Durable medical equipment high costs

[Brian Elfert]

I recently had a sleep study at a sleep center. The sleep center also supplied the CPAP machine, mask, and all the various parts. I got the bill yesterday and was horrified by how much they charged for the durable medical equipment. Just the mask alone was $289! Insurance plus my 20% co-pay paid about $150 for the mask after the insurance discount. The same mask is $75 at cpap.com. Would they have charged a cash customer $289 for the mask? They also charged $78 for the six foot hose and insurance/co-pay looks like they paid about $50 for the hose. Hoses range from $9 to $40 at cpap.com. I doubt I got the most expensive hose, but I don't know.

I certainly understand the sleep center has higher overhead than an Internet retailer, but to charge more than four times what I can buy the same item for online? The sleep center did have a CPAP technician spend 30 minutes going over the equipment, but they also got paid by insurance for that time.

[ray hampton]

they can get wealthy if the insurance pay the bill full amount

[David Weaver]

I am always amazed at how big of a budget the durable goods sellers have to take the staff at various hospitals out for dinners, "educational presentations", etc. It's not hard to figure out where the money comes from when you look at medical bills.

When the person (or company) authorizing payment isn't the person getting the services, there will always be an issue with cost - especially when there are two or more payers in each scenario (as in, you might not object if the mask was $75, and the insurance might not object if they pay $150, but if there was one payer and it was you and you found out the mask was $225, you'd surely object. Two people paying for one item really screws up your mental calibration for reasonable costs...it's a situation that's ripe for abuse.

[Brian Elfert]

My insurance company should be getting the best deal they can. Employer supplied health insurance is part of my compensation plus I pay a portion of the insurance premium. If the insurance company had lower costs in theory the premiums would be lower.

Even better is how they charged $30 for the water chamber for the CPAP humidifier even though I am pretty certain it comes with the machine. The cost for machine itself is more than double what I could buy one for online.

[Bruce Wrenn]

I'll make you feel better. Medicare, my insurance, and co-payment just paid over One Hundred Three Thousand ($103,000) for a pair of Stryker Replacement Knees. This doesn't include hospital, doctors, drugs, rehab, or cement to attach replacement knees. Just the knees themselves. As for CPAP. just you wait till you have buy a new mask (every six months recommended.) My 20% co-pay is over $30. And you have to do a doctor visit to get prescription. As a part of my annual physical, my doctor just renews my prescription.

[Matt Meiser]

As for CPAP. just you wait till you have buy a new mask (every six months recommended.) My 20% co-pay is over $30. And you have to do a doctor visit to get prescription. As a part of my annual physical, my doctor just renews my prescription.

Or you can buy new headgear and a new interface every 6-9 months from CPAP.com for way less than that an the plastic parts of the mask will last 1-2 years in my experience. Buying from CPAP.com I'm paying out of pocket and its still costing me less than what I'd pay from the local place with my insurance's help. The local DME place was pushing waaay too many supplies on me the first year. I had a lot of expenses that and exceeded my out of pocket max so I took everything they pushed on me and still haven't run out of things like filters and hoses.

[Brian Elfert]

At least with replacement knees one doesn't have any way to compare the costs. I don't know why I would have to replace my entire nasal pillow system every six months. I could see replacing the pillows and maybe the headgear every six months. I don't see the rest wearing out although they could be worried about keeping it clean. I can replace the pillows and headgear for $50 through cpap.com versus $75 for the entire system. Some of the online places don't need a prescription for just the masks as I bought a Sleepweaver Elan mask without a prescription. (They do need a prescription for a machine.)

[Matt Meiser]

CPAP.com requires a prescription for a full mask--just ordered one.

[Jim Matthews]

I am always amazed at how big of a budget the durable goods sellers have to take the staff at various hospitals out for dinners, "educational presentations", etc. It's not hard to figure out where the money comes from when you look at medical bills.

Is that the case, today?
I left that end of the medical equipment business when my entertainment budget vanished.
I couldn't even get in the door to pitch to the staff, unless I brought lunch.

§403.902 and §403.904 essentially pushed small manufacturers off the stage.

Is there something going on that I haven't heard about?

[Jim Matthews]

I'll make you feel better. Medicare, my insurance, and co-payment just paid over One Hundred Three Thousand ($103,000) for a pair of Stryker Replacement Knees.

How is the rehab going?
I've heard mixed reviews about the post op...some feel great.

Others, not so much.

[David Weaver]

Is that the case, today?
I left that end of the medical equipment business when my entertainment budget vanished.
I couldn't even get in the door to pitch to the staff, unless I brought lunch.

§403.902 and §403.904 essentially pushed small manufacturers off the stage.

Is there something going on that I haven't heard about?

I think you have to be more creative about how you use your budget. Instead now, let's say you have a clinic and you have continuing education credits that all of the (credentialed) clinic members need to get. You can get them either paying to listen on a phone conference, or by going to dinner at Monterey Bay (which is about $60 a head) and listening to a doctor that you have to pay to fly in.

The problem might be that you can't get the budget from the clinic or hospital to do anything but the former, and sometimes not even that (my wife generally pays for her continuing education, because she's very part time). BUT, you might be able to get one of your vendors to pay for everything....which is what they do. The vendor pays the doctor that flies in, the doc's speaking fee, and dinner. How that's not a gift, I don't know. But to be clear, it's not an issue where the vendor has set up everything and invited people to get CE credits, it's the clinic setting up what they want for CE credits and then shopping the vendors to find out who might pay.

And it might be a vendor who just sells special $220 socks for diabetics.

