Going to War with DME again This Morning

I believe Medical equipment issued by a DME should always be Sealed and New.

When I first received my machine, I was as naive as most first-timers here. Had no idea it was a top-of-the-line machine and had no idea of its cost. A brief Internet search showed it was worth from about $1000 to $2000, as I recall. It was a month later when I obtained the software I found out it had been used about 40 hours the month before I received it.

I was steamed! I called my DME (they are 90 miles away) and spoke to several different people. The answers I got: "It really is not used, those hours are just the laboratory testing"; "We sterilized and reconditioned it before sending it to you"; "When you have totally paid for the machine, we will give you a new one" (I got her name and saved it for later!); "Because it was reconditioned, we can sell it at the new price". Not once has anyone told me, when I've asked, how much my machine costs, nor what my part of that cost will be. So far, in eight months, they have billed me twice, for about $35. (I'm on Medicare.)

I've heard from other sources the machine is mine after 13 months. Just before that time comes, I intend to raise hell and stop paying their bills until I get some straight answers from management. No wonder DME's, in general, have such poor reputations.

Hello Sheffey, in my instance, the DME wanted to charge triple the price I paid for my equipment from cpap.com They were also going to use the 13 month rental trick whereby you fall into the insurance deductible for two years and not just one. They wanted $400 for my first months rental which based on the cpap.com retail price would easily cover the wholesale price of the equipment. I also think it is not just about the price but the fundamental dishonesty of not informing a person about the state of the equipment they will send you.

Sheffey wrote:

I would not accept a used Device

If I understand it correctly, these DMEs send out a lot of machines to patients who flunk on compliance and the machines come back to the DME with only a fraction of the cost recouped (one month rental?). So here you have all these machines and the cost needs to be recouped or else the DMEs will have to start charging all of us higher prices for new machines. I don't think we want that.

I'm not sure with the prices they charge that they lose money very often if ever. The prices seem to be inflated to at least twice as much . I don't know the figures on how many machines the end up getting back, but I would think even on the few the end up getting back they at least broke even. I could see them raising the prices like you say, if only to maintain there profit margin.
I'm not saying that they shouldn't sell the used ones. I do think they need to be honest and about it. I have a bad habit about giving most of my stuff away. I don't have a problem with being generous or reasonable. I do have a problem being lied to and taken advantage of. Which is how I would feel in the same situation.

letsride wrote:I believe Medical equipment issued by a DME should always be Sealed and New.

Jimster wrote: If the Device that you have now was purchased by you with or without your insurance company then yes a new machine is called for no question.

No, if your insurance company is paying for any part of the machine, what you get depends on the contract your insurance company has with the DME and what is in your policy. If your insurance company allows used machines, then you have no recourse except maybe to buy out-of-pocket from an internet provider or other low-cost provider.

Lugus wrote: in my instance, the DME wanted to charge triple the price I paid for my equipment from cpap.com

Al N wrote:

I'm not sure with the prices they charge that they lose money very often if ever. The prices seem to be inflated to at least twice as much .

Kate M wrote: I am renting an oxygen concentrator for over $400.00 a month and can buy that same model for approx $800.00 online. The "fraction" of the cost in this case is 1/2! Two months and they recoup the price. I imagine they have a lower price that they pay as well. I would hesitate to give them the benefit of any doubt at all, which is why I am waiting for the pricing from them before going to some other DMEs and being prepared to walk away and buy online.

Lugus wrote: the DME wanted to charge triple the price I paid for my equipment from cpap.com They were also going to use the 13 month rental trick whereby you fall into the insurance deductible for two years and not just one. They wanted $400 for my first months rental which based on the cpap.com retail price would easily cover the wholesale price of the equipment.

There seems to be a lot of confusion because of the industry practice of billing "list price" for all equipment. The insurance companies usually pay per their contract a price that is very much lower than list prices. These high prices you are seeing and commenting on here are very likely never paid.

This practice needs to be ended. Instead of the huge Obamacare, we should have enacted some much smaller regulations. The first one I would propose is a "Medical Care Transparency Act". This would require all providers (doctors, hospitals, DMEs, clinics) to publish their rates and prices and they could only bill these prices. This would make it easy for the consumer to shop around and pressure would be put on the inefficient suppliers.

The Transparency Act would also require clear labelling and clear contracts specifying whether equipment is new or used.

Transparency will go a very long way in reducing confusion and reducing costs.

I agree the practice should end. There should be the same price up front insurance or not. I also know all to well the insurance companies dictate what they will pay, and even the length of hospital stays. Regardless of what Dr's think at times. All of that should end.
I highly disagree with the statement that those high prices aren't being paid. I saw my statement. They charged my ins way more than I would have paid online. They make money and a lot of it.

Cereal Killer, the prices I used for my example are the prices both the DME and the insurance company told me it would cost. They were triple the price I paid for a new machine from cpap.com The DME also told me their price was good because it was below list price. Another advantage for myself is my spouse works in the 'business' and is able to show me hospital book prices so I know about the backroom deals going on between the DME companies and insurance providers.

