Let's clear up some misinformation

jedimark · Post by **jedimark** » Sat Jan 21, 2012 3:51 am

Guest wrote: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.

Most (if not all) insurance companies are run by the greediest, most unprincipled "humans" on this planet. I personally wouldn't spit on them to put a fire out..

But this doesn't stop the fact that many DME's have been riding for years on the backs of these companies.

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).

What matters to us patients is that we are getting the proper treatment for a crappy condition.. Why the heck should we care about anything else?
There is corruption and greed through the entire chain of supply from the manufacturer to the DME.
Insurance companies don't pay for a damn thing. the fact they are turning disgustingly high profits shows who is really paying for it!

These devices are not complicated or magical, yet users are being rorted every day.

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.

I agree with you there.

The sooner this crappy house of cards falls the better.

ltts · Post by **ltts** » Sat Jan 21, 2012 4:05 am

jedimark wrote: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...

Again the average profit for an independent DME is 6%. Again I ask, is that too much? Really?

What you call "offloading crap machines" is exactly the machine your insurance company has agreed to pay for and nothing more.

And yes, it's the internet, so I must be a troll if I am trying to inject some reality into your deeply held fantasies that you hold so dear. But do me a favor -- call your insurance company and ask them if the DME provider is obligated to give you an autoset machine, or one that displays AHI, or detects mask leaks, or any other deluxe feature. I guarantee you with 100% certainty that each and every one of them will tell you no way. And while you're at it, ask them if they have to give you a new device when your insurance pays on a rental basis. Nada, never. In fact there are posts here from many individuals that have done so and are deeply, deeply shocked when they are told, no, the DME provider does not have to do that. Ever. Never.

I'm sorry to burst your bubble. However, that does not make me a troll. That makes me a person willing to spend my evening trying to educate posters here to the reality of insurance based DME coverage. You can hate it, and I don't blame you, but it is still fact. And you don't need to know my identity to verify those facts on your own should you choose not to believe me.

ltts · Post by **ltts** » Sat Jan 21, 2012 4:26 am

jedimark wrote:
Guest wrote: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.
Most (if not all) insurance companies are run by the greediest, most unprincipled "humans" on this planet. I personally wouldn't spit on them to put a fire out..

But this doesn't stop the fact that many DME's have been riding for years on the backs of these companies.

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).
What matters to us patients is that we are getting the proper treatment for a crappy condition.. Why the heck should we care about anything else?
There is corruption and greed through the entire chain of supply from the manufacturer to the DME.
Insurance companies don't pay for a damn thing. the fact they are turning disgustingly high profits shows who is really paying for it!

These devices are not complicated or magical, yet users are being rorted every day.

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.
I agree with you there.

The sooner this crappy house of cards falls the better.

I'm not saying you should care about anything other than your care. What I am saying is you are blaming the wrong people. I have spent 27 years in this industry and I advise DME providers on a daily basis. And I can tell you that if a consumer came into a DME I owned and ASKED for those deluxe features, and I felt they would use them to their benefit, as an RCP I would probably take the hit on my costs and provide them without charging an upgrade fee. I would at least consider it.

The problem here is that you have numerous posters here who think they are entitled to a deluxe machine with features that payers have no intention whatsover of paying for and think they have every right to DEMAND the DME provider give them that at the cost of a basic machine. If you want me to simply donate $100 dollars to your care and you want me to even consider doing that the least you can do is ask nicely rather than demand.

There is one poster here, in particular, that has a blog instructing patients to demand such products and NEVER pay the upgrade fee out of pocket. I'd throw that person out of my store so fast her head would swim. The main issue here is that patients need to either shop around to find someone that is amenable to their "demands" -- and that could take some time -- or they can get on the reality train and realize that any DME that does that for you is not being reimbursed the cost of request, and is actually someone you should appreciate rather than villify. The vast majority of DME providers that see this forum would be appalled to say the least. And they might learn to stop giving things away for free real darn fast.

jedimark · Post by **jedimark** » Sat Jan 21, 2012 4:45 am

LTTS, we just want DME's (EDIT: and insurance companies) gone who don't recognize the importance of tracking data..

