I have been talking to my DME off and on all day. Here's the deal, for our purposes let's just say that a CPAP costs $1000 and an APAP costs $2000 (because they told me the APAP is "about $1000 more than the CPAP).
The code for a CPAP and an APAP is the same code for medical billing. My insurance would only reimburse my DME about $800 for the CPAP. DME loses $200. I need an APAP. My insurance STILL only reimburses the $800. DME loses $1200. This is how it was explained to me today. The girl I spoke to in billing was VERY nice. She just had no authority. She turned my case over to the owner of the DME and, last I heard, "He's working on it."
I am nosey. I googled "wholesale cpap". Lookie what I found:
That is EXACTLY what was prescribed to me. I realize I would need the hose and the mask and headgear.
This machine is about 1/4 of what she explained to me that mine will cost.
I'm pretty close to fired up. Real close, in fact.
They are supposed to call me in the morning.
I would appreciate insights and suggestions. I promise when I get all this taken care of I'll quit bugging the crap out of everyone and do normal posts.
Fired up in Bama
As the sales manager for a reputable and ACCREDITED DME company, I would like to offer this comment.
There is a place for both on line as well as brick and mortar companies. What you may fail to realize is the we as a brick and mortar DME's, are required to become accredited. That means we must spend the time and resources to ensure not only that we provide excellent service and equipment, but that we do necessary follow-ups to ensure our patients get the most benefit from their treatment as well as their dollars! We perform downloads on a consistent basis and change masks out to ensure patient comfort acceptance and successful therapy. Online operations are not held to the same standards, typically wont file insurance and don't accept mask changes or perform downloads. They also don't have anyone to fit you properly! Those marks you get on your face are typically a result of a poor fit. Wasted money and time!!!!! We talk the masks back and ensure your comfort through our mask guarantee!
The other major distinction that has never been discussed here is that the insurance companies typically follow Medicare guidelines. What does this mean?
They require that we RENT to PURCHASE over 13 months!!!! That includes all the supplies necessary, typically sent quarterly but only with the patients consent.
Not only must we wait to be paid, but we must assure the patient is compliant and by downloading reports that reflect the patient is using their machine for a minimum of 4 hours per day for a period of 30 consecutive days. Then they must have face to face follow up visits with their doctors. We, the DME are responsible to maintain these records to ensure we remain accredited or the insurance companies will NOT PAY!!! Online companies don't have to do any of this. We also keep the doctors aware of their patients treatment an to help keep them aware of technology advances and benefits for the patient. If a patient was prescribed a cpap, but fails and needs to be moved to bi-level therapy, how would the unit you bought from the online company help you there? They would not, why? You own the unit, and they will gladly seel you another bi-;pap at your expense. We on the other hand, will exchange the unit, and continue to assist you in your therapy to ensure your success.
We take alot of pride in what we do as well as being tremendous patient advocates.
When is the last time an online provider came to your house on Sunday evening because your cpap failed? I do it all the time.
j n k said:Ms. Hertel,
I've been reading posts on apnea boards for a while, and yours ranks right up there as one of the most beautifully worded, most informative, and bravest posts I've ever read. It actually brought a lump to my throat. Good stuff.
Personally, I don't mind the arrangements from the honest brick-and-mortar DMEs when they actually provide something to the patients that keeps the patients happy and compliant and successful. I only resent the places that lie and milk the patients and do more to make the patients unhappy, non-compliant, and unsuccessful than to help. It is obvious that you are one of the good guys and gals.
Is there any chance you would be willing to go further on record to explain the following statement and make any suggestions about how to do it? (Not for me; I already buy online and get reimbursed, but not exactly by an insurance company.) It might help those in circumstances who need to do so.
"Most insurance companies will reimburse you if you pay cash."
Thanks. Truly a VERY nice post. And I'm not easily impressed. :-)
I'm a RRT for a Home care company, DME, I also use Cpap therapy to treat my OSA.
My Company provides a fair amount of cpap and service to many patients each month. I always put the patient first in every situation. My Company believes patient care must be first and is a core value that we practice every day.
Our patient cpap compliance rate is very high (you probably wouldn't believe me if I told the %) we are successful because we realize most people need clinical support initially and ongoing in order to treat OSA successfully.
Know what you’re buying. All CPAP machines are not equal, some cpap machines will treat your apnea better than others. Please trust that I'm telling you the truth, if you spend $500 on a machine that is not going to meet your needs well this is money that has been wasted and most importantly has not meet your health care needs. In all fairness I must say a percentage of patients may benefit from this type of unit, but it is a gamble, a gamble I would choose to avoid myself.
I believe an experienced Healthcare provider must support your every step starting at the beginning of cpap therapy. Insurance reimbursement decline is definitely affecting the quality of healthcare which is unfortunate for all us. without sufficient support most people will fail CPAP therapy which will result in poor quality of life and increase healthcare cost.
I was able to try the CPAP machine you are considering purchasing its brand new technology from this Manufacturer. A Representative let me have a cpap machine, I tried it for 4 days, it did not prform well for me. My OSA symptoms returned i.e., frequent awakenings, increased AHI, daytime naps :( so I switched back to my previous CPAP machine. My life is much better now.
A lot’s been said here I hope it helps you.
P.S. a happy patient is the best.