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poor reimbursement on supplies: what's the answer?
Some health insurance companies pay so poorly for CPAP replenishment supplies that DME dealers avoid such transactions. The result is that xPAP users employ masks, etc. longer than specs call for, or xPAP users end up paying out of pocket for replenishment supplies. What's an equitable solution?
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Replies to This Discussion
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Permalink Reply by sleepycarol on
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Okay so I am beginning to understand some of this. Sorry for the 20 questions.
I have insurance through my work. The total cost is not covered but allows a flat amount that we are allowed and then we pay the difference in price. Last year were on Blue Cross/Blue Shield -- I elected to go with the "buy-up" plan due to it needing my needs more. Didn't have any problems with it and it seemed like the vast majority of doctors were "in network".
Last fall the district (I teach) decided to look at other options. I won't go into the details -- but they chose to go with United Health Care. Premiums are a little cheaper -- but the coverage seems to stink. Very, very few doctors in this area are in network. We now have a much higher deductible (it doubled) and out of pocket expense. I am going to assume that they are one of the culprits you are talking about. I threw a big fit about this change and told them they needed to look at the "big" picture and compare apples to apples (meaning same covereage) and not the dollar amount of the premium (apples to oranges in my opinion).
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Permalink Reply by Rock Conner RRT on
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That's frustrating, and unfortunately typical. What we need is not just change, but transformation.
sleepycarol said:Okay so I am beginning to understand some of this. Sorry for the 20 questions.
I have insurance through my work. The total cost is not covered but allows a flat amount that we are allowed and then we pay the difference in price. Last year were on Blue Cross/Blue Shield -- I elected to go with the "buy-up" plan due to it needing my needs more. Didn't have any problems with it and it seemed like the vast majority of doctors were "in network".
Last fall the district (I teach) decided to look at other options. I won't go into the details -- but they chose to go with United Health Care. Premiums are a little cheaper -- but the coverage seems to stink. Very, very few doctors in this area are in network. We now have a much higher deductible (it doubled) and out of pocket expense. I am going to assume that they are one of the culprits you are talking about. I threw a big fit about this change and told them they needed to look at the "big" picture and compare apples to apples (meaning same covereage) and not the dollar amount of the premium (apples to oranges in my opinion).
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Do you have any suggestions for the consumers to help this situation?
If we knew what we could do to help I am sure many of us would be willing to try.
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Honestly, no. The entrenched powers who benefit financially from the status quo are bigger & smarter than I am. I was hoping the discussion would generate ideas.
sleepycarol said:Do you have any suggestions for the consumers to help this situation?
If we knew what we could do to help I am sure many of us would be willing to try.
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Maybe some ideas will come out of this. It has given me something to think about and I am sure others as well.
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Permalink Reply by Melodie on
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Carol and Rock,
I would hope that if we, as patients and consumers, sent in enough complaints to the "powers that be" (meaning the Medical Associations and Insurance Companies) we could possibly get something done about the ever-increasing out-of-pocket expenses we are having to pay every year.
If nothing else works, then we should start writing to our respective State Congressmen/women and begin some petitions to send to the House of Representatives under the overall Health Care plans for the new President-elect and his cabinet. I have been reading that our Health Care is priority on the new President's list of things to change. So hopefully it will be handled so that ALL Americans will benefit in some way.
It would make our lives a lot easier if we had the kind of Health Care that they do in Canada, just as an example. Everyone is covered the same and barely ever any out-of-pocket expenses. That would be the ultimate step for the USA!
Hope I have helped to open up some more discussion about this subject, as it highly affects us ALL!
Melodie
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I hope that some of those from Canada will respond. I have done some research on the Canadian system and it appears that it is worse than the USA. I for one, at least for now, hope that we do NOT go to such a system.
In Canada it can take months to get appointments and for some medical procedures it can take over a year for treatment. You have little say in your medical care from what I gather. Many Canadians are coming to the USA for treatment due to these types of problems.
I was recently told by my doctor the system in England is terrible because if you are over a certain age (55) they often elect not to treat certain conditions -- one being dialysis.
Our system is broken and needs fixed but unsure what the answer is.
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EVERY real-world healthcare system has limits. You mentioned some in Canada & England. In the US we limit healthcare spending by excluding some from some or all types of healthcare. I want a more equitable healthcare system that does not provide opulent care to some and exclude others, while many healthcare providers are rewarded with lavish lifestyles.
Here's a question to stir up the upper class: do we really want to pay doctors & nurses more than we pay police officers and teachers? Which group is more important to our society's future?
sleepycarol said:I hope that some of those from Canada will respond. I have done some research on the Canadian system and it appears that it is worse than the USA. I for one, at least for now, hope that we do NOT go to such a system.
In Canada it can take months to get appointments and for some medical procedures it can take over a year for treatment. You have little say in your medical care from what I gather. Many Canadians are coming to the USA for treatment due to these types of problems.
I was recently told by my doctor the system in England is terrible because if you are over a certain age (55) they often elect not to treat certain conditions -- one being dialysis.
Our system is broken and needs fixed but unsure what the answer is.
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Permalink Reply by Maribeth Zelinsky on
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Always remember that you have the choice to pick the DME company that services you. The sleep lab or dr might prefer one company over another but you can choose who you want. Do some research and make some calls to the DME companies that participate with your insurances, Call your member services and ask them who is participating in your area. Our cpap/bpap supplies need to be replenished at different invervals. Insurance companies have cut back on the amount of supplies that can be given to you. Make sure that you clean your mask and tubing daily. Check your filters and change them when needed. Try and make sure you always have an "extra". Some of your DME companies have an automated ordering system that you sign up for and aqccording to your insurance companies reimbursement, will be sent to you when needed.
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On the insurance I have I have a choice of ONE dme!! If I use another I pay out of pocket. So not all of us have a choice.
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My insurance is pretty good, except our co-pays just went out the roof for prescription drugs!!!!!!!!!! The co-pay for any doc visit is always $35, but our prescriptions are $10, $45, and $50 - and most of my meds fall under the $50 bracket! My medications alone are costing me a fortune, as I am on alot of meds!
Also, if a physician writes up a procedure with specific "codes", it will always be covered, but if they write down the wrong "code" - you may or may NOT be covered! I think my docs are getting it right most of the time. Thank God!
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