Post Reply 
Why US health care costs so much
Author Message
me50 Offline

Advisory Members

Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #21
RE: Why US health care costs so much
(03-13-2014 06:41 AM)JimZZZ Wrote:  It seems the DME maximizes profits and burdens Medicare by instructing the patient to replace masks, hoses, filters, etc. when the parts are perfectly serviceable. I suppose they are simply recommending replacement based on Medicare's allowable resupply schedule but it seems too frequent to me. If Medicare operates like this on all medical supplies, patients are tossing a lot of taxpayer money into the trash basket.

these are good points. But, I think medicare has those in place because they have to have a blanket policy and some people need to change their supplies often to keep from getting respiratory problems and/or pneumonia, etc. I change my supplies according to the medicare schedule because I need to keep healthy as I can for my family and I can more afford the supplies than I can a hospital stay or my other half (the better half) burial expenses.

I read an article the other day (and I have said this or something similar many times b/c I have lost family members that never collected their social security and they either had no children or their children were not eligible for their benefits) about how many people pass away at a young age and they haven't collected social security yet. That stays in the pot and we should have a great surplus if the government would stay out of it and not use those funds for other reasons. Anyway, I won't get myself started on that today or I am going to stop before I get started on it lol
03-13-2014 10:17 AM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
me50 Offline

Advisory Members

Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #22
RE: Why US health care costs so much
(03-13-2014 08:55 AM)ImaSurvivor Wrote:  I picked up a couple new cushions for my Swift FX from DME last weekend and noticed the cost on the paperwork listed as $56.00. I think that is absurd for two little silicone cushions. I am allowed two new ones every month. I probably don't need them that often. Seems I can use one for a month before I start having problems with it. I will slow down getting them as I just don't think it is right getting them that often for that cost if I don't need them as often. Will be interesting to see what my insurance shows as having actually paid for those cushions.

yep, paying the middle man sucks..........err stinks. My insurance allows $44 for 2 wisp cushions it would be nice not to have to deal with a DME. I was supposed to get my supplies on the 7th of this month. The DME notified me they were shipped on the 7th. However, they did not get to the post office until the 11th. I just got notification that the post office just got the electronic shipping info today, almost a week later. crap by the time I get them, it will be time to order again and I will never get my supplies on time. No way it should take a week to get them shipped and mine aren't even shipped.
(This post was last modified: 03-13-2014 10:26 AM by me50.)
03-13-2014 10:22 AM
Find all posts by this user Post Reply Quote this message in a reply
JJJ Offline

Advisory Members

Posts: 751
Joined: Apr 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: Most recent: Wisp, Pilairo, Mirage Vista
Humidifier: ResMed S9 Autoset
CPAP Pressure: 17-20
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: USA 97217

Post: #23
RE: Why US health care costs so much
(03-13-2014 05:51 AM)me50 Wrote:  
(03-12-2014 07:18 PM)JJJ Wrote:  It seems to me that Medicare could save a fortune if they just had everyone buy everything on Amazon.

well, that might be great if they (medicare) pays a portion of it. I don't want to pay insurance premiums and then have to pay 100% out of pocket buying from amazon or a supplier from a supplier on the forum supplier list

That is what I had in mind.

After sleeping on it I came up with another idea. What if Medicare offered to pay for certain consumables from any major supplier (e.g., Amazon), not just DMEs that they have a contract with. And suppose Medicare published the amount they expect to pay for an item, and offered to share savings with the consumer can find the item at a lower price, like maybe half the savings.

Just for an example (I am making up all the numbers here, just as a demonstration), suppose Medicare said that they would pay up to $30 for a Wisp cushion. As a consumer I find one on Amazon for $12 and order it and pay for it myself, with Medicare to reimburse me what I paid for it, plus half of the $18 savings. By doing it this way Amazon can keep their prices low because they don't have to deal with the Medicare paperwork. I am the one who will have to deal with the paperwork, and I can choose not to bother and just buy from a DME if I want.

Everyone agrees that Medicare is paying exorbitant prices. But no one is going to do anything about it because there is no incentive for anyone to do so. Lay a couple shekels on a consumer and amazing things might happen.
03-13-2014 10:51 AM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
herbm Offline

Preferred Members-2

Posts: 852
Joined: Jan 2014

Machine: ResMed AutoSet S9
Mask Type: Oral
Mask Make & Model: ResMed Airfit P10 Nasal Pillow
Humidifier: ResMed H5i
CPAP Pressure: 11-16
CPAP Software: ResScan SleepyHead

Other Comments: Backup Mask: Innomed Hybrid FFM -- Oral+Nasal Pillows

Sex: Male
Location: Austin, TX

Post: #24
RE: Why US health care costs so much
JJJ, I like that idea.

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
03-13-2014 11:24 AM
Find all posts by this user Post Reply Quote this message in a reply
me50 Offline

Advisory Members

Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #25
RE: Why US health care costs so much
(03-13-2014 10:51 AM)JJJ Wrote:  
(03-13-2014 05:51 AM)me50 Wrote:  
(03-12-2014 07:18 PM)JJJ Wrote:  It seems to me that Medicare could save a fortune if they just had everyone buy everything on Amazon.

well, that might be great if they (medicare) pays a portion of it. I don't want to pay insurance premiums and then have to pay 100% out of pocket buying from amazon or a supplier from a supplier on the forum supplier list

That is what I had in mind.

