely different codes. The ABN does not apply to machines within the same code.

As one of the other posters said, welcome to the real world of patients. I for one am glad you are here. I don't expect you to agree with our viewpoint, but I do hope you can at least understand a little bit where we as CPAP patients are coming from. As the old adage says, "S*** rolls downhill," and we feel like we are at the bottom of the hill!

All your insurance company is willing to pay for is hours of use, and/or data capable machines that will show usage for specific days in hours used per day. That's all your insurance company cares about, therefore all they are willing to pay for. I'm very familar with the real world of patients, but in reading here I have found that some people are training you to direct your ire at DME companies rather than insurance payers. And that is wrong and will never benefit patients in the long run.

Let me try to open your eyes a bit. Medicare pays between $680 and $800 dollars for a machine that costs between $350 and $450 dollars depending on the feature set. They pay that over the course of 13 months, so Medicare gets an interest free loan given that the DME must pay for the product in total at the time of acquisition.

In 2010 they instituted competitive bidding in 10 large metropolitan areas that cut that reimbursement by 20-25%. You do the math. I can guarantee you that no medicare patient in those 10 areas is ever going to get an autoset system that costs $100-$150 dollars more than the basic machine that Medicare believes is medically necessary.

That same bid program is set to hit an additional 90 cities in 2013 and covers most of the population of the country. Private insurance already pays at a discount off the Medicare rates, for instance Aetna in WA state pays 43% of the current Medicare fee schedule. Humana pays at 60 to 70% of the Medicare fee schedule. And that is normal for a private insurance payer. Again, do the math.

You know what I have found over 27 years in DME? That the vast majority of DME providers will give the patient what they believe is best for them even in the face of insurance payers declining to pay for those items. Do you have any idea of how many DME providers allow patients to keep equipment that the insurance company has weasled out of paying for based on some technicality? That's because they know the patients need the equipment even if their rotten insurance company has found a way to weasel out of paying.

The DME providers don't come to your grandma's house and take away her oxygen because the insurance won't pay simply because the physician couldn't be bothered to write oxygen on their medication list (and yes, insurance payers require this, in addition to a prescription). They just provide it for free rather than see your grandma die, and continue to deliver what costs them $100s of dollars of portable oxygen tanks a month so grandma can visit the grandkids or go to the mall when your insurance provider has declined to pay even the $35 dollars per month for portable oxygen on the fee schedule). The doctor didn't do the correct paperwork so the DME doesn't get paid.

The DME provider doesn't come to your house and demand you PAP device back when you missed your 90 day compliance by one day. They just don't get paid until you either get with the program, or decide you aren't going to use it.

All you have to do is look here to see how many DME providers have given posters here deluxe PAP devices even though no insurance payer in the history of insurance reimbursement has agreed to pay for those deluxe features.

Your beef should be with your insurance providers that are raking in billions in profit a year (yes, even so called "non-profit" insurance payers -- all that means is that the CEOs and executives get rich instead of stockholders).

Those of you who think DMEs are making a killing need to hear me clearly. The average independent DME profit margin is 6%. You have no idea what they really get paid because insurance payers are experts at sending you EOBs that make it seem like they are making a killing. 6% margin is not much for a business that is mandated to provide service 24/7/365. Yes, even on Christmas, and even at 2 AM every day of the year if they provide PAP devices or other respiratory products.

It might be easy to strike out at the DME provider -- after all, you're never going to get anyone in authority on the phone with a private insurance payer or Medicare. But DMEs are not the problem. If you don't think you are getting the proper service from your DME provider, by all means shop around. There is very likely some sucker out there that values business even if it is below their cost of doing business, or providers that are still old school and put the patient first even if they don't get paid to do that. Eventually that will end when they go out of business (and believe me, I get phone calls daily from providers seeking a way to save their business). Check back here in 3 years. Your only choices will be corporate DMEs that would have no problem ripping the cannula out of grandma's nose and leaving her to die when insurance declined to pay.

ltts,

The mathematician in me will concede one point: Not all DMEs are slimy, evil monsters out to cheat us. I've got one of the very rare good ones. So good ones do exist. But most DMEs act as though we are indeed idiots and provide us with mighty little real service.

