Mask and supplies: DME pricing vs. online pricing

[JohnO]

Wow. I think that'll be the last set of supplies I get from the local DME. Granted, the filters at CPAP.COM are not genuine Philips Respironics, but I've used them, and can't tell them apart. The DME has good and helpful people, but once you've been in this rodeo for a year, the service is unneeded for the price you pay. I don't know what that extra Headgear line item was for. The cynic in me says, "it was for extra DME profit." I imagine some folks have a higher percentage of the item cost covered by insurance, but for me, I think CPAP.COM is the way to go.

John

Code: Select all

Item	             Price (DME)	Ins. Covers	My Share		CPAP.COM
TrueBlue Mask	          $163.00 	 $67.83 	 $95.17 		 $99.00 
Headgear?	               $55.00 	 $22.85 	 $32.15 		 $-   
Tubing	                  $50.00 	 $16.82 	 $33.18 		 $15.99 
Disposable Filters	      $33.00 	 $10.74 	 $22.26 		 $11.95 
Non-Disposable Filters	  $18.00 	  $5.99 	 $12.01 		 $11.95 
Totals	                 $319.00 	$124.23 	$194.77 		$138.89 

[chunkyfrog]

My last two years, I used cpap.com, knowing that it would take several months each year before I met my deductible,
and after that, I would be tied to DME whims, schedules and other nonsense.
Now on Medicare, I bought a part B supplement that works best with my needs and budget.
(I had the free SHIP service--well worth the time, I might add)
I still expect to seek out Johnny and Caroline for whatever the local guys can't "find".

[Wulfman...]

I've never (in eight years) purchased anything from a brick & mortar DME........virtually all supplies from online suppliers or from private individuals.

Now that I'm on Medicare, I have no plans to use it for CPAP supplies or anything related. I have stockpiled enough supplies for the rest of my life (and then some).


Den

.

[archangle]

Double check your insurance. In many cases, the insurance has "in network" providers who cannot charge more than what insurance allows.

YMMV, though.

[hyperlexis]

Wow. I think that'll be the last set of supplies I get from the local DME. Granted, the filters at CPAP.COM are not genuine Philips Respironics, but I've used them, and can't tell them apart. The DME has good and helpful people, but once you've been in this rodeo for a year, the service is unneeded for the price you pay. I don't know what that extra Headgear line item was for. The cynic in me says, "it was for extra DME profit." I imagine some folks have a higher percentage of the item cost covered by insurance, but for me, I think CPAP.COM is the way to go.

John

Code: Select all

Item	             Price (DME)	Ins. Covers	My Share		CPAP.COM
TrueBlue Mask	          $163.00 	 $67.83 	 $95.17 		 $99.00 
Headgear?	               $55.00 	 $22.85 	 $32.15 		 $-   
Tubing	                  $50.00 	 $16.82 	 $33.18 		 $15.99 
Disposable Filters	      $33.00 	 $10.74 	 $22.26 		 $11.95 
Non-Disposable Filters	  $18.00 	  $5.99 	 $12.01 		 $11.95 
Totals	                 $319.00 	$124.23 	$194.77 		$138.89 

This seems more than a little off -- why are you paying more than what your 'insurance' pays? The way its supposed to work is that you pay a percentage of the total amount allowed by the insurance. So if the DME charges 100, your insurance gets a preferred provider discount, dropping the total allowed charge to say 70. You then only pay a percentage of that 70, depending if you have met your deductible. Even if you have not met your deductible, you don't pay more than the 70. That's one of the whole points of having insurance. I suggest you re-check your figures again. Or you have some really crap insurance. I think its likely your computations are wrong.

[caffeinatedcfo]

Cpap.com beats my local DME pricing too. Significantly!

[JohnO]

So if the DME charges 100, your insurance gets a preferred provider discount, dropping the total allowed charge to say 70. You then only pay a percentage of that 70, depending if you have met your deductible. Even if you have not met your deductible, you don't pay more than the 70. That's one of the whole points of having insurance. I suggest you re-check your figures again. Or you have some really crap insurance. I think its likely your computations are wrong.

I did no math. This is straight from the DME paperwork (which matches the insurance company paperwork).

I'll have to review the deductible rules.

[oak]

John, most insurance companies have "in network" DME providers who accept the insurance allowed amounts. If your insurance required you to pay out of pocket/deductibles for medical equipment, the statement would show insurance paying nothing and you paying the full amount.

If you go to an out of network DME the numbers would look like what you have shown (for most insurance).

I would check with your insurance to see if the DME you use is an in network provider and if not, what your choices are in the area for in network providers.

(On the other hand, as the other poster stated, you could just have really crappy insurance). Hope you don't.

[Jeannh]

About xPAP, I know next to nothing - mine comes in a week!
About health insurance, though, I know a bit. Your insurance company has contracted provider(s). This entitles you to their contracted rate, ALWAYS much lower than what the DME bills, and your copayment or coinsurance is based on what insurance PAYS, always. As well, the provider's contract with the insurance company expressly forbids "balance billing", which means the DME canNOT bill you for the difference between their listed price and their contractually agreed discounted rate paid by the insurer. Always insist your DME gets an authorization, even if they say they don't need it. YOU need it, to get your claim paid at those contracted rAtes.
Hope that helps.

[oak]

About xPAP, I know next to nothing - mine comes in a week!
About health insurance, though, I know a bit. Your insurance company has contracted provider(s). This entitles you to their contracted rate, ALWAYS much lower than what the DME bills, and your copayment or coinsurance is based on what insurance PAYS, always. As well, the provider's contract with the insurance company expressly forbids "balance billing", which means the DME canNOT bill you for the difference between their listed price and their contractually agreed discounted rate paid by the insurer. Always insist your DME gets an authorization, even if they say they don't need it. YOU need it, to get your claim paid at those contracted rAtes.
Hope that helps.

Unless its an out of network provider. If so, they can charge whatever they want, insurance pays reasonable and necessary amounts and patient pays the difference.

[JohnO]

I did a little more digging. The provider -is- in network. I am paying what I am paying (which is the "agreed upon price per item") because I have not yet hit my annual deductible. The line I marked as "Ins.Covers" was really the amount above what the insurance will pay.

John

[Jeannh]

Contracted rates still count, until you hit the deductible, for network providers. If you have a high-deductible plan, do the math to see if you should even bother with the DME, or just go online.

[JohnO]

Contracted rates still count, until you hit the deductible, for network providers. If you have a high-deductible plan, do the math to see if you should even bother with the DME, or just go online.

Yes, I guess that was the point of my original post. While the contracted rate is not too far above the online prices, cpap.com is cheaper, especially because they have some OEM items (filters, etc.) that help bring the prices down.

If I were in a year where I was likely to go above my deductible, then I might take advantage of my insurance. I guess I should be thankful that my medical needs are such that it is September and I haven't gotten close to my deductible for the year!

Thanks,

John

[jdm2857]

About the headgear issue: DME bill the mask and the headgear separately, even if they buy
them as one unit. So the mask charge plus the headgear charge should be compared to
cpap.com's single price for the whole shebang.

[pbriggs]

okay, so here is another question along this line...

Can we just purchase from cpap.com and send a copy of the paid bill to the insurance company to be counted towards our deductible? With my high deductible plan typically I don't reach my deductible, but some years I do. So I am thinking to purchase supplies from cpap.com and then send a copy to the insurance company to keep track of to meet my deductible. Assuming of course that the cost at cpap.com is less than the cost from the DME based on the "reasonable" insurance contract price.
Paul