CPAPtalk.com

Wulfman wrote:I just happened to run across this thread awhile ago and thought it kind of fit this discussion (price/quality/service).

http://www.apneasupport.org/about4571.html

I don't think anyone will argue that on the whole - most peoples experiences with Apria are not entirely positive.

BUT - if you are going to point that out than in all fairness you have to also admit that a fair number of people ON THIS SITE have stated that they have had great experiences with Apria.

We have to be careful of the human nature that allows us to forget the positives when discussing the negatives.

EVERYONE can stand to improve - even us here posting. But let's not get so wrapped up in that that we cannot see the positive things either.

B

Thank you for adding fresh air to this discussion, Bingo.

Bingo wrote: If too many doctors feel an equipment provider is no good, that provider will go out of business. I've seen at least a dozen in the past 5 years just in my area alone go out of business.

If they aren't meeting the needs of their customers then that is probably for the best. It's interesting though that you indicate it's the physicians who determine whether the equipment provider stays in business, not the users of the equipment.

Bingo wrote:However, if too many Equipment Providers stop being willing to accept orders from a particular doctor because they are much too difficult to deal with, or won't submit the paperwork required to get equipment reimbursed - that doctor is going to find their ability to take care of patients is very tough!

Have you observed that to happen, Bingo?

Bingo wrote:The same goes with insurance companies - if too many doctors or equipment providers refuse to deal with an insurance company - those patients are going to quickly drop thier coverage.

I watched the physicians at a major medical center in Dallas some years ago band together against Texas Instruments and refuse to sign on to their terms and conditions. After a year or so the physicians had lost so much business that they decided it was in their best interests to accept TI's terms, because TI despite protests from its employees hadn't changed their terms. Business is business, after all. It is possible to get the attention of physicians, but even a very big corporation found it very difficult to impact things much. The average person has much less chance of meeting with success.

Regards,
Bill

GoofyUT wrote:The one area that I think that I agree with you most about but we might differ somewhat is that, I believe that we all must take final ownership and responsibility for our care, but I'm not sure that we all have the competence to administer our care. I know that, with the demands of my life, I haven't been able to study the theory and technique of each and every body system that OSA affects. So, I found a fella who has studied this enough and demonstrated that to me, that he's earned my trust. And then, I pay him lots to administer my care, just like I'd pay any other servcie-providser to administer the fix for any other problem I had in my life. Like a plugged up toilet, for instance. I'd find a plumber trhat I trusted and then I'd pay him/her to get the problem fixed. At any time that I began to doubt that my pulmonologist or my plumber was performing in a way worthy of my trust, I'd fire his/her *ss, and find another that I believed I could place my trust in.

I got central air installed last Monday. The next day I saw from the data displayed on my thermostat that the temperature in my house was 84 degrees. I was going to press the button to lower the temperature, but consulted an air conditioning forum and read a post that suggested I was not competent to administer my own care and that doing so could be dangerous. After all, I'm not a trained electrician. What if I got the temperature too low? I could get hypothermia and die. What if I got the temperature too high? I could get heat stroke and die. One misstep and it could affect each and every body system. I know that, with the demands of my life, I haven't been able to study the theory and technique of each and every body system this could affect. So, I found a fella who has studied this enough and demonstrated that to me (after all, he installed my air conditioner), so he's earned my trust.

I called this trained professional and he came out and pressed the button for me to adjust my thermostat. I pay him lots to administer my care, just like I'd pay any other service-providers to administer the fix for any other problem I had in my life. For instance, just yesterday, the toilet was plugged. Sure, I could have gotten out the plunger and unclogged it myself, but God knows what body system that could have affected and I am not a trained plumber. So I called a plumber that I trusted and paid him to fix the problem. I'm no dummy.

So let this be a lesson to all of you. Do NOT, under any circumstances attempt to do something you can do yourself when you can pay someone else to do it for you. Remember, there's nothing wrong with these people making a profit and we need to keep them in business.

Just one more thing. The trained air conditioner professional set the thermostat wrong and now it's too cold. (Not to mention the fact he brought out the wrong size filters for my machine.) I was thinking I'd look in the directions to see if I could fix this myself (mum's the word) and maybe pick up the correct filters from Home Depot, but it turns out I don't have the owner's manual. The equipment provider wouldn't give it to me. Too dangerous. He removed it from the box my air conditioner came in and is selling it on ebay for a profit. Isn't that ingenious? Anyway, I was going to order my owner's manual on ebay, but thought I'd try to save a few bucks and see if someone here could email it to me.

Thanks.

Bingo wrote: So there is accountibilty there.

Does that make you feel ANY better now when you've apparently had difficulties in the past? I'm willing to bet it doesn't!

However, going forward perhaps it will.