However, these points I must contest:

ltts wrote: All recent PAP devices are data capable. They ALL monitor usage

We know our own usage. The usage data is NOT collected to make sure that our therapy is actually effective in terms of keeping the number of apneas and hypopneas sufficiently low. Nor does usage data help us determine whether leaks are a reasonable explanation of why we're not feeling better in spite of being 100% compliant. You have to understand, from our point of view, you've just given us Big Lie Number 1: Too many of us have asked DMEs if the machine they want to sell/rent us record full efficacy data and we're told, "yes it does, it records usage data."

But I wonder if you go to McD's and demand a big Mac for the price of a cheeseburger. Or go to the Ford dealer and insist they give you a loaded car with a navi system for the price of a basic escort? You wouldn't even dream of it, right? So why, pray tell, do you think a DME provider should give you a high end device when your insurance will only pay for a basic model?

My own insurance company demands that I pay a 50% copay, and when I was first put on CPAP in September 2010, the allowable TOTAL amount for the blower unit for a CPAP was in the neighborhood of $900, plus another $250 for the humidifier. This is enough to completely cover the price that on-line CPAP providers routinely charge for the S9 AutoSet and it more than covers the cost of a PR System One Auto or a F&P Icon Auto.

And every DME I contacted said the contract would be for a 10 month rental on the blower unit (insurance company demand) and an outright purchase for the humidifier. And every single one of them said my copays would be $45/month and the insurance company would pay $45/month. And every single one of them except for the one that earned my business would not talk to me about anything except an S9 Escape or PR System One Plus, which I was not interested in. I wasn't interested in paying $450 out of pocket as my 50% copay for a machine that would record no efficacy data and that I could buy on-line for about $600 or $650 on line.

The DME that earned my business, however, specializes in CPAP equipment and offers each of their new customers/patients a choice of the S9 AutoSet or the PR System One Auto. They don't even bother with selling their customers cheaper, more basic machines. Hence the markup they put on their machines is roughly the same as the on-line places. And why do they only sell the APAPs? Well, the company was founded by a group of RTs who USE PAP machines and had gotten disgusted with the constant efforts by their former managers to insist on denying customers the higher end machines when the company would still make a profit on the higher end machines. They also believe that customers/patients should be able to track all their data---particular in the early, difficult days of adjusting to CPAP. And they know that any APAP can be set up to run in straight CPAP mode. And by setting their customers up with APAPs, they don't need to worry about "loaner" machines whenever a sleep doc decides to order a week or two of autotitration because a patient is not feeling any better with the machine than before or when a patient's symptoms returns. It's simply easier on both them as a DME and the patient for the patient to bring the their machine in and have the settings changed to APAP.

And so, because I was forewarned and in no hurry to start my therapy with a machine I did not want, I was able to do some serious comparison shopping around before settling on a DME. And with lots of hard work, I managed to find a DME that doesn't gouge their customers (or their customers insurance companies) and does provide top of the line equipment to all their customers. And also provides some top notch customer service too. Because in the end, this particular DME realizes that a customer who "makes" it and becomes compliant and stays compliant will, in the long run, generate far more profit for the company than they "lose" up front by providing the S9 AutoSet and PR System One Auto instead of the cheaper, more basic S9 Escape and PR System One Plus machines.

But from what I've read and from folks whom I've talked to in person, most people are not as lucky as I am at finding a quality DME that genuinely cares whether they make it to successful PAPing or not.

idamtnboy wrote:

ltts wrote:For some reason people have developed this entitlement mentality that makes them believe that DME providers are obligated to provide them with the most deluxe machine made when the insurance company barely wants to pay above the actual cost of providing the product.

Excuse me, but since when has the agreed upon contract price between the insurance company and the DME supplier been the patient's problem? The Resmed S9 Escape, Escape Auto, Elite, and Autoset all are in the HCPCS code E0601. I read that in Resmed's official Product List. When Medicare and Blue Cross tell me they will pay for a machine in code E0601 then I don't see why you believe you have a right to belly ache about me asking for the Autoset when the DME wants to give me an Escape. I'm sorry, but we as patients have no responsibility nor authority to mediate contract pricing between DMEs and insurance companies, nor to prop up the DME's bottom line if he has chosen to sell a machine for a miniscule profit margin.

