I Learned A Lesson in Health Care Costs

Long time readers of Nick’s Bytes may remember that in October of 2005 my CPAP died. There followed a living hell for me—i.e., no sleep—until, with the gracious help of others, I could afford to replace the machine. Since then, the new CPAP has worked extremely well.

Of course, things do wear out. What primarily wears out with a CPAP is the mask. I’ve been told that the mask needs to be replaced yearly. I’m not sure if that is true, because the mask I obtained with the new machine in 2005 has worked well until recently. Now it is beginning to leak air from the flexible part of it that molds itself around my nose and mouth. This has been happening for a month or two and I was really hoping to get a new mask from the Veterans Administration.

However, as with any bureaucracy, the VA moves very, very slow. For example, on September 1 a referral was made by the VA emergency room to the orthopedic clinic to deal with my still swollen leg. After numerous telephone calls in which I pushed a lot of buttons but never spoke to a human, I learned yesterday that the appointment is not set until September 17^th.

Now, I told you that to tell you this. Tuesday, after a VA clinic appointment dealing with another health issue and a visit with a clergy colleague whose church is located next to the VA clinic, I was driving home when I (thankfully) remembered that Alex was almost out of his favorite cat food. I took a short detour to Wal-Mart, where the Furball’s choice of cuisine is less expensive than anywhere else.

This was a super-dooper Wal-Mart that sold everything imaginable, including the kitchen sink. At the front of the store, across from the cash registers, were several small shops: a bank, a beauty parlor, and a medical supply shop. As I walked by the latter I notice a display of CPAP masks. A vision of sleeping without constantly awakening to readjust my leaking mask entered by mind. So, I entered the shop and ask the clerk about the masks.

The clerk was on the telephone and she told me to walk over to the display and, if I found what I wanted, to bring it back to her counter. On the display I was pleased to find a mask exactly like the one I own. It was even made by the same company and was the same size as mine. What was especially please was that this type of mask is the simplest made, the best made, and the least expensive. In my sixteen years of using a CPAP, I have tried the complex, expensive type masks and found them all to be CPAP CRAP.

Therefore I took the mask from the display and walked to the countered, waited for the clerk to finish her personal phone call, and, smiling, said, “I’ll take this one.” The clerk responded by asking for my medical prescription and I told her I had no prescription with me but I had one for a CPAP and I didn’t want to purchase the whole machine, just a replacement mask.

CLERK: “Well, I can sell it to you but I can’t bill your medical insurance without a prescription.”

Since my current mask, which I purchased from an online company in 2005 only cost $65.00, I told he that I would pay cash. And I would have—until she told me that the mask cost $147.50 plus tax!

What gives? How can a product I can by online cost over two times as much from a traditional store? Why do people pay that amount? Does no one shop around for the best price?

I rather suspect the answer to those rhetorical questions is in the words of the shop clerk: “bill your medical insurance.” As long as insurance is paying the bill, why should people shop around!

That’s what’s behind this article. I believe that it is third party payments of medical expenses that are increasing the costs for everyone. And I really don’t know what the answer is.

Regarding the replacement CPAP mask: yesterday I went online and ordered the exact same mask and brand for $42.00, including shipping. That’s $23.00 less than I paid for the same mask in 2005 and $105.00 less that she medical supplies shop is charging. The difference, of course, is that the online store does not accept third-party (insurance) payment.

Fellow Bloggers: September 27 is quickly approaching

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