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who has the most expensive CPAP machine, mask + other CPAP supplies?
thought for fun i'd do an informal poll of what the highest amount our forum members have seen their insurance company charged for a cpap machine, a cpap mask, a hose, a filter, etc. i know all this stuff is available cheaper online. what i'm after are the most exorbitant charges from the brick & mortar guys... please also include some indication of how much, if any, service you got from the equipment provider.
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Replies to This Discussion
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Permalink Reply by Judy on
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Not quite a fair question, Mike. Those billed amounts to insurances are just pipedreams since they don't get paid anywhere near that amount.
But I'll list my first and second DME suppliers' dream prices.
Resmed S8 Elite w/EPR ($135 x 13 months) = $2160
6' Hose = $48
Nasal interface = $130
Headgear for nasal interface = $45
Integrated, heated humidifier = $325
Resmed VPAP Auto ($239.92 x 13 months) = $3118.96
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Ha! In 2009 the billed price for the nasal interface went down to $129.40 - BUT - the dream (er, billed) price for the headgear went up to $70.
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Permalink Reply by Mike on
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i'm interested in hearing the pipedream "ask" by the DME supplier, and also how high the insurance companies in fact went toward those pipedream amounts.
Judy said:Not quite a fair question, Mike. Those billed amounts to insurances are just pipedreams since they don't get paid anywhere near that amount.
But I'll list my first and second DME suppliers' dream prices.
Resmed S8 Elite w/EPR ($135 x 13 months) = $2160
6' Hose = $48
Nasal interface = $130
Headgear for nasal interface = $45
Integrated, heated humidifier = $325
Resmed VPAP Auto ($239.92 x 13 months) = $3118.96
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Permalink Reply by sleepycarol on
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I got a new mask right before Christmas. Insurance billed the insurance company nearly $300 for it. Geez, then the DME (Lincare) kept sending me duns saying I owed for it and took them nearly 4 months before submitting to insurance. Insurance paid promptly and sent me notice that because my out of pocket expense was met I didn't owe anything on the mask and showed a $0 balance. Yet, Lincare has been dunning me for the difference. The last letter threatened to turn me over to a collection agency if I didn't pay the difference between what was billed and insurance paid. I kept the insurance statement for proof.
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Okay. *sigh* I knew I should have posted this when I posted the local DME supplier's "pipedream" 2006 billed amounts:
Resmed S8 Elite w/EPR monthly amounts for 13 months:
Billed: $135 - Medicare allowed: $99.95 - Medicare paid: $79.96 - Copay: $19.99 (thank goodness for secondary insurance)
Accessories outright purchase:
Billed: $548.00 - Medicare allowed: $499.63 - Medicare paid: $399.70 - CoPay: $99.93
Broken down:
6' Hose - Billed: $48 - Medicare paid: $32.82
Nasal interface- Billed: $130 - Medicare paid: $94.11
Headgear for nasal interface - Billed: $45 - Medicare paid $31.80
Integrated, heated humidifier - Billed: $325 - Medicare paid: $240.97
Resmed VPAP Auto (bi-level) 2008 monthly amounts for 13 months
Billed: $239.92 - Medicare allowed: $218.11 - Medicare paid: $174.49 - CoPay: $43.62
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Permalink Reply by Dan Lyons on
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And each and every one of us pays the price for the greed these legal thieves are allowed to perpetrate on the broken system.
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I agree - to a point.
One has to keep in mind the expensive inventory they have to shell out for and keep on hand only to have the reimbursement dribble in over a 13 month period.
Keep in mind the tremendous expense and paperwork involved in obtaining reimbursement from insurance companies.
And IF the local DME supplier maintains a good RRT on staff to educate, support and advise patients w/a caring manner and knows how to conduct a proper mask fitting .....
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Permalink Reply by Aaron McDonald on
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I work for a DME provider and we all know that our billed price doesn't matter because the insurance companies have their own fee schedules. If you check MSRP on all these item they will match up better with most DME companies billed amounts than the insurance fee schedules. Everyone knows that you can get products online for less but what people don't realize is the services the local DME companies offer. We offer mask, AutoCPAP and BiPAP trials at no extra charge, loaner equipment, mask guarantees and our knowlegable staff are available 24 hrs/day 7 days/week. We see our new patients 1 week, 30 days, 3 months and 6 months and every 6 months after they are setup, all at no extra charge. We coordinate our follow-up with the physicians and are considered their "eyes and hears." These are just some of the services that we offer which no online store can. Most insurance companies recognize these services and they are included in the price of the equipment.
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Unfortunately, Aaron, not all local DME suppliers go the extra mile that your company does. I've used two different local DME suppliers. The first one was the kind that drives patients to these online apnea support forums and online DME suppliers. The second one is good, I'm happy w/them, but they don't go quite as far as you do w/their service as far as follow up that you describe. Nonetheless, I AM happy w/them. And they sure as heck beat that first outfit I had the misfortune to encounter!!!!! By miles and miles!
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Permalink Reply by Rock Conner RRT on
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Aaron said it well.
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Let's be honest....
CPAP equipment is some of the most over-priced, poorly designed junk in the world.
My first CPAP was this hideous design. The separate humidifier was even worse, it featured a shallow metal pan that you had three clamps to unseat. Had to refill everyday, and it sat until the CPAP. For that poorly designed system which I quickly quit using, I had to shell out over $700 (out-of-pocket) beyond what the insurance covered.
About 2 1/2 years ago I got a replacement CPAP. It's a resmed, but it is better designed than my first. Still not perfect. Water capactity is still too small (must refill every other day). And often filling results in spilling.
How hard is it to design a decent piece of equipment?
So my mask broke. I recently had it replaced. The company charged like $275 for a mask and two gel replacements. Seriously? Apparently they charge more than the insurance was willing to pay. And now want an additional $30 beyond my $30 co-pay.
Seriously, the whole thing shouldn't cost more than $30-$60. You can buy a respirator filter from Home Depot for $29 with a set of filters. While it's slightly different in intended use. Manufacturing wise they're very similar. Essentially a CPAP mask is a not much more than a $30 respirator with $4 of hose tubing. And yet these companies bill $200-$300 (10x markup).How these rip-off companies justify these outlandish costs I will never know. I guess we have the FDA in part to thank. They make it a limited market and allow these micro-monopolies.
Seriously, this is the big problem with our healthcare system. I went in for a first patient visit/physical. They take my pulse, temp, and give me a list of blood tests to get done in order to return for a physical. "Um, excuse me, I thought I was having a physical TODAY!" Nope, this way they make it a double-billing situation. They don't do jack. And then bill insurance twice.
It sucks. Even worse if you have to pay out of pocket.
People can deny it all they want. But the truth of it, and it is undeniable, is that it is an entire industry built on greed and fraud.
And yes, I know the arguments. You're paying for the people who don't pay. My wife is a nurse at the hospital. I understand that argument. But most people would pay if the prices were fair.
$1,000 for an ER visit where they tell you the right staff person isn't in so you'll just have to go to your doctor tomorrow is totally BS. But it happens all the time.
It's the status quo of this industry.
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Permalink Reply by Mary Z on
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In the best of worlds you should replace your humidifier water every day. Having to fill it every other day should not be an inconvenience! There is a fill line on the chamber- just don't fill higher than that. Use a funnel if necessary so you don't spill water.
I feel like my S8 is a very well made machine and I am very happy with it's performance and data capabilities.
Everything costs too much these days, especially medical equipment. I paid $1,200 OOP over 12 months for my machine which operates in CPAP, Bilevel and AUTO mode
I have been very happy with my DME, they take good care of me.
Sorry your experience is so bad.
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