How much does DME get paid?

hayeswildrick · Post by **hayeswildrick** » Thu Mar 08, 2007 3:19 pm

While shopping for my equipment I contacted the folks at billmyinsurance.com. They checked out my insurance (Blue Cross) and said that my co-pay for an initial setup (machine, mask, hose, humidifier) would be $268.51, REGARDLESS OF WHAT EQUIPMENT I BUY. This represents 20% of what my insurance company will allow for the total cost of the equipment.

I hope someone will correct me if my understanding or calculations are wrong, but it seems to me that this means that regardless of what equipment they provide, any DME will be getting $1342.55. (I took my 20% copay and multiplied it times five.)

Now, when I first requested an APAP, the company told me that they don't want to supply them because they'll loose money. But, I can buy the complete setup from cpap.com for $893 (including a very expensive mask and M series APAP without software). I assume that at these prices cpap.com is still making money. And, I assume that my DME can purchase the equipment at the same cost as cpap.com.

So, the fact is that even with the most expensive machine and mask they are not loosing money -- they are just not making quite as much money.

Fun to do math, isn't it?

Slinky · Post by **Slinky** » Thu Mar 08, 2007 5:24 pm

Voila!!!

But ... you aren't allowing the local DME anything for those WONDERFUL RT's they hire to provide you w/assistance ....

bast · Post by **bast** » Thu Mar 08, 2007 5:45 pm

Just a thought along this line -

if the DMEs really make a lot of money, maybe some of the experienced hose-heads around here should switch professions. At least the newly diagnosed and struggling apneacs (how do you spell that?) would have POSITIVE and helpful support instead of the moronic obstructionist interference I keep hearing about.

Slinky · Post by **Slinky** » Thu Mar 08, 2007 5:54 pm

40 lashes w/a wet noodle for me!!! My apologies to MattMan, KansasRT, SAG, fidget .... the few brave, kind RT souls who have shared their views and advice w/us. The Caring Few, that's "our" RTs who have been so kind as to put up w/us here and try to help us. I'm sorry if I missed anyone.

blarg · Post by **blarg** » Thu Mar 08, 2007 6:14 pm

It's really pretty simple. Either it's worth it to you or it isn't. I don't understand why people get all upset over the pricing scheme. It is how it is. Zen moment. Accept it. Ok, so now what are your options?

Buy from them.
Buy online.
Buy from a different B&M DME.

Your choice. Just put the options out and then take your best one. If they won't offer you the machine you want, then looks like option one is off the table.

I think people feel like because it's health equipment that the DME is somehow supposed to bend over backwards for them and not make any profit. They're an industry, just like any other. I chose to take my DME + Insurance because it was a bit cheaper and paid for it with some of my time. Oh well. I'll live.

Do I defend DMEs? No. But it's your choice. I don't use Microsoft software either when I can get away with it. Just another industry.

fidget · Post by **fidget** » Thu Mar 08, 2007 6:43 pm

Hey, if it makes you feel any better, I probably wouldn't buy from a DME either. I have a pretty high deductable, and a hefty copay.

I also have lots of patients who come to my office every couple of weeks, to have me help them readjust their mask. Or fiddle with the ramp. Or reset the temp on the humidifier. They're just to uncomfortable to do it themselves, in spite of repeated reinstruction. Try getting that if you are using an online company. A big part of my job is hand holding till people feel comfortable doing things themselves.

Most of my patients don't have any desire to know how to set their own settings. A big share still call the machine a CPACK in spite of explaining what the letters stand for. I have one lady who claims it gives her diarrhea, as she's allergic to it. She changes her filters more often now, and it helps, she says. Probably 75% of the phone calls I get, the patient can't even tell me what brand the machine is, or what size the mask is. Or what kind. Just last week, this is the call I got, he wants the mask like his mom got last, but she didn't get it from us. He has no idea what kind it is, but it's not the one he got from us, so could we just send him the other kind? He doesn't want to come in to look at masks, but it's "the other kind".

You guys are the exception to the rule of patients. Honest to pete you are.

