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learned something interesting
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dfstarman Offline

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Posts: 29
Joined: Nov 2013

Machine: Resmed S9 autoset
Mask Type: Nasal mask
Mask Make & Model: Resmed Mirage softgel
Humidifier: Resmed H5/climateline
CPAP Pressure: 6.6-10.5
CPAP Software: ResScan

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Sex: Male
Location: Florida

Post: #1
Money learned something interesting
About a month ago I ordered a Resmed autoset plus the humdifier package from [link removed] for $923. They offered to file with my insurance company which has an 80-20 plan plus they were out of network and I had not satisfied my out of network deductible, but I could get it in a hurry and the price was competitive . So my out of pocket was $340

So I get the notice from my insurance company and they bill the MSRP to the insurance company and they bill 1836 for just the resmed S9 and then another 536.00 for the humidifier package. So my insurance company paid them 289 plus 991 plus I paid them about $340 out of pocket. So they got paid 991+340+289=$1620 for a machine that had a retail price of $923.00 . So I called them and they said yes that was for the trouble of filing the claim. Pretty good profit margin.
Now I checked to see what would have happened if I paid cash and then submitted the bill to my insurance company and my out of pocket would be pretty much the same.

So I am not out any money but was amazed at how much profit they made by billing the company MSRP rather than the real price.
The real loser was the insurance company.
I know they have to bill higher to get the real amount but that is really over compensating. No wonder HC insurance is so freaking expensive

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Moderator Action: Link Removed
To maintain our status as an educational organization, the only commercial links allowed in this forum are to CPAP-related manufacturer websites. This is stated in the Apnea Board Rules with details given in the Commercial Links Policy section.
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(This post was last modified: 12-10-2013 06:03 PM by dfstarman.)
12-10-2013 06:01 PM
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zonk Offline

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Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #2
RE: learned something interesting
I think its a fraud but that's the way the cookie crumble
Brick and mortar stores (DME) have a higher overhead expenses and act as the go-between between insurance, doctors and you
12-10-2013 06:13 PM
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drgrimes Offline

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Posts: 235
Joined: Sep 2013

Machine: S9 Resmed Autoset
Mask Type: Nasal pillows
Mask Make & Model: Philips Dreamwear
Humidifier: resmed
CPAP Pressure: 5-15
CPAP Software: ResScan

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Sex: Male
Location: Texas

Post: #3
RE: learned something interesting
DFStarman, you said the real loser was the insurance company? Think about it. They just pass it back to the consumer in higher premiums. So, WE ultimately pay for everything.
12-10-2013 06:57 PM
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Airstream Offline

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Posts: 147
Joined: Feb 2013

Machine: Resmed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: Resmed H51
CPAP Pressure: 10-20
CPAP Software: SleepyHead

Other Comments: White Noise Aficionado

Sex: Male
Location: Smoky Mountains, East Tennessee

Post: #4
RE: learned something interesting
(12-10-2013 06:01 PM)dfstarman Wrote:  The real loser was the insurance company.
I know they have to bill higher to get the real amount but that is really over compensating. No wonder HC insurance is so freaking expensive

Actually the real loser is me and you because the insurance company pays them with money they collect from all their customers.

I agree it's no wonder that Health Care Insurance has been going up 10-20 percent per year over the last decade or longer and that HC costs in the U.S. are the highest in the world.

As the price about doubled for the machine, why did your copay amount remain the same?

If [link removed] had told you that the price quoted for the machine was going to double if they filed the insurance claim, would you have reconsidered the purchase? Just wondering.


Thanks for sharing this story.

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Moderator Action: Link Removed
To maintain our status as an educational organization, the only commercial links allowed in this forum are to CPAP-related manufacturer websites. This is stated in the Apnea Board Rules with details given in the Commercial Links Policy section.
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To err is human, but to really mess things up, you need a computer.
12-10-2013 07:24 PM
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Airstream Offline

Advisory Members

Posts: 147
Joined: Feb 2013

Machine: Resmed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: Resmed H51
CPAP Pressure: 10-20
CPAP Software: SleepyHead

Other Comments: White Noise Aficionado

Sex: Male
Location: Smoky Mountains, East Tennessee

Post: #5
RE: learned something interesting
(12-10-2013 06:57 PM)drgrimes Wrote:  DFStarman, you said the real loser was the insurance company? Think about it. They just pass it back to the consumer in higher premiums. So, WE ultimately pay for everything.

