Noob question: Why are DMEs more expensive than CPAP.com?

aeroscout17 · Post by **aeroscout17** » Thu Apr 05, 2007 9:25 am

I will evidently be needing a CPAP after two sleep studies.

I was impressed with the wealth of info on the CPAP.com site, and now I am impressed with the prices.

My question is: Why are DMEs prices for the same equipment so much more? For example, a local DME quoted a price of around $1550 for the "Respironics M Series Auto with C-Flex," and CPAP.com has it for $574.

My insurance company (BCBS) wants me to go with a local DME since they don't contract with CPAP.com. Are the insurance companies getting a kickback?

Any suggestions? I am thinking of with CPAP.com since it will still be cheaper although I will be paying 50% of the cost vs 35% of the cost from a DME.

-Steve-

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): cpap.com, C-FLEX, CPAP, DME, auto

Slinky · Post by **Slinky** » Thu Apr 05, 2007 10:16 am

Well, there are some obvious reasons:

cpap.com works on a cash sale basis. The local DMEs do most of their business thru Medicare and other insurances. A much lesser percentage of their business is on a cash basis. Therefore there is the hassle and expense of insurance paperwork plus the delay in Medicare and insurance reimbursement. Most insurances require AT LEAST a 30 day proof of compliance before they will reimburse AFTER they receive that proof of compliance. Then there is the delay whilst the insurance processes the proof of compliance and issues the reimbursement. It took from 09 Oct when I received my equipment until March 07 for Medicare to process and make payment. That's quite a bit of money tied up for quite some time vs cash upon delivery.

In addition, Medicare pretty much sets the reimbursement amounts and they only pay 80% of the billed amount. Other insurances negotiate and contract w/the local DMEs for the amount they will reimburse for items. So, only cash paying patients pay the local DMEs the amount that is billed. Medicare and insurances pay considerably less. All of this raises the billable amount for the equipment.

I'm not 100% sure of the following, but it is my understanding. Those who accept Medicare can NOT charge others who aren't Medicare beneficiaries less than what they charge Medicare or they lose their right to participate in Medicare reimbursement. If you purchase thru cpap.com's "sister" online DME, billmyinsurance, you will find their prices similar to the local DMEs.

Last, but not least, there is turn over of inventory. The local DMEs have money tied up in a vast inventory of non-CPAP equipment as well as the CPAP equipment. CPAP is only a small part of their overall business sales and (choke) service. Sales volume can reduce cost and thus prices as well. You will notice cpap.com is almost always cheaper than other online DME suppliers.

Other than that? Well, they like to hand us the line that the local DME's have the expense of maintaining staff to provide service and assistance to the patient. Ha! The thing is very few do if you read these forums for long.

Am I sticking up for the local DMEs?? Heck, no!!! At least NOT for the MAJORITY of them! There are a few good ones out there. But they sure seem to be in the vast minority. It seems MOST of them are NOT worth doing business with. My local CPAP DME is the typical local DME, a real PITA and not worth a darn.

On the other hand, my local 02 DME supplier is a smaller DME, covering only my own state and maybe not even the entire state, and they are GREAT! I'm stuck w/my CPAP DME for the rest of my capped rental for my CPAP machine itself. (They service a three state area). BUT, since the rest of my equipment, masks, etc. were outright purchases I did have the opportunity to switch getting them to my 02 DME and I have done so. Wow! When it came time for a new mask ... here lets try 2-3, however many you need to find which mask works best for you!!! Boggles my mind the difference in quality of service!!!! A PLEASURE to do business with rather than a big fat PITA.

Goofproof · Post by **Goofproof** » Thu Apr 05, 2007 10:18 am

Because they like faster cars and more vacations. Jim

Wulfman · Post by **Wulfman** » Thu Apr 05, 2007 10:40 am

Many insurers will re-imburse YOU for out-of-pocket purchases. I've seen people report that BCBS will, too.....somewhere in the 80% range. You need to talk to them and ask if they will reimburse YOU if you buy from CPAP.COM. You would need to purchase with a credit card and then make out an invoice to BCBS from yourself. Tell them that you can save them a pile of money by doing it this way.

Another option is BILLMYINSURANCE.COM.

I don't have BCBS, but it worked for me and lots of other folks here.

Don't be shy with them......if you're paying premiums, it's YOUR money they're using.

Best wishes,

Den

Guest · Post by **Guest** » Thu Apr 05, 2007 10:42 am

aeroscout17 wrote:My insurance company (BCBS) wants me to go with a local DME since they don't contract with CPAP.com. Are the insurance companies getting a kickback?

Any suggestions? I am thinking of with CPAP.com since it will still be cheaper although I will be paying 50% of the cost vs 35% of the cost from a DME.

Hi Steve,

Here's my suggestion (and exactly what I did when I purchased my first machine).

1) Check with BCBS and find out whether they will allow you to submit a claim directly. When I first asked BCBS, they gave me the same answer you state they gave you. When I started asking why I couldn't buy the product off the internet and submit a claim directly to them, then the answer changed to yes, that could be done. End result - they reimbursed me 100% for BiPAP-auto and mask I purchased from CPAP.com.

2) Submit claim to BCBS.

Now, some folks here have claimed that some BCBS companies won't allow this, but it worked just fine for me. Apparently, the different BCBS entities operate differently from each other though, so I can't guarantee what I did will work for you. Good luck.

Regards,
Bill

UncleLeo · Post by **UncleLeo** » Thu Apr 05, 2007 12:27 pm

Slinky wrote:Well, there are some obvious reasons:
Last, but not least, there is turn over of inventory. The local DMEs have money tied up in a vast inventory of non-CPAP equipment as well as the CPAP equipment. CPAP is only a small part of their overall business sales and (choke) service. Sales volume can reduce cost and thus prices as well. You will notice cpap.com is almost always cheaper than other online DME suppliers.