Stuff like that still goes on all the time. It costs just as much, and the same conflict is there. Are you going to can the vendor who always provides good service and who has fronted the cost for special events, just because their socks are n-times as expensive as another vendor who is might be a bit of a dud and who will not pay for anything?

(It's funny that you mention it took lunch to get in the door to make a pitch, because it seemed like my wife got free lunch sometimes 3 times a week when she was working full time. I also couldn't figure out how that wasn't a conflict. Someone pays for that, and it's the patients.)

[Brian Elfert]

CPAP.com requires a prescription for a full mask--just ordered one.

I used cpap-supply.com to order a mask with no prescription required. cpap-supply.com was also $10 less than other with free shipping.

[Matt Meiser]

Interesting. Must be state law differences--yours, mine, or where the companies are located. Looks like its good to shop around on an item-by-item basis--cpap-supply.com is almost double cpap.com for the mask I use.

Its been a couple years, but I was at the doctor's office one day when one of the reps stopped by. The receptionist spouted off the free lunch scheduling policy for the office, including specifics on where the rep should order the the food from, from memory. They were booked several weeks out. I'm sure that's not the case everywhere, but it was an eye opener. Different doctor we tried they had a regular stream of reps. We only stayed with her about 2 months and during that time my wife and I were both diagnosed with a large number of maladies requiring the latest drugs. As soon as we realized we were out of there.

So how is it going with the machine anyway?

[Brian Elfert]

So how is it going with the machine anyway?

I'm sleeping the entire night with the mask on now, but it hasn't seemed to help my sleep issues yet. I had a 30 day checkup last week and the sleep doctor wants me back in 30 days for another checkup.

[Jerry Bruette]

I recently had a sleep study at a sleep center. The sleep center also supplied the CPAP machine, mask, and all the various parts. I got the bill yesterday and was horrified by how much they charged for the durable medical equipment. Just the mask alone was $289! Insurance plus my 20% co-pay paid about $150 for the mask after the insurance discount. The same mask is $75 at cpap.com. Would they have charged a cash customer $289 for the mask? They also charged $78 for the six foot hose and insurance/co-pay looks like they paid about $50 for the hose. Hoses range from $9 to $40 at cpap.com. I doubt I got the most expensive hose, but I don't know.

I certainly understand the sleep center has higher overhead than an Internet retailer, but to charge more than four times what I can buy the same item for online? The sleep center did have a CPAP technician spend 30 minutes going over the equipment, but they also got paid by insurance for that time.

Brian reread your original post and you'll see the game that's being played at your expense. The DME contracts with your insurance company for a set price for equipment you need. Looks like they start at a MSRP and then supposedly the insurance company gets a discounted price,$289 mask for $150, $78 hose for $50 etc. and to think you pay insurance premiums for that type of service. Once the DME knows you have insurance they treat you like a cash cow. I stopped using my insurance for CPAP supplies and pay out of my own pocket with my HSA or my wife's FSA card. My insurance company told me that a DME can charge any amount they want but they'll only be paid the contracted amount. My insurance also won't deal with cpap.com or let me submit a claim from them because they're not in the "network plan". Which translates to cpap.com won't play the price setting game with the insurance company.

I did have a DME from Tennessee mark up the price on equipment about 500% from the cash price after they found out I had insurance and never told me they were going to mark it up, I found out after the equipment arrived and I was using it. I will never do business with them again.

The more I deal with my insurance company the more I think that they're more effecient at extorting money from me than the mafia ever could be.

Good luck with your cpap therapy it really can be a life changing thing.

[Bill ThompsonNM]

It gets even more complicated at times- one of my buddies at work was discussing a similar case where it ended up cheaper for him to just pay for the equipment.. After some investigation we discovered the equipment distributor used by the insurance company was owned by a larger entity that was wholly owned by the insurance company!
no wonder they didn't want him going elsewhere no matter what the cost'

[Brian Elfert]

I don't understand why insurance wouldn't want to pay lower prices for DME. The less they pay out the more profit they make, or the lower the premium increases can be. If an insurer owns a DME provider isn't it just a shell game? If the insurer pays higher prices to their DME provider doesn't it just mean profits transfer from the insurer to the DME? I suppose the insurer just increases their premium due to inflated higher costs.

The state of Minnesota only allows not-for-profit companies to provide health insurance in the state. It is ironic as one of the largest for-profit health insurers is headquartered here in Minnesota with thousands of employees and they are hiring hundreds or thousands more people because they won a federal contract to administer Tricare.

[ray hampton]

I don't understand why insurance wouldn't want to pay lower prices for DME. The less they pay out the more profit they make, or the lower the premium increases can be. If an insurer owns a DME provider isn't it just a shell game? If the insurer pays higher prices to their DME provider doesn't it just mean profits transfer from the insurer to the DME? I suppose the insurer just increases their premium due to inflated higher costs.

The state of Minnesota only allows not-for-profit companies to provide health insurance in the state. It is ironic as one of the largest for-profit health insurers is headquartered here in Minnesota with thousands of employees and they are hiring hundreds or thousands more people because they won a federal contract to administer Tricare.

what about the reports that some doctors are taking kick-back from the insurance companies

[David Weaver]

Ray, i'm not following. They're directly compensated by the insurance companies. Why would they need a kickback?

[ray hampton]

Ray, i'm not following. They're directly compensated by the insurance companies. Why would they need a kickback?

this reported kick-back happen x numbers of years ago so I could be slightly wrong but maybe the doctors would inflate the patient bills and the insurance companies would kick -back , but this report could be a big lie told to embarrass the doctors

[glenn bradley]

So, the secret as to why some hack outfits will perform services for just what the insurance will pay is out :).