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Thread: $10,000.00+ For a Tilite ZR

  1. #11
    on mine, they are making prob 4500
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  2. #12
    so the shop is getting the extra as profit - fair enough, but why would the insurance companies knowing pay out/lose so much extra? i dont really understand how it works. surely if they have a known network of shops you can buy from, and they would refuse to pay over msrp, so the shop only bills for it......... i dont know, confusing myself. it just doesnt make sense. unless the guys who own the insurance company also own the shop.

  3. #13
    But if the "house always wins" as Dale put it -- that is, the insurance companies always maximize their profits -- why are they willing to contract with in-network providers who are shaking them down? That's the part of the equation that's always had me .

  4. #14
    do you guys really think insurance companies actually pay the sticker price? that's like going to a car lot and out a car, saying, "i'll take that one" and writing the salesman a check for the total. insurance companies have contracted/negotiated rates for durable medical equipment. do you get 'explanations of benefits' (eob's) it show what is charged, and what is actually paid. when i got my first chair, i was blown away to see united seating and mobility charge over $7500 for my chair. then i got the eob. my insurance paid a little over $3000. i paid nothing.

    am i missing a part of this conversation. insurance companies aren't stupid.

  5. #15
    Quote Originally Posted by Notwoodward View Post
    do you guys really think insurance companies actually pay the sticker price? that's like going to a car lot and out a car, saying, "i'll take that one" and writing the salesman a check for the total. insurance companies have contracted/negotiated rates for durable medical equipment. do you get 'explanations of benefits' (eob's) it show what is charged, and what is actually paid. when i got my first chair, i was blown away to see united seating and mobility charge over $7500 for my chair. then i got the eob. my insurance paid a little over $3000. i paid nothing.

    am i missing a part of this conversation. insurance companies aren't stupid.
    So then the in-network DMEs are jacking up the quotes knowing that the insurance companies will only pay the contracted rate while sticking the subscribers with inflated co-insurance charges. Otherwise what's the point of the inflated quotes? Or do they write off the difference hoping for a tax break? Whatever the explanation, the system as is is fucked.

  6. #16
    Quote Originally Posted by stephen212 View Post
    So then the in-network DMEs are jacking up the quotes knowing that the insurance companies will only pay the contracted rate while sticking the subscribers with inflated co-insurance charges. Otherwise what's the point of the inflated quotes? Or do they write off the difference hoping for a tax break? Whatever the explanation, the system as is is fucked.
    i only know what happened in my case. i assume it's somewhat similar elsewhere. but yeah, i agree with the rest of your conclusion.

  7. #17
    Senior Member DaleB's Avatar
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    Quote Originally Posted by stephen212 View Post
    So then the in-network DMEs are jacking up the quotes knowing that the insurance companies will only pay the contracted rate while sticking the subscribers with inflated co-insurance charges. Otherwise what's the point of the inflated quotes? Or do they write off the difference hoping for a tax break? Whatever the explanation, the system as is is fucked.
    With the DME stuff there is not typically a contracted rate between the DME provider and the ins. co., rather their reimbursement is governed by the annual limit for DME, according to the benefit plan the member is paying for. I've never seen a provider contract (and I've seen a few...thousand) which prescribed a flat rate in exchange for a variable cost piece of equipment like a wheelchair. Being 'In-network' for DME shops has more to do with their credentialing and/or certification than their reimbursement, in my experience.

    Brianm has to appeal just to get an upgrade from K0001 and Titanium4Motion has 100% covered on a $10k, K0009 chair. It's all about your contract between the ins. co. and you, aka your "benefit plan", not your needs (unless as defined within the BP ).

    The ins. co.'s position is that you should have thought about your potential needs when you entered into the contract with them to cover some portion of your potential future medical cost. Many ppl just look for the cheapest option on the 'compare plans' form they get from HR and then wonder why they're ins. co. is so cheap with them. Duh. Nobody wants to pay for it but everyone wants the best care, regardless of their premiums, when it comes down to it. And for those who would pay for added protection many don't believe the have any choice because they're beholden to whatever quality plans their employer want to share cost on. Not true, but it seems most folks are pretty ambivalent about it, and take whatever their fed.

    But, in the end it's about means and medians and basic risk management. The actuaries work near tirelessly at ins. co.'s and are far from stupid. Their job is to make sure that for every Titanium4Motion that comes by with a $10k chair there are thousands of others paying fat premiums to make it well worth their while to be in business. Insurance is a racket.

    The only for certain influence we can have on all this is to stay healthy. We wouldn't be having a "health care" crisis in this country if we didn't have a corresponding crisis of "health", in general. Back away from the buffet, America! End this ridiculous addiction to fat, sugar and salt! Take your fate back from the hands of for profit medical and insurance markets!

    Oh...sorry...my 'get your shit together, America!" tourettes fired off there...I know we are a captive audience and can't much control our need of a chair, but we can understand our contracts when we sign them so we won't be upset when we don't end up getting what we think we deserve out of an insurance company!
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  8. #18
    Senior Member canuck's Avatar
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    Can't believe the companies in the states charge above MSRP, Don't think I've ever paid MSRP always less.

  9. #19
    Quote Originally Posted by fuentejps View Post
    on mine, they are making prob 4500
    John, F this. I would rather have a caring, knowledgeable PT measure me out, print out spec sheets from manufacturer's web site and then submit to Spinlife/Sportaide(ugh) for the chair. Shit, I'd rather just slip someone a couple hundred dollars tax-free, direct rather than this.
    And the truth shall set you free.

  10. #20
    Quote Originally Posted by Notwoodward View Post
    i only know what happened in my case. i assume it's somewhat similar elsewhere. but yeah, i agree with the rest of your conclusion.
    they make monies on the misc codes and whatever they have contracted and agreed on w/ tilite. then our copay is bsed on the inflated price. still im only paying 1k, which isnt much, but to some it may be. my gripe is, i do EVERYTHING, they just bill, i never even see them.
    Bike-on.com rep
    John@bike-on.com
    c4/5 inc funtioning c6. 28 yrs post.
    sponsored handcycle racer

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