This thread seems to be getting to the heart of “should DMEs tell us up-front or should they just let us find out on our own about the equipment that we are paying them for ?”

Like me when I found out that I had a machine that was used a couple of times before I certainly didn’t know what to think. Here I was given a new tube along with a new mask and along with what I thought was a New Machine and Humidifier.

When I downloaded the SD Card, of course I saw where the “New Machine” had been used twice before by a couple of people that didn’t meet their compliance requirements.

I called my DME and told them what I had found and was told that the Machine that was given was not the one that they should have given me. They went on to say that the machine I now had, had been put back in their inventory in the wrong place.

I didn’t have too much of a problem with what had happened because at that time I was trying to make up my mind as to which company to go with either Respironics or ResMed.

There are all kinds of ins and outs when it comes to getting set up on CPAP Therapy, and of course one’s machine is very important and we certainly want to get what we are paying for.

I take it that this problem didn’t exist until personal data collection came along. If I hadn’t downloaded the Machine’s SD Card I wouldn’t have known anything about the history of the machine.

My concern wasn’t about the used machine that the DME had handed me, but more so about the Humidifier. A CPAP device is nothing more than a teched-up air-compressor, but the humidifier is a totally different animal.

I don’t know what might have been put in the used humidifier by someone else. Now whether or not the Humidifier was use before I haven’t a clue, but my DME did give me a new humidifier when I tried out another brand of a used machine, and I didn’t ask to be given one.

I am going to check with my insurance company to see what their policy is as to DME equipment, but I will say they would only pay for new equipment. I will let you know what I find out.

Cereal Killer brings up a good point as to Transparency. Of course that’s what all of this is about. As I said before there is an implied understanding that goes along with all purchase transactions. In other words no one has the right to take advantage of you. There is no place in a purchase transaction for the slightest hint of embezzlement.

If you think you are getting a Never Before Used Device and you are not then you should be told you are not getting a new device by the seller. Being a new customer of a DME doesn’t put you behind the 8 Ball just because you are dealing in something that you know nothing about.

I’m sure that DMEs have a difficult task at hand, but outside of being somewhat distant as far as interaction my current DME seems to be on the up and up.

I do believe that this new era of teched-up patient data enlightenment is something that DMEs are just now learning that they are going to have to deal with from now on.

Now with the above being said if I could just now get my Mask to now Stop Leaking, and also remember to fill up my humidifier.

The problem we have here is that almost all DME is used by a patient for a limited amount of time, not permanently. CPAP machines are treated pretty much the same as hospital beds, walkers, crutches, potty chairs, weights and pulley systems (whatever they're called), and so on. All of this type of equipment is rented out over and over again and is returned when the patient recovers or dies. So if your doc says you need a CPAP, and your insurance company pays to rent usable, but not always new, DME, you stand a good chance of getting a used CPAP. The only reason so many of us can get a new CPAP is because a whole lot more of them go out the DME's door than come back in. That's not the case with oxygen concentrators or hospital beds.

Now, if the patient pays up front the entire cost of the machine, then in that case the patient should get a new machine. But, as has been said, if insurance is paying for it, it depends on what the insurance company contract calls for. If it allows serviceable used equipment to be supplied, then that is what you may get. Them's the rules you agree to when you buys the insurance policy!

Now, we could argue that since the intention is for the CPAP machine to last for years with the original patient, it really should be a new machine, not used. But as has been said, in the long run is there really any difference in a slightly used vs. brand new machine? These are not cars that the owner is free to sell or trade in any time after buying it. Remember, your insurance company, or Medicare, provides the real warranty for your CPAP. If it craps out in 3.25 years insurance will pay to repair or replace it. Since it is a medical necessity your insurance company must provide you one, but I suppose you may have to pay a copayment.

Now, I believe the rules are different for disposable and expendable items such as masks, hoses, and filters. Those must be new since the planned life is short, they are to be used by only one patient, and disposed of when the patient no longer needs them. Same for paper gowns, diapers, urine bottles, and such. Blankets, pillows, and sheets are not disposable and can be washed, hence a patient will probably get used ones of those.

Things are going to get worse when more and more DMEs are brought in under Medicare's Competitive Pricing program. I predict it will be hard as hell for anyone to get a data capable machine without paying extra or getting a specific prescription for one. My current DME lost out on the competitive bidding. Medicare rental rates for CPAP are dropping 50%. Essentially, my therapist told me, their choice was to get of the Medicare part of the business, or go broke servicing it.

Al N wrote:
I highly disagree with the statement that those high prices aren't being paid. I saw my statement. They charged my ins way more than I would have paid online.

Lugus wrote: Cereal Killer, the prices I used for my example are the prices both the DME and the insurance company told me it would cost. They were triple the price I paid for a new machine from cpap.com

You saw your statement. You were told costs by the insurance company and the DME. However, you don't say you saw what the insurance company actually paid.

I have seen many statements with "high prices" and I have been quoted the high prices. But every time I see what was actually paid by the insurance company, it is much lower.

