Can I get a medical device for less?
August 13, 2013 9:02 PM Subscribe
The co-pay is still high, because the device's mark-up seems ridiculous.
I have a medical condition for which I’ve been getting my blood tested at a lab every other week. My insurance covers these visits in full. Because it’s been determined I’ll need to have these tests in perpetuity, my doctor sent an order in to my insurance company to apply for a home-testing device.
I since received a call from a rep of a manufacturer of one of these devices. She told me my insurance company approved the purchase, but I would be on the hook for a 20% co-pay. It’s a whopping $470. And that would mean the full price of one of these devices is $2,350.
I told her I’d think about it. I did some research online and found I could order one of these devices for $700-$750 from “wholesale” companies that seemed to sell direct to consumers. That price still more than the co-pay, but still, my suspicions of an extreme mark-up were confirmed.
How could I get this device for a fair price? Should I haggle with the rep? Call the insurance company and tell them what I found? Find a reasonable price ordering the product from Canada or overseas?
For the record, I don’t absolutely need this device. I could keep on going to the labs for my testing. But it would be more convenient and allow for better monitoring of my condition.
I have a medical condition for which I’ve been getting my blood tested at a lab every other week. My insurance covers these visits in full. Because it’s been determined I’ll need to have these tests in perpetuity, my doctor sent an order in to my insurance company to apply for a home-testing device.
I since received a call from a rep of a manufacturer of one of these devices. She told me my insurance company approved the purchase, but I would be on the hook for a 20% co-pay. It’s a whopping $470. And that would mean the full price of one of these devices is $2,350.
I told her I’d think about it. I did some research online and found I could order one of these devices for $700-$750 from “wholesale” companies that seemed to sell direct to consumers. That price still more than the co-pay, but still, my suspicions of an extreme mark-up were confirmed.
How could I get this device for a fair price? Should I haggle with the rep? Call the insurance company and tell them what I found? Find a reasonable price ordering the product from Canada or overseas?
For the record, I don’t absolutely need this device. I could keep on going to the labs for my testing. But it would be more convenient and allow for better monitoring of my condition.
I'd explore haggling with the rep. When it looked like I might have to purchase a device with a co-pay that exceeded $2,500, I talked to the rep and got it down to $1,500 with a payment plan.
You have my sympathies. There is nothing more frustrating and rage-inducing than dumb crap like this.
posted by sevensnowflakes at 11:27 PM on August 13, 2013
You have my sympathies. There is nothing more frustrating and rage-inducing than dumb crap like this.
posted by sevensnowflakes at 11:27 PM on August 13, 2013
Oh, someone asked something similar in the last year, but they wanted to whip something up using a Raspberry Pi or whatnot instead.
The answer is that to be covered by insurance, medical devices need to undergo thorough federal certification. I can't say what all that entails, but basically it results in a big up front sunk cost that needs to be amortized across the very few retail purchasers. There are also quality of materials and construction considerations, and unimaginably complex documentation and records retention requirements. It's not all cynical profiteering, in other words.
posted by dhartung at 12:35 AM on August 14, 2013
The answer is that to be covered by insurance, medical devices need to undergo thorough federal certification. I can't say what all that entails, but basically it results in a big up front sunk cost that needs to be amortized across the very few retail purchasers. There are also quality of materials and construction considerations, and unimaginably complex documentation and records retention requirements. It's not all cynical profiteering, in other words.
posted by dhartung at 12:35 AM on August 14, 2013
Negotiate. Explain the situation to the rep that called. You can continue to get this done for the cost of gas, but you prefer to do it at home because of the convenience and likely closer monitoring of the situation. You ask about a reasonable price. Have one in mind. Tell him. "I would agree to this if I could pay $250 in two $125 installments."
I recently had a procedure that had a 20% co-pay. The first bill I got was for 20% of list price. After telling them that was not acceptable, they billed me at 20% of the rate paid by the insurance company. Then, with a different person, I negotiated that down by about 17%.
The bottom line is there is no sale if they cannot come to agreement with you. You have a very viable alternative.
posted by JohnnyGunn at 6:41 AM on August 14, 2013 [1 favorite]
I recently had a procedure that had a 20% co-pay. The first bill I got was for 20% of list price. After telling them that was not acceptable, they billed me at 20% of the rate paid by the insurance company. Then, with a different person, I negotiated that down by about 17%.
The bottom line is there is no sale if they cannot come to agreement with you. You have a very viable alternative.
posted by JohnnyGunn at 6:41 AM on August 14, 2013 [1 favorite]
Call your insurance company and ask them for a list of approved providers of this equipment. Then price shop. When you find one you can work with, haggle with them.
posted by Ruthless Bunny at 6:57 AM on August 14, 2013
posted by Ruthless Bunny at 6:57 AM on August 14, 2013
If this is the device I think it is, they are just pricy. I think my enormous hospital system pays about $500 each for them, and we buy hundreds. Not to mention the strips which are also spendy. I don't know why they're so expensive--I think home testing is just beginning to catch on so I would expect the cost to come down the way it did for glucometers for diabetics, perhaps also due to competition from the newer meds that don't require monitoring.
posted by The Elusive Architeuthis at 10:44 AM on August 14, 2013
posted by The Elusive Architeuthis at 10:44 AM on August 14, 2013
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Do you know what the fair price is? I'm not being flippant here.
Like everything in American healthcare, you should assume that the "full price" is set like the rack rate on a hotel room: once an insurer discount is calculated along with your copay, it equals the amount the manufacturer actually wants to receive for this device. Which is, I'd guess, around $750. Of course, this creates ridiculous inefficiencies, but so it goes.
The insurer knows all about the wholesale dealers; you are not going to have the option of paying 20% of the grey market price.
posted by holgate at 9:51 PM on August 13, 2013