If you're capable of using messageboards, you're capable of being in charge of your treatment. I'm all for knowing your settings, your preferred mask, your sleep study results. You NEED to know that stuff to be an informed person.

Very many aren't, and for those, people like me are important, not to toot my own horn.

I don't like the pricing thing either. I also don't like that gas prices are totally out of whack. I don't like that the next state over doesn't pay income tax. There are things you can change, and things that you can just drive yourself crazy griping about.

If you don't want to use a DME, don't. If you have any pull with your Congressman, please, with my blessings, urge insurance reform, ok?

bluegrassfan · Post by **bluegrassfan** » Thu Mar 08, 2007 6:50 pm

I went in to my DME today to get a copy of my sleep study, and had a good conversation with one of the ladies...told her about all the wonderful people on cpap.com...expressed my dissatisfaction with the followup from my DME after my initial purchase. She said my tech person has 6 sleep labs she has to service, and doesn't even have time to turn around...she has requested an assistant. So they have their problems also. Not defending them, but I do look at some of them with a different view now. The queen bee at the DME is the one who is causing our lack of service, in my opnion, not the worker bees. just my nickle's worth. hope everyone sleeps well tonite, can't wait to get my ff mask tomorrow....haven't slept 6 straight hrs in over 10 years...no wonder I look like I do...lol

onecoknower · Post by **onecoknower** » Thu Mar 08, 2007 7:09 pm

In my experience, the dme was OK - but I did my research ahead of time and knew what to ask for. I haven't been back however, or contacted them for adjustments. I feel educated, I watch my numbers, I frequent the board. But I don't think I'm the average patient, either.

I know people who had brain cancer that couldn't tell me what kind of cancer it was. I know many people like those fidget described, and I agree with him that RT's are important for a large population of hoseheads.

But for me, I agree with Blarg - dme + insurance was my cheapest option. If it hadn't been, I would have done something different.

Oneco

fidget · Post by **fidget** » Thu Mar 08, 2007 7:14 pm

*waves*
Not to nitpick, but fidget's a her

Slinky · Post by **Slinky** » Thu Mar 08, 2007 8:04 pm

Thank you, fidget. Well said. I know it is hard for me to fathom those patients who don't know and don't want to know. For crying out loud, my HUSBAND is one of THOSE kind of people!! It drives me nuts how a patient can be so PASSIVE about their own health care!!!!

Guest · Post by **Guest** » Thu Mar 08, 2007 8:41 pm

Amen Fidget and well put. For those that need extra service a local supplier is worth it. I would still be using Lincare if they could get their billing office in my area fixed. When I started therapy four years ago I needed the RT. When I get service I expect to pay for it. If I want it cheap and don't need service I go to an online supplier like I do now with internet suppliers such as the host of this forum. If you really want to know what your insurance company alllows you need to call your insurance company to find out. You can also check your EOB when you receive it. Bottom line: it's your chloice on how you b uy. If cost is all you are interested in and don't need the service go with the supplier that has the lowest out of pocket cost for you. I get very tired of all of you expecting that a DME should not make a profit.

TGregg · Post by **TGregg** » Thu Mar 08, 2007 9:07 pm

Anonymous wrote:I get very tired of all of you expecting that a DME should not make a profit.

And I get very tired of people that justify terrible treatment, unethical billing of insurance companies, lies to patients and flat out poor service by saying "Hey, they're just trying to make a buck."

Are all DMEs rotten idiots who engage in questionable billing practices? No. Are some patients more interested in American Idol than their xPAP therapy, and thus need hours and hours and hours of costly hand-holding? Yes, maybe even a majority. For them, the DMEs are a good thing. Mostly. They'd still be way better off using forums and figuring stuff out on their own, but that ain't gonna happen.

I can tell you for a fact I knew more about my CPAP machine than my DME tech did within an hour of getting it. And if my insurance company just cut me a check, they'd spend less on my therapy. Now, I don't begrudge anybody a profit, they should make the most money they can. I know I sure try to. But it feels bad to be going through my DME and watching my insurance get soaked, when I could go to CPAP.com and get the stuff I want for less. Not bad enough to shell out a few hundred bucks to do it on my own.

