Classic Sleepcare DME charges

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bidd24
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Classic Sleepcare DME charges

Post by bidd24 » Thu Sep 11, 2014 5:36 am

Is anyone using Classic Sleepcare as DME? My doctor referred me to them and now they want to charge $35.00 every 3 months for service I have BCBS insurance and they are out of network. Dont know why doctor did this and just wondered if anyone else has been thru this and what options I have.

TIA
Joe

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Re: Classic Sleepcare DME charges

Post by Guest » Thu Sep 11, 2014 6:33 am

bidd24 wrote:Is anyone using Classic Sleepcare as DME? My doctor referred me to them and now they want to charge $35.00 every 3 months for service I have BCBS insurance and they are out of network. Dont know why doctor did this and just wondered if anyone else has been thru this and what options I have.

TIA
Joe
Maybe your doc doesn't know they are out-of-network or maybe he doesn't care?

But no you should not pay any membership or service fee. But they are cheaper than Costco <smile>
Contact your insurance to find out who is in network then re-direct all the paperwork.

Be sure to get copies of your sleep study and prescriptions - for yourself.

Paralel
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Re: Classic Sleepcare DME charges

Post by Paralel » Thu Sep 11, 2014 11:33 am

Stay in-network, it shouldn't be hard, most places accept BCBS. If your doc won't help you find someone in-network, tell your doc your want your Rx on paper and take it with you to where you want to do your business. Your doctor CANNOT refuse to either provide you with a paper Rx that you can take with you to whomever you wish to handle your DME needs, or transmit it electronically to the DME of your choice. If they refuse they are in violation of patient rights laws and you can take up their conduct up with the medical lic. board in your state.
Last edited by Paralel on Fri Sep 12, 2014 12:08 pm, edited 1 time in total.

JDS74
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Re: Classic Sleepcare DME charges

Post by JDS74 » Thu Sep 11, 2014 5:49 pm

Paralel is exactly correct. Another avenue is through the HIPAA mechanism regarding access to your medical records.
Both paths will lead, eventually, to permanently severing your relationship with that physician. There will be an underlying hostility and that is not good for the best treatment.

So, the best path, IMHO, is to just explain the problem and ask for copies of your prescriptions and guidance in finding an in network DME that your doctor feels comfortable with. It may be that he is just unaware.

As part of that process it will be helpful if you ask BCBS for their list of in network providers so you and your doctor have a basis for the discussion.

I had to go the HIPAA route just once, and completely severed the relationship in the process. If you like your doc, I recommend honey and not vinegar.

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Ogeo
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Re: Classic Sleepcare DME charges

Post by Ogeo » Thu Sep 11, 2014 6:21 pm

bidd24 wrote: Dont know why doctor did this and just wondered if anyone else has been thru this and what options I have.
Most doctors do not know anything about insurance and they do not do the billing. They have staff that handles that for them.

My suggestion would be to contact your insurance and find out who is in-network. Check the places out yourself and then you can then call your doctor's office and ask for the referral to be sent to a provider that is in-network with your insurance. If you want, give a list of in-network providers to your doctor's office. They will usually work with you.

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chunkyfrog
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Re: Classic Sleepcare DME charges

Post by chunkyfrog » Fri Sep 12, 2014 5:46 am

Most doctors have to be reminded that many of us do not have income comparable to theirs.
So we have to remind them.

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cathyf
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Re: Classic Sleepcare DME charges

Post by cathyf » Fri Sep 12, 2014 10:16 am

Being in the throes of this, I say that you really need to remember that the doctors don't know these details which are different for different insurance companies and plans and patients. I'm just one patient with one plan at one insurance company, and I am at the end of week number THREE in just the process of getting my prescription to a DME who is in network. (Good thing my apnea isn't severe -- I might be dead by now... ) Those of you who live in or near big cities have no idea what it is like... The town 20 miles from my house has two in-network DMEs. Except that one of them isn't really in network because they are having a big fight with the insurance company, and the other one is a data-entry error and doesn't exist. When you live in a big city it takes only a few days before a patient needs to use the information in an insurance company database, so errors get shaken out pretty quick. But in Outer Forgottenia, it can take months before anybody notices something is wrong. The town 30 miles away also has two small DMEs, one of which only carries brick APAPs and the other only carries the RemStar that was before the current RemStar model (I wonder how much dust THAT has on it?!?!)

