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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: 3644
Replies to This Discussion
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Permalink Reply by Mark Andrew Hixson on
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Again, i'm i just replied to your earlier post. I would be glad to help you. Call you are the reason we started our company. No joke! http;//1800cpap.com
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Permalink Reply by Jo E on
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I am not surprised by this at all. I thank you very much for posting this site. I will also check out Mark Hixson's site. My son was diagnosed with OSA about the time I had my last surgery and was able to give up CPAP. It turned out that his insurance would pay for the test, it would pay for surgery if he got an UPPP, but it would pay nothing for his PAP treatment at all. They showed him the cost of a BiPAP that his dr had Rxed him. There was no way he could pay for that! Then she took the paper back, drew a line thru the price and told him that that was the price they showed the insurance companies and rich patients. She reduced the price by 50%. There was no way he could afford that either. He told her that he knew where he could get a CPAP for free. She inquired as to the age, how long it had been used, and what his source was. Mother got it less than a year ago and quit using it when she had finished having the needed surgeries. Mother had told him he could have it. How soon would he be able to get it? In about an hour. Great! Go get it! She looked at it and saw that it was a very recent, reliable model, in good condition. She would be able to translate the BiPAP Rx into a CPAP Rx. Then they chose a mask. Then she totalled up the cost of supplies. No way could he afford that. Price slashed by 50% again. He still couldn't afford that. She divided the cost by 6. Could he afford that much per month? That he could do! Due to the cost of the supplies, he rarely replaces them because of the cost. With those prices, he might just get a Christmas present of CPAP supplies.
Yeah. They definitely do raise the prices on PAP machines and supplies! All medical equipment is priced very high. Everyone wants their cut of the action.
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cpap.com is very reasonable, they have some of the best prices on the net and they will price match any ADVERTISED price. Their service and support are very good. This is NOT to drag you away from Mark Hixson. But cpap.com is a good site to check out and compare a variety of PAPs and masks, etc. to at least get a good idea of which PAPs interest you most.
If you have insurance call you insurance company and ask them what local DME CPAP providers they are contracted with. Hopefully you will have the option of more than 1. The more options you have, the more bargaining/negotiating room you have. Shop all your options before committing to any of them.
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I've used cpapplus.com for years, they are good also. They have a lightweight tubing now for only $4.95, it's lighter on the bed, flipping around, but still smooth on the inside for cleaning. They sell a tube-cleaning brush which I use, fantastic if you buy your own stuff.
http://cpapplus.com/CPAP_Tubing/Lightweight_Tubing/New_Lightweight_...
Judy said:cpap.com is very reasonable, they have some of the best prices on the net and they will price match any ADVERTISED price. Their service and support are very good. This is NOT to drag you away from Mark Hixson. But cpap.com is a good site to check out and compare a variety of PAPs and masks, etc. to at least get a good idea of which PAPs interest you most.
If you have insurance call you insurance company and ask them what local DME CPAP providers they are contracted with. Hopefully you will have the option of more than 1. The more options you have, the more bargaining/negotiating room you have. Shop all your options before committing to any of them.
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I'm sure they are both good companies... but they are not offering sleep guide member discounts....:) I don't see them on here.... LOL.
gordon said:I've used cpapplus.com for years, they are good also. They have a lightweight tubing now for only $4.95, it's lighter on the bed, flipping around, but still smooth on the inside for cleaning. They sell a tube-cleaning brush which I use, fantastic if you buy your own stuff.
http://cpapplus.com/CPAP_Tubing/Lightweight_Tubing/New_Lightweight_...
Judy said:cpap.com is very reasonable, they have some of the best prices on the net and they will price match any ADVERTISED price. Their service and support are very good. This is NOT to drag you away from Mark Hixson. But cpap.com is a good site to check out and compare a variety of PAPs and masks, etc. to at least get a good idea of which PAPs interest you most.
If you have insurance call you insurance company and ask them what local DME CPAP providers they are contracted with. Hopefully you will have the option of more than 1. The more options you have, the more bargaining/negotiating room you have. Shop all your options before committing to any of them.
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Permalink Reply by 99 on
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ask for your prescrition back and say there are others willing to deal at a lower and affordable price
once you have it photocopy it and alway passon the photocopy to whoever you deal with,look after the original
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Permalink Reply by sleepycarol on
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If you are paying out of pocket try cpapauction.com. Read the feedback of the seller and ask questions. You can get some good buys on that site. secondwind also has some good buys and is not an auction site.
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Permalink Reply by Linda Osborne on
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I actually ordered quit a bit online. I ordered a variety of different masks so I could see which one worked best as my pulmonary specialist had a limited inventory. I have been very happy with all of my orders.
Linda
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Permalink Reply by Bill Grace on
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Mark Andrew Hixson said:I'm sure they are both good companies... but they are not offering sleep guide member discounts....:) I don't see them on here.... LOL.
gordon said:I've used cpapplus.com for years, they are good also. They have a lightweight tubing now for only $4.95, it's lighter on the bed, flipping around, but still smooth on the inside for cleaning. They sell a tube-cleaning brush which I use, fantastic if you buy your own stuff.
http://cpapplus.com/CPAP_Tubing/Lightweight_Tubing/New_Lightweight_...
Judy said:cpap.com is very reasonable, they have some of the best prices on the net and they will price match any ADVERTISED price. Their service and support are very good. This is NOT to drag you away from Mark Hixson. But cpap.com is a good site to check out and compare a variety of PAPs and masks, etc. to at least get a good idea of which PAPs interest you most.
If you have insurance call you insurance company and ask them what local DME CPAP providers they are contracted with. Hopefully you will have the option of more than 1. The more options you have, the more bargaining/negotiating room you have. Shop all your options before committing to any of them.
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Permalink Reply by Melinda Hertel on
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Hi Allison. I work in a sleep physician's office and run a CPAP business, so I can at least tell you what I know from both sides of the DME v. online companies. The physician's office is given a list of contracted prices that they can charge the insurance company. The insurance company then agrees to cover a percentage of that amount minus any deductibles and/or copays. If the physician contracts with insurance companies, the physician cannot then charge cash pay patients a lower price because of the contract. The same goes for a DME company, and I understand that DME contracted (allowed) prices are even higher than those for physician offices.
Since DME companies have high overhead and are required (by insurance companies and the state they are located in) to have a respiratory therapist on staff to set pressures, their overall costs are higher. I'm not defending them because most are more concerned about their profit margin than making sure a patient has the right stuff. But, online companies in some states are not required to have a respiratory therapist on staff to set machine pressures. And the rest of their overhead is very low. Plus, if they are not contracted with insurance companies, they are able to charge lower prices.
Our company does not contract with insurance companies so that we can offer a lower cost to people who don't have insurance or who have high deductibles. Sometimes a person's deductible is so high that it would save them money to just purchase a machine at a cash price.
Most insurance companies will reimburse you if you pay cash. I would definitely call your insurance company first to make sure, but that might be a better option for you.
I hope that all makes sense. I think it's ridiculous myself and no wonder medical costs are so high. But, that's how it works. Feel free to send me a message if I can be of any help. You can call me too at 877-392-7270.
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