You're not listening. When deluxe features were added to PAP devices the insurance payers emphatically denied paying for those extra features. THEY decided to code them at the basic rate, ignoring the deluxe features THEY decided were not medically necessary. And there is not a DME provider with ANY insurance contract on god's green earth that is obligated via their contract with the insurance payer to provide you with that deluxe device. None, nada. Those features cost the DME provider extra, while the insurance payer has actually decreased their reimbursement for any E0601 over the past few years, some by as much as 25%. So, any DME provider that is willing to give you one is doing it as a favor. They are in no way required to do that.

And, as Medicare and other insurance payers fee schedules decrease as they have done steadily, the manufacturers will either have to drop the extra charges for the deluxe features or DME providers will, out of economic necessity, have to discontinue offering them. They are at an average profit margin of 6% now, so there is not much more DME providers can give.

I'm sorry if you can't digest that, but it's the facts. Patients can "demand" whatever they want to demand, but at some point they just aren't going to find a DME provider willing to meet those demands unless insurance payers stop cutting reimbursement or manufacturers start making the deluxe features available at the basic price. No one can stay in business for very long without making a decent profit. Many posters here have no idea how hard DME providers work on a constant basis. They have demands and demands and demands, and they expect those demands to bet met. But at some point it just becomes not worth it.

robysue wrote:ltts,

The mathematician in me will concede one point: Not all DMEs are slimy, evil monsters out to cheat us. I've got one of the very rare good ones. So good ones do exist. But most DMEs act as though we are indeed idiots and provide us with mighty little real service.

However, these points I must contest:

ltts wrote: All recent PAP devices are data capable. They ALL monitor usage

We know our own usage. The usage data is NOT collected to make sure that our therapy is actually effective in terms of keeping the number of apneas and hypopneas sufficiently low. Nor does usage data help us determine whether leaks are a reasonable explanation of why we're not feeling better in spite of being 100% compliant. You have to understand, from our point of view, you've just given us Big Lie Number 1: Too many of us have asked DMEs if the machine they want to sell/rent us record full efficacy data and we're told, "yes it does, it records usage data."

But I wonder if you go to McD's and demand a big Mac for the price of a cheeseburger. Or go to the Ford dealer and insist they give you a loaded car with a navi system for the price of a basic escort? You wouldn't even dream of it, right? So why, pray tell, do you think a DME provider should give you a high end device when your insurance will only pay for a basic model?

My own insurance company demands that I pay a 50% copay, and when I was first put on CPAP in September 2010, the allowable TOTAL amount for the blower unit for a CPAP was in the neighborhood of $900, plus another $250 for the humidifier. This is enough to completely cover the price that on-line CPAP providers routinely charge for the S9 AutoSet and it more than covers the cost of a PR System One Auto or a F&P Icon Auto.

And every DME I contacted said the contract would be for a 10 month rental on the blower unit (insurance company demand) and an outright purchase for the humidifier. And every single one of them said my copays would be $45/month and the insurance company would pay $45/month. And every single one of them except for the one that earned my business would not talk to me about anything except an S9 Escape or PR System One Plus, which I was not interested in. I wasn't interested in paying $450 out of pocket as my 50% copay for a machine that would record no efficacy data and that I could buy on-line for about $600 or $650 on line.

The DME that earned my business, however, specializes in CPAP equipment and offers each of their new customers/patients a choice of the S9 AutoSet or the PR System One Auto. They don't even bother with selling their customers cheaper, more basic machines. Hence the markup they put on their machines is roughly the same as the on-line places. And why do they only sell the APAPs? Well, the company was founded by a group of RTs who USE PAP machines and had gotten disgusted with the constant efforts by their former managers to insist on denying customers the higher end machines when the company would still make a profit on the higher end machines. They also believe that customers/patients should be able to track all their data---particular in the early, difficult days of adjusting to CPAP. And they know that any APAP can be set up to run in straight CPAP mode. And by setting their customers up with APAPs, they don't need to worry about "loaner" machines whenever a sleep doc decides to order a week or two of autotitration because a patient is not feeling any better with the machine than before or when a patient's symptoms returns. It's simply easier on both them as a DME and the patient for the patient to bring the their machine in and have the settings changed to APAP.

