Durable medical equipment is a term used for "hardware" that is used to treat medical conditions or make life easier. These can be anything from wheelchairs to oxygen tanks to insulin pumps to crutches. I recently got a CPAP machine to help me with sleep apnea so I will use that as a specific example. There have been studies that suggest that sleep apnea contributes to high blood pressure and obesity - and the insurance company saves if they are under control. At the very least, not getting a good nights sleep does adversely effect how someone functions during the day.
My insurance plan, which is a bit lame in the durable medical equipment department, I'll call "Plan A". My boyfriend's plan is more generous in this department, I'll call it "Plan B".
Plan A: Start up - $200 (included a humidifier not covered by my insurance), then 4 months of rental at about $50 per month. Then supposedly the machine is mine, since I have been a good "compliant" (medical speak for follows the doctor's orders) girl. That is for a total of about $400. Supposedly that is 50% of what the medical supply company charges my insurance (more on that later), but the breakdown is a bit complicated so I am not exactly sure how much the machine actually costs. Plan A provided the initial extra supplies, such as hosing, the mask and filters, but from now on they are my expense. For example, the medical supply company my doctor sent me to charges about $100 for a mask.
Plan B: Covers everything, as long as the patient is "compliant". When I say everything, I mean everything - machine, humidifier, masks, tubing, filters. Plan sends a new mask, tubing and filters every 6 months as needed. Not sure how much my model would have cost Plan B insurance, but the fact is they would likely cover it.
On-line: I looked up the cost of my machine on-line. Same machine that was paid for in the discussion under Plan A. Machine plus humidifier costs about $500. This is only $100 more than I forked out under Plan A and I have to kiss their asses and demonstrate "compliance". The same mask that I have from this on-line supplier is about $75 and since I am on my own in getting masks, I will opt to buy on-line and save $25 over the local supplier.
Walk-in to local supplier: While I was at the local medical supply store having the electronic card from my machine read (to show "compliance"), I asked the question: "How much would this machine be if I didn't go through insurance?" Easy enough question I thought, but it was not. It seemed like my insurance company negotiated a price of $500 for the machine itself. It also seemed like other insurance companies have negotiated their own prices. The representative could not really answer my question. Her best answer was whatever they bill Medicare - which $1200! To make it even more infuriating, she indicated that Medicare doesn't reimburse anywhere near that much.
Does that seem fair to anyone? The uninsured, who tend to be the self-employed and/or low-wage earners, get screwed by paying higher rates because the big insurance companies "negotiate" lower rates.
Also, what is the "price" of the services of the local supplier provider? I roughly estimate that Plan A paid about $200 for my machine. Add that to my $400 and we have about $600 for the machine and humidifier. Since I can get the exact same machine with the humidifier for about $500, the local supplier essentially gets $100 more than the same product can be purchased elsewhere. What services did I get? I went to their office to select a mask and try it out. Then I was shown how to operate the machine (which is not complicated). Valuable services, but it may have been about a half hour of face time for $100 - not a bad gig in my opinion.
Medical insurance and what it covers is all over the place. Using this as only and example - Is it any wonder why the uninsured can't pay for their own care?