What we NEED is fully data capable machines. Doesn't matter if they are shiny and new..
Survey ANY user here (or any of the other decent forums around) and they will agree how important it is to self monitor CPAP treatment, especially in the first months of starting CPAP.

If you can't supply what we need, Go away.. Be Gone.. Good bye.. We don't want, and certainly don't expect "charity" from you.
It sucks insurance companies make it difficult for you AND us.. We would love to tell those corrupt insurance companies to GO JUMP just as much as you would.

The fact you are still trying to push this outdated crap shows your business is past it's usefulness.

JointPain · Post by **JointPain** » Sat Jan 21, 2012 4:47 am

Guest wrote: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

so would the insurance companies.

I think I prefer the Australian model (at least when I was there): patient pays the provider, insurance reimburses the patient. Free market can determine the rates providers charge as well as the reimbursement rates that the insurers provide. (Yes, there's a cash flow problem for the patient.)

In the US, the real financials are deliberately hidden from the patient. We typically don't get a say in what insurance we have. Every year, my company announces the "new and improved" (i.e. cheaper and nastier) health plan and insurer for next year. What can we do?

Well, at least we can insist on the getting the equipment we need. We here are successful CPAP patients. We don't think APAP mode and full efficacy data are luxuries. We think they are medical necessities. (Luxuries are devices shaped liked fashion accessories in designer colors.)

If the DME can't make a profit at 43% of the Medicare rate, they should drop the insurance company concerned. Don't whinge to us if you accept a deal with the devil.

ltts · Post by **ltts** » Sat Jan 21, 2012 5:23 am

jedimark wrote:LTTS, we just want DME's (EDIT: and insurance companies) gone who don't recognize the importance of tracking data..

What we NEED is fully data capable machines. Doesn't matter if they are shiny and new..
Survey ANY user here (or any of the other decent forums around) and they will agree how important it is to self monitor CPAP treatment, especially in the first months of starting CPAP.

If you can't supply what we need, Go away.. Be Gone.. Good bye.. We don't want, and certainly don't expect "charity" from you.
It sucks insurance companies make it difficult for you AND us.. We would love to tell those corrupt insurance companies to GO JUMP just as much as you would.

The fact you are still trying to push this outdated crap shows your business is past it's usefulness.

No one is pushing anything on you. DME providers are not knocking on your door and soliciting your business. You are always, always, always free to pay out of pocket, buy online and ask your insurance payer to send you a check. You can do that now, today! They might send you a check and they might not, depending on the insurance payer. If might cover your costs and it might not. This is America. You have a right to purchase from whomever you'd like if you want to spend your own money -- go for it. No DME is trying to stop you from doing that.

What you actually want is for DME providers to give you the most expensive option even though your insurance company wants to pay for the least expensive option. And you don't want the DME to ask you to pay the difference. That's charity.

ltts · Post by **ltts** » Sat Jan 21, 2012 5:32 am

JointPain wrote:
Guest wrote: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
so would the insurance companies.

I think I prefer the Australian model (at least when I was there) patient pays the provider, insurance reimburses the patient. Free market can determine the rates providers charge as well as the reimbursement rates that the insurers provide. (Yes, there's a cash flow problem for the patient.)

In the US, the real financials are deliberately hidden from the patient. We typically don't get a say in what insurance we have. Every year, my company announces the "new and improved" (ie cheaper and nastier) health plan and insurer for next year. What can we do?

Well, at least we can insist on the getting the equipment we need. We here are successful CPAP patients. We don't think APAP mode and full efficacy data are luxuries. We think they are medical necessities. (Luxuries are devices shaped liked fashion accessories in designer colors.)

If the DME can't make a profit at 43% of the Medicare rate, they should drop the insurance company concerned. Don't whinge to us if you accept a deal with the devil.

