[Equipment] dme overcharges?

[sheepless]

thanks for all your insights.  still listening though 'cause I'm not ready to accept that I'm completely SOL.  I'm sure I'm constrained by the contract I signed; need to pull that out for another look.  you all are also correct that I did not do my usual due diligence.  usually I drive others crazy agonizing over finding just the right value.  in this case, after a lifetime of untreated apnea, I was desperate for immediate relief (still waiting for that but that's for another post) and chose to assume the medical community would take care of me. meanwhile, there's something fundamentally wrong with this double charging for parts.  it's my contention that E601 alone applies to the integrated machine; i.e., the standard equipment with no options.  in this case: part #37207, which includes the cpap device, integrated humidifier, standard water chamber & standard hose.  my dme provider, or maybe the doctor's prescription, which I never saw, called for heated hose (that I've identified as part #37296 & code A4604), as an example of an option & which I agree should incur an additional charge.  same argument regarding the headgear but I won't bore you with my "proof".  if this kind of nonsense is standard practice, it's no wonder our health care system is so obscenely expensive. apparently rife with corruption & fraud (?)  oh, & good suggestion to check with state regarding sales tax as it applies to dme.  hadn't occurred to me it might be different.

[SideSleeper]

I recommend that anyone on Medicare get on http://www.my.medicare.com and create an account. You can then follow all of your medical providers. I got my PR 560 just a couple of months (September 2015) before the Dreamstation came out. The DME billed Medicare $860--of course he didn't get that--but that price doesn't seem to be inflated. It was a 13 mo rental with Medicare and secondary paid 100%. I got the full ride machine---heated hose and humidifier.

[Hydrangea]

meanwhile, there's something fundamentally wrong with this double charging for parts.  ...  same argument regarding the headgear but I won't bore you with my "proof".  if this kind of nonsense is standard practice, it's no wonder our health care system is so obscenely expensive. apparently rife with corruption & fraud (?) 

I totally agree. Another example is how they bill (and receive money from insurance) for the whole mask fit-pack, but only give me the single size of cushion that they believe fits me.  (I ditched that DME.)

[Walla Walla]

I recommend that anyone on Medicare get on http://www.my.medicare.com and create an account.  You can then follow all of your medical providers.  I got my PR 560 just a couple of months (September 2015) before the Dreamstation came out.  The DME billed Medicare $860--of course he didn't get that--but that price doesn't seem to be inflated.  It was a 13 mo rental with Medicare and secondary paid 100%.   I got the full ride machine---heated hose and humidifier.

The web address for my medicare is: https://www.mymedicare.gov/

[Mosquitobait]

there's something fundamentally wrong with this double charging for parts.  it's my contention that E601 alone applies to the integrated machine; i.e., the standard equipment with no options.  in this case: part #37207, which includes the cpap device, integrated humidifier, standard water chamber & standard hose.

It's not a double charging for parts. It's your inability to accept the fact that there is no code for integrated machines.  Despite the fact that it is one unit, it is still an xpap plus a humidifier - 2 things.  You are not being cheated.  Just go to any online store and compare the price of the Airsense with any other manufacturer's cpap/humidifier combo.

[Sleeprider]

1.  DME provider billed insurance by medicare code including codes for exhaulation port, humidifier & humidifier chamber (among others).  Exhaulation port is built into resmed's airfit mask system which they also charge for.  Humidifier is built into the machine and included in the machine price charged by every online vendor I checked.  Humidifier chamber is also included in the machine price although periodic replacements are recommended and can be purchased by separate code. 

My contention is that separate codes for these items are appropriate for machines for which these items are options, not standard equipment.  I argue that they cannot charge me for parts neither they nor I can buy separately (except when buying parts for replacement/repair).  They tell me their hands are tied, that they have to bill certain codes no matter what, but refuse to identify whatever it is they believe controls how they bill.  They say take it up with insurance.  Insurer says take it up with DME provider.  State insurance commission says we don't regulate non-Medicare DME providers.  It seems DME providers say they are limited by Medicare AND Medicare is only a guide in cases with individual insurance coverage.

2.  DME provider billed insurance at more than twice online & insurer contracted allowed amounts.  Not at all clear why since DME provider knows & tells me in advance what the contracted allowed amounts are.  In any event, they apply state and local sales tax against this inflated figure.  Explanation of Benefits from insurer simply carried over those tax amounts even though actual contracted allowed amounts are significanly less. DME provider seems to acknowledge this but continues to tell me they're charging everything correctly.   

The amount in contention is more than $500 at the insurer's lower allowed amounts. Since we have a very high deductible, it's all out of pocket. I hesitate to think there's fraud here but it has crossed my mind.

Has anyone figured out how to successfully contest DME provider charges?

Call your insurer and obtain a statement for the claim. That should show the amount billed and the amount paid. Also, verify when you will own the machine. If this is a permanent rental, and that is not required by insurance, then discuss your options with the insurer.

[scroydon]

Not to muddy the water but I recently read that there is no state and local sales tax allowed on DME. However, Obamacare did get Congressional favor for a 2.3 percent federal tax to offset the cost of this boondoggle.
Link to DME removed.  Instead search for article "Will CPAP Be Taxed" on Supplier #9 website under header: Articles.

My apologies to those who already know this for this newbie is just beginning to wade into the turbulent waters of nocturnal snorkeling.

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[scroydon]

Same here. The DME gave me one of three cushions. From what I can find online, the Dreamwear mask come one of two ways: one cushion or a "Fit pack" with S-M-L nose cushion. The cost is the same.

I have no way of knowing which was ordered but a dishonest DME could pad their books selling the other two cushions.

[Hydrangea]

Same here. The DME gave me one of three cushions. From what I can find online, the Dreamwear mask come one of two ways: one cushion or a "Fit pack" with S-M-L nose cushion. The cost is the same.

I have no way of knowing which was ordered but a dishonest DME could pad their books selling the other two cushions.

Yep.  I assume they are the Amazon sellers who only sell the less popular sizes of cushions.

[scroydon]

Sorry. My intention was to share an article from a website that happened to be a DME. How should I cite such in the future so I follow the board guidelines?

Thx.

BTW. On a different matter,  please excuse my ignorance at posting but I can find a way back to a drafted post saved so I can finish that posting. I can get to the draft title but not the post so as to continue with my product review. Please advise.