Dealing with DMEs (& Docs)

[Dawei]

SuperSleeper, I believe your idea of creating a sticky or Wiki (something that can be easily found by new folks) with info re: what's going on with DMEs, machine brands, models, and how to deal with it all is a good one.
For what it's worth, here are some of my own thoughts and questions on this subject.
I'm trying to understand how the fixed reimbursement price for a machine supplied through Medicare (and other insurers?), regardless of which machine, goes with my recent experience in getting a switch from an S9 Elite to the AutoSet. I'm confused because it was my DME's RT who told me that it was possible for me to make this change (assuming I could supply him with a doc's Rx). I responded by saying that my Elite was now beyond the initial 30 days. He said that did not matter, as long as it was still within the initial 13 months.
Although I was happy to hear his invitation to make the change to a more expensive machine, I do not understand how/why he was telling me about how to do it if it was going to reduce his company's profit?

Paula02 and SlightlySleepy are two members who recently commented on their experiences of having DMEs trying to direct them to a Respironics machine rather than a ResMed, saying the Respironics is better or as good. Paula posted that the motive of one DME contacted was really to make a larger profit by selling the cheaper machine. No problem following that, but it still leaves a question when I recall my initial visit to a sleep doc after "passing" a first sleep study five plus years ago. There I was in his office and he told me that I do have apnea and that I need a CPAP machine. Then, he put his hand on the Respironics machine sitting on his desk and announced to me that this will be the machine I will be using. There were no alternatives, no second choices. Of course, I was new to it all and didn't know then what I've learned since. So, I used that no data M-Series for five years!
Thinking back, I wonder if there was something going on between that group of docs and Respironics' salespeople that had locked those docs in to pushing only that brand of machine.
A couple years into my use of that first machine, I was planning an overseas trip and was visiting the DME where I saw a small ResMed machine in an RT's office. I asked about it, and he happily showed it to me and told me about its features. It turned out to be an S8, which the RT let me borrow for my upcoming trip. When I returned it, he suggested that I remember the model and look for one when I upgrade. Did I like the S-8 over my own machine? Yes!
Sorry this post got so long.

[CHanlon]

Sounds to me like you have a good RT. Shame there aren't more - I went to 3 here before I found one I trusted to actually supply my machine. The first one was the one my doctor sent me to - and the one that gave me answers to my questions that contradicted things that I'd already learned from my own research. Stuff like what OHIP (in Ontario) would cover, what percentage they paid of the machine, etc. Not to mention telling me that all an autopap does is ramp up through the night, as I need more pressure... "it doesn't go down when you need less..."

Um? What?

It was about that point that I hit the directory listings for other DME's. :-p

[JumpStart]

I don't think anyone with knowledge has posted what the actual prices paid by various DMEs are for upper level PR and ResMed machines. It probably varies by company. Your DME obviously dealt with ResMed, and since the online price difference between an Elite and an Autoset is around $50, I would imagine a volume buyer would get a far smaller difference, if any at all. And most resellers (at least those without captive audiences) recognize that a happy customer is a returning customer, so that could explain the offer. As CHanlon said, it is a pity there aren't more.

[Schnauzers 5]

I am located in a large city area of Az where there are tons of senior live in places, 55+ and just a lot of seniors in general. Even more when winter comes and they come here from cold snow areas. There seems to be only ONE supplier and you get the cheapest Respironics they make...take it or leave it. I did manage to get the respironics auto but had to fight for it and at the time went thru a DME and medicare, not the usual supplier others use. Now my DME has cut ties with Res Med and I go thru this supplier and my supplies are delivered to my door when I call and if the time for new is due. I really do want a different DME doc who is willing to give me more info from my machines' memory card. I think I am one of those people who will forever be tired in the afternoon and with 5 HTP and cammomile tea ea night will never be one who gladly jumps out of bed to face a new day. If it were not for this fprum, I would never have had or known about auto set machines or different machines and what they offer, or their limitations.

[Sleepster]

Although I was happy to hear his invitation to make the change to a more expensive machine, I do not understand how/why he was telling me about how to do it if it was going to reduce his company's profit?

There are several possible explanations for this behavior.

The DME does not receive a fixed amount from the insurance company regardless of the type of machine provided. The amount received depends on several factors, especially the type of insurance you have. Not all insurance companies follow that Medicare model.

It's possible that profits can be raised by lowering profits per machine. A DME that provides only the cheapest type of machine may not make as much profit, in the long run, as a DME that provides more expensive machines. A lot of the profit is earned by providing the patient with supplies for many years, long after the initial sale of the machine itself.

Some DME's are in the business of providing quality service. Some partner with doctor's offices, and need to maintain a good reputation with their patients. Doctors talk to other doctors, and may recommend their DME to another doctor. Doctors are interested in making profits, too, and having a relationship with a good DME makes their office more efficient. There are fewer call backs from unsatisfied patients, and more recommendations from satisfied patients.