Shocked by my DME Supplier Prices!

My insurance authorization for a CPAP machine and mask just came through and I called my designated DME supply company. I got my doctor to write a prescription for a ResMed AirSense 11 Auto-CPAP machine which retails online for $989 (minus 10% for first time customers). Since the DME company bills insurance, I expected their price for this machine to be higher. However, I was told I could buy the machine from them outright (without insurance) for about $503 or I could go through my insurance and pay a monthly rental fee. Their purchase price for my recommend mask was also well below retail. Is this believable??? Is there a catch? Or did I speak with an incompetent representative who quoted me incorrect prices? [I did have her check it three times.] What's going on?

There is a big mark up on these machines..That's most likely what the insurance company would pay them if you used insurance.

LSAT wrote: ↑

Wed Apr 05, 2023 2:19 pm

There is a big mark up on these machines..That's most likely what the insurance company would pay them if you used insurance.

This is the opposite of what I expected. I read that companies can jack up the price of equipment sold to insurance companies so much that it is sometimes cheaper to buy the equipment yourself rather than pay 20% (or whatever is your copay) of what the insurance company is charged. So it's normal for insurance companies to pay less for a CPAP machine than online retailers charge individuals?

MJS_ wrote: ↑

Wed Apr 05, 2023 2:24 pm

LSAT wrote: ↑

Wed Apr 05, 2023 2:19 pm

There is a big mark up on these machines..That's most likely what the insurance company would pay them if you used insurance.

This is the opposite of what I expected. I read that companies can jack up the price of equipment sold to insurance companies so much that it is sometimes cheaper to buy the equipment yourself rather than pay 20% (or whatever is your copay) of what the insurance company is charged. So it's normal for insurance companies to pay less for a CPAP machine than online retailers charge individuals?

Insurance companies are not stupid...they make lots of money. Regardless of what the DME bills the insurance companies have pre negotiated prices that they pay. If the agreed upon price is $500, it doesn't matter if the DME charges $988 or $1500.

My designated DME provider did need to confirm my insurance coverage before offering to sell me the machine at that price. Do DME providers charge insured patients the same price they would charge the patients' insurance companies, but jack up their prices for uninsured patients? If so, my expectation was totally wrong!

MJS_ wrote: ↑

Wed Apr 05, 2023 4:29 pm

Do DME providers charge insured patients the same price they would charge the patients' insurance companies, but jack up their prices for uninsured patients? If so, my expectation was totally wrong!

Well.....they aren't supposed to have one fee structure for insured people and a different fee structure for uninsured people....at least if they are a participating provider with Medicare. To do that is a big no-no (against medicare regulations).
Even if your insurance isn't medicare they still aren't supposed to have different fee schedules but unless someone files a complaint no one is going to do anything because no one knows about it.
And if someone gets a machine for less cash outlay....they aren't likely going to be the ones to file a complaint are they?

Finally I have heard of DMEs doing both....either dramatically reduce the price for a cash purchase and/or double the price for non insured purchase. I guess it depends on how much they want that cash up front.
Think about it....file insurance and have it take 10 or 13 months partial payment to end up with the agreed upon contract price the DME has with the insurance company??? Which do they want?

Anyhow....make sure they aren't supplying you with a bare bones no detailed data machine for that price you were quoted.

Pugsy wrote: ↑

Wed Apr 05, 2023 4:45 pm

Anyhow....make sure they aren't supplying you with a bare bones no detailed data machine for that price you were quoted.

I do not like to make deals over the phone when nothing is in writing, so I made the lady confirm to me multiple times that I was buying a NEW "Auto-CPAP" AirSense 11, rather than a used lesser model. I'll be relieved (or not) when I see in person what I paid for.

Regarding DME pricing, I first inquired about buying a face mask from the same sleep clinic and DME provider that conducted my sleep study, even though their DME service was not covered by my insurance. I did this because I wanted to meet with a sleep technician who could help me select a good face mask model and size and I was told the DME provider that my insurance works with would just ship the equipment to me. The price that the sleep clinic quoted me (with no insurance) for their recommended mask was a bit higher than online retail prices. However, the DME provider that accepts my insurance quoted me a much lower price for the same mask (and I only need to pay 20% of their lower price).

I would check it out in person.
You need to check run time--it could be a USED machine.
It might not be an auto.
It might not even be a RESMED.
Eyes on--hands on--trust no DME.
They are just guys trying to make a living. (but not always an honest one)

chunkyfrog wrote: ↑

Fri Apr 07, 2023 5:55 pm

I would check it out in person.
You need to check run time--it could be a USED machine.
It might not be an auto.
It might not even be a RESMED.
Eyes on--hands on--trust no DME.
They are just guys trying to make a living. (but not always an honest one)

Good advice I suspect. I wanted to pay for my machine with a prepaid VISA card which my DME would only accept over the phone via their national headquarters; they said I'd have to pay cash if I wanted to inspect the machine before paying for it at their local facility. I spent two hours on the phone with two agents from their order processing department (mostly on hold while they consulted with supervisors) who disagreed with each other regarding my insurance coverage, my "medical group" authorization, whether the ResMed machine was eligible for up-front purchase, etc. During this time, I repeatedly confirmed with them that the machine was a NEW auto-CPAP model 11. So I decided to gamble and luckily received what was promised. It even came with the heated air hose tube which I had not bothered to confirm while on the phone as I was losing the will to live.

" . . . losing the will to live . . . "
So far, I only have one item on my bucket list: "Don't jump."