In fact I advise my clients to turn down those type of contracts, and most do. There will always be stupid business people about, but they of course won't last. I think you have a good point about paying up front and letting your insurance reimburse you. Then it's the burden of the patient to find what they want at the price they are willing to pay.

DME providers here would love that model as well. It would significantly reduce their overhead and they would be assured payment in full at the time of delivery without incurring the costs of billing insurance payers that consistently deny or delay payment. I'm all for it, and I know DME providers would be in heaven under that kind of system. Unfortunately they don't get to make the rules.

ltts · Post by **ltts** » Sat Jan 21, 2012 5:47 am

Goofproof wrote:
ltts wrote: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

But YOU are not paying for it. Your insurance company is paying for it, and on your behalf they decided that all they will pay for is the used car with no special features. And didn't you agree to engage with that insurance company? The DME did not force that insurance company or their policies on to you. Did they?

And by the way, can we dispense with the 10 year old car with high mileage exaggeration? 85% of PAP devices convert to a purchase within the first year. And the rest convert to purchase before 2 years. So no one is getting a 10 year old PAP device with high mileage. There isn't a PAP device on earth with a blower that would even last that long if it is in use on a daily basis. My you folks are prone to some serious hyperbole!

jedimark · Post by **jedimark** » Sat Jan 21, 2012 5:54 am

ltts wrote:
Goofproof wrote:
ltts wrote: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
But YOU are not paying for it. Your insurance company is paying for it, and on your behalf they decided that all they will pay for is the used car with no special features. And didn't you agree to engage with that insurance company? The DME did not force that insurance company or their policies on to you. Did they?

And by the way, can we dispense with the 10 year old car with high mileage exaggeration? 85% of PAP devices convert to a purchase within the first year. And the rest convert to purchase before 2 years. So no one is getting a 10 year old PAP device with high mileage. There isn't a PAP device on earth with a blower that would even last that long if it is in use on a daily basis. My you folks are prone to some serious hyperbole!

All we are asking for is machines with full data capabilities..

That is not exactly deluxe..

No go troll your bullocks on another forum..

snuginarug · Post by **snuginarug** » Sat Jan 21, 2012 6:26 am

I haven't read a single word of this thread, as the OP has an agenda that totally unrelated to the purpose of this forum. The purpose of this forum is for mutual support among patients. The purpose of this forum is not to cater to the insurance company, DME or billing companies that run back and forth between the two.

Now I'll ask the OP a question... why do you care?

ltts · Post by **ltts** » Sat Jan 21, 2012 7:16 am

snuginarug wrote:I haven't read a single word of this thread, as the OP has an agenda that totally unrelated to the purpose of this forum. The purpose of this forum is for mutual support among patients. The purpose of this forum is not to cater to the insurance company, DME or billing companies that run back and forth between the two.

Now I'll ask the OP a question... why do you care?

I answered that question very completely in the other thread in which you asked it, so I will not repeat it here. As a hint, it's the thread that claims a "DME" is "lying" again. Only they aren't based on the description of events. Instead they are being lied about.

And there are plenty of those type of threads on this forum based on my searches. I was actually alerted to this forum by a DME provider that ran across it. And she was astounded as I am with the level of misinformation spread here about DME providers and insurance companies.

We all know that the internet is rife with misinformation, but nothing like I have seen here. And these aren't matters of opinion, these are bald faced factually incorrect claims and assumptions.

If the purpose of this forum is to support and inform PAP patients then there is a lot of cleaning up to do. My advice to patients is to call your own insurance company and get the information you need. I can assure you that you will find that this is not the place to get correct answers about insurance and DMEs.

Guest · Post by **Guest** » Sat Jan 21, 2012 7:22 am

jedimark wrote:
ltts wrote:
Goofproof wrote:
ltts wrote: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
But YOU are not paying for it. Your insurance company is paying for it, and on your behalf they decided that all they will pay for is the used car with no special features. And didn't you agree to engage with that insurance company? The DME did not force that insurance company or their policies on to you. Did they?

