Sleep Dr refuses to give me RX

[Frustrated in Knoxville TN]

Had sleep study 9 days ago, was sent home with a cpap machine (resmed elite ll with humidifier thing). When I learned that I would have to pay $140 per month for ten months for this machine, I called my sleep dr's office to get a copy of my rx so I could get my machine elsewhere. They told me that it is against their policy to give me a written rx and that they don't approve of buying the machine on the internet and will not provide me with a copy for that reason. Insurance isn't the issue, I have a high deductible so just want to buy the machine and go on and if my insurance co reimburses me at all great, if not-i dont care.
Ironically, I was so impressed with the sleep center that I referred my dad and my son...they have appts next week, will seek another place for them if this isnt' resolved promptly as both of them would want to just buy the machine outright as well.

[BlackSpinner]

In the US what they are saying is illegal. Do a search here and you will find the references to HEPA and your right to your records.

[Cygnusia]

According to the HIPAA, you have every right to your own prescription. You should demand that either he gives you a written prescription or you will report him to the regulatory boards for violating the HIPAA regulations. It doesn't matter what they approve or don't approve of... what matters is that you get the necessary equipment... regardless of the source.

[sunrunnerdave]

cough search sites such as l-bay and johnies list . slight miss spellings

[Kiralynx]

Considering that you can get the machine they handed you for around the price of 3 months' co-pay, maybe four, from our hosts, I can see why you might want to get the machine from CPAP.COM.

Does your doctor have an interest in the DME which provided your current machine? That might explain their unwillingness to let you go elsewhere.

My doctor's office staff tried to deny me a copy of my prescription, saying it wasn't their policy. I asked, "Why not?"

And they said, "Because you can't."

Now, as it happens, my doctor had given me a written copy of the prescription, which was later revised. (I wanted a copy of the revised prescription.) So I said, "I already have the original in my pocket. Why can't I have a copy of the revised one?" At which point, they gave me a copy.

In your case, you might tell them, very politely, that your prescription is a part of your medical records, and that therefore, you want a copy of it for your records. It would also be worthwhile to get copies of your sleep studies.

What you're after includes:

1. the doctor's dictated results (1-2 pages each)

2. the full scored data summary report w/condensed graphs (5+ pages each) from both your in-lab sleep evaulation PSG "and" your in-lab CPAP titration PSG "

3. a copy of your equipment order (prescription)

These are part of your medical records, and you are entitled, in the U.S. to copies of them. If they refuse a verbal request, then send them a letter making the request, and retain a copy of your letter for your records.

If they refuse the written request, then write another letter. Tell your doctor that you will report him/her to the regulatory boards for violating HIPAA regulations. It doesn't matter what they approve or don't approve of. Most likely, what they don't approve of is the loss of their income if you going elsewhere. There is no reason why you should pay double or triple the cost in co-payments alone. What matters is that you get the necessary equipment. The source doesn't matter.

[harry33]

perhaps yopu could get a lawyer to write them a letter

[GumbyCT]

Had sleep study 9 days ago, was sent home with a cpap machine (resmed elite ll with humidifier thing). When I learned that I would have to pay $140 per month for ten months for this machine, I called my sleep dr's office to get a copy of my rx so I could get my machine elsewhere. They told me that it is against their policy to give me a written rx and that they don't approve of buying the machine on the internet and will not provide me with a copy for that reason. Insurance isn't the issue, I have a high deductible so just want to buy the machine and go on and if my insurance co reimburses me at all great, if not-i dont care.
Ironically, I was so impressed with the sleep center that I referred my dad and my son...they have appts next week, will seek another place for them if this isnt' resolved promptly as both of them would want to just buy the machine outright as well.

Certainly you should have them cancel immediately or they WILL face the same problems.

You should also request a copy of your sleep study too. Educate yourself by searching and reading the posts here about problems DME's and HIPPA.

