DME Equipment Cost to Me ???

VVV wrote:Now why the hell do you think DMEs would sell the more expensive machines to this type of customer base?

Because their doctor should be periodically monitoring the data. Or at least looking at if if the patient presents with problems.

Data-capable machines can avoid the need for many follow-up sleep studies and so actually save money in the long run. But no one cares about the long run.

Cosmo wrote:You can't blame the DMEs for trying. They have an incentive to give you the cheapest option. Its to maximize their profits.
The manufactures are coming out with these bricks so they are more at fault.

The manufacturers make the bricks because their customers, the DMEs, buy them. If no one buys Yugos, they will disappear.
Oh, wait, they already did,

I thought most of the machines have cards in them for some years now. What am I missing here?

Are we talking about old machines? I know they do run well for years.

The cheapest machines (bricks) don't provide efficiency data. I haven't seen one for myself or data from one. You don't get AHI numbers, leak values, etc. Just hours of usage.

So you only have subjective input as to cpap treatment working or not.

Sheffey wrote:I thought most of the machines have cards in them for some years now. What am I missing here?

Are we talking about old machines? I know they do run well for years.

I have one, and it only shows the pressure it has been set to and the number of hours I have used it.......... and its only 3 years old and it is still sold by the manufacturer and the dme's. Take a look at the pages of machines at cpap.com and you will find many of them that show nothing useful to the patient let alone the doctors. Greedy dmes. will sell you one and pocket the extra $$$$$ they have made with a smile.

Sheffey you bring up a good point.

More knowledgeable here say that the hardware, and PC board are the same for all the machines in the line The difference between a low level CPAP with no data, and an Auto, Bi machine with Full Data is the firmware which is loaded onto the machine, and the plastic covers with the labels on the outside.

I agree that companies should be compensated for all the extra work in the software/Firmware for the more advanced machines versus the brick CPAP machines. However the companies sell crippled machines (no data brick CPAP) in the guise of needing to make more money for the more expensive machines. I believe that the insurers should never purchase the crippled machines, and the manufacturers should limit the price on the more advanced models, which gives the manufacturers a similar profit level, as they get a little bit more for each machine over what a crippled machine sells for.

I now see Respironics is beginning to do something like this. However, I am not sure that the lower cost Bi machine from Respironics is what I need, or as useful as the higher cost -similar, but slightly different Resmed machines. For what is worth, seems to me that PR machines are more solidly made, and generally very reliable. Still, if money were not an issue, I would get the Resmed S9 VPAP. and I can not justify that with a good reason.

OP should be aware that there are several different dollar numbers that are involved in xPAP machines and supplies. The first dollar number is what the DME wants for a machine, usually a large number that is only intended to influence the next number, what the insurer agrees to pay, and what will be paid for the new machine, usually on a long term rental for purchase. Medicare that is a 13 rental to buy. The dance between what the DME wants and what the insure agrees to pay goes on all the time. The DME is supposed to be providing support, as well as selling you supplies, to enable you to stay on the therapy, which is meant to justify the higher price they charge versus what one can buy the same thing on the internet. I think only about fifty percent of those who start treatment, actually stay with treatment. That is a lot of premature deaths, and lowered enjoyment of life for that group who leave treatment. That is the justification for paying the DME more. The next number of your co-pay, the portion of what you will pay. If it Medicare, I understand that now you will have to pay for the humidifier immediately. Then a monthly payment for your co-pay for the next 13 months. To make it less clear, more of the cost of the machine is front loaded in the first several payments, so the monthly payments are not equal. Beware of Balance Billing (from JanKnitz blog).

Insofar as DME's giving you an itemized bill. While a lot of folks here complain about DMEs, my experience with DME employees is that not only do that not know what the costs for me will be, the ones I speak with do not care. They are concerned with my having successful treatment, even if their company loses money. Part of that is, not only are the DME people I speak with told not to comment on money issues, all the different insurance plans and machines makes getting those dollar numbers difficult for those at my local DME office. They will only refer me to some billing department, in another part of the country, and the local DME is really only concerned with my getting service.

What is important that you keep, is the receipt saying when you got the machine. Some years from now, you might need that receipt to prove when you got the machine you have as part of getting a scheduled replacement machine.