Didn't see this post earlier drgrimes. I agree.

Their is no incentive to get the best price, but paying double is crazy.

Kinda like the government paying $900 for toilet seats.

To err is human, but to really mess things up, you need a computer.
12-10-2013 07:32 PM
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dfstarman Offline

Preferred Members

Posts: 29
Joined: Nov 2013

Machine: Resmed S9 autoset
Mask Type: Nasal mask
Mask Make & Model: Resmed Mirage softgel
Humidifier: Resmed H5/climateline
CPAP Pressure: 6.6-10.5
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: Florida

Post: #6
RE: learned something interesting
As the price about doubled for the machine, why did your copay amount remain the same?

because my out of network deductible was 218 no matter what and I my copay was 20% 120 and the company EASYbreathe charged me based upon the advertised price not the inflated price they submitted to the insurance company.

If [link removed] had told you that the price quoted for the machine was going to double if they filed the insurance claim, would you have reconsidered the purchase? Just wondering.

I would not have purchased had I known
Oh-jeez
(This post was last modified: 12-11-2013 06:13 AM by dfstarman.)
12-11-2013 06:10 AM
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me50 Offline

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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: #7
RE: learned something interesting
While I don't know what your insurance does when purchasing from an out of network provider, i.e., do they pay them the same amount that they would an in network provider, It seems as though they would have taken the $340 you had to pay away from what they were paying the provider. If they billed your insurance for $1836 and paid $991, the $991 might be what they would pay an in network provider. If that is the case, I would think they would deduct the $340 you had to pay from that amount. You may want to talk with your insurance company and ask them to explain...they make mistakes too. One thing that I have learned and I watch for on all of my EOB's is that the insured is only responsible to pay the % of the contracted price (allowed amount) between the insurance company and the in network provider. Another thing we learned is that sometimes, going out of network (not likely in your case) can be paid at the in network rates if the out of network provider is the only provider that was qualified to provide the treatment required.
12-11-2013 06:28 AM
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Shastzi Offline

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Posts: 1,174
Joined: Dec 2012

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: FitLife Total face mask
Humidifier: F&P HC150 with Hybernite heated hose.
CPAP Pressure: 15cm-20cm H2O (auto)
CPAP Software: SleepyHead Other Software

Other Comments: CMS50-F wearable Oximeter; Software: SPO2 Assistant

Sex: Undisclosed
Location: Florida, USA.

Post: #8
RE: learned something interesting
It's a real racket and the insurance companies never lose.
Just us poor slobs in the consumer trenches.

Tongue

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

Cool
12-11-2013 03:26 PM
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Airstream Offline

Advisory Members

Posts: 147
Joined: Feb 2013

Machine: Resmed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: Resmed H51
CPAP Pressure: 10-20
CPAP Software: SleepyHead

Other Comments: White Noise Aficionado

Sex: Male
Location: Smoky Mountains, East Tennessee

Post: #9
RE: learned something interesting
Sorry about the unauthorized link. It is all dfstarman's fault (lol, just kidding). These kind of stories get me upset and not paying attention to forum rules I guess.
Anyway, regardless of what site you (we) spoke of drstarman, I am sure most or all of them do the same type of billing. Again, I am glad you shared this because I had thought of bypassing my local DME, who is more expensive than the suppliers I see online.
With my insurance, my copay is going to be directly impacted by what the insurance company coughs up.
Buyer Beware. Thanks for the warning.

To err is human, but to really mess things up, you need a computer.
12-11-2013 07:24 PM
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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: #10
RE: learned something interesting
yep, it is hard to monitor things when you go through insurance. Depending on what the contracted price is with pharmacies, as an example, your co-pay may be higher. I found that out when one pharmacy was going to charge me a lot of money so I went to another pharmacy and it was about 1/2 what the first pharmacy was going to charge me.
12-11-2013 07:51 PM
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