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DME vs. CPAP Wholesaler
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:
http://www.directhomemedical.com/machines-cpap-bipap/intellipap-aut...
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.
Thanks,
Fired up in Bama
Views: 3610
Replies to This Discussion
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Permalink Reply by Peggy B. on
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I have purchased my machine from my dr. Then I saw the difference in the prices, and asked them about it. I was told, that if you purchase from on line company, and then you have difficulties with the machine, there is no recourse. You are just stuck with it. Does anyone have any comment on this statement? I do know that I have have trouble with the machines that I have purchased and they have been good about working with me.
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Hi,
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.
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Permalink Reply by Banyon on
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Donald,
I appreciate your post, but it stops short and thereby leaves some mystery.
Which machine do you use and specifically why do you think it works better for you than the Intellipap?
Regards.
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Permalink Reply by Rock Conner RRT on
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The old CPAP sales platform assumed no patient recourse other than the local DME provider. Online availability is changing the market. The best DME providers give much more personal support than online providers, but few DME are among the best.
If this is your first CPAP experience, see if your insurance company will let you purchase an online device then reimburse you. You can get great support from the SleepGuide community.
For subsequent CPAP purchases, you'll need no instruction & little support. Get stuff where it's cheapest
I'm a proponent of APAP, but there are others with reasoned opinions in favor of CPAP. Check out all the angles.
Rock C.
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You hit the nail on the head, Donald. The KEY to CPAP therapy success is the support, advice and encouragement new patients receive. If you provide that support, advice and encouragement, I'd even believe a 100% success rate.
The problem is, your industry needs to clean up its own act and until it does it could do the patients a favor by stopping the pressure on the manufacturers to punish and cut off the online DME providers. Percentage-wise I'd venture a guess that your industry's track record for honesty, support and advice is no better and possibly even worse than the online DME suppliers' track record.
AND - given yet another of Resmed's bullying tactics against online DME providers ...... I'm all for taking a better look at the DeVilbiss, Fisher & Paykel and Sandman xPAPs and even Breas to see what they have to offer.
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"Respironics recommends that new patients purchase their devices, masks and initial accessories from a homecare company that can provide an individualized patient equipment set-up, clinical and after-sale support, and a program to assist patients with therapy success." - excerpt from the website referenced above.
Success with PAP therapy involves more than just getting the lowest price machine - if your deductible and/or copay are a large portion of the allowed amount by your insurer, then it may make sense to purchase online. The age-old adage still applies - you get what you pay for.
If a patient purchases their equipment online, it is reasonable for a DME to charge the patient for a clinical fee (NOT covered by your insurer) - but, they may not be able to help you if their contract prohibits charges like this - then where do you get help with mask fitting, cleaning instructions, warranty services, clinical advice, adjustments to your cpap, etc.?
Approximately 40 to 50% of patients are unsuccessful with CPAP therapy as measured by clinical indices such as >= 4hrs per night for 70% of nights over a 30 day period (Medicare guideline for continued therapy beyond the 90th day). An experienced PAP technician or Respiratory Therapist can give advice, make adjustments, change masks, etc. - and can certainly take downloaded information (assuming you get a machine that has compliance recording) and review it with you to see if anything obvious is causing a patient difficulty.
Think having problems is "rare" ? Why do you think there's a sleep support forum in the first place?
Not to put too fine a point on it - think about your healthcare - would you buy your physician services from an online source whom you will never see? PAP therapy can be wonderful, when properly applied and a patient has adequate support and follow-up by experienced clinicians - it's true that not all DME companies have any experience at all in providing the necessary follow-up and clinical care for a new PAP patient - I agree with the post(s) that recommend you check around and inquire as to exactly what services you will get from your DME for your money.
Don't forget - sometimes your insurer will NOT credit your deductible/copay amounts paid out of pocket unless you use their (certified - often accredited) DME plan provider - you see - they like to get their money's worth too.
Look into (and for) an accredited DME company with experience - yes, the price will be more than you pay online - they have quality standards, bureaucratic hoops to jump through, coordination of a third party payer system and YOU to deal with.
Good luck with your PAP therapy.
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Yup, if you've got insurance, your insurance dictates which local DME providers you can use.
Just because you bought your CPAP elsewhere does NOT mean that your insurance contracted providers can't or won't provide your masks and other accessories.
And when it comes to local DME providers you do NOT always get what you pay for!!!! Not by ANY stretch of the imagination! Far too often that is just one big pipedream someone invented.
They get their "clinical fee" in the extra sky high price of the mask. They get their "clinical fee" in the extra sky high prices of all the CPAP equipment they sell.
Why are there apnea support forums in the first place? Where else can new patients go when their bottom of the barrel, entry level equipment dumped on them doesn't seem to be working right for them and their local provider is about as much help as a boil on their butt??? They come to these forums for the advice, support and assistance they do NOT get from their local DME providers.
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Good morning,
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.
Sheri
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. :-)
-jeff
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Thank you, Sheri. The local DME provider you work for is obviously one of the good ones. Unfortunately, all too many new CPAP patients aren't so fortunate to start w/a local provider such as yours. I know my first "accredited" provider contracted w/my secondary insurance sure wasn't!!!
I always recommend that a first time CPAP patient utilize a GOOD local DME provider - IF - they have one available via their insurance. But I also advise them to call their insurance, get a list of all local DME CPAP providers their insurance is contracted with and to shop EACH one before committing themselves. Sometimes we do what we gotta do and even a first time PAP user may well be much better off buying on line than being taken for a ride and ill-advised by a sheister local DME provider.
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Permalink Reply by 99 on
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it apeares that you are one of the good providors who do things correctly and by the book this is very commendable of you and you should be rewarded for your hard work.
the other providor undercut you by their shoddy make money and move on again and again and getting away with the deceit, even claiming lies to promote themselves
this one reason we have a sister site to reccommend or not to reccommend so called "EXPERTS" and expose them
sSheri Fellat said:Good morning,
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.
Sheri
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. :-)
-jeff
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Permalink Reply by Rooster on
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I have been dealing with "The Big A" brick-and-mortar DME for five years and during this time there was nothing they did for me that could not have been done better, more quickly, more easily, less expensively, and more conveniently than WalMart, if this business were not strictly regulated.
The regulatory model for this business is wrong. It takes away the power of the individual to manage his treatment and it diverts the focus of the providers to the regulations and away from the well-being of the patient.
When I am criticizing the DMEs, the sleep doctors, and the insurance companies, I often stop to remind myself that it is the government regulatory environment that is driving all the bad behavior.
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