Also get a copy of your doctors RX for machine/supplies, and the summary copy of the Sleep study. I keep a copy in the machine bag. If I am traveling, which could happen all of a sudden, I might need something, like a hose, or . . . Since everything is by Prescription, it is nearly impossible to get something in an emergency. (I Also have the doc FAX a script to our host, CPAP.com, that way if I need anything in an emergency (holiday, travel, weekend) , and if I had the money, LOL, then I could directly get it quickly. Else from home I get everything from my regular DME who will directly ship things, without me paying in advance. (Might take a week for the regular DME supplies to arrive)

Before you trust anything that I say, wait for JanKnitz to come in here and correct my miss understanding.

purple wrote: I believe that the insurers should never purchase the crippled machines, and the manufacturers should limit the price on the more advanced models, which gives the manufacturers a similar profit level, as they get a little bit more for each machine over what a crippled machine sells for.

The medical industry is a complex beast.

My insurance, Kaiser of N. Cali gives data machines to all I believe. Each region is a separate entity though. I don't know what their strategy is. Treating us is cheaper in the long run? I get any mask I want and 4 new ones a year.

It is interesting that organized crime and health insurance came to raise at the same period of time. Both during the start of the prohibition period in the 1920's. Both have the same racketeering structure. Health industry is organized crime of today. But very much legalized. Under the guise of peddling medicines and health treatments. Brilliant!

http://en.wikipedia.org/wiki/Health_ins ... _evolution
Hospital and medical expense policies were introduced during the first half of the 20th century. During the 1920s, individual hospitals began offering services to individuals on a pre-paid basis, eventually leading to the development of Blue Cross organizations.[43] The predecessors of today's Health Maintenance Organizations (HMOs) originated beginning in 1929, through the 1930s and on during World War II.

http://en.wikipedia.org/wiki/American_M ... bition_era
On January 17, 1920, Prohibition began in the United States with the Eighteenth Amendment making it illegal to sell, manufacture or transport alcohol. Despite alcohol production and consumption being made illegal, there was still a very high demand for it from the public. This created an atmosphere that tolerated crime as a means to provide liquor to the public, even amongst the police and city politicians. The profits that could be made from selling and distributing alcohol were worth the risk of punishment from the government, which had a difficult time enforcing prohibition. There were over 900,000 cases of liquor shipped to the borders of American cities.[9] Criminal gangs and politicians saw the opportunity to make fortunes and began shipping larger quantities of alcohol to American cities. The majority of the alcohol was imported from Canada,[10][11] the Caribbean, and the American Midwest where stills manufactured illegal alcohol.

The health insurance industry sure can be defined below....
http://en.wikipedia.org/wiki/Organized_Crime
Organised crime or criminal organisations are transnational, national, or local groupings of highly centralised enterprises run by criminals for the purpose of engaging in illegal activity, most commonly for monetary profit. Sometimes criminal organisations force people to do business with them, as when a gang extorts money from shopkeepers for so-called "protection".

Sheffey wrote:I thought most of the machines have cards in them for some years now. What am I missing here?

The presence of a card in a machine doesn't guarantee full efficacy data.
The older machines used the Smart Card which looks sort of like a credit card and the new machines used SD cards.
The data on the cards is limited to what the machine as the ability to collect.
The bricks do collect data...hours of use is data...but that's all they collect. It's used to prove compliance.
So the presence of a card of any kind in the back of a machine doesn't mean anything until we know what model the machine is and figure out if that card in the back of the machine has only hours of use on it or full efficacy data.

Thanks everybody I really enjoyed reading all your posts of how to go about dealing with "The Secretive, You'll Take What We Give You DMEs".

At this point I don't have much to add, except that I have read everything here that was posted to read, and I talked with Medicare for over an hour today, and unlike some might think their representatives, Emily and Charles were not only very forthcoming, but also very pleasant.

The reason that I talked to them today was that I had already discussed DMEs with my secondary insurance company 3 days ago. After Janice told me that Medicare would pay 80% of the PAP Device Cost, and they would be charged the other 20% which I would be responsible for 20% of that 20%. Yes, that's a whole lot of 20%'s, kind of like "Who's on First".

So it would be something like this: PAP Device Cost $1500.00 of which Medicare would pay 80% or $1200.00. Their $1200.00 payment would be made over a period of 13 months, which they referred to as rental payments. The other 20% or $300.00 would be charged to my secondary insurance company, which they would pay $240.00, and I would pay my out of pocket 20% which works out to be $60.00, and we would all live Happily Ever After.

So that leaves the Government Paying 80% of DEM's Charges; however, and here's the KICKER, Medicare will only pay the DEM's a pre-set rate that they have previously agree to. ( Confused Yet? ) Well, I am to some extent, but I have just made up my mind that I will take my time and figure all this out before I put a roof over this deal.

I'm getting an uneasy feeling about all of this, although I must say talking to you guys, my insurance company, and Medicare I do believe that I am slowly getting a foothold.

The reason that I am asking all these questions here is that once I have bought this, whatever kind, or brand of PAP Device then its mind to keep, no questions ask.