And so, because I was forewarned and in no hurry to start my therapy with a machine I did not want, I was able to do some serious comparison shopping around before settling on a DME. And with lots of hard work, I managed to find a DME that doesn't gouge their customers (or their customers insurance companies) and does provide top of the line equipment to all their customers. And also provides some top notch customer service too. Because in the end, this particular DME realizes that a customer who "makes" it and becomes compliant and stays compliant will, in the long run, generate far more profit for the company than they "lose" up front by providing the S9 AutoSet and PR System One Auto instead of the cheaper, more basic S9 Escape and PR System One Plus machines.

But from what I've read and from folks whom I've talked to in person, most people are not as lucky as I am at finding a quality DME that genuinely cares whether they make it to successful PAPing or not.

Baloney on good DMEs being rare. If you live in an area dominated by Aetna, United, or other payers dedicated to profits and paying barely above the cost of the product itself, no you are not going to get good care. Because the DME in that area is not being paid to provide care. They are being paid to give you a product and that is all.

All current PAP products on the market provide usage data, because almost every insurance company requires that to continue paying beyond 2-3 months. No one is lying to you. The vast majority of patients don't even know what AHI is let alone how to moniter it, and couldn't care less. And more importantly, there is no insurance company willing to actually pay for that feature. None. Period. Not a single one in the whole US of A. You want it because you are an informed patient, but that doesn't matter to your insurance payer, and they have no intention of paying for that feature. Nor does your insurance payer pay your DME provider because "you know your own usage." They couldn't care less what "you" know.

They want cold hard data downloaded from the basic machines that they cover. And guess what? Many will even refuse to pay if your physician did not sign the download report (because, hey, s/he was just too busy to be bothered). And after all, the insurance payer does not pay them an extra fee to review it, so they won't. Why should they care if the DME gets paid? They don't.

The insurance payer also does not care if you have a mask leak. All they care about is that they met their minimum obligation to provide the minimum necessary product. That's it. And they are not willing to pay one dime to make sure you are treated properly. Ergo, they have continually declined to pay for the features you folks feel are necessary. I can't imagine why that is so hard to understand. It's almost as if none of you have ever had any other interactions with insurance companies.

But somehow you think the DME should provide products and services that are unreimbursed by insurance payers. Where did you get that idea? I constantly wonder about that, because my doctor and hospital won't do that. I wonder why patients seem convinced that DMEs should do what no other health care provider is expected to do.

Again, it's a mystery. But at least do me one favor. Appreciate your DMEs that provide you all these deluxe features and services out of the goodness of their hearts that your insurance payers have long declined to pay for. That is the least you can do. Stop slamming them for their measly 6% profit margin. You will see many, many of them go out of business over the next 2 years because of major decreases in the Medicare fee schedule that are coming soon and will be matched by private payers.

ltts wrote:You're not listening.

Neither are you.

When deluxe features were added to PAP devices the insurance payers emphatically denied paying for those extra features. THEY decided to code them at the basic rate, ignoring the deluxe features THEY decided were not medically necessary. And there is not a DME provider with ANY insurance contract on god's green earth that is obligated via their contract with the insurance payer to provide you with that deluxe device. None, nada.

And that simply is not my problem, as a patient.

I'm sorry if you can't digest that, but it's the facts. Patients can "demand" whatever they want to demand, but at some point they just aren't going to find a DME provider willing to meet those demands unless insurance payers stop cutting reimbursement or manufacturers start making the deluxe features available at the basic price. No one can stay in business for very long without making a decent profit. Many posters here have no idea how hard DME providers work on a constant basis. They have demands and demands and demands, and they expect those demands to bet met. But at some point it just becomes not worth it.

And that, my dear, is the strength of the capitalist system the Republicans say will solve all our problems. Profits are guaranteed only when the business is regulated. Maybe the DMEs should start lobbying for a regulatory system like used to exist for the telephone system and still does for electric utilities. Rural customers received superb phone service from the Bell system at an affordable price and the phone companies made a decent profit.

If the profit margin is so bad for DMEs look at the poor online DMEs having a lower profit. Maybe the Poor B&M DMEs should get into loan sharking, to help their profits. Jim

LTTS,

We already know the Insurance companies basically pay the same inflated price for the category.