And by the way, can we dispense with the 10 year old car with high mileage exaggeration? 85% of PAP devices convert to a purchase within the first year. And the rest convert to purchase before 2 years. So no one is getting a 10 year old PAP device with high mileage. There isn't a PAP device on earth with a blower that would even last that long if it is in use on a daily basis. My you folks are prone to some serious hyperbole!
All we are asking for is machines with full data capabilities..

That is not exactly deluxe..

No go troll your bullocks on another forum..

The basic machines have the data capabilities your insurance payers are willing to pay for. Not Medicare, not Aetna, not Humana, not Cigna, not United, not ANY insurance company pays for the features you think you need. Your quarrel is with them. Not DME providers. Get over the idea that DME providers should provide something your insurance company will not pay for and does not think you need. Complain to them - they make the rules. And if you aren't willing to do that open your wallet and pay the difference - there is a reason the insurance company provides a mechanism to do that.

Guest · Post by **Guest** » Sat Jan 21, 2012 7:41 am

ltts wrote:
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.

Good thing nobody on this forum shops at a Walmart. Because then we might be buying a product that was manufactured in an area with no OSHA rules or strict government regulations! (*cough* China *cough*)
Face it. Its a dog-eat-dog world. When I first got my CPAP, I called two local DMEs. One never called me back. The other I asked about an S9 Autoset and they said don't I want an F&P. I said no, I want an S9 Autoset. So they couldn't help me either so I just bought my own online since my insurance wasn't going to pay anyway. I had no idea how much drama I avoided by buying it myself! I'm sorry you are fighting for your dying industry and I'm sorry you'll be out of a job without new people buying high profit DME products. But like I said, dog-eat-dog world. I'd rather spend my money on food than spend a couple thousand getting polysomnographs every time I gain 5 pounds and need a CPAP adjustment.

jedimark · Post by **jedimark** » Sat Jan 21, 2012 8:18 am

Guest wrote:
jedimark wrote:
ltts wrote:
Goofproof wrote:
ltts wrote: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
But YOU are not paying for it. Your insurance company is paying for it, and on your behalf they decided that all they will pay for is the used car with no special features. And didn't you agree to engage with that insurance company? The DME did not force that insurance company or their policies on to you. Did they?

And by the way, can we dispense with the 10 year old car with high mileage exaggeration? 85% of PAP devices convert to a purchase within the first year. And the rest convert to purchase before 2 years. So no one is getting a 10 year old PAP device with high mileage. There isn't a PAP device on earth with a blower that would even last that long if it is in use on a daily basis. My you folks are prone to some serious hyperbole!
All we are asking for is machines with full data capabilities..

That is not exactly deluxe..

No go troll your bullocks on another forum..
The basic machines have the data capabilities your insurance payers are willing to pay for. Not Medicare, not Aetna, not Humana, not Cigna, not United, not ANY insurance company pays for the features you think you need. Your quarrel is with them. Not DME providers. Get over the idea that DME providers should provide something your insurance company will not pay for and does not think you need. Complain to them - they make the rules. And if you aren't willing to do that open your wallet and pay the difference - there is a reason the insurance company provides a mechanism to do that.

I am well aware of this.. The main difference is a piddly piece of software flashed on a chip.

As a software engineer I find this practice disgusting.

Personally, I bought my machine outright.. and am damn glad I did.

I'm just damn sick of seeing people used and ripped off by greedy arrogant b*stards.

Komodo · Post by **Komodo** » Sat Jan 21, 2012 8:37 am

LTTS wrote: In reality the DME provider that supplies PAP devices, oxygen, and other respiratory products makes a profit of about 6% on average. .

Maybe 6% on the blower unit (although I think your a little low) but they more than make up for that with the other needed supplies. There is no way you can ever make me believe they only make 6% on masks, cushions, filters, hoses, tanks, ect.

Also, if a DME isn't happy with the payout from an insurance company.......don't accept that company!

The bottom line is that both the DME & insurance are out to make the most money they can. Neither one cares about the patient.

Let's clear up some misinformation

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Re: Let's clear up some misinformation (DMEs)

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