December 11, 2008
I have two sons with Duchenne Muscular Dystrophy; age 27 and 29 both have lived past their life expectancy of late teens to early twenties. Both require constant care and assistance with all daily life activities. That being said both are wonderful bright young men with outgoing personalities and great attitudes.
Both of my young men need durable medical equipment for a variety of reasons, for now I’d like to talk about David and what I’ve just discovered about DME rentals. David is on a ventilator, to be precise an LTV 950, small, lightweight, size of a lap top ventilator. David has been on a vent since December of 2002.
Recently, we have changed insurance companies, which is another story for another time. However, in changing companies, I for the first time received an itemized statement for the costs of David numerous medical support supplies. Prior to changing insurance companies the only thing I ever saw was a brief explanation of benefits stating Medical/Medical Surgical Supplies.
Now I had a description of what was being paid in a breakdown for specific items. I am only going to refer to a few of the items to provide you with a glimpse of what is happening. We are currently or I should say our insurance company, is being charged $6000.00 per month for David’s vent. My understanding is the purchase price of this machine is $50,000.00. So of course our new insurance company wanted to purchase the machine outright. Here is where it gets interesting, Aetna who was our Insurer for many years, had continued to pay rental on this piece of equipment. The explanation of the DME supplier was that Aetna did not want to pay the maintenance agreement for the piece of equipment because the cost was about the same. So Aetna just continued to rent it, as was their choice according to the DME supplier. Let’s do the math; December 02 to December 08 is 6 years or 72 months at the current rental costs of $6000.00 per month equals $432,000.00. This is part of what is wrong with our Health Care System.
First, why would Aetna continue to pay and not purchase the machine out right and then pay a reasonable fee when maintenance is needed, which by the way has not been an issue. Secondly, why would the DME supplier ever even imagine they should have this kind of a profit, off of someone else’s hardship, it’s a vent for Christ’s sake to keep a severely disabled young men breathing.
In recent conversations with the DME supplier I have learned that they plan to bill the new insurer for the ventilator all over again, or for as much as they can until the new insurer chooses to purchase the equipment. I was appalled and shocked, when I exclaimed my dismay; I was informed that this was two separate contracts with two different insurers. My reply, which would be that of any normal minded person, was that it was the same contract with the same family and the company had already charged enough for the vent to buy a nice house in the area.
In addition to the extortionately inflated price of the vent rental, there are now glaringly clear, other, over charges and erroneous charges. We have been billed for and our insurance company paid for, such items as infusion therapy and oral injectable medications, neither of which we have ever had. We have been billed for and paid for, O2 supplies for David on a sometimes next day basis when we receive O2 every other week. Finally, in terms of equipment, I believe we are being billed for an Oximeter which was originally supplied by another company; $1,000.00 per month for approximately the last 72 months equaling $72,000, this item purchased brand new is barely $1,000.00. We are also being billed for, and again they are being paid for, office visits and home health care visits all the while the rental equipment is on a rental basis and maintenence is supposed to be, according to the DME included.
I feel I am just touching the tip of the iceberg here and I have much research to do to see how far back this goes, I know there are charges of an erroneous nature back to 2006 and now I need detailed records for every year. Which I would assume won’t be easy to get.
I have more than enough to do everyday to take care of two young men who are Tetrapledgic with out having to audit my DME and Health insurer, my mistake was in trusting either of them to do what was right. We have had a very good relationship with our DME supplier they have been kind, courteous and helpful and for the kind of money they have been paid they probably should have been even more so.
If this happening to us, then this is happening to others, this cost and the waste are staggering in their proportions. Let’s stop it now. For DME providers rental for a period of a year should be suffice. After that all rental goes towards purchase; if the individual has an illness similar to my sons Duchenne Muscular Dystrophy, and the doctor has made it clear that this will be a piece of equipment for life, than all rental should go towards purchase. Electric wheelchairs are purchased at $30,000.00 plus for a 5 year period of time after age 21 and then in 5 year increments as needed and assessed for positioning comfort and control. So, why not ventilators?
Clear and concise statements should be provided to insurer and participant, not a brief EOB that is vague and obscured. Extensive penalties should be affixed for gross errors, erroneous charges, overbilling or overpaying. Penalty reimbursement should go directly to the policyholder, why you might ask, because this way you put a watchdog on both insurer and DME supplier. Policy holders for the most part will continuously audit their records, the DME and insurer won’t get a chance to make errors and misjudgments like I’ve seen, before they would be called on by policy holders who stand to gain, instead of lose by catching errors.
I have many other concerns and suggestions as do friends and acquaintances of mine in similar situations. As long as we remain a for profit based health care system we are going to continue to have sub standard care, especially for those most fragile and in need of specialized care. Why do we need any variety at all in insurance health care coverage, simply because of costs to the employer or consumer, you pay for what you get, or more likely what you can afford. Let’s all pay the same, let’s all get the same coverage, regardless of; race, creed, color, background, disability or age. I implore you to fix this system now and I pledge to help in anyway I can.
Vickie Lee Beard