When we have the nerve to ask you to supply a better machine than the worthless heap of junk you recommend, you obviously are making less cash.

The question is who is screwing who?

The whole reason this industry exists in the first place is because of the needs of us "users".

The manufacturers are mass producing low grade machines NOBODY WANTS..
The insurance companies are not willing to supply the full funds for the machines we NEED.
DME's are caught in the middle trying to make a living (and in some cases pretend they care.)
And a lot of Doctors are too busy getting bribed by the manufacturers and drug companies to have any real valid input in the matter.

Take your beef up with the cause of the problem, rather than taking it out on us users.. WE are the ones being screwed in the end..

You have raised a very strong case for purchasing our machines outright..

I'm pretty darn sure if the honest truth was given to most sleep disorder patients at the beginning, they would bypass both the DME's and the insurance companies, unless their finances made this impossible.

idamtnboy wrote:

ltts wrote:You're not listening.

Neither are you.

When deluxe features were added to PAP devices the insurance payers emphatically denied paying for those extra features. THEY decided to code them at the basic rate, ignoring the deluxe features THEY decided were not medically necessary. And there is not a DME provider with ANY insurance contract on god's green earth that is obligated via their contract with the insurance payer to provide you with that deluxe device. None, nada.

And that simply is not my problem, as a patient.

I'm sorry if you can't digest that, but it's the facts. Patients can "demand" whatever they want to demand, but at some point they just aren't going to find a DME provider willing to meet those demands unless insurance payers stop cutting reimbursement or manufacturers start making the deluxe features available at the basic price. No one can stay in business for very long without making a decent profit. Many posters here have no idea how hard DME providers work on a constant basis. They have demands and demands and demands, and they expect those demands to bet met. But at some point it just becomes not worth it.

And that, my dear, is the strength of the capitalist system the Republicans say will solve all our problems. Profits are guaranteed only when the business is regulated. Maybe the DMEs should start lobbying for a regulatory system like used to exist for the telephone system and still does for electric utilities. Rural customers received superb phone service from the Bell system at an affordable price and the phone companies made a decent profit.

Oh, I am listening, but you still don't get it. DMEs don't set the fee schedules. Greedy insurance companies do instead. IOW you are going to get what your insurance company is willing to pay for. And to expect DMEs to provide charity to support the billions in profit insurance payers want to rake in is, sorry, just not realistic.

If you want to get into politics I am happy to do that, because you are correct, it's the root of evil in our healthcare system. Did you know that Bush and the republicans that passed Medicare Part D prescription drugs (with the help of plenty of wimpy dems) included $350 billion in subsidies to private insurance companies in that bill to try to take Medicare private? That's right, and as a result 28% of seniors are now enrolled in a private Medicare plan that pays DME providers 40-50% less than they recieved from Medicare. So instead of your DME making a profit CEOs and executives of private insurance companies are making tens of millions each.

The problem is that private health insurance companies add absolutely NOTHING of value to healthcare in the US. Nothing. Not a single thing.

Medicare administrative fees (cost of doing business) are 3-4% plus no profit. Private insurance administrative fees are 13-20% plus an additional cost for profit. It doesn't take a math genius to figure out which one costs more in the long run and in the short run. But hey, add a 35 billion dollar a year subsidy to private insurance to take seniors out of fee for service medicare and add an unfunded mandate like prescription drug coverage and all of the sudden Medicare is BROKE! OMG, we must cut, cut, cut the Medicare reimbursement (and the private insurance payers will use that as an excuse to follow with cuts of their own, to make even more profits).

All of the sudden politicians have a damn good excuse to get rid of Medicare or cut it to the bone like republicans have always wanted. And our center right "democratic" president, commonly referred to as a socialist was more than happy to oblige and appease.

The problem with all of that is that the actual healthcare providers go broke while the private insurance companies rake in billions. And that, my friend, is the nub of the problem and why it matters who you vote for. Thanks for bringing it up. And if you figure out a way for DME providers to continue to operate as their profits are shifted to private insurance payers who couldn't care less if you get any care at all (just pay your $500-$800 per month in premiums, please) do let us know.

jedimark wrote:LTTS,

We already know the Insurance companies basically pay the same inflated price for the category.

