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hn7609

Distinguished member
Joined
Sep 7, 2011
Messages
121
Reason
PALS
Diagnosis
08/2011
Country
US
State
Virginia
City
Moseley
At my last clinic visit the Dr. wrote a prescription for my feeding tube supplies and set me up with the provider that they use. My first delivery came a few weeks ago and consisted of 5 cases of osmolite 1.5 as well as a box of 100 drain sponges. Today I received my explanation of benefits statement from Anthem and I just about fell out of my chair. The provider charged Anthem a bit over $1900.00 for these supplies and Anthem paid them a bit over $900. The letter states that I may be responsible for$225. Knowing what I was paying for Boost plus I just couldn’t believe the amount that they were billing my insurance for. A quick search on Amazon shows a price per case for the Osmolite 1.5 to be $38.18 including delivery, a box of sponges can be had for $8.00. How can the provider charge these prices and get away with it? They are gouging the hell out of my insurance company. Why would Anthem put up with this?
 
Oh, it i show insurance works, why premiums are so high, and why we choose to purchase certain things outside of insurance especially at the end of the year with no benefit to you. If it gets you thru your deductible and coinsurance so things are free, sometimes you just have to but...if not we go outside. If you are goin gto order it from.amazon, think about being a.prime member. Shipping is.free and fast..2 days I believe.
 
The medical supply industry in general is full of greedy bastids(trust me you don't want to know what I really think).
They inflate items 2-3 times before billing the insurance..leaving the patient holding the balance often unless they have real good ins.
Example: my first Cpap unit sold for 895.00 online, one of the local med suppliers priced it at 2695.00, Blue Cross would only pay about 1695.00, leaving me with the balance. I demanded a discount and the gave me about 20% off.
I have had similar experiences with several med suppliers and they are all the same.:evil:
 
I work at a hospital as a switchboard operator. For a short time they had me enter charges in the computer for the billing office. If you didn't bring your own toothbrush you got a $12.00 charge. It was unbelievable.
 
Gooseberry is right -- it is often cheaper to buy online yourself. Check prices on everything before ordering it through insurance. In answer to the question of why MCOs "put up with it," they don't have any legal authority to demand that DMEs charge less and the whole MCO/DME thing is nod/wink anyway. DMEs have to rob a bank before anyone prosecutes them for fraud, instances of which I've seen numerous times. Payors can reimburse for less, but you wouldn't like that, either. You saw the fallout when Medicare tried to institute some competitive bidding (putting price before product) instead of looking at root causes.

Ultimately, all but the biggest ticket items are going to move from the DME setting to where many of us already buy them, from Craigslist to small DMEs on Amazon to large warehouse players. The manufacturers are trying to limit new product distribution to DMEs so they can keep prices up, but it won't work forever with so many used items in play and the boomers (who know how to shop on line) aging. Stupid federal regulations on "prescription item" resale also constrain the free market. Stay tuned.
 
I have a question. Could I order my Osmolite from Amazon and then file the claim myself? I have the prescription for the Osmolite.
 
The only thing about Amazon and DME is the service. I do not think that Amazon will deliver a new mattress or Kangaroo pump at 2AM when it fails. Our provider is great and is on-call 24/7.
 
True, Gil, though for Prime members, one-day delivery is possible for extra for many items and 2 days is the norm. And the items we are talking about should not fail at 2 am. But certainly, I take your point about fixing a pump!

Tracy, depends if your plan has a closed network for med supplies. Check your plan. Some of the online suppliers that also sell on Amazon are more likely to be accepted if you get an invoice via their non-Amazon site.
 
> leaving me with the balance. I demanded a discount and the gave me about 20% off.
I have had similar experiences with several med suppliers and they are all the same

>The medical supply industry in general is full of greedy bastids


Ditto that!
 
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