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Insurance question....is this typical?
#1
I have had my respironics auto with heated hose since August. I get a new mask every 6 months, new cushions every month and new heated hose every three months. I see the eob's and the insurance company has paid the DME about $6,000 so far. I saw that today, the paid the DME $3,000. I assume that is for the machine. I can't believe how much more than the going rate insurance pays for the equipment. Is this typical? Thank goodness, I don't have any out of pocket but I am just curious if this type of overpayment to DME's is typical.
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#2
maybe some insurance ceo getting kickbacks from the DME
what goes around comes around Too-funny
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#3
Wow. Holy cow.

They could have bought two machines for that price.

Most insurances "rent" the machine for a certain number of months. In the end, they are paying a lot more than if they just bought it for you outright.

DMEs also typically charge much, much more for masks than is necessary. It's freaking ridiculous.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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
(12-21-2012, 09:33 PM)Roxy Wrote: I have had my respironics auto with heated hose since August. I get a new mask every 6 months, new cushions every month and new heated hose every three months. I see the eob's and the insurance company has paid the DME about $6,000 so far. I saw that today, the paid the DME $3,000. I assume that is for the machine. I can't believe how much more than the going rate insurance pays for the equipment. Is this typical? Thank goodness, I don't have any out of pocket but I am just curious if this type of overpayment to DME's is typical.

YES!!
It is freaking ridiculous.
But it sounds like you are getting a lot of equipment as in masks & cushions.

I was told my cushions should last up to a year not to mention the mask & Hose.

It is no wonder why medical is in such trouble.
Their getting raped & we are getting raped!
Vicious circle!!
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#5
Uhm, yah. I think the companies are hosing each other and then later upping the premiums/co-pay and cutting benefits so the consumer ends up picking up the tab.

Sometimes there just isn't enough hot pine tar and feathers to go around.....

Oh-jeez
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#6
After paying $175.00 per month for the rental, my insurance company just paid the DME more money than the consumer would have for a brand new, not three month old machine. Go figure!!!!! I am amazed that the insurance company (largest in the state) didn't negotiate with the DME that the rental cost is applied to the purchase price. Now I know why the DME was so eager to get me to use them. They waved my copay for all equipment so I have no out of pocket.

Now we know why medical/insurance costs are so insane!!!


Several years ago after knee surgery, my insurance company rented an ice machine for me. The rental cost was approximately 4 times the cost of just purchasing the exact same machine at the typical consumer rate.
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#7
My insurance company bought the humidifier, hoses, and mask outright at ~50% the DME's list price and had the cpap machine set up on a $90/month rent to own schedule for 11 months. I petitioned them to purchase the machine after 100% compliance in first 21 days and a 98% reduction in AHI. They agreed, saving me $720 in 2013 rental fees as my deductible turns over on Jan 1. An awesome Christmas gift! Smile
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#8
Slightly off topic: I just got a new power wheelchair via Medicare. The price list is jaw dropping but one in particular made me write to my congress folks.

Two Group 34 deep cycle batteries: $1200.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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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