B

No, it doesn't make me feel better. My path is not linear, it is branching matrix and begins with my PCP and branches to Sleep Lab, Sleep Doctor, ENT, it is poorly matrixed. My PCP is the prescribing Physician. He's pretty good but as far as I know he rarely, if ever, talks to the Sleep Doctor and ENT. The Sleep Doctor does talk to the lab but generally through his assisting RT. Each of the group have a differing opinion about how to treat my OSA. ENT thinks surgery first, Sleep Doctor does not particularly believe in APAPs and self monitoring although I was able to get a script out of him but unable to get him to intercede with the HMO on my behalf. I can have an APAP if I want to pay (I do). My PCP would not take issue with the insurance without the Sleep Doc's assistance. My PCP defers sleep issues to Sleep Doc and ENT. ENT is a "cutter", at least from what I can see. I don't get to change for a year. All three have no idea who my DME is and really don't care since that is an insurance issue. They have no desire to deal with insurance issues, that is my baliwick.

From what you relate it seems that you think the feedback loop works, and it may to a point, but is inefficient beyond comprehension and the insurance anecdote did not say if they still were in business or not (they shouldn't be but I bet they are). With companies going out of business more and more business accrues to the Apria's (not a good thing really) of the world and more and more folks that can afford it buy on their own. Your point sounds nice in theory but, in my experience, what accountability there is does not function well and few among this matrix seem to feel particularly accountable to me which is where they should be accountable. I am the patient or customer, if you will.

So, again, I am not reassured. In Sleep Therapy I'm with Bill in thinking, or perhaps hoping, the real change will come from the internet and the rapidly improving technology.

David

Anonymous wrote: I got central air installed last Monday. The next day I saw from the data displayed on my thermostat that the temperature in my house was 84 degrees. I was going to press the button to lower the temperature, but consulted an air conditioning forum and read a post that suggested I was not competent to administer my own care and that doing so could be dangerous....

Sounds like Ric. If it ain't ---- Ric, you've got competition baby!

Bingo wrote:An Equipment Provider could bill for virtually any dollar amount they wanted - it will not make a difference. All they will be reimbursed is what the Insurance Company has contracted. And generally only 80% of that amount anyways.

Typically, the range will usually be in the 700-800 dollar area.

By the way, although no one brings it up, our very host here ALSO gets paid those same amounts. No one refers to him as "evil" either.

What is the difference? Again, WHY is it so wrong for someone to make a profit from dealing in healthcare equipment?

So when the cost of a machine through a traditional DME is double or more than double the cost of the identical machine from an online vendor, it's the insurance companies who are keeping all that extra money?

Anonymous wrote:So when the cost of a machine through a traditional DME is double or more than double the cost of the identical machine from an online vendor, it's the insurance companies who are keeping all that extra money?

First off, show me ANY case where an insurance claim has been "double or more" what anyone has paid online.

However, I will again state that the amount anyone gets PAID is based on the specific insurance contract. That rate is decided on by the insurance company.

So an insurance company will come into an area and say "Here is our contract. We pay $800.00 for an E0601. Do you want to accept that rate? If you do, then we will allow you to provide equipment for our patients and bill us. If not, fine. We will find someone else."

Bingo

It is interesting to me that many people who are a part of the industry think it works well, adequately, or just needs to be tweaked and many, if not most, of those who are the clients, patients, consumers, customers, almost without fail, think it is broken, even when they have managed, with real effort, to make it work for them. No one that I know enters the system with confidence that it is going to be a smooth, efficient road with quick, trustworthy, effective care and reasonably realistic outcomes assured. Most that I know enter the industry maw with trepidation either over the hassles or the outcome. That is quite a disconnect. The best, in general, I have heard is "well, for health care, it works pretty much OK" and that is not a common refrain. This tells me that it serves those who are making a living within the business pretty well. Hmmmmm, now what could the problem with reform be?

The flip side is that when one hits a good doctor or enters a really good hospital it can be a truly revelatory and reassuring experience until one thinks about the insurance, the referrals, the paperwork and the overall administration.

David

Bingo wrote: First off, show me ANY case where an insurance claim has been "double or more" what anyone has paid online.

In my case, the online price would have been 58.6% of what my insurance approved for payment to the local DME.

For Respironics Auto BIPAP, hose, manuals, humidifier & Swift mask

BCBS approved price to DME = $2718.52 total
cpap.com price = $1593.00 total

In my case, I took the DME price instead of getting it through cpap.com because I was already finding that my DME was friendly and helpful, and because I wanted to try on the masks before I bought one. (After a few days or weeks, I did wind up getting an Activa online from cpap.com anyway, so the trying-on idea didn't really work out too well.) I don't regret the decision to go through the DME, because I think I needed help when I was a newbie. Also, my DME experience was MUCH more positive than the treatment that many others have reported.

