Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

learned something interesting
#1
Money 
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

-----
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.
-----
Post Reply Post Reply
#2
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
Post Reply Post Reply
#3
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.
Post Reply Post Reply


#4
(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.

-----
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.
-----
To err is human, but to really mess things up, you need a computer.
Post Reply Post Reply
#5
(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.
Post Reply Post Reply
#6
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

Post Reply Post Reply


#7
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.
Post Reply Post Reply
#8
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
Post Reply Post Reply
#9
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.
Post Reply Post Reply


#10
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.
Post Reply Post Reply


Possibly Related Threads...
Thread Author Replies Views Last Post
  Interesting clip on BBC website dugdale 2 239 02-24-2017, 10:09 PM
Last Post: tedgreen
  INTERESTING READS FOR NEWBIES srlevine1 1 395 12-02-2016, 06:21 PM
Last Post: kwhenrykerr
  Found something interesting.. tisho23 4 463 12-02-2016, 05:36 AM
Last Post: tisho23
  Just learned I have sleep apnea, waiting to hear full results of sleep study SleeplessInOklahoma 18 1,291 09-06-2016, 04:41 PM
Last Post: livingwithapnea
  Some interesting differences between PAP resultes and sleep study results KSMatthew 4 592 08-23-2016, 07:16 PM
Last Post: richb
  Medicare covered Codes - interesting docs and links for US icyura10 0 347 08-10-2016, 12:48 AM
Last Post: icyura10
  What I learned today about mini-apneas and fatigue or why SH is the bomb Mark Douglas 44 7,230 07-02-2016, 07:28 AM
Last Post: silverny1

Forum Jump:

New Posts   Today's Posts




About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.

For any more information, please use our contact form.