I will put this back on the Front Burner Monday, until then let's all have a Great Week End. Hey, Pre-Spring is here, and I'm going to go out tomorrow and enjoy it, that is if I can get all the snow off my Driveway.

To find participating providers, use the link in my signature.
Enter your zip code, and check "cpaps, rads, etc".
The resulting list will indicate contracted providers with a green dot with a "P".
The others will accept money from Uncle Moneybags, but as for your share, the sky is the limit.
Expect to be lied to by any DME.

Most machines today have compliance cards. And also most people in that age group are on Medicare and Medicare demands compliance information from the DME supplier. If Medicare patients are not compliant Medicare may take the machine away and charge the patient the full amount for the machine. Providing you have a good DME company they should follow up with you and do compliance downloads so they can check your AHI and make sure you're at the correct pressure. Unfortunately there are too many DME companies out there that just throw you the machine and never follow up.

So it would be something like this: PAP Device Cost $1500.00

That sounds high. Looks like I could order a totally new outfit, top of the line, for about $1000. Includes heated humidity and hose.

Are you getting some kind of specialized machine?

Should I put in a profile picture? Of me? Cartoon?

Sheffey wrote:That sounds high. Looks like I could order a totally new outfit, top of the line, for about $1000. Includes heated humidity and hose.

I think OP was just using $1500 amount as an easy example for purposes of showing the math involved.

This is last years allowable schedule (I haven't found one for this year but it won't be off by much)
http://www.resmed.com/us/documents/1013 ... ilevel.pdf

Note this is for the blower unit only when someone does the math. The blower is the only thing that comes under the rent to own contract for Medicare
The humidifier isn't rented under Medicare rules...it's a straight up purchase with one billing.
Everything is always broken down into parts too. That's just the way Medicare does things.
Heated hose, humidifier, mask into headgear and mask, filters, anything else is one time purchase.

It's real hard to get an exact number because Medicare pays differently by regions and often the allowed amount is a little higher for the first 3 months then it is reduced for the next 10 months.

Brick and mortar DMEs have a higher overhead than an online seller. So yes, Medicare will pay a DME more in the long run than the machine could be bought on line for. There are services expected from a brick and mortar DME that an online seller doesn't perform. Finally...a lot of people don't have a stash of cash to pay $1000 a machine...sometimes its a stretch to pay that 20% copay monthly rental. Brick and mortar DMEs have their cash tied up for 13 months but when they bought the machine they had to pay for it up front. Just another cost of doing business.

If we use last years allowable amount for the cpap/apap machine...and just choose the highest allowable for an example and pretend they paid the same for the entire 13 months...which they don't but let's pretend they do.
The E0601 allowed is $103 a month ... times 13 months equals $1339 just for the blower part of the machine.
That on the high end...my area is not the high end region..it depends on where you live and doesn't take in competitive bidding areas.
This is why DMEs like to supply the cheapest basic machine that they can get by with supplying. Medicare pays them the same whether they supply the Escape or the AutoSet. Now I am not defending the DMEs in general but I do understand where they come from.

Some DMEs actually do provide full data machines up front realizing that if someone does poorly and needs help and they use the data to help figure out what is going on because they do want to help people AND they realized that a person who is successful with their therapy is going to keep coming back and buying all those other supplies that they make money on.
Sadly some DMEs are still short sighted and want to hit a home run profit wise with the dispensing of the cheapest machine available that will satisfy the requirements written on the RX.

Wow Pugsy, you must run an excellent DME practice. And you come here and help many people with all the details. How do you do it all?

Sheffey wrote:Wow Pugsy, you must run an excellent DME practice. And you come here and help many people with all the details. How do you do it all?

Actually I don't have any such business and I actually fired my first DME for being an idiot and treating me like I didn't have a brain in my head. I have no great love for DME brick and mortar establishments but I can look at things from their perspective though. I can understand where they are coming from but I don't have to agree with it.

I am just another cpap user. Nothing more...nothing less.
We do have some forum members who do operate a brick and mortar DME business so some of my insight has come from what they have said. Common sense really if someone will just sit back and look at things from the other side.

Also this forum probably reflects a very small minority of cpap patients. I do have a DME that I get my masks and supplies from so I can use the insurance that I pay for each month. He's a nice guy and really wants to help his patients and says that I and one other guy are the only patients that he has who even give a hoot about monitoring their own therapy. Don't have a clue and really don't want to put forth any effort to learn.
Most people say just "fix it" and don't want to be bothered with the gory details. Just like when we go to a doctor for an ailment...we want him to "fix it" by some method and get mad when he can't produce a magic wand to "fix it" promptly and completely.