Doesn't pretty much every brick-and-mortar business invest in it's inventory? How would a DME be any different from a Wal-Mart or a local mom-and-pop cafe? They're all investing in inventory in the hopes that it'll sell for a profit.

Changing direction, I can understand why DMEs charge more, but it's why so much more that makes me run from them. If I'm a cash-paying customer, and I'm making up the difference for insurance customers, then that's wholly unacceptable to me.

blarg · Post by **blarg** » Fri Apr 06, 2007 1:41 am

UncleLeo wrote:How would a DME be any different from a Wal-Mart or a local mom-and-pop cafe?

The local Wal-Mart or mom-and-pop cafe doesn't have to bill insurance. CPAP.com doesn't have to either. Hence the price difference.

hayeswildrick · Post by **hayeswildrick** » Fri Apr 06, 2007 8:05 am

As in all things, there are great DMEs, and not-so-good, and terrible. I'm fortunate that my doctor hooked me up with a pretty good one.

1) They handled all of the insurance certification, which requires a lot of paperwork (and the time of one of their employees).

2) They delivered my unit to my home. When the RT got here she spent about an hour-and-a-half setting up and demonstrating the equipment, answering my questions about cleaning and service, and fitting me with a mask. She had to try several to get the right fit. What happens to the masks I tried on but didn't buy? My guess is that they go into the trash, just like the rolls you don't eat at a restaurant. Certainly every mask she showed me was taken out of it's factory sealed packaging. With CPAP.com, if you don't like it, you own it, unless you buy their insurance.

3) When I called two days later because I couldn't tolerate the mask, the RT came the same day to fit me with another one. Again she spent about an hour in my home. Yes, they did get to bill the insurance company again, but they provided a real service.

All of this costs money. Are they making a profit? Of course! Probably a pretty good one.

One of the biggest reasons that patients have problems with DMEs is that we are not their primary customer. Your doctor probably chose your DME, so it's the doctor they market to and seek to please. I'm glad to say that my doctor quizzed me about how well the DME treated me. She's got many to choose from, and wants the best for her patients. Likewise, when I wanted to get a better machine from the DME (who gets reimbursed the same no matter what machine they sell me) I made sure that they understood that MY DOCTOR wouldn't be happy if they didn't give me the machine I wanted.

After all of this, I should say that I've been very happy with Cpap.com when buying accessories. And billmyinsurance.com was very candid about what they could and could-not do for me.

Hope it all works out for you!

Jeff

Slinky · Post by **Slinky** » Fri Apr 06, 2007 9:08 am

Thank you, Jeff, for sharing your GOOD experiences w/your GOOD DME "and" w/a GOOD sleep doctor to boot! Its so reassurring to be reminded there are some good ones out there!

Heaven knows, I've whined and moaned and groaned and griped about my sheister CPAP DME supplier on this forum enough. My 02 DME supplier is such a refreshing change. Much like your DME CPAP supplier and my sleep doctor and lab are much like your sleep doctor. What a blessing!

BrianRT · Post by **BrianRT** » Fri Apr 06, 2007 11:20 am

Yes, do keep in mind that at billmyinsurance that the prices for the same equip. is raised considerably.

At my DME (and I HOPE all others) if someone wants to do a cash sale, we have a much lower price than the insurance price.

As far as masks that didn't work out, say during a fitting, Respironics, F&P, and Resmed have a form we fill out (within 30 days) and fax for a discarded mask and they send a replacement for free, so we're not out anything.

Slinky · Post by **Slinky** » Fri Apr 06, 2007 11:45 am

THANK YOU, BrianRT, for telling us that. KansasRT has told us about this manufacturer's replacement to DME's as well. "My" DME denies it. Snort. Just one more bit of horsepuckies out of her mouth. It also explains WHY my 02 supplier has been so cooperative in helping me to find a proper fitting mask. Those have been the 3 brands (manufacturers) of masks they have suggested and allowed me to try.

Its NOT like my CPAP DME is a large nationwide organization such as Lincaire or Apria where they have to get their supplies from a regional Lincaire or Apria supply office. This outfit just covers a three state area and I'm not even sure they cover the entire three states or just parts of those three states. Whatever, their DME I have to work with is either not too smart, uninformed or a liar and I strongly suspect all three apply to her.

aeroscout17 · Post by **aeroscout17** » Fri Apr 06, 2007 1:44 pm

[quote="BrianRT"]At my DME (and I HOPE all others) if someone wants to do a cash sale, we have a much lower price than the insurance price.

Wulfman · Post by **Wulfman** » Fri Apr 06, 2007 1:52 pm

When I was interviewing one of the local DME shops two years ago, I pulled up CPAP.COM's website on their computer and showed them the prices. They told me that those prices were lower than what they had to pay.

Didn't take me long to make up MY mind where I was going to do my shopping.

Den

KansasRT · Post by **KansasRT** » Fri Apr 06, 2007 2:41 pm

If you are a contracting Medicare provider it is against the rules to charge different prices to patients with different insurances or no insurance. (I am not saying that it dosen't happen everywhere, but it is definatly against the rules.)

BrianRT · Post by **BrianRT** » Fri Apr 06, 2007 3:31 pm

[quote="KansasRT"]If you are a contracting Medicare provider it is against the rules to charge different prices to patients with different insurances or no insurance. (I am not saying that it dosen't happen everywhere, but it is definatly against the rules.)

quote]

Provided it's an insurance billed transaction.

Noob question: Why are DMEs more expensive than CPAP.com?

Noob question: Why are DMEs more expensive than CPAP.com?

Re: Noob question: Why are DMEs more expensive than CPAP.co