The insurance companies are not so stupid that they will pay three times for a CPAP machine what it would cost you to buy from an internet supplier.

Believe me it is not happening. The insurance companies are good at negotiating prices and they have good internal controls that make sure they pay the negotiated price and no more. They are not paying three times the market price for CPAP machines.

Jimster wrote: embezzlement

You need to look up the definition. You are using an incorrect word. Depending on the context, "deception" might be a better word.

I agree "deception" should not be part of the transaction and neither should "fraud".

idamtnboy wrote: Things are going to get worse when more and more DMEs are brought in under Medicare's Competitive Pricing program. I predict it will be hard as hell for anyone to get a data capable machine without paying extra or getting a specific prescription for one. My current DME lost out on the competitive bidding. Medicare rental rates for CPAP are dropping 50%. Essentially, my therapist told me, their choice was to get of the Medicare part of the business, or go broke servicing it.

The ultimate solution is that CPAP machines and related equipment are not covered by insurance and everyone pays for their own. (Get rid of the prescription requirement at the same time.) Then you get a real market and costs will become transparent without regulation. You will refuse to buy from suppliers who are not transparent or are deceptive.

In terms of your overall health costs CPAP is relatively small. If you shop wisely, maybe $1200 over five years for machine and all necessities. This is $240/year - definitely not the kind of thing you want to pay insurance premiums for.

For destitute people who cannot even afford $240/year, an open market will provide plenty of opportunities for very low cost slightly used machines (demos really) and charitable donations. It will be easier for destitute people to get what they want.

We don't buy insurance to cover $240 annual maintenance on our automobile and likewise insurance to cover $240 annual CPAP costs is a poor idea that leads to tremendous waste, distortion of costs and inefficiencies.

Cereal Killer wrote:

Al N wrote:
I highly disagree with the statement that those high prices aren't being paid. I saw my statement. They charged my ins way more than I would have paid online.

Lugus wrote: Cereal Killer, the prices I used for my example are the prices both the DME and the insurance company told me it would cost. They were triple the price I paid for a new machine from cpap.com

You saw your statement. You were told costs by the insurance company and the DME. However, you don't say you saw what the insurance company actually paid.

I have seen many statements with "high prices" and I have been quoted the high prices. But every time I see what was actually paid by the insurance company, it is much lower.

The insurance companies are not so stupid that they will pay three times for a CPAP machine what it would cost you to buy from an internet supplier.

Believe me it is not happening. The insurance companies are good at negotiating prices and they have good internal controls that make sure they pay the negotiated price and no more. They are not paying three times the market price for CPAP machines.

I've seen the statements. I go to the ins website and log into my account to see what is paid out. I get statements every time there is a charge to the ins. What they are billed, what they consider allowable , what they pay and my share if any. To believe you story, which unless I'm wrong, consist of trust me. There would have to be more than one set of completely different records. Sorry not buying it. They pay that much because they have that much of a surplus. They still make their money. Plus don't have to worry with the small stuff. They are already charging you and me too much in up front premiums to start with. Just my opinion

Cereal Killer, without sounding defensive and whilst providing no evidence to back my statements, my spouse works in the supplies side of the industry, I have seen wholesale, retail and insurance negotiated prices (including the hidden hospital book prices) for for all my treatments and equipment over the last decade. There is massive collusion in the industry that serves only to maximize profits and minimize the chance a patient will ever fully understand the finances behind the health industry. I have seen hospitals charge patients $3 for a paper cup holding water, seen the insurance pay $2.50 for that cup in a claim and seen the hospital pay its supplier less than 10c for the same cup.

I do agree that the insurance company very likely does not pay the exorbitant rates, but I am expected to if I am in my deductible period. The rental prices confuse me. I am not kidding that I am paying $420.00 a month for an oxygen concentrator because I am in my deductible period. I was told that after 36 months of rental ($15,120.00) I would own it! I can buy one on-line for $795.00, so if I spent $15,120.00 I could by 19 of them and open my own DME company! But my insurance won't give me credit towards my deductible unless I spend the money at one of their approved DMEs, but I am certain they don't give me the same price they give my insurance company, but of course my insurance co. won't tell me what that price is so that I can negotiate a better price for myself. Sigh.

I agree transparency is definitely needed!!

Cereal Killer wrote: There seems to be a lot of confusion because of the industry practice of billing "list price" for all equipment. The insurance companies usually pay per their contract a price that is very much lower than list prices. These high prices you are seeing and commenting on here are very likely never paid.

This practice needs to be ended. Instead of the huge Obamacare, we should have enacted some much smaller regulations. The first one I would propose is a "Medical Care Transparency Act". This would require all providers (doctors, hospitals, DMEs, clinics) to publish their rates and prices and they could only bill these prices. This would make it easy for the consumer to shop around and pressure would be put on the inefficient suppliers.

The Transparency Act would also require clear labelling and clear contracts specifying whether equipment is new or used.

Transparency will go a very long way in reducing confusion and reducing costs.