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Insurance question....is this typical?
#1
Insurance question....is this typical?
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
RE: Insurance question....is this typical?
maybe some insurance ceo getting kickbacks from the DME
what goes around comes around Too-funny
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#3
RE: Insurance question....is this typical?
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.
PaulaO

Take a deep breath and count to zen.




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#4
RE: Insurance question....is this typical?
(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
RE: Insurance question....is this typical?
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
RE: Insurance question....is this typical?
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
RE: Insurance question....is this typical?
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
RE: Insurance question....is this typical?
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.
PaulaO

Take a deep breath and count to zen.




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