Today I received in the mail a flyer from my local DME offering me supplies, and which included a brief list of what Medicare will pay for. Having just acquired a couple of Wisp cushions from Amazon for $22 and change, including shipping, I was curious how much my copay would be if I ordered them from the DME in the future. They said they billed Medicare $50 each, and that my copay would be 20% of that, or $20. For the $2 difference I think I'll just continue to buy them on Amazon.
My point here is that the Amazon merchant is clearly making a profit selling them to me at $11 each. The cost to the DME can't be much more than the Amazon merchant is paying, so their profit is enormous. Further in the conversation the DME representative told me that they would sell them to me for $25 each if I just paid cash in full so they wouldn't have to bill Medicare. She pointed out that they could sell them to me for half price because it costs them so much in paperwork to bill Medicare.
I have long felt that at least half the dollars we pay for health care goes for paperwork, and from the above example, it's probably far worse than that.
03-12-2014, 01:13 AM
(This post was last modified: 03-12-2014, 04:41 AM by me50.)
JJJ, you said: "I was curious how much my copay would be if I ordered them from the DME in the future. They said they billed Medicare $50 each, and that my copay would be 20% of that, or $20".
I want to know where the person at your DME went to school. First, there is an allowed amount no matter what the DME bills the insurance company. Secondly, 20% of $50 is not $20, it is $10 but would be $20 for 2 cushions. BUT, you never pay 20% of the cost that is billed to the insurance company; you may 20% of what the contracted price is with the insurance company. So, if the DME bills your insurance company $100 for 2 cushions, and the contracted price for 2 cushions is $60, then you only pay $12.
I only pay around $9 for 2 cushions and 2 filters each month.
I think JJJ might have meant $20 copay for 2 cushions.
Whenever the government gets involves in something, the cost rises; and the choices become limited.
And they sure love paperwork.
It pays to have a medigap policy if you're on US Medicare. The medigap policy pays that 20% -- and if medicare pays, they they cannot refuse to pay the 20%
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