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Thread: Paperwork : So much much back and forth - just for a cushion

  1. #11
    My experience after my regular dealer went to a national company was seamless while old owner was there as Manager. But, next go around I usually got my new chair within 2 to 3 months, besides when gotten 21st Century then took longer cause they said they built per order.
    Anyway, first time after old owner left guy collected all paperwork and 3 months passed I called dealership. The guy handling it was on vacation and they knew nothing about my chair. Three weeks called back and guy was out due to sickness in family and check back in week. Then was told they had not placed order and need change chair I wanted or accept a "Demo" chair. I said "NO!" to demo.
    Then told that doctor Face-to-Face was out of date.
    That was my last dealing with them.
    Called couple other places and 2 of them even though their company names were not a national company found they were really owned by one.
    Figured not worth hassel at time cause my health was in dumps. Mama been usung a backup chair so bought her a used one off Craigslist. I still recycling my backups. Quintam Q-6 Edge the joystick quit working but picked up brand new stick on E-bay for less than a service call would been from dealer. It was plug and play (knock wood) still working.
    Mama needs new seat cushion but not sure worth dealing with any dealer or just buy new one out-of-pocket.
    I gave up!

  2. #12
    I just buy my stuff on eBay. No running around and aggravation.

  3. #13
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    Quote Originally Posted by Oddity View Post
    This is either the worst insurance ever, you've got your facts mixed up, or you're being scammed. 20% of whatever a DME wants to charge isn't a benefit worth paying for.

    (edit: The Medicare allowable amount for a new skin protecting cushion (Roho, Stimulite, etc. HCPCS E2624) is $331.37 in my region. It varies across the country but it's between ~$250-350 everywhere. Our 20% copay is ONLY 20% of this allowable charge, not 20% of whatever the DME wants to bill. ~$66 is all we should pay.)
    Yea, Rshadd got ripped off somehow.
    Also, opting for supplemental insurance is something to consider. I got the kind that has no copay or deductible for anything. $400 a month, a bit expensive. However, with a new Permobil on the way, the insurance will basically pay for it self this year because I won't have to pay 20% of a big ticket item.

  4. #14
    Quote Originally Posted by Gearhead View Post
    Yea, Rshadd got ripped off somehow.
    Also, opting for supplemental insurance is something to consider. I got the kind that has no copay or deductible for anything. $400 a month, a bit expensive. However, with a new Permobil on the way, the insurance will basically pay for it self this year because I won't have to pay 20% of a big ticket item.
    I would bet Rshadd has private insurance. They have their own rules about allowable amounts and what the co-pay applies to. If it is actually Medicare or a Medicaid plan, then yeah, might be a ripoff.
    Co-founder & CTO of MYOLYN - FES Technology for People with Paralysis - Empowering People to Move

  5. #15
    Senior Member Oddity's Avatar
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    Definitely possible but unlikely. Even with private insurance no insurance company would accept a bill for 3x a retail price. Prices are contractual obligations between payer and provider, so it's hard to imagine a payer signing a contract that allows them to be billed (and have to pay) whatever the hell a DME wants to charge.

    Quote Originally Posted by Matt Bellman View Post
    I would bet Rshadd has private insurance. They have their own rules about allowable amounts and what the co-pay applies to. If it is actually Medicare or a Medicaid plan, then yeah, might be a ripoff.
    "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

  6. #16
    Quote Originally Posted by Oddity View Post
    Definitely possible but unlikely. Even with private insurance no insurance company would accept a bill for 3x a retail price. Prices are contractual obligations between payer and provider, so it's hard to imagine a payer signing a contract that allows them to be billed (and have to pay) whatever the hell a DME wants to charge.
    Based on my experience in the DME world, that's exactly how it works. Of course, the insurance company isn't likely to pay the full amount, but, because of how convoluted the insurance industry is, the DME supplier doesn't really know how much they'll get paid, or if they'll get paid at all, by the insurer. The system is set up so there's no penalty for overbilling, but you run a high risk of leaving money on the table if you underbill, so standard operating procedure is to overbill by a large margin (I've heard DME suppliers say anything from 1.8x to 3.7x the "cash price") with the expectation that they won't get what they ask for, but they'll at least get as much as they can. And if, by some great fortune, you actually get paid what you ask for, it helps cover the losses on those times that you didn't get paid at all. This is true for the entire industry of healthcare providers, not just DME suppliers.

    This article describes the situation really well, and even though it's from the perspective of a physician and not a DME supplier, the same game is played: http://truecostofhealthcare.org/outpatient_charges/
    Co-founder & CTO of MYOLYN - FES Technology for People with Paralysis - Empowering People to Move

  7. #17
    Senior Member Oddity's Avatar
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    That's pretty scary how much that doctor/author doesn't know about how his business works. I was in the med-finance field for 15 years prior to my SCI (actuarial analysis and risk/knowledge management) so maybe I have more expertise than he does, on the payer side, but every time they claimed they have no access to information or pricing or why or when they get kick payments for capitation contracts, etc is a data/knowledge management issue on their end. I'm not going down this rabbit hole, because it's beside the point, so it'll have to suffice to say that I don't believe his ignorance is evidence of fact. That author is "doing their own billing", which is like a plumber doing his own electrical work and complaining it's complicated and doesn't make sense. Well, that's because he isn't an electrician.

    The point being, that article bears out exactly what I said. Providers can bill whatever they want but the payer won't accept it, and will only pay out based on the rates and terms in the contracts between themselves and the provider, and themselves and the patient.

    The co-pays are determined by the contract with the patient, not the provider. I've never seen a benefit plan that pegged a co-pay to 20% of whatever a provider wanted to charge. I've seen balance billing arrangements (ages ago and illegal post-ACA). I've seen 20% of allowable charges co-pays. I've seen flat fee co-pays. But I've never seen a payer provide a "benefit" with completely open ended costs to the patient based on whatever the provider wanted to charge. That's actually the opposite of insurance.
    "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

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