Some are listed below -

According to the HIPAA, you have every right to your own prescription. You should demand that either he gives you a written prescription or you will report him to the regulatory boards for violating the HIPAA regulations. It doesn't matter what they approve or don't approve of... what matters is that you get the necessary equipment... regardless of the source.

Use this Advanced Search found at the top of each forum page - right under the Home icon search.php

This is worth repeating -
viewtopic.php?f=1&t=45976&p=412376&hilit=hippa#p412376

I called my doctor's office yesterday to ask that they fax my rx to cpap.com and also prepare a paper one for me to have. They called this morning to say the dr. is off until next Tuesday, so they couldn't fax my rx until then. I guess I can't do anything about that, although there is another sleep dr. in the office who could sign it if they really wanted to help me. I then asked her about a paper rx written for me for a machine and mask that I could have on hand in case something else came up when I needed it. She hesitated, then said he'd probably give me one for a mask, but not for a machine. I said why not, and she replied that I only get one machine every five years. I said I know that's insurance policy, but what if I want to get an extra one. She said, well, the dr. wants to see you every year anyway, so you could talk to him then about it. My year will be up next May. I got kind of ticked off and said, "Well, it's my prescription. Don't I have a right to it?" She said no. I asked why. She said it's against the rules. I said I don't think that's the law. She said, well, it's their policy.

What are my rights?

Irene

Certainly YOU do have a right to anything in your records also. It is a stall to say the doc wasn't in - he has already written the script and it IS part of your records. You can also get it from the DME.

As mentioned this tactic is used so you don't spend your money any place but with them and who they choose for you. It is ALL about control.

Remember when a doc gave you a prescription (in your hand) to take to the pharmacy of your choice?
This should be handled the same way. Except many have seen this as a money mill control feature.

"Well, it's my prescription. Don't I have a right to it?" She said no. I asked why. She said it's against the rules.

Many providers want you to believe that HIPPA is to protect you from You - Not so.

1st you need to contact the licensing authority in your state, talk to them to find out what they suggest you do and follow their advise. Generally that is part of the Health Dept. in your state. They have to be licensed in your state, not town or city. Some states have an online search feature so you can stay clear from those with problems.

They will likely tell you to hand deliver a written request and let the staff know what you found out. That should get you everything you want.

If you don't know how to contact the licensing authority - contact the Attorney General for your state and follow their advise. Too many times people let this pass and then this happens again to the next person. Filing a complaint will document this problem and if it continues will be resolved correctly.

What does the HIPAA Privacy Rule do?
For patients – it means being able to make informed choices when seeking care and reimbursement for care based on how personal health information may be used.

*It enables patients to find out how their information may be used, and about certain disclosures of their information that have been made.

*It generally limits release of information to the minimum reasonably needed for the purpose of the disclosure.

*It generally gives patients the right to examine and obtain a copy of their own health records and request corrections.

*It empowers individuals to control certain uses and disclosures of their health information.
More here - http://www.hhs.gov/ocr/privacy/hipaa/faq/about/187.html

If patients request copies of their medical records as permitted by the Privacy Rule, are they required to pay for the copies?
http://www.hhs.gov/ocr/privacy/hipaa/fa ... e/353.html

How To File a Complaint
http://www.hhs.gov/ocr/privacy/hipaa/co ... index.html

HIPAA - Frequently Asked Questions
http://www.hhs.gov/ocr/privacy/hipaa/faq/index.html

Good Luck and do keep us posted as to how you make out.

viewtopic.php?f=1&t=45976&p=412376&hilit=hippa#p412376

[Wulfman]

Looks like everybody else was writing responses while I was searching, too.

Anyway, as has been stated, the doctor is violating Federal HIPPA laws. Here's some more links to review.

http://www.privacyrights.org/fs/fs8-med.htm

http://www.privacyrights.org/fs/fs8a-hipaa.htm


Prescriptions for CPAP are no different than eyeglass prescriptions.
From:

http://ezinearticles.com/?Understanding ... &id=473762

"Did you know that you have a legal right to obtain your eyeglass prescription from your eyecare professional? That's right. Request your prescription at the time of your eye examination or request it later, it's your right."

http://www.contactlensesonline.us/is-my ... valid.html

PS It sounds like either your doctor IS the DME (a conflict of interest) or has his fingers in the local DME businesses (same difference).


