Let's clear up some misinformation

LTTS, why any DME has not yet been suing any of the bloggers on this discussion forum, who provide false information?

In the past I have been warning a few bloggers about such a possibility and even posted this message:

Bloggers, Beware: What You Write Can Get You Sued

http://online.wsj.com/article/SB124287328648142113.html

I was assuming that the few bloggers who blog here might not know about such a possibility and my intent was to save them problems.
It also referred to posters who defamed DMEs by enclosing their identities.

Komodo wrote:

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.

I am in no way sticking up for most DME's (although I have a good one), but I disagree that they are making lots of money on cushions, tubing, filters etc. Here are some examples of recent purchases from my DME...Medicare.

Silicone cushion for Quattro...Billed $70...Medicare allowed 29.65.....CPAP.COM price $54

Quattro Mask...Billed 225.00....Medicare Allowed 80.50
Quattro Headgear....Billed .$50...Medicare Allowed...$16.90......CPAP.COM price for both...$176.00


My DME is losing money on most of my purchases, but continues to give me great service. I have a Resmed S8 Auto that I occasionally use to check my data...I do not have a card reader. My DME reads the card and gives me a print out at no charge.

Replying in this thread goes against my better judgment. This seems to be an early "Calist" type of thing, where a person seems knowledgeable and sucks so many of us in with replies. I'll blame this on impaired judgment if it goes awry, which it most likely will.

A lot of what is being said here IS true (or a portion of it is) and much of it is absolutely opinion with no basis in fact.

Insurance/DME relationship is at the root of a lot of the issues and I agree that blaming it solely on the DME is wrong. That being said...

What most of us object to, DME wise, is being out and out LIED to by DME's (and they do OP and YOU need to take the blinders off on that one) -- about what equipment is available and what it can do.

I think most of us can (and would) work within the system as best as possible if we were working in an honest relationship. But to have a DME tell you you are wearing a black dress when everyone else on the planet can see it's red -- and that happens all the time.

For me -- my DME's have NOT been dishonest. They have been incompetent. My new DME is VERY, VERY good and aside from taking a while to return calls, I have never uttered one negative word about them. Because they are HONEST with me. Because they are honest, any issues or problems ARE blamed on insurance.

How did I miss this long thread?

Have we discussed masks yet, and the issue of manufacturers' willingness to take back masks within 30 days vs. some/many DMEs refusal to allow that?

avi123 wrote:LTTS, why any DME has not yet been suing any of the bloggers on this discussion forum, who provide false information?

If something's plainly inaccurate, take it up with the blog's author.. perhaps the OP can convey their concerns in a way that doesn't involve insulting a large number of this forums members.

It's generally considered polite to try to talk to people before unleashing frivolous and unfounded lawsuits upon them.

And I guess we users also need to start suing the heck out of sleep clinics and DME's who provide utterly crap service?

Like dodgy titrations given based on 20 minutes of sleep data, without so much as check-up to see if the damn thing isn't killing the patient.

Me thinks this thread needs to be shut down.. It's neither productive or positive.

Funny thing about DMEs......I have had my machine since April 2011 and I have no insurance and am a senior on a limited pension. I told all this to the dme when I purchased my machine and mask.....the funny part is....they have NEVER called me back to offer me a new mask or supplies......Why?... Obviously this old lady has no money or insurance, so we won't make any money off of her (their thinking) so just drop her from our lists as a purchaser. Now you can't tell me the dmes arn't ALL about profit and $$$$, if they were not (as you say LTTS), they would have called me when they thought I needed filters or other supplies. When you can buy a machine or mask from an on-line supplier like cpap.com for X dollars and buy the same machine and mask from a brick and morter dme for XXXXXX dollars...they are both making a profit...so which one of them is making the LARGEST (like 3 or 4 times) as much profit?????????????????????????????
You are obviously a troll who just likes to insight decent folks...so go home and bug someone else for a change.
You have posted 22 times on this thread that is only a day old, if that isn't like another troll that did the same thing........I'll eat my mask Gee.. just noticed, your posts are from 9:22 last night to early this morning...Bored on night shift are you????

Wow! I have no idea what all is in this thread but if I am every laid up for weeks with broken bones it might be interesting to read through.

I only read the original post and would like to comment on a piece of it.

LTTS wrote:
There are many differences, the chief one being that online suppliers are not regulated. Many dispense PAP products against federal laws that regulate those products as prescription only. In addition, many operate in violation of state laws that require competent personnel and a state DME license to dispense RX only products. They do not have to pass any quality assurance checks. In fact many are simply a guy with a computer in his basement who ships out of his garage.

Whether that is true I have no idea. But if it is true I say, "Hurrah!"

Hurrah for a market economy where suppliers and consumers make a match to the benefit of both. Hurrah for getting a quality product delivered through the supply chain to a customer at a reasonable cost. Hurrah for getting around regulations of bureaucrats who have their own self interest in mind and not the interest of the patients.

When governments make unreasonable laws the people find ways around them. Hurrah for the people!

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

No, but they're not the only ones operating on a paper thin margin. My older brother, who worked for a regional grocery distributor, said one time the only profit many small grocery stores make off of basic food items is the rebate at the end of the year from the distributor.

I think 6% profit is a bit low.
Wireless Modem Billed amt. $750.00 Allowed amt. $450.00 Paid by Ins. $382.50 I'm 15% co-pay

Here's where it gets even better: SD Card Billed amt $750.00 Allowed amt. $450.00 Paid by Ins. $382.50!!!!!!!
These two items have same billing code.

