10/06/2021    Keith L. Gurnick, DPM

DME Companies Selling on Amazon or Online (Mathew M. John, DPM)

This is a challenging question to address but it
all comes down to educating your patient in
advance and knowing in advance what their
insurance situation is. Patients do not want to
pay more money for something than they could have,
and often in situations like this they feel like
"they got ripped off" by the doctor, but this
simply is not true.

Both you and your patient have a signed contract
with the healthcare insurance company, and both
the provider and the patient are bound by the
contract. Irrespective of any deductibles or co-
insurance you should be paid by either the
insurance company or the patient the contract
allowable amount for covered services and covered
medically necessary supplies including those DME
items that you stock so you can provide them on
the spot from your office to your patients' DME
items some of which that could be ordered on-line
by the patient and received in a day or two by
delivery as well.

Would it be wrong to say to a patient up front
that you might be able to find this on line for
less money, but I feel you need it now and we have
it in stock in your size for such reason? Do we
want our injured patients to have to wait even one
or two days for a walker boot? Isn't that the main
reason we stock these products that take up so
much shelf and cabinet space in our offices for
our patients?

You might want to consider educating your patients
that the contracted fee for an item, such as a
walker boot brace includes not only the brace as a
product, but also doctor or staff time to fit the
brace, educate the patient how to apply and remove
the brace, any adjustments to the brace and also
training the patient to ambulate in the brace and
also warranty (from the manufacturer) for defects
or problems with the brace during the usual and
expected time the patient will be required to use
the product.

This education process can be reinforced by
creating a form for your patients to whom you
dispense any DME products. The form should include
what is involved in stocking and dispensing the
brace, and that some products that may be
available on the Internet (or equal, more or less
quality) could cost more or less depending on many
variables and then have the patient read and sign
the form and keep it on file. Thus, if the patient
should receive a bill from you after the insurance
processes the claim, and the patient owes you
money (either because the allowable fee was
applied to a deductible, or even when the
insurance pays a portion of the allowable) you and
the patient both have proof that the patient was
informed in advance. It is fairly easy in 2021
for a patient to price shop after the fact, but a
contract is a contract. As doctors who dispense
DME at the time of the service from our offices to
our patients, we need to be more proactive to
avoid this type of "price shopping after the fact
issue.

Keith L. Gurnick, DPM, Los Angeles, CA

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