(02-04-2013, 08:53 AM)Sleepster Wrote: If my co-pay is $190 with the brick then where does the incentive come from?
Apparently I'm not making myself very clear. Again, your co-pay has nothing to do with how much the DME was paid for the CPAP
. Forget about that co-pay - it really has nothing to do with the DME's financial incentive to give you a brick. That co-pay amount is simply your
portion of the total bill.
Let's take this from the top:
The DME got paid roughly $1500 for the REMstar Pro as I said (actually $1,507.94, as you said). DMEs always get paid roughly $1500 to dispense CPAP, no matter what kind (Plus, Pro or Auto). That was exactly
what happened in your situation.
Some of that $1500 was given to them through your co-pay, and some of that was through direct insurance company reimbursement, but the fact remains that the DME was paid a total of $1500 to give you a data-capable CPAP. The total amount the DME received (made up of the amount insurance paid plus your co-pay) would have been the exact same amount
had you been given a REMstar Plus, REMstar Pro or REMstar Auto.
If the DME gets paid $1500 no matter what CPAP is given to you, that is where the financial incentive comes in: They benefit by giving you a cheap brick over a more expensive data-capable CPAP. It's pretty simple, really.
DME cares not that the $1500 was paid partly by insurance and party by your co-pay. They still got their flat $1500 fee for the CPAP as dictated by CMS guidelines.
Having said all that, the extra $100 "upgrade fee" (while legal) is bogus. That's simply the DME trying to extract more money from you.