After sleeping on it I came up with another idea. What if Medicare offered to pay for certain consumables from any major supplier (e.g., Amazon), not just DMEs that they have a contract with. And suppose Medicare published the amount they expect to pay for an item, and offered to share savings with the consumer can find the item at a lower price, like maybe half the savings.

Just for an example (I am making up all the numbers here, just as a demonstration), suppose Medicare said that they would pay up to $30 for a Wisp cushion. As a consumer I find one on Amazon for $12 and order it and pay for it myself, with Medicare to reimburse me what I paid for it, plus half of the $18 savings. By doing it this way Amazon can keep their prices low because they don't have to deal with the Medicare paperwork. I am the one who will have to deal with the paperwork, and I can choose not to bother and just buy from a DME if I want.

Everyone agrees that Medicare is paying exorbitant prices. But no one is going to do anything about it because there is no incentive for anyone to do so. Lay a couple shekels on a consumer and amazing things might happen.

great idea but imho, medicare will never go for it because they will have to hire people to process all of that and issue some form of payments to the insured and I don't see that happening. they probably wouldn't be able to use employees they currently have b/c it takes all of them to process the claim load they currently have. of course, it is usually the public that comes up with the solution but I betcha medicare will find at least one reason to say they can't handle the extra load and they may even find multiple reasons. My bet is another reason is that the additional cost in manpower will add to the claims so it is easier to use their providers that have contracts with medicare. jmho...not saying I am right.
03-13-2014 01:11 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
mjbearit Offline

Preferred Members-2

Posts: 605
Joined: May 2012

Machine: REMstar Auto AFlex DS550
Mask Type: Nasal pillows
Mask Make & Model: RESMed Swift FX
Humidifier: Heated humidifier - 2
CPAP Pressure: 12.5-20
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: So Cal

Post: #26
RE: Why US health care costs so much
(03-13-2014 10:51 AM)JJJ Wrote:  
(03-13-2014 05:51 AM)me50 Wrote:  
(03-12-2014 07:18 PM)JJJ Wrote:  It seems to me that Medicare could save a fortune if they just had everyone buy everything on Amazon.

well, that might be great if they (medicare) pays a portion of it. I don't want to pay insurance premiums and then have to pay 100% out of pocket buying from amazon or a supplier from a supplier on the forum supplier list

That is what I had in mind.

After sleeping on it I came up with another idea. What if Medicare offered to pay for certain consumables from any major supplier (e.g., Amazon), not just DMEs that they have a contract with. And suppose Medicare published the amount they expect to pay for an item, and offered to share savings with the consumer can find the item at a lower price, like maybe half the savings.

Just for an example (I am making up all the numbers here, just as a demonstration), suppose Medicare said that they would pay up to $30 for a Wisp cushion. As a consumer I find one on Amazon for $12 and order it and pay for it myself, with Medicare to reimburse me what I paid for it, plus half of the $18 savings. By doing it this way Amazon can keep their prices low because they don't have to deal with the Medicare paperwork. I am the one who will have to deal with the paperwork, and I can choose not to bother and just buy from a DME if I want.

Everyone agrees that Medicare is paying exorbitant prices. But no one is going to do anything about it because there is no incentive for anyone to do so. Lay a couple shekels on a consumer and amazing things might happen.

First of all, I think your DME is full of... um...bananas! Paperwork? Really? It is all part of the computerized system. You order an item, the DME goes into your account places the info in the form, the item is shipped to you with a bill for your co-pay and the info with code is automatically transmitted to Medicare. The only reason they still use this old excuse is because they can still convince people that they have to pull out the carbon paper and the old Underwood and type up the order in triplicate. If a DME uses this as an excuse, they are liars and thieves!
JMHO

As always, YMMV! You do not have to agree or disagree, I am not a professional so my mental meanderings are simply recollections of things from my own life.

PRS1 - Auto - A-Flex x2 - 12.50 - 20 - Humid x2 - Swift FX
03-13-2014 02:14 PM
Find all posts by this user Post Reply Quote this message in a reply
Post Reply 


Possibly Related Threads...
Thread: Author Replies: Views: Last Post
  Can home care provider make our machine unusable? LPN2012 10 356 12-01-2016 05:22 AM
Last Post: LPN2012
Question Doctors does yours care ? kwhenrykerr 3 349 08-09-2016 04:31 AM
Last Post: kwhenrykerr
  Advise please - navigating US health system for a sleep study Carbon 16 1,112 07-21-2016 11:49 PM
Last Post: ED OF SO CAL
  Concerns about sleep and health joepodz 4 337 07-20-2016 07:07 PM
Last Post: eseedhouse
  VIC Roads health audits on Sleep Apnea sufferers Chevy59 11 998 05-04-2016 04:42 PM
Last Post: eseedhouse
  [Health] The apnea epidemic tmoody 13 1,030 04-21-2016 06:31 PM
Last Post: Terry
  [Diagnosis] Care pathway / first steps MrEGuy 6 525 04-08-2016 01:07 PM
Last Post: PaulaO2

Forum Jump:

Who's Online (Complete List)