My PA is really good about listening to the information that I tracked down and doing what I ask her to, but she is not a sleep doc, and not an insurance company expert, and I just assume that I am going to have to be the one who does the leg work. (And researching here has been SO valuable!)

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Ogeo
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Re: Classic Sleepcare DME charges

Post by Ogeo » Fri Sep 12, 2014 11:04 am

cathyf wrote: The town 20 miles from my house has two in-network DMEs.
I hear you. I have an hour & half drive one way to my nearest DME. And the sleep doctor that read all the data lives in another town another half hour away from the DME away from me. It is an all day trip to go do anything in a town large enough to have a DME. It is a good thing I'm retired. At least my DME will ship to me when I need supplies. But I wouldn't trade living in the mountains for anything at this point.

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Hubby's equipment: PR System One REMstar Auto A-Flex model 560P. Doctor's orders left it open 5-20. We changed it to 8-20 after a couple nights. Start Date was 1/30/15. Oh, mask is the new nasal pico.

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archangle
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Re: Classic Sleepcare DME charges

Post by archangle » Fri Sep 12, 2014 11:30 pm

Doctors sometimes have a "tight" relationship with one DME. This can be because the doctor thinks that they are good. He may know that all the other DME's in town are idtiots. It may just be that he finds it easier to only deal with one DME. He may have no clue that there are differences in DME's. There may be an incestuous relationship such as kickbacks or a personal friend.

Find out who's in-network and ask your doctor to send the prescription to them. See if he objects.

Definitely go in-network unless you have a good reason not to.

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chunkyfrog
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Re: Classic Sleepcare DME charges

Post by chunkyfrog » Sat Sep 13, 2014 1:45 pm

Medicare frowns on such coziness. Even if you are not a medicare patient, others are,
and if they suspect the doc is in bed with the supplier,
---hilarity could ensue.

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Re: Classic Sleepcare DME charges

Post by palerider » Sat Sep 13, 2014 1:50 pm

chunkyfrog wrote:frowns on such coziness.
speaking of coziness... don't you think you're getting a little too close to this fish?
Image

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archangle
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Re: Classic Sleepcare DME charges

Post by archangle » Sat Sep 13, 2014 3:27 pm

chunkyfrog wrote:Medicare frowns on such coziness.
I suspect there's only going to be a legal problem if it's a formal financial connection like ownership interest, which DOES happen. Or if they catch actual direct payments or discreet agreements.

I suspect most of the time, it's the good old boy network. Doctor A is friendly with Doctor B and they do each other favors. Maybe an occasional golf outing or supper with an old school chum. Or some other favors. There are probably a number of outright bribes as well, but I suspect they are pretty careful to make that hard to trace in most cases.

Sometimes Doctor A really does believe his good buddy Doctor B actually does run a good business. Sometimes, it's more sinister. How does Medicare make the distinction?

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Re: Classic Sleepcare DME charges

Post by Paralel » Sun Sep 14, 2014 8:58 am

archangle wrote:
chunkyfrog wrote:Medicare frowns on such coziness.
I suspect there's only going to be a legal problem if it's a formal financial connection like ownership interest, which DOES happen. Or if they catch actual direct payments or discreet agreements.

I suspect most of the time, it's the good old boy network. Doctor A is friendly with Doctor B and they do each other favors. Maybe an occasional golf outing or supper with an old school chum. Or some other favors. There are probably a number of outright bribes as well, but I suspect they are pretty careful to make that hard to trace in most cases.

Sometimes Doctor A really does believe his good buddy Doctor B actually does run a good business. Sometimes, it's more sinister. How does Medicare make the distinction?
What you're describing is looked upon very, very poorly by state medical ethics boards these days. Doctors have to be exceptionally careful now not to appear too "buddy buddy" with anyone.

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chunkyfrog
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Re: Classic Sleepcare DME charges

Post by chunkyfrog » Sun Sep 14, 2014 9:51 am

I would think that one or more complaints would draw their attention in the right direction.
---"hey, you guys, stop doing that"
Palerider. Get Marvin out of that fish's mouth--immediately! That's just mean!

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Re: Classic Sleepcare DME charges

Post by palerider » Sun Sep 14, 2014 1:13 pm

chunkyfrog wrote:Palerider. Get Marvin out of that fish's mouth--immediately! That's just mean!
I didn't put him in there!! the real question is, why is he taking a selfie in such a strange place!

and is that what's really meant by "a frog strangler"

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