Medical Billing Pachinko

I use a CPAP machine when I sleep.  I have for the past 20 years.   One thing that has always boggled me was the cost of the equipment.  One would think as something becomes more mainstream, the equipment costs would go down.  While that’s true in the case of the machines that pump and filter the air, the masks that direct the air into your nose (and mouth sometimes, depending) are still hideously expensive.  And even with medical insurance, sometimes the costs are ridiculous.

The other thing is the companies that make the masks are incredibly sneaky with the way that they bill them.  Instead of billing as one unit, they break the mask down into 3 or 4 components and then charge a good deal of money for each.  Although attributed to Aristotle, apparently he never said: “the whole is greater than the sum of its parts“.  In this instance, however, the sum of the parts of the mask are greater than if you sold the mask as a whole unit.

Last week I received a bill from the medical supply depot and it broke down the bill into several different medical id codes, which I managed to find online in a PDF that detailed the parts of the mask.  Just coincidentally, nearly identical to the information brochure that came with the mask in its commercial packaging.  Looking at the more informative one, it gave me not only a breakdown of the pieces of the mask and their respective codes, but it also showed me that on my bill (at least it looked to me) that I was charged for the whole mask and two of the respective parts of it.  I’d meant to go there this week to talk to them about it, but with the hullabaloo of what was going on with the car, I had forgotten about it.  At least until I stumbled upon the bill while looking for something else in the pile on my desk.   Seemed like the perfect time to argue my case.

I drove to the supply office and was greeted when I walked through the door.  I asked if there was someone I could speak to about a bill, and the woman who greeted me said she could help.  I laid out my case, showing her the documentation, and the itemized things I was seeing and asking her if she understood what I was getting at.  She did, though she insisted that I had been billed correctly.  She then got out the original bill (which I’d signed the receipt of) and showed me different item codes for the mask.  Sure enough, the mask was broken down into pieces on the bill and charged separately.  Even though the cost of the ‘whole’ mask was more than the cost of the other two pieces.  I still believe I was overcharged.  A facial mask that is made out of cloth, plastic, and silicone should not cost nearly $300.  At least to my mind.   My insurance only covered about $60 (due mostly to my deductible not yet being met) so the rest I had to pay for.  I paid the bill but left dissatisfied.  Not with them, but with what they had to deal with in order to bill patients that come to them.

CPAP masks and machines are huge business nowadays.  25 years ago, I had never heard of them.  But the overabundance of people being obese has ballooned the business to ever greater heights.  More and more companies are getting into the game and charging greater and greater amounts of money.  The costs of the machines is a lot less than it used to be.  The costs of the masks and other equipment involved with the machines have taken up a great amount of the slack.   I equate it to a printer and printer cartridges.  Companies sell a printer for $50-75 and then charge you an arm and a leg for the ink,  since they know you need to have the ink in order to make the printer work.  So you’re somewhat stuck unless you can find a generic seller that can copy the chip that’s used by the printer company.

Fortunately, with the mask that I’m using, the pieces are available on eBay for a LOT less than what the manufacturer charges.  Since it’s (from what I’ve heard and read) one of the most popular models used in the US, there are a good deal of sellers that will vend you the parts, and won’t break the bank.  And the mask is comfortable and doesn’t mark my forehead where the old one did, which is a great improvement.

Just another instance where the way the medical insurance business works here in the US is frustrating.  Even with insurance, it can be a toss-up on getting what you need or getting what you want to make it easier to sleep or live.