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[Equipment] Ripped Off by Medical Industry
#1
The amount of money paid by insurance companies to medical equipment suppliers is outrageous, and these costs are passed on to us, the consumer, in the form of co-payments, insurance premiums, and deductibles.

Here's an example. My CPAP machine is the ResMed AirCurve VAuto. Supplier #1 charges $1726 US dollars for this machine and the humidifier.

My insurance company paid my equipment supplier $3984.
I paid my equipment supplier $779.

That's a total of $4673 for something that costs $1726.

This is a system in need of reform!

And on top of this, the equipment supplier is now telling me that I owe another $270 for this machine.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#2
Most insurance companies pay a significant discount on the invoiced price. Are you sure that was the final settlement? With your costs over $1000, I'm pretty sure I would have found a different source. Maybe call your insurance and ask why they allow this much when the advertised price is so much less nearly everywhere. They pay a premium for monitoring, service and warranty. but it's hard to believe they are paying over twice the price.
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#3
(05-23-2016, 02:43 PM)Sleeprider Wrote: Most insurance companies pay a significant discount on the invoiced price. Are you sure that was the final settlement?

Yes.

Quote:With your costs over $1000, I'm pretty sure I would have found a different source.

Time travel?!

Quote:Maybe call your insurance and ask why they allow this much when the advertised price is so much less nearly everywhere. They pay a premium for monitoring, service and warranty. but it's hard to believe they are paying over twice the price.

Yes, it is hard to believe. Which is why I chose to post this information.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
I don't think it would matter what supplier Sleepster used, would it? His insurance has a fixed amount that they reimburse for that particular machine, so he's stuck paying his ~20% of the bill.

(05-23-2016, 02:43 PM)Sleeprider Wrote: Most insurance companies pay a significant discount on the invoiced price. Are you sure that was the final settlement? With your costs over $1000, I'm pretty sure I would have found a different source. Maybe call your insurance and ask why they allow this much when the advertised price is so much less nearly everywhere. They pay a premium for monitoring, service and warranty. but it's hard to believe they are paying over twice the price.

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#5
Sleepster: You should take a look at your EOB. I'm sort of with Sleeprider here.
I frequently see where a provider bills for one price; but must settle for a lower contracted price.
Of which the patient co-pay is a % of the contracted price.

Let's name names -- who's the insurance carrier and who's the DME?
And that extra $270 -- sounds like a Crapria stunt.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
(05-23-2016, 05:12 PM)justMongo Wrote: Sleepster: You should take a look at your EOB.

Yes, I did that before posting. I, too, was in denial. But it's true. The EOB justifies the extra $270. The only "stunt" is that I was not informed of the actual cost before I agreed to the purchase. This American medical system is allowed to get away this preposterous scheme. That's the crime that we allow them to commit because of their highly successful lobbying efforts.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
Pay them in pennies.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
My last set of replacement parts was as follows:

Insurance Billed: 603.93; Allowed 202.60; Paid 162.08. My cost - 40.52 (which was picked up by my supplement).

This was not as bad as when my wife had her back surgery - hospital billed $650,000 and change and the allowed amount was around $70,000. This was for the surgery and a week's stay. Our supplement picked up what was left (less than $200). Our insurance also has a catastrophic cap of $3000 for the family so we hit the cap on this one.

Homer
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#9
Goodness, what a system, it almost makes our setup look half reasonable, with the emphasis on ALMOST.

Best of luck Sleepster.
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#10
It is outrageous and quite the racket. Hows this for a dilemma. My DME, sleep center wanted to charge my insurance $2600.00 for a Resmed 10 Auto, $2,000 of which my insurance would pay leaving $600.00 to me.

I discovered a reputable company offering to me "2" Resmed 10's with all the gear for $2,000 total. Once they knew my insurance limit they were more than willing to sell me 2 billed as one unit. how's that for a pickle.

Should I have been honest and let the DME screw me and my insurance for 1 machine or get 2 for $600.00 less. Of course i doubt the insurance company would see my logic in getting 2 for the price of one.

It's a pickle.
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