Moogy

I just retrieved a message from local Evil-DME quoting the owner as saying "the machine you have presently is FINE"
((CPAP-PRO (NOT PRO2)).

Fine with THEM, I'm sure. Fine with ME?, NO!They DO HAVE PRO2 machines because an instruction manual was inadvertedly left in my pro bag!! I requested a PRO2 due to its tracking more information, which is necessary for me, as I have pulmonary problems beyond Apnea.
NURSE PRACTITIONER wrote a script for APAP and they will not honor that either. I was hoping for a compromise to a PRO2.
Please provide ammunition for me to use productively. Problem I see is that even though you may be lucky enough to get a doctor, lpn, team of specialists, it doesn't mean a damn to THIS DME!!! They've stretched it out to my 'last month'. I don't find this acceptable, but don't know that I can successfully argue with a rock.

Any ideas?

I'm also renting an oxygen concentrator from them; I believe I shall put a stop to that and get another Rx and gladly let another DME get the $$.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): DME, APAP

Offerocker wrote:Please provide ammunition for me to use productively.

For the record, Kathleen, no way am I gonna give you any ammunition. You've already killed off dozens of sycophantic creatures. I will not be party to further destruction, no matter how well deserved it may be.

Umm . . ., now that I think about it, you might just leave a few copies of "those" mysterious reports with your DME tomorrow.

How confrontational are you willing to be?

Regards,
Bill

Bingo wrote:First off, show me ANY case where an insurance claim has been "double or more" what anyone has paid online.

Did a search. Took less than 5 minutes to find these. There are tons more, but there aren't enough hours in the day to find them all.

viewtopic.php?t=4455
and
viewtopic.php?t=9079
and
viewtopic.php?t=9212
and
viewtopic.php?t=1356

Snoozin' Bluezzz wrote:Sounds like Ric. If it ain't ---- Ric, you've got competition baby!

Thx David, ah iz flattered, but if I wrote that i wud CHEERFULLY sign it.

Guest make a good point, and said it MUCH better than I.

(Guest: HIGH FIVE!)



CHEERS!

-Ric

Offerocker wrote:I just retrieved a message from local Evil-DME quoting the owner as saying "the machine you have presently is FINE"
((CPAP-PRO (NOT PRO2)).

Fine with THEM, I'm sure. Fine with ME?, NO!

See, this is where I think the largest part of the problem is coming from in so many of the cases here.

You WANT a new CPAP that has these nifty reporting features that your current unit does not have.

There isn't any actual specific FUNCTION your current unit is not performing that is required for it to do it's job. There is just more NOW that it COULD do.

And now, because they won't give you one, they are awful, evil people.

Why???

I mean, I'd love a newer model truck than I currently have. Sure mine is only a couple years old now, but it doesn't have the cool navigation system that would keep me from getting lost.

However, I'm not calling the bank who loaned me the money, the car dealer who sold me the car (KNOWING A NEW ONE WAS COMING OUT NO LESS!) and everyone else evil because of it?

I honestly don't see the difference between the two. In both cases the initial item is performing exactly as it is supposed to. In both cases I have paid for and received an item.

I just *want* the new one. It doesn't mean I'm *entitled* to it.

Just one minority opinion -

B

Anonymous wrote:

Bingo wrote:First off, show me ANY case where an insurance claim has been "double or more" what anyone has paid online.

Did a search. Took less than 5 minutes to find these. There are tons more, but there aren't enough hours in the day to find them all.

viewtopic.php?t=4455
and
viewtopic.php?t=9079
and
viewtopic.php?t=9212
and
viewtopic.php?t=1356

There was another thread here where I warned about people making snap judgements without having all the facts.

I was pretty soundly mocked by the folks posting in that thread, and even given specifics showing me where I wasn't paying attention to the facts.

It was then shown that the initial person posting misunderstood a couple things and had made an error.

No one really stopped to offer any apologies - nor did I expect any.

It's very, VERY easy to make all sorts of judgement claims without knowing the specifics.

Case in point - your first link sure sounds like someone was quoting a price for a unit complete with software and card reader. Of course, no one actually followed up to double check.

I could also just as easily find 12 posts of people raving about thier doctors, their insurance companies and thier equipment providers.

Heck, I bet I could fill this space up with people posting messages about the fact that they loved getting a colonoscopy. It doesn't mean a thing.

Without seeing things like actual claims paperwork - without being able to call these various people involved in horror stories and checking out the facts, all ANY of us are doing here is shooting in the dark at worst, and perhaps shooting in twilight at best.

That's all I've EVER been saying.

Bingo - Mr. Minority