Den

[jweeks]

perhaps yopu could get a lawyer to write them a letter

Hi,

I'd consider going one better...file suit in small claims court and sue for your money back. The outcome of the service is the prescription, and if you don't get it, you are not getting the service that you paid for (or are being billed for). I'd spend the filing fee just to get a measure of revenge.

-john-

[rested gal]

The others are telling you right, Frustrated in Knoxville TN. You have a right to a copy of your Rx.

If a person wants to take a non-confrontational approach to getting that copy, I think a good way to ask for it is this:

"I'd like to have a copy of my CPAP prescription so I can have the Rx with me when I travel. If my machine breaks when I'm out of town, it might be easier to get a replacement or loaner if I can show my prescription to an out-of-town DME."

If you'll register on this forum, you can send and receive Private Messages. I live in East Tennessee. I'd like to be able to PM you some suggestions.

[snoregirl]

This kind of attitude is typical of doctors and hospitals in general. About 10 years ago I was told by a hospital that I could not have a copy of the xray of my leg. Of course I knew better and refused to leave without it. Once they understood that I KNEW that it was my right, they caved in a hurry. The problem as I see it is much worse when a person doesn't know their rights and his and haws when asking.

[greyhound]

I agree with the other posters who say that you have every right to your cpap perscription. However, it might be faster if you just asked your primary physician to write a perscription for you.

[Slinky]

Well, I am a crochety ole broad who detests these control freak doctors. So, for my health - and for spite - I would do TWO things.

1] For my health I would ask my family doctor to write the script for CPAP at xx pressure w/xx expiration pressure relief, heated humidifier and full face, nasal cushion or nasal pillows mask of patient's choice. Nice and generic and will allow for purchasing the Elite II (which is a great, fully data capable CPAP) or any brand and model CPAP or APAP you want when purchasing from an online CPAP supplier.

2] I would send a WRITTEN REQUEST for a copy of 1] the doctor's dictated results (1-2 pages each), 2] the full scored data summary report w/condensed graphs (also sometimes called the full disclosure report) (5+ pages) each for BOTH my in-lab sleep evaluation AND my in-lab CPAP titration, plus 3] my equipment order (prescription) AND I would send that dated, WRITTEN request via CERTIFIED MAIL, RETURN RECEIPT REQUESTED. Keep a copy of the WRITTEN request and the proof of certification including the green return receipt when it arrives. To speed up the process I would cc to your state licensing board, to the accrediting agency if this sleep doctor and lab are accredited, and to HIPAA.

When the sheister sees those cc notations on your letter he/they get the drift you mean business and know your rights. Be sure to send those copies to the mentioned organizations as well. The sleep lab/doctor have 30 days to comply.

It won't take much online searching to find your state's licensing board, the accrediting organization and just where to send a HIPAA complaint. If they haven't complied w/in 30 days then be sure to follow thru and follow the rest of the formal complaint process. Don't let this sheister get away w/this!!!!

3] Have both your son and your father call or better yet write if there is sufficient time to cancel their appointments AND BE SURE THAT THEY SAY WHY THEY ARE CANCELLING!!!!

I LOVE the chance to deal them a DOUBLE WHAMMY - the loss of two sleep evaluations and possibly two titrations PLUS possible problems w/official organizations!!!! Don't get angry, GET EVEN!!!

[carbonman]

Well, I am a crochety ole broad who detests these control freak doctors.
Don't get angry, GET EVEN!!!

.....wow....I love it when you talk dirty.

[falvesjr]

Ouch! I wouldn't want to be on the receiving end of your stick, Slinky!