My prescription clusterf**ck; DME doesn't take my insurance.

[JV1967]

So, I called the doctor's office to find out who my DME is, and the secretary said "Oh, don't worry, they'll call you." I decided to call the DME, to see what's going on, and to ask a few questions, as I'm new to all of this. I found out that the DME they sent me to doesn't accept my insurance, so now the rep has to call the doctor's office back and tell them to send me elsewhere. Meanwhile, the secretaries at the doc's office aren't exactly great about picking up the phone, so the wait... and I have very good health insurance (Blue Cross) in the state I live in. The DME they sent me to is one state over. Is it common for this to happen when the DME is not in your state? Thankfully the rep there was nice to me on the phone. It eased some stress.

I've been through some heavy medical drama, sans this apnea problem, so this is frustrating me more. I'm eager to get started on my therapy; as soon as possible, because I want to get well. I hope they get this sorted so I can get my ASV, and get on with learning it, adapting to it, etc...

[Huh?]

Get a copy of your prescription from the doctor (you should keep one in your records anyway) and use whatever DME you want. You don't need a damn doctor's referral to a DME.

[squid13]

Call your insurance company and find out what DME's you can use locally and get a copy of your prescription and pick the DME of your choice. You don't have to use the one the Doctor picks. Call them and find out which one is the best for you and, also get a copy of your sleep test.

[Wulfman...]

So, I called the doctor's office to find out who my DME is, and the secretary said "Oh, don't worry, they'll call you." I decided to call the DME, to see what's going on, and to ask a few questions, as I'm new to all of this. I found out that the DME they sent me to doesn't accept my insurance, so now the rep has to call the doctor's office back and tell them to send me elsewhere. Meanwhile, the secretaries at the doc's office aren't exactly great about picking up the phone, so the wait... and I have very good health insurance (Blue Cross) in the state I live in. The DME they sent me to is one state over. Is it common for this to happen when the DME is not in your state? Thankfully the rep there was nice to me on the phone. It eased some stress.

I've been through some heavy medical drama, sans this apnea problem, so this is frustrating me more. I'm eager to get started on my therapy; as soon as possible, because I want to get well. I hope they get this sorted so I can get my ASV, and get on with learning it, adapting to it, etc...

It should have been your responsibility to check with your insurance provider to see which entities ARE in your "in-network" coverage.
I can't tell you how many times I've seen this happen on the forum.......doctor sends the Rx to their preferred provider and that one isn't in the insurance network.

Live and learn.


Den

.

[JV1967]

So, I called the doctor's office to find out who my DME is, and the secretary said "Oh, don't worry, they'll call you." I decided to call the DME, to see what's going on, and to ask a few questions, as I'm new to all of this. I found out that the DME they sent me to doesn't accept my insurance, so now the rep has to call the doctor's office back and tell them to send me elsewhere. Meanwhile, the secretaries at the doc's office aren't exactly great about picking up the phone, so the wait... and I have very good health insurance (Blue Cross) in the state I live in. The DME they sent me to is one state over. Is it common for this to happen when the DME is not in your state? Thankfully the rep there was nice to me on the phone. It eased some stress.

I've been through some heavy medical drama, sans this apnea problem, so this is frustrating me more. I'm eager to get started on my therapy; as soon as possible, because I want to get well. I hope they get this sorted so I can get my ASV, and get on with learning it, adapting to it, etc...

It should have been your responsibility to check with your insurance provider to see which entities ARE in your "in-network" coverage.
I can't tell you how many times I've seen this happen on the forum.......doctor sends the Rx to their preferred provider and that one isn't in the insurance network.

Live and learn.


Den

.

I'm completely new to all of this, so that's why this happened. I have them sending me my sleep lab report, and I will ask for a copy of my prescription today. Thank you for responding. No one at the doctor's office told me I could do it myself.

[JV1967]

Call your insurance company and find out what DME's you can use locally and get a copy of your prescription and pick the DME of your choice. You don't have to use the one the Doctor picks. Call them and find out which one is the best for you and, also get a copy of your sleep test.

The sleep test is in the mail, and I am going to ask them for a copy of my prescription. I'm totally new to all of this. Thank you for responding. I'm extremely glad you and everyone else on this site is here. It's a huge help, and I appreciate it. Thank you.

