DME provider fraud (not gun related)

[treadlightly]

DME (Durable Medical Equipment) providers are, in my limited experience, thieves. I hate to be so blunt, but my desire for accuracy overrides my nicer intentions.

My wife suffered serious trauma last year and now has a permanent need for a wheelchair.

My insurance company steered us to an in-network DME provider who supplied a wheelchair on a crazy rent-to-own contract. Other equipment they delivered was a simple sale.

We weren't as vigilant as we should have been.

The DME provider billed a total contract of about $2,200 for the wheelchair. Our stalwart insurance company only allowed about $770.

But the wheelchair wasn't worth that much. It's a $250 chair.

The insurance company got the first two months' bills, November and December, and I've now gotten my first bill for them, dated January 8. Galling. At my first wake up call, thanks to the DME provider's bills running 90 days behind, I'm already on the hook for two more months.

The replacement chair, the same make and model, an identical twin to the first one supplied on a $770 contract, cost $251.99, freight included.

Other everyday low prices in our transaction included a seat cushion at $160. The same seat cushion sells at Walmart - the same manufacturer, the same part number - for $19.99.

We got a walker, $148.99, that sells at Wally world and a number of other places for $29.99.

Our insurance company wouldn't authorize purchase outside of their network, but it would have been far cheaper to buy what we needed without insurance coverage. Even paying five months' rent to own payments, losing that, losing any equity in the chair we could have bought, plus paying for a replacement chair without help from insurance ended up being about $100 cheaper than letting the contract, approved and negotiated by our insurer, run to completion.

I don't do rent-to-own. I'm disgusted I got snookered into that kind of plan.

The Texas Department of Insurance has only one role in this kind of situations - they enforce the contracts, even if the contracts are bat-poo crazy. If the pricing is insane, it's OK as long as the contracts stipulate insane prices.

The AG's consumer protection office can't regulate what a vendor asks, even though State and Federal medical programs are getting taken for a ride.

I wrote the Texas Health and Human Services Ombudsman's office and got a nice return phone call from an investigator. HHS didn't have any jurisdiction, but the investigator said he checked on his CPAP machine. His unit retails for about $1300, his insurance company paid $3500 to a DME provider.

As best I can figure, the scam must work like this. An insurance company enters into contracts with DME providers, who, I believe, are largely thieves. The DME providers graciously agree to charge three to ten times retail prices. The insurance company sets their premiums so they can turn maybe a 2% profit, but as their expenses and premiums rise, that 2% gets larger in terms of dollars, too.

Anybody have an idea how to shut these guys down? This is part of what's ruining health care in America.

[Odiferous]

The DMEs seem to set their pricing by what Medicare will pay. Their goal is to give you the cheapest item for a given billing code.

There's one code for a CPAP. Whether they give you a cheap unit that only tracks the time used, or a fancy unit with continuously variable pressure and detailed logging, they get the same from the insurance. Guess which unit you get unless you get your doctor to specify it on the Rx?

Same with wheelchairs. Not only are you grossly overpaying, but they default to giving you basically a transfer chair. When you start paying attention to the folks you see that have been confined to one for years, it's a very different chair.

[Liberty]

There is that Obamacare tax, that I haven't quite figured out. If I understand it correctly:
There is a tax on Durable Medical goods, like pacemakers and wheelchairs, to subsidize insurance so that it can cover abortions, and viagra. I do appreciate that places like UTMB are putting up beautiful new gunfree structures all over the place. It seems it was only a few years ago they were telling us that there wasn't enough money to repair the flooded basements. Insurance has gone up medical costs have gone up, consumers getting ripped off. New buildings and Urgent care centers. Importing Doctors from foreign lands cause Americans aren't smart enough anymore.

I am not exactly the smartest person on this planet, but I do wish I could understand how this Obamacare was supposed to fix things for the patient.

[bblhd672]

There is a quick and easy fix- require every one working for or elected to government service use the same health care system as the people they allegedly serve.

[RoyGBiv]

HDHP + HSA + requiring all health care providers in every corner of the market to maintain up to date, price lists and post them online. That includes reimbursement rates from insurers.

Some smart entrepreneurs will be along shortly thereafter with the consumer tools that empower health care consumers to make good decisions and that will drive this secretive market to a correction.

FYI. Our HDHP + HSA total cost (with enough in the HSA to cover out of pocket costs to the same degree as the traditional plan) is the same as the traditional plan we could have signed up for, except that the money we don't spend from our out of pocket deductible stays in our HSA and rolls over to help cover any extraordinary expenses in the future instead of becoming profit for the insurance company.

If you have access to an HDHP, be sure to do the math.

We've also found that we consume health care differently now that we pay 100% until we hit our out of pocket numbers. And we are setting expectations with providers as if WE are actually CUSTOMERS and the health care providers are SERVICE providers.

[jminn1]

I ran into the same gouging when I was prescribed a CPAP machine 3 years ago. They charged $3500 for a machine I can clone on EBay for $400.
They do the same type of price gouging on consumable supplies. Ebay is now my preferred vendor for consumables. The thieves want $120 for a new headgear harness. Ebay - $25 for the very same thing.