Yes, I know how to read my EOB's and I called both my insurance Co. and DME to confirm this. As per my 15% co-pay, my insurance Co. showed me to be responsible for the $67.50
each for these two items on my EOB's. When I received my bill from DME, wireless modem and SD card were on there without the 15% co-pay due. 99% of patients wouldn't look twice at this bill as seeing no charged amounts for these two items. I am a "have to know why" type of guy. These are the reasons why our insurance rates skyrocket. If a9279 billing code can fetch $450.00 for an at maximum $12.00 SD 2 Gigabyte Card I know why the DME provided these two items to me at no charge. They collected $382.50 for the $12.00 item, I paid no co-pay, supposedly insurance co. and patient are none the wiser and everybody is happy.

ltts wrote: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.

And I say again, that is not my problem as a patient. Stop trying to make it so. If the DME wants to be a preferred supplier then it is against the rules and regs he operates under to ask for more money than the reimbursement rate. If the DME doesn't want o live by that rule, then get of the preferred network. Pardon my naivete, but the fact that I can look around and see DMEs staying in business selling the S9 Autoset instead of the S9 Escape tells me there is either a reasonable profit margin in selling it, or they know how to run an efficient tight business ship. If every DME on the block was going broke, then that would be an absolutely indisputable indicator that the reimbursement rate is too low.

idamtnboy wrote:

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

No, but they're not the only ones operating on a paper thin margin. My older brother, who worked for a regional grocery distributor, said one time the only profit many small grocery stores make off of basic food items is the rebate at the end of the year from the distributor.

You guys need to specify whether you are talking about gross profit or net profit (before taxes).

Only the guy in the basement of his parents with an old computer can survive on 6% gross profit, so I believe you may be talking about net profit.

6% net profit is not a paper thin profit. The average net profit for the companies in the S&P 500 runs around 7%. Many of them are making 6% and less.

That is the way capitalism works. Your net profits are almost always "thin". This forces companies to strive to innovate, to produce better products, to produce lower priced products, and to make the customers happy.

Sure there are times when companies temporarily run profits higher than 7%. But others notice this and try to get in on the action by bringing in better/lower-priced products and taking away customers. When you are making higher than average profits you cannot rest. Always be recreating your company or die. A market economy may seem cruel in this regard but it is the greatest concept for building wealth and providing benefit to a society.

But back to the original subject, 6% is a completely normal net profit.

The theme that strikes me throughout the OP's posts is the concept that true data tracking (i.e., AHI, leak rates, all the stuff we know we need) is considered "DELUXE" and not necessary.

I think this is the heart of the issue. As long as the doctors and RTs continue to think that teaching a patient how to truly monitor and adjust their own treatment--similar to what diabetics do in learning how to test and monitor their levels--then insurance companies and DMEs will continue to view true data capable machines as deluxe and unnecessary and therefore too expensive/cutting into their profit margin. It really is easier to make money off of patients who are uneducated and passive.

It has to start with the medical personnel first, pushing for all OSA patients to learn how to monitor, track, and be involved in their own therapy. Then the pressure has to be applied to the manufacturers to change their product lines. The only reason they offer non-data capable machines is because there is a market for them. If doctors start insisting on only full data machines, then that part of the market dries up. Then it is up to the DMEs and insurance companies to decide what happens with compensation for such, but I'm betting that if manufacturers only offered data capable machines, the prices would adjust to a lower price point.

Basically, I'm with those that think these devices need to be offered at WalMart on the open market and that we should be able to purchase machines, accessories, and masks without prescriptions. That would really bring the prices down. If I'm allowed to comparison shop for a blood sugar monitor and compare the cost of the monitor with the cost of the ongoing supplies and then buy them wherever I want, why can't I do that for my cpap equipment?

Weezy

ltts wrote: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.

Taking into consideration the financial condition of nearly every middle class working American family, let alone the working poor and unemployed, it is absolutely ignorant thinking to believe that approach has any viability whatever.

I am surprised the OP's very first post wasn't marked SPAM and deleted.
Although, in sympathy with the poster, it must be heartbreaking
to discover that she went to school to learn a trade that would help people;
only to find that she has been conned into becoming something that so
many regard as being no better than a pimp.
The truth really hurts. But think for just a moment how many patients
have machines gathering dust in a closet (50%, according to the experts),
when the same patients could be compliant and healing with proper equipment and education.
Shame on you and all your ilk.

jedimark wrote:

avi123 wrote:LTTS, why any DME has not yet been suing any of the bloggers on this discussion forum, who provide false information?

If something's plainly inaccurate, take it up with the blog's author.. perhaps the OP can convey their concerns in a way that doesn't involve insulting a large number of this forums members.

It's generally considered polite to try to talk to people before unleashing frivolous and unfounded lawsuits upon them.

And I guess we users also need to start suing the heck out of sleep clinics and DME's who provide utterly crap service?

Like dodgy titrations given based on 20 minutes of sleep data, without so much as check-up to see if the damn thing isn't killing the patient.

Me thinks this thread needs to be shut down.. It's neither productive or positive.

I agree that this entire conversation should be deleted especially b/c the OP has not identified itself. Judging by RCPs from the BinarySleep website where some of them moderate there, well, their knowledge in the field is pitiful. The clinical manager at my DME who is an RCP knows almost nothing about sleep medicine.