[JV1967]

Get a copy of your prescription from the doctor (you should keep one in your records anyway) and use whatever DME you want. You don't need a damn doctor's referral to a DME.

Will do, and thank you. Please forgive me, as I am a total noob at this.

[Wulfman...]

I'm completely new to all of this, so that's why this happened. I have them sending me my sleep lab report, and I will ask for a copy of my prescription today. Thank you for responding. No one at the doctor's office told me I could do it myself.

That's why I said "Live and learn". We were all new at this when we went through it. Hang in there. Get the physical copy of your Rx, check with online suppliers, the local DMEs and do the math. Sometimes it's cheaper to go out-of-pocket or some combination, depending on the person's coverage, deductibles, co-pays, etc.


Den

.

[Huh?]

Get a copy of your prescription from the doctor (you should keep one in your records anyway) and use whatever DME you want. You don't need a damn doctor's referral to a DME.

Will do, and thank you. Please forgive me, as I am a total noob at this.

No need to apologize. Most of us started out in your position. The medical professions treats patients like a farmer treats his mushrooms - throw manure on them and keep them in the dark.

Well, not most doctors, but enough of them to make me cynical some days.

[JV1967]

Is a faxed prescription still valid? I could ask them to fax it to me so I don't have to wait for the mail.

[JV1967]

Get a copy of your prescription from the doctor (you should keep one in your records anyway) and use whatever DME you want. You don't need a damn doctor's referral to a DME.

Will do, and thank you. Please forgive me, as I am a total noob at this.

No need to apologize. Most of us started out in your position. The medical professions treats patients like a farmer treats his mushrooms - throw manure on them and keep them in the dark.

Well, not most doctors, but enough of them to make me cynical some days.

Unfortunately, I've been treated that way by more than a few doctors. One of the cardiologists I went to see, yelled at me on the phone for asking him a question I thought was important. I immediately switched doctors.

[Drowsy Dancer]

Is a faxed prescription still valid? I could ask them to fax it to me so I don't have to wait for the mail.

Check with the DME you select.

We really have a very confusing health care system in this country.

[msla]

Is a faxed prescription still valid? I could ask them to fax it to me so I don't have to wait for the mail.

Get both for your files. Then send a copy of one to the hosts of this forum, CPAP dot com. You can then print out a copy wherever you have internet access, for example if you need a part in an emergency while on a trip (at least in the US)

[Wulfman...]

Is a faxed prescription still valid? I could ask them to fax it to me so I don't have to wait for the mail.

Should be. But, I'd still ask for an "original" to stick in my files (which is what I did).
In my case, I also scanned and uploaded my prescription to CPAP.COM so I could order all of my original equipment and supplies from them......then, I used their invoice to create my own and then billed my insurance provider for my equipment. They considered me to be "in-network", so they reimbursed me for 80% of my purchase. I did clear this with them ahead of time, but was also prepared to fully pay out-of-pocket if necessary. I was bound and determined not to have to use a local DME (I had already read too many horror stories on this forum by then).


Den

.

[novatom]

So, I called the doctor's office to find out who my DME is, and the secretary said "Oh, don't worry, they'll call you." I decided to call the DME, to see what's going on, and to ask a few questions, as I'm new to all of this. I found out that the DME they sent me to doesn't accept my insurance, so now the rep has to call the doctor's office back and tell them to send me elsewhere. Meanwhile, the secretaries at the doc's office aren't exactly great about picking up the phone, so the wait... and I have very good health insurance (Blue Cross) in the state I live in. The DME they sent me to is one state over. Is it common for this to happen when the DME is not in your state? Thankfully the rep there was nice to me on the phone. It eased some stress.

I've been through some heavy medical drama, sans this apnea problem, so this is frustrating me more. I'm eager to get started on my therapy; as soon as possible, because I want to get well. I hope they get this sorted so I can get my ASV, and get on with learning it, adapting to it, etc...

I had a similar same problem initially. About a month ago I called my insurance company to check on coverage (this was after almost two months of therapy, sleep study, titration) to find out that the clinic (which is also my DME) was NOT a preferred provider for my insurance. I nearly freaked out until they informed me that the doctor that contracts with the sleep clinic IS a preferred provider in my network. All they had to do was resubmit the paperwork, which has since been accepted.