This is our voice and I need help from ANY Lawmaker or Insurance company that will listen! Dear Sir/Maam: I am writing to you because of my deep concern for our economy and I think I can help.
My plan calls for immediate action since this will save our government BILLIONS each year.
Right now, the way the Durable Medical Equipment industry works is stated below.
I have eliminated all the acronyms and terms for better understanding: 1.
Patient gets a prescription for any durable medical product and they MUST take it to an accredited (this is great-new change) Medicare, private insurance or state funded company (dealer) to fill order.
2.
The company that gets prescription has to follow the guidelines and must do the appropriate steps including a CMN (Certificate of Medical Necessity) to get paid for the product that they gave to their patient.
Some products require more information and some are real easy to get paid.
3.
After submission, the company has to wait on the payment.
With some products they get paid right away for it like a Gel Mattress for a hospital bed and some they have to bill the insurance monthly over the approved time.
For instance, a hospital bed, the company puts the patient on it and they submit payment once a month for 36 months at $15.
95 per month.
With this, they have to attend to the patient and do what the guidelines are recommended.
There is a lot of flaws in this system and I really DO not see any positives about how this is done (I have been in this industry for over 10 years) except that the little "mom and pop" dealer most of the time really cares about the patient and will do what is right to make sure that the patient is getting what they want and will be doing exactly what the guidelines ask for.
I have compiled a list of the biggest problems with this plan: 1.
Government is paying way too much for these products both up front and monthly.
2.
Too much greed with the dealers and with the high overhead.
It is all about making money.
3.
Really no personal care anymore and these companies providing service puts the patient on used and cheap equipment and the patient is at the mercy of the prescription holder and has no choice what he or she gets and MANY other factors but I could literally write a book on this.
My solution is really simple and it could save our economy and government BILLIONS and there would be no tie up in cash because everything flows.
Right now with the system in place, the manufacturer fronts the product on terms and the dealer buys it on terms and then the patient gets the product for free and the dealer has to wait to get paid and does not pay bill until they receive the money and sometimes they did the paperwork wrong and so on and so on.
This causes a lot of cash flow problems (this happened on my distribution side of my business) for all the people involved.
With my plan, the money that the government would save would solve our credit crisis along with not allowing these CEOs of fortune 500 companies to make millions in bonuses and then leave or retire but this is an entirely different issue.
Please see solution: 1.
Allow the patient to submit the form that the government provides, the CMN or prescription and a receipt from buying direct either on-line or at a local dealer and then the patient waits on the reimbursement.
What happens here is the patient is liable and the patient can pick out his or her own product and the product is NEW.
Now, I agree that there should be dealers available to help, set up, choose or give advice but this is the built in cost of the sale that the dealer will profit from but these margins are way less then what they are now.
2.
Retail plan would save the government Billions how? I will give you one small example.
For instance, a COPD patient has just been diagnosed and he/she has a prescription for oxygen.
The doctor says go over to the local national dealer and give them the prescription to fill your order.
So, they go over to the dealer and the respiratory therapist sets them up on a concentrator and provides them training and does the set up in the home.
Most of the time, the patient will get some old, loud, bulky unit that is not the best solution.
Then the company will be responsible to check on the patient once a month, bring them tubing, clean filters and with that they bill the insurance $135/month for 36 months.
This is a total amount of $4860 during the 36 month term of the product.
I have factored time and money and cost if they happen to buy a new concentrator at about $3,000 plus that the government handed over to this company.
If this patient went on line or into a local showroom and purchased the unit for $620.
00, it would save the government about $2500 per concentrator.
Lets multiply that by about 100,000 concentrators a year that are funded by the government and now we are looking at a savings of $25,000,000 and there is about 5,000+ items that are being reimbursed.
Now, I agree with the local serviced company and the government could have these dealers on call to help these patients out if something happens and they need help with their retail order but it does not happen often and the company will get reimbursed by the government for a fee to take care of the issue.
But it is an hourly fee and must have proof and guidelines.
Also, the patient that cannot make the choice could be done by a loved one or whoever is put on as the caregiver.
Also, for the patient that cannot afford to buy the product via credit card can get the product purchased by the government direct.
This is a real simple and easy way to pay for medical supplies and the way that I have done this letter is in the simplest form of writing so that way the full understanding is there.
This plan is guaranteed to work and I could literally put it together in a week.
Please contact me with any questions at 602-920-8847.
I am the little guy that is for the little guy and this will be my mission in life to guarantee that the patient is covered the right way once in for all.
A very concerned American and citizen, Robert E.
Remitz