Was I Cheated By The Equipment Supplier?
I'm not an expert at medical billing so I want to make sure I'm understanding what happened the other day at the medical supply company (DME) that contracts with our health insurance company.
I went in to buy a new mask, but when I saw the invoice it looked like they were charging me for two masks (see below). When I asked them, they told me they did it that way because that's what they needed to do for the billing codes.
Nevertheless, charging $290 for a mask that only costs $85 retail seems a little fishy to me. My co-pay was $25, in case you're curious.
Would you experts please have a look at the invoice below and tell me how many masks I should have walked out with.
Thanks!!!
RE: Was I Cheated By The Equipment Supplier?
It looks like they've charged for the mask and headgear separately. I don't think there's anything fishy about that, as they are available as separate items.
From what I've heard on the forums, the DME will charge an enormous markup, of which the insurance will only pay a portion. Why do they do it that way? "Creative accounting" would be my guess.
01-01-2019, 06:32 AM
(This post was last modified: 01-01-2019, 07:27 AM by Fats Drywaller.)
RE: Was I Cheated By The Equipment Supplier?
That charge is not for two masks; it's for the complete kit (which includes one headgear) plus a separate second headgear only. Presumably the complete kit includes headgear of one size but you take a different size: included is M, but you take S or L. Is that what's happening? If so, then if the DME is strictly honest, it will give you both sizes and everything else that's included in the complete kit. I haven't used the Swift FX so I don't know what-all that consists of. However, aside from that "everything else" (which should always be included because it is useful to the patient and the patient's insurance is paying for it), in this case it's understandable and IMO somewhat justifiable if the DME doesn't give you the first headgear of the wrong size. The general attitude there is "Let's not confuse the patient with extraneous details." Strict honesty would say that everything paid for should be given to the patient along with an explanation (in this case, "This first original headgear doesn't fit you, so don't use it"), but strictly honest DMEs are like four-leaf clovers.
As for the markup, that's normal. (And in this case it happens to be not astronomical.) The insurers have deep pockets and the patients pay only a fraction of the total charge, so the DMEs take advantage of that to inflate their bank accounts. It's the system we're stuck with.
RE: Was I Cheated By The Equipment Supplier?
I left the obvious alternative explanation unstated just out of politeness, I guess, but I might as well state it because we're all adults here. If the headgear included in the full kit does fit you, and if you were given only that one headgear, then the DME is putting the second headgear into its stash of new mask parts to be doled out to any patient at a later date, as needed, and to be charged for a second time in another insurance invoice. Creative accounting, yes. That would be the "cheated" case, or possibility.
So, of course, the $64,000 question is: What goodies were you given, exactly?
RE: Was I Cheated By The Equipment Supplier?
DeepBreathing is right in this case. Many online sites also do this. A kit includes everything but the headgear. When sold this way the headgear is purchased separately. You can also buy what is called a complete mask which would the headgear. The reason DME's sell them as separate parts is Social Security lists them that way for claims. The DME did nothing wrong it's just the medical system is broken.
01-01-2019, 08:47 AM
(This post was last modified: 01-01-2019, 08:47 AM by Fats Drywaller.)
RE: Was I Cheated By The Equipment Supplier?
(01-01-2019, 08:41 AM)Walla Walla Wrote: DeepBreathing is right in this case. Many online sites also do this. A kit includes everything but the headgear. When sold this way the headgear is purchased separately. You can also buy what is called a complete mask which would the headgear. The reason DME's sell them as separate parts is Social Security lists them that way for claims. The DME did nothing wrong it's just the medical system is broken.
Bizarre! That's the first time I've seen that. Are you saying that's for all masks, or only for the Swift FX? All the masks I've bought (no Swift) have included the headgear, and the mask packages I've got from my insurance via DME, when I was using a DME, included the headgear as standard equipment.
RE: Was I Cheated By The Equipment Supplier?
All masks can be handled that way. And it gets worse. Let's say the Rx called for a ResMed Fx30 large. In the US the DME cannot legally sell a medium to this patient. If the Rx did not say a mask period a complete mask could not leagaly be sold. However a full "repair" kit and headgear could be sold legal. Go figure
RE: Was I Cheated By The Equipment Supplier?
(01-01-2019, 01:53 AM)fortywinks Wrote: I'm not an expert at medical billing so I want to make sure I'm understanding what happened the other day at the medical supply company (DME) that contracts with our health insurance company.
I went in to buy a new mask, but when I saw the invoice it looked like they were charging me for two masks (see below). When I asked them, they told me they did it that way because that's what they needed to do for the billing codes.
Nevertheless, charging $290 for a mask that only costs $85 retail seems a little fishy to me. My co-pay was $25, in case you're curious.
Would you experts please have a look at the invoice below and tell me how many masks I should have walked out with.
Thanks!!!
fortywinks,
Yes, this is normal practice. It’s bizarre, but this is how Medicare and most insurances require the billing to be handled. Almost everything is broken down with separate billing codes.
The headgear is usually billed separately, and you should be able to order a new headgear every 6 months.
The thing to do now, so that you can understand and see the breakdown and payments by your insurance is to go online and look at the cost breakdown by your insurance. They will list mask parts separately, what was billed, and exactly what they paid the DME. You will be surprised to see the DME received far less than you think.
In this wiki article, there is a chart with billing codes. You should see these codes when you check your insurance statement.
http://www.apneaboard.com/wiki/index.php...ask_Primer
RE: Was I Cheated By The Equipment Supplier?
The people who really get ripped off by this system are those without insurance. They pay the full inflated price and don't benefit from the marked down price the insurance pays.
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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.
RE: Was I Cheated By The Equipment Supplier?
(01-01-2019, 02:12 PM)Melman Wrote: The people who really get ripped off by this system are those without insurance. They pay the full inflated price and don't benefit from the marked down price the insurance pays.
That I will not argue with. Even if you can find a decent used machine on Craigslist the cost of the supplies would kill you.
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