+- Apnea Board Forum - CPAP | Sleep Apnea (https://www.apneaboard.com/forums)
+-- Forum: Public Area (https://www.apneaboard.com/forums/Forum-Public-Area)
+--- Forum: Main Apnea Board Forum (https://www.apneaboard.com/forums/Forum-Main-Apnea-Board-Forum)
+--- Thread: Insurance question....is this typical? (/Thread-Insurance-question-is-this-typical)
Insurance question....is this typical? - Roxy - 12-21-2012
I have had my respironics auto with heated hose since August. I get a new mask every 6 months, new cushions every month and new heated hose every three months. I see the eob's and the insurance company has paid the DME about $6,000 so far. I saw that today, the paid the DME $3,000. I assume that is for the machine. I can't believe how much more than the going rate insurance pays for the equipment. Is this typical? Thank goodness, I don't have any out of pocket but I am just curious if this type of overpayment to DME's is typical.
RE: Insurance question....is this typical? - zonk - 12-21-2012
maybe some insurance ceo getting kickbacks from the DME
what goes around comes around
RE: Insurance question....is this typical? - PaulaO2 - 12-21-2012
Wow. Holy cow.
They could have bought two machines for that price.
Most insurances "rent" the machine for a certain number of months. In the end, they are paying a lot more than if they just bought it for you outright.
DMEs also typically charge much, much more for masks than is necessary. It's freaking ridiculous.
RE: Insurance question....is this typical? - dcgrafix - 12-22-2012
(12-21-2012, 09:33 PM)Roxy Wrote: I have had my respironics auto with heated hose since August. I get a new mask every 6 months, new cushions every month and new heated hose every three months. I see the eob's and the insurance company has paid the DME about $6,000 so far. I saw that today, the paid the DME $3,000. I assume that is for the machine. I can't believe how much more than the going rate insurance pays for the equipment. Is this typical? Thank goodness, I don't have any out of pocket but I am just curious if this type of overpayment to DME's is typical.
YES!!
It is freaking ridiculous.
But it sounds like you are getting a lot of equipment as in masks & cushions.
I was told my cushions should last up to a year not to mention the mask & Hose.
It is no wonder why medical is in such trouble.
Their getting raped & we are getting raped!
Vicious circle!!
RE: Insurance question....is this typical? - Shastzi - 12-22-2012
Uhm, yah. I think the companies are hosing each other and then later upping the premiums/co-pay and cutting benefits so the consumer ends up picking up the tab.
Sometimes there just isn't enough hot pine tar and feathers to go around.....
RE: Insurance question....is this typical? - Roxy - 12-22-2012
After paying $175.00 per month for the rental, my insurance company just paid the DME more money than the consumer would have for a brand new, not three month old machine. Go figure!!!!! I am amazed that the insurance company (largest in the state) didn't negotiate with the DME that the rental cost is applied to the purchase price. Now I know why the DME was so eager to get me to use them. They waved my copay for all equipment so I have no out of pocket.
Now we know why medical/insurance costs are so insane!!!
Several years ago after knee surgery, my insurance company rented an ice machine for me. The rental cost was approximately 4 times the cost of just purchasing the exact same machine at the typical consumer rate.
RE: Insurance question....is this typical? - IDRIck - 12-22-2012
My insurance company bought the humidifier, hoses, and mask outright at ~50% the DME's list price and had the cpap machine set up on a $90/month rent to own schedule for 11 months. I petitioned them to purchase the machine after 100% compliance in first 21 days and a 98% reduction in AHI. They agreed, saving me $720 in 2013 rental fees as my deductible turns over on Jan 1. An awesome Christmas gift!
RE: Insurance question....is this typical? - PaulaO2 - 12-22-2012
Slightly off topic: I just got a new power wheelchair via Medicare. The price list is jaw dropping but one in particular made me write to my congress folks.
Two Group 34 deep cycle batteries: $1200.