CPAPtalk.com

OK, EVIL IT IS!!!
And I thought that I was the first to coin the phrase.

The insurance company decides what equipment you are allowed.

I'd like proof of that!!
As it has been quoted many times, and I have checked directly with my insurance company, there is ONE CODE for CPAP equipment. They may have a contract that states HOW MUCH any DME is paid by them, but never WHICH equipment! Then there would be the matter of restricting which BRAND!!

Bingo wrote:The insurance company decides how much they will pay for it.

Could somebody/anybody provide any information for the statement made by Bingo?
Since I purchased my equipment from CPAP.COM and didn't go through a local DME, I only have MY records to compare in my insurance reimbursement. However, any of you who DID go through a local DME should have in your insurance billing records how much was billed by the DME and how much was actually paid by your insurance (whether it was the actual or a "negotiated" amount).

Any volunteers?

Thanks,

Den

RemStar Auto w/ C-flex, NOT including humidifier or any extras:

billed: $1880.00
ins write-off: $774.77
ins pmt: $994.70
pt. co-pay: $110.53

I also paid $150 to upgrade to the AUTO.

insurance carrier: UHC
DME: Sleepmed

-Ric

Seems to me that works out to 3 times CPAP.COM's price. With the write off 1.5 times.

Bingoooooooo, where are you??????? Helllloooooo!!!!!

David

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): cpap.com

Respironics suggested retail price for Remstar Auto with c-flex, Including: REMstar Auto unit w/ C-Flex, carrying case, 6ft. tubing, 2 reusable pollen
filters, one ultra-fine filter, power cord, patient instructions and home care providerset-up instructions, for March 2006

$1900

O.

So, we are ALL getting great deals! Right? I mean, probably no one got that price - did they?

Snoozin....


I wouldn't bother with the July visit to sleep doctor. Why pay him for nothing?

Your regular doctor can ask those "how is it going?" questions when you go for something else. Is there anything forcing you to go see this guy? If you don't go will they take your CPAP away? Is that office the one checking for compliance for your insurance co? If so can you get them to do that without an office visit?

Why not a phone call (usually free) for a new interface prescription?

Next item

On the billed cost of my machine, I haven't seen it on the insurance form that they send me to advise me that someone has submitted a claim in my behalf but what they told me it would be is (Apria)

PAP machine $1182
Humidifier $237

Mask UMFF -- $150.91
Headgear -- 28.34
Tubing -- 31.37

Remstar Auto, HH, UMFF Mask

My cost is 20% of what is above. I have no information on Insurance write off. As I understand it (and I could be wrong) but I am supposed to pay 20% of their real cost (after any writeoff). I will be watching closely to make sure that I actually do.

I actually wrote a check on the numbers above when I picked up the machine. (full 20% of total for the mask headgear and tubing, and about $21 for the month rent to buy on the machine and humidifier.

We will see what actually shows up on the insurance company paperwork when it comes. This was mid May so it might be a while.

Hope this helps someone compare.

snoregirl wrote:Snoozin....


I wouldn't bother with the July visit to sleep doctor. Why pay him for nothing?

Your regular doctor can ask those "how is it going?" questions when you go for something else. Is there anything forcing you to go see this guy?

Why not a phone call (usually free) for a new interface prescription?

Because for $10 (my copay for the visit) it's cheap to be a pain in the ass and educate them a little. Also it's a process of oiling the gears for when I really may need them. If I buy my auto by then I will take what data I have to share and I suspect they will find that enlightening. I don't think they get very many assertive patients so I guess I am taking upon myself to "break 'em in".

I have broken other health care providers in and they have ended up better for it. Too bad I don't get paid for educating them. Not only am I a pain in the ass but I have been told that I am a bright, articulate and persistent pain in the ass so they sort of end up liking me in spite of themselves.

David

My ___DME submits a bill to the insurance co. for $150 a month, $102.23 of which is "allowed" and paid.
The insurance co told me that it usually takes ten months before the claim to be denied.

So, in my case, ___DME is getting from insurance company $1022.30 , and I "get" an old , USED Pro model, (NOT the PRO2), with heated hiuidifier, which would cost ME, RETAIL $545 for the PRO2.
In addition, they will expect ME to pay the difference of their charge of $1500 to the insurance company. So, they're actually expecting to get that amount, which is DOUBLE what I paid RETAIL for an AUTO!!!!!
(I won't be paying the difference; have secondary insurance, TG!)

I paid $614.00 from CPAP.COM for an AUTO, and $179. for an HC150 HH, a grand total of $719.00.
(Note: the cost of a PRO2 is only $70 less expensive!)

It is NOT OUR fault that they agree to whatever terms they have with the insurance companies. My insurance is through the Fed'l Governmant, and believe me, they're going to hear about this "Provider" !!!

Maybe that's what we need to do - complain to the insurance companies IN WRITING. That's some grass roots action we can take - relieves the pressure, anyway, sssssssttttttttttteammmmmmmmmm

Just want you to know I am a DME employee and not at all evil. I am a Christian, mother of 3 and very happily married. I dont always enjoy my job but for the most part I do. I am a volunteer at my local hospital and teach Sunday School. I am not evil. I just wanted you to know.