It's frustrating to see the cost of healthcare spiraling up, and to know that this is part of that problem, and either deal with my idiot DME or cover all the costs myself. Especially since I could do it all myself and save the insurance company some bucks at the same time.

Bookbear · Post by **Bookbear** » Thu Mar 08, 2007 9:15 pm

At the risk of offending the honest DME's out there (there must be some...there MUST!), Blarg and guest, I believe the initial post on this thread indicated that the DME lied to them... saying that they would "lose money" providing an apap, when they in fact would not. The issue was the lie, not the profit.

Capitalist running dog that I am, I have no problem with a business making an honest profit. What I don't like are businesses that lie to me, businesses that provide me with less than I (or my insurance company) pay for, or show a willingness to sacrifice my health for their profit.

A good reliable product at a fair price with a decent profit for the provider.... throw in a a bit of accurate, helpful information for a person who is only there because they have been diagnosed with a life-threatening condition and may not have that much knowledge.... now THERE's a winning business plan.

blarg · Post by **blarg** » Fri Mar 09, 2007 12:37 am

Bookbear wrote:At the risk of offending the honest DME's out there (there must be some...there MUST!), Blarg and guest, I believe the initial post on this thread indicated that the DME lied to them... saying that they would "lose money" providing an apap, when they in fact would not. The issue was the lie, not the profit.

We can't be sure they're lying. That's the scary thing. Who knows how many middle managers they have to pay for? Could just be that the cost to them to provide an APAP is simply higher than their returns.

I'm just trying to say that it's a lot easier to spare the character judgements and simply go "Well, that's a crazy outfit they've got going on over there....moving on..."

hayeswildrick · Post by **hayeswildrick** » Fri Mar 09, 2007 7:54 am

Wow! This discussion has really taken some interesting twists and turns.

Just a reminder of what I actually started off saying (and not saying).

I don't think I used the word "lying" anywhere. I just pointed out that if my math is right, the DME (any DME) will be paid $1342.55 by my insurance company for an initial setup of mask, hose, and xPAP. I'll end up paying $268.51 regardless of what equipment they supply. I also pointed out that the same equipment can be purchased retail here at cpap.com for less than $900.

That being said, it's also true that the local DME undoubtedly has higher overhead than an internet vender. And, one hopes, they'll also be providing a lot more hands-on service. They deserve to make as much money as they can.

Blarg's choices are right on the money. Every consumer should be educated, and then make an informed decision about what's right for him/herself. I'll go the insurance route through a local DME since they seem to have agreed to provide me with the equipment I want. I guess they decided they're making enough money to make it worth their while. That's up to them! Chance are, if they give good service I'll become a repeat customer, so it's a good business decision.

This discussion has crystallized two ideas about the medical equipment industry in my mind. Neither is unique to me:

1) For most local DME's, the primary customer is the doctor, not the patient. This is because it is most likely the physician who will choose the vender and even the equipment that the patient will receive. I've seldom seen a TV ad for any of the DMEs in our area, and I probably never will. But I bet they are regular visitors to my doctor's office. For internet providers, such as cpap.com, the patient is the primary customer. It's strictly an economic reality.

2) Because of the weird nature of insurance reimbursment in the United States, it is in the DME's best interest to provide you with the least expensive equipment possible. Imagine going to a car dealer and having them try to talk you down to the basic model with no frills! But, if your insurance company was paying the dealer directly for a new car, at a fixed rate, that's exactly what would happen! Our reliance on insurance, not the DME, is the reason for this strange reversal from the normal sales paradigm. (Kind of makes me wonder how bad it would get if everyone had government insurance! Good-bye choice!)

There are really no bad guys here. Just lots of folks trying to make or save a buck.

But, if we're informed it will help us to make better choices and do better good-faith negotiations all around.

Press on!
Jeff

Machine	Mask

Additional Comments: Avg. AHI .4

How much does DME get paid?

How much does DME get paid?

DMEs and xPAP veterans