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Outrageous DME prices
#1
I finally got my order in from Bless His Heart Ron and Can Never Get It Right Mitch. What a pair.

Anyway, for the first time ever, I got extra cushions. I have never gotten extra cushions. Never. But this time I got the mask with its cushion and two others of the same size. Cool.

So I glanced at the price sheet and about sheeted a brick.

Mask, SM Simplus = 226.84
Headgear = 49.69 (although it was all in the same package...)
Cushion, SM Simplus (87.21x2) = 174.42
Tubing, Climateline = 83.51
Filters = 40.44 (says 6x6.74 although they are pre-packaged, 2 to a package)
Chamber, H5i = 29.39

A grand total of $604.29. More than I paid for my Autoset.

Ho-lee cow.

I went to Supplier #26 and added everything to my basket. I didn't add the headgear, though, since it is included with the mask (duh).

Mask, SM Simplus = 99 (on sale; normal price 135)
Cushion, SM Simplus (32.95x2) = 65.90
Tubing, Climateline = 40.00
Filters (6x1.85) = 11.10
Chamber, H5i = 32.95

For a total of 248.95. That's a difference of 355.34. Meaning I could order my supplies twice and have some left over for shipping twice.

I have insurance which is going to cover all this thank god. And with the way my home state is going with Medicaid, I think I will stretch these supplies out for as long as I can.
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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#2
Holy crap, looks like they want to pay all overhead on every sale, I am waiting to see some charges from mine also paid by insurance but I already know they will be off the deep end price wise and have moving elsewhere in the back of my head.
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#3
Yep, my DME prices out a mask the same way. It cracks me up to see a charge of over $200 for a P10 mask, and then they charge again for the the headgear at $65, Plus they charge separately for the nasal pillows, $30 each. Mind you, all of this is packaged as one complete mask!

Been looking for a second backup machine, but I wanted new, not used. My DME wanted to charge me $3200.00 for a new PR 560 Auto, no humifier. Huh

So instead I checked on line, supplier 26 and purchased a new PR 560 Auto CPAP, same as in my profile, to have on hand in case something happens to current machine.

Supplier #26 - brand new machine, complete with heated humidifier, heated hose, 80 watt power brick, filters, extra hose all packaged in zippered case for $501.00,
minus $11.00 (customer loyalty discount). Total at checkout = $490.00.

OpalRose
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www.ApneaBoard.com

How to Organize and Post ScreenShots

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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
That's because they're generous.
If they were greedy they'd be going with 1000% markup.
(yes. Sarcasm.)

Smile
"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
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#5
Insurance companies are to blame for this. It would be interesting to compare the EOB with the bill... Insurance will contract with DME for a certain amt. DME's bill high to keep Insurance Co happy with the contracted amount which is a "steep discount." It ought to be done like vision insurance. patient has an allowance toward both lenses and frames... it is up to the patient if they want Dior frames and Zeiss Lenses or generics. and whether they want them fitted at a pricey optometrist office or pick them up at costco. Unlike most vision insurance tho, the allowance should cover the base machine, and the DME should go ahead and charge for services (and insurance should pay) when they are needed instead of padding it into the supplies.
هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
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#6
It's all marketing. The insurance allows for billing specific items (billing codes) and no matter how something is packaged the DME will break it up into billing codes to submit it to the insurance co.

When I get my EOB it always says "gee look how much we saved you!", well yes but NO ONE ever pays what the DME asks, so it may look good, but in reality it's all just marketing.
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#7
When I get the final statement from Medicare, I'll let y'all know what was paid.

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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#8
The amount paid by your insurance will closely resemble the prices you got from Supplier #26. If you read your insurance claim settlement you will find the "insurance discount", or amount allowed. The problem is when a person without good insurance has to source materials through the DME and is not aware of less expensive alternatives, they won't receive a discounted price.

I find all medical billing is he same way. My doctor's fees, lab fees, prescription medications, etc. are all invoiced significantly higher than what insurance or medicare pays. As much as I hate the idea, having regulated pricing may be the only solution.
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#9
(10-14-2015, 03:03 PM)Sleeprider Wrote: The amount paid by your insurance will closely resemble the prices you got from Supplier #26. If you read your insurance claim settlement you will find the "insurance discount", or amount allowed. The problem is when a person without good insurance has to source materials through the DME and is not aware of less expensive alternatives, they won't receive a discounted price.

I find all medical billing is he same way. My doctor's fees, lab fees, prescription medications, etc. are all invoiced significantly higher than what insurance or medicare pays. As much as I hate the idea, having regulated pricing may be the only solution.


Hi Sleeprider,
I am aware that the amount billed is different than the amount allowed. I can see that when looking at the EOB. It is still amazing to see the billed amount compared to the negotiated amount. And you are correct, this is the same whether it is a doctor bill, lab work, xrays, etc.

My problem with the DME is that they were more than happy to charge me three X's the amount for the APAP knowing it was not going through my insurance.

If anyone is self paying, I hope they check online suppliers before paying local DME prices.
OpalRose
Apnea Board Moderator
www.ApneaBoard.com

How to Organize and Post ScreenShots

http://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

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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#10
Are self pay prices different? If I were paying out of pocket, would this be the price I would have to pay?

And what is an EOB?
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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