When we have the nerve to ask you to supply a better machine than the worthless heap of junk you recommend, you obviously are making less cash.

The question is who is screwing who?

The whole reason this industry exists in the first place is because of the needs of us "users".

The manufacturers are mass producing low grade machines NOBODY WANTS..
The insurance companies are not willing to supply the full funds for the machines we NEED.
DME's are caught in the middle trying to make a living (and in some cases pretend they care.)
And a lot of Doctors are too busy getting bribed by the manufacturers and drug companies to have any real valid input in the matter.

Take your beef up with the cause of the problem, rather than taking it out on us users.. WE are the ones being screwed in the end..

You have raised a very strong case for purchasing our machines outright..

I'm pretty darn sure if the honest truth was given to most sleep disorder patients at the beginning, they would bypass both the DME's and the insurance companies, unless their finances made this impossible.

If users decided to bypass insurance and buy their machines outright out of their own pockets I can promise you that every DME supplier would love it, and create a web site with competitive cash pricing in a heartbeat. Are you under the illusion that they LIKE dealing with insurance payers? That they enjoy the overhead involved with billing insurane and watching them try every trick in the book to weasel out of paying? Ha. No.

No DME is taking anything out on the users. The honest ones are simply confronting you with the actual facts that your insurance company dictates. I personally think each and every DME supplier should tell you the honest truth -- that your insurance company will not pay for the deluxe features you want or believe you need. I don't think it's "nervy" of you to ask, but I do think you should be told the objective truth. And I think DME providers should stop (and I mean immediately stop) shielding you from the realities of what your insurance payer will cover. I think each and every DME in this country should tell you the god's honest truth -- your insurance payer will not pay for these deluxe features, and if you think that is wrong encourage you to call them up and give them hell (instead of blaming the DME that has the guts to tell you the truth and risk losing the small amount of profit they might make from the transaction).

As it stands, all the DME providers are doing is perpetuating the problem and eventually putting themselves out of business while enriching insurance payers. And that is the advice I give each of the ones that call me on a daily basis asking me how they can stay in business in this environment.

Just gotta love unmoderated forums..

LTTS, nobody is arguing that insurance companies and politicians aren't the suckiest and greediest part of this equation.

But the truth of the matter an awful lot of DME's have been further exploiting CPAP patients, by offloading crap machines in an effort to turn a quick profit.

After just nine or ten months I've been monitoring these forums, I couldn't even begin to recount the number of stories from people who've been given a raw deal from DME's.

Clearly you are a troll and a waste of space, otherwise you would have identified your organization if you had any real standards...

Goofproof wrote:If the profit margin is so bad for DMEs look at the poor online DMEs having a lower profit. Maybe the Poor B&M DMEs should get into loan sharking, to help their profits. Jim

There is no such thing as an online "DME" - online medical equipment companies are companies that are simply unregulated internet shopkeepers, and the majority are operating outside of federal and state regulations.

It's easy to compete on price when you don't have to have healthcare accreditation, abide by state laws or pay their license fees, hire a compliance officer, have a consumer complaint policy in place, are not required to take returns, have an emergency plan, abide by OSHA regulations, prove that your equipment and supplies are not counterfeit, report device malfunctions to the FDA, have HIPAA policies in place and be subject to fines if you violate HIPAA regulations, protect your customers credit card information with government approved IT systems and processes, develop goverrnment approved policies and procedures and make sure they stay updated as the regulations change, pay for a bond required by the government, have a handicap accessible facility, ensure that your place of business meets minimum square footage regulations, complete 15-20 mandatory trainings and competency assessments on each of your employees on an annual basis, hold a minimum of $300K in liability insurance, calibrate devices used to check the functionality of equipment provided on a daily basis and document it, complete and document patient education and training at the time of set up, obtain physician progress notes for payment, schedule follow up visits with patients and download the data, then provide it to physicians and wait until they respond to continue billing rental payments, develop an approved employee manual, have a company safety officer in place and document safety training and monitoring..... I could go on and on (that's not even a third of it).

But yeah, you're right --none of those things cost any money, I guess. They are all free, free, free, and should have no impact on consumer pricing at all. Those damn insurance based DMEs are obviously just ripping people off.