Guest,

Why would you think you being Christian or married or a mother would matter as far as how I would view a DME?

Sorry, I just got my feelings hurt and wanted you to know I am not evil. i know I shouldnt take these posts personally. I will leave though. Sorry!

guest/guestback
Do not read anything else into these words but their meaning from the dictionary, OK?
If you are not 'evil', why not JOIN in and help us out by filling out a Profile (see top of page). That way, you'll be notified of replies to topics of interest to you.
If you are only interested in our knowing that you are not 'evil', then, OK, I'll go along and take your word for it. Better yet, by NOT being evil, you would therefore be GOOD, and GOOD people help out others, don't they?
You may be what we need, a GOOD DME to whom we can ask questions, because we've run into too many that aren't GOOD.
We use the term Evil in varying degrees of true meaning, so you'll have to 'toughen up' to that fact. We get frustrated, and can't curse, so that's our outlet.
I've a feeling you're still lurking, so just fill out a profile and join in.

I've got another example of the "Big Lie" in operation. This one falls under the category of docs being insulated from their patients, and docs not doing what's best for their patients. I'll preface this story by saying that the "eye" doc in this instance is a good guy who I've seen for years, and will continue to see. Unfortunately, he's in a large practice and the way the office works very much insulates him.

I had a good visit with this eye doc yesterday just to get another prescription for prednisolone sodium phosphate eye drops. Being on these steroid drops which raise intra-ocular pressure I have to have my pressure checked periodically. (I should have checked the prescription the doc handed me before I left yesterday, but for some reason didn't. My bad. I knew better. It's not the first time.) It seems that what they like to prescribe is prednisolone acetate rather than prednisolone sodium phosphate.

I eventually checked the prescription but that wasn't until long after the office was closed. I knew it would be a big deal to change it today, so I started out by calling the pharmacy to see if they would do a direct substitution. No dice (but there seemed uncertainty in the answer). So I called the doctor's office and left a message with the receptionist. After an hour and a half I called again and was told they were extremely busy. They finally called back a little after noon, when I wasn't by my phone, just to say they had called, but then didn't bother to give a name, just a message to play phone tag. So I called back, but didn't have a name so the receptionist had to put me on hold to find out who had called me and then came back to tell me that Nancy was busy, but would call me back. Another hour or so later Nancy calls back. She had my message but hadn't acted on it, and only reluctantly, after I went through the whole story of how I'd been using these drops for a year and they worked better than prednisolone acetate. . ., anyway she finally agreed to ask the "doctor" to rewrite the prescription for prednisolone sodium phosphate rather than prednisolone acetate. Another hour later she calls back to tell me that the prescription is ready for me to pick up.

I go to get it but I notice that it doesn't have any dosage size listed. Yesterday's prescription was for 10 cc, but since the smallest size is 5 cc, I feel certain that is what the pharmacy would go with. So I ask for Nancy, only to be told that Nancy has already gone home today, but that they could ask one of the other docs to see if one of them would be willing to fix it. I look at the prescription, which is in black ink, and then at the black ink pen in my pocket, and decide that my best course of action is to simply write in the size, so I do, and tell the receptionist, "I'm good now", and smile. She says "Good", and so I leave, thankful for one small victory.

As someone else has commented, the only folks who don't seem to notice these "small problems" with the health care system are the ones who work in it. I suspect that's because they know how to circumnavigate around these sorts of things. I can think of several examples of folks on this forum who work in the health care system and who seem to be able to get the system to respond in a more rational way.

I honestly don't understand how anyone can say there's nothing wrong with the current health care system, but, of course, that's just my opinion.

Regards,
Bill

Ahhhh geez, I had to get in on this:

Bingo posts - Now, in the quote I've snagged above this again raises one of the same central questions I've asked a number of times but no one has responded to.

One of the regular points of contention in many posts around here has been the amounts being reimbursed by an insurance company for equipment. Cpap.com gets reimbursed the same amounts from the insurance companies, yet he is regularly considered a wonderful person/company here. Why the schism between the two entities? The same equipment - the same reimbursement. Yet one group (The Equipment Providers) are considered money-grubbing scum out to get rich, the other considered 'The beginning of a revolution!'. Understand, I have ZERO problem with that model, and both sides should be allowed to make whatever living they can in their chosen field. I just take issue with the double-standard.

On another thread neversleeps posted the links to information dealing with your question. I have included the link below.

viewtopic.php?t=9758&start=15

Also, cpap.com does not get reimbursed the same amounts. From all my reading on this forum, cpap.com is a direct seller to the client and doesn't accept insurance claims. That is something you have to work out with your own insurance company and likely is a good reason for lower prices. However, billmyinsurance would be the ones who may be able to work with your insurance at a little higher cost. I would suspect that the rates charged here would be a lot less than a DME would charge but I have no evidence to this.