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Ontario question...Understand ADP Rules?
#1
Just had my prescription finally written. I'm supposed to leave for Florida in 2 weeks, so this is kind of time sensitive.

Just wondering if anyone understands how it works with Ontario and the ADP. According to the ADP Product Manual:
http://www.health.gov.on.ca/en/pro/progr...manual.pdf

it looks like DME's are reimbursed $860 for the basic CPAP machines which include:

Airsense 10 CPAP,
Airsense 10 Elite,
ResMed S9 Elite CPAP
Resmed S9 Escape,
etc....

you get the full kit; hose, humidifier, basic mask (F&P Flexifit 407) etc.

My DME is telling me I will pay an extra $275 to get the Airsense 10 Elite, over and above the $860. And they have to order it in and might take up to 2 weeks to get.
Also I was originally told that with this $275 upcharge I got the mask of my choosing. Now they are saying no.

Are they allowed to charge whatever they want? Can they change the rules whenever they want?


I called another local DME and they told me over the phone that they would sell the A10 Elite for $860 with the full kit and almost same mask (F&P Zest). They also said they have them in stock. I'm only unsure cause I don't have this in writing.


So how do I negotiate with the original DME? I've had a loaner from them for just slightly more than 3 months. Are they allowed to charge for the loaner machine? Also full disclosure, they have allowed me to try at home 4 different masks during my loaner time so I give them credit for this.
APNEABOARD - A great place to be if you're a hosehead!! Rolleyes

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EVERY ACCOMPLISHMENT BEGINS WITH THE DECISION TO TRY!
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#2
I bought my auto cpap A10 from Canadacpabsupply and had no issues at a reasonable price. I'm from Alberta and the cpaps are pricey here, payed out of pocket.
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#3
Thanks but things work differently here in Ontario with ADP rules.
APNEABOARD - A great place to be if you're a hosehead!! Rolleyes

-------------------------------------------------------------------------------------------------
EVERY ACCOMPLISHMENT BEGINS WITH THE DECISION TO TRY!
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#4
$860 is the approved price for a CPAP system with basic hose, mask, humidifier filters etc.
As far as I know, DME gets 75% from Ontario ADP and 25% from the client (you).
So, you'd be paying them 25% of $860 which is $215
If they demand more, you should report them to ADP - they should be taken off the list of approved vendors.
In any case, just go to the DME that has the machine in stock and doesn't try to overcharge.
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#5
http://www.health.gov.on.ca/en/pro/progr...manual.pdf
CPAP is a fixed price device so;
page 27 (PARA 305) makes it very clear.
 Fixed price: the ADP pays 75% of an ADP Approved Price. Where
the Ministry pays 75% of the cost of the Device, the Client’s portion
must be at least 25% of the cost of the Device. The Vendor cannot
charge the Client more than the ADP Approved Price;
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#6
Thats good but in the paragraph below it says the opposite.
APNEABOARD - A great place to be if you're a hosehead!! Rolleyes

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EVERY ACCOMPLISHMENT BEGINS WITH THE DECISION TO TRY!
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#7
@cate1898 - Did you notice that the AirSense 10 Autoset for Her is listed along with all the CPAP machines? It's the first item in the ResMed CPAP list. I'm sure it's an error, but you might try to talk them into it... Smile

Now I'm searching for my receipts from February so I can see how my machine and all its accessories was billed. My insurance did pay for all the extras, fortunately.
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#8
(12-17-2015, 04:21 PM)cate1898 Wrote: Thats good but in the paragraph below it says the opposite.

Paragraph 305.00 in sections below the one I quoted, talks about other than "fixed price" funding models. CPAP belongs to the Fixed Price model.

Para 305.01 allows to charge extra for extra / upgraded supplies.
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#9
(12-17-2015, 04:24 PM)pholynyk Wrote: @cate1898 - Did you notice that the AirSense 10 Autoset for Her is listed along with all the CPAP machines? It's the first item in the ResMed CPAP list. I'm sure it's an error, but you might try to talk them into it... Smile

Now I'm searching for my receipts from February so I can see how my machine and all its accessories was billed. My insurance did pay for all the extras, fortunately.

I doubt any DME will be willing to take the risk of allowing you to purchase the APAP at a cheaper price seeing that they would never get their money back from the ADP.
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#10
(12-17-2015, 04:15 PM)GPSMapNut Wrote: http://www.health.gov.on.ca/en/pro/progr...manual.pdf
CPAP is a fixed price device so;
page 27 (PARA 305) makes it very clear.
 Fixed price: the ADP pays 75% of an ADP Approved Price. Where
the Ministry pays 75% of the cost of the Device, the Client’s portion
must be at least 25% of the cost of the Device. The Vendor cannot
charge the Client more than the ADP Approved Price;

I skim read thru the entire 98 pages and couldn't find anything telling me that CPAP devices fall under the 'Fixed Price" category. Where did you find that? EDIT: Found it on this document at 600.01: http://health.gov.on.ca/en/pro/programs/...manual.pdf


Also, I'm going to go to the DME that verbally told me on the phone that they'd sell the A10 Elite + basic mask + hose, etc with all my paperwork in hand. I'll also bring my loaner with me in case I am successful in purchasing thru the new DME and go home with the new equipment. Then I'll return my loaner tomorrow to the original DME. Do you think they can then charge me for the loaner machine, mask etc??

Also, look at that document 515.01 " ...vendors may differ in device options, service plans, and in some instances, price" ?? Looks like a legal loophole to me.

APNEABOARD - A great place to be if you're a hosehead!! Rolleyes

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EVERY ACCOMPLISHMENT BEGINS WITH THE DECISION TO TRY!
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