DMEs asking for physician notes

[49er]

After my elan cloth mask gave out that had been given to me by a friend, I realized how foolish I was for not having a backup mask that I was comfortable with. So even though I purchased a new mask from cpap.com since I needed one in a hurry, I am looking to work with a local DME to get a backup that works since insurance will provide coverage.

Let's just say I understand why they have such a bad reputation and even though I am not justifying my foolishness for not getting a mask earlier, this is why I procrastinated on doing so. However, I did narrow it down to two companies who seemed the most reasonable.

Well, after thinking I had provided the one company with the necessary information (a copy of sleep study and prescription) the woman called back wanting a copy of the physician notes during my followup visit after the sleep study. Since many DMEs had asked for this that I dealt with, I am curious why this is necessary since pharmacists don't ask for copies of doctor notes during visits when they prescribe a med.

Thanks!

49er

PS - I did ask a member services rep what the rules were for in network DMEs asking for information and he said they could do anything they wanted. But he gave me incorrect information on another issue as an FYI so he may have been totally off base.

[MarylandCPAPer]

I have been to 2 DMEs and they have never asked for physician notes after a sleep study, fortunately, because I usually don't have a physician visit to get the results of the sleep study and CPAP Rx. I have had 4 sleep studies since 2009, 2 in the last few weeks. Fortunately, my DME didn't even ask for the results of those last 2 sleep studies, as the results were worthless and a prescription based on them was also completely worthless. Fortunately, my primary care dr. was willing to write a CPAP order based on the results from the last 2 years of CPAP/ APAP data.

The DME said they would be sending my doctor a form to sign before they issued the prescribed equipment. The dr. has said in the past that the form asks something like 2 simple questions that she already answered. Perhaps the DME wants confirmation from the dr. that they actually wrote the prescription?

[49er]

I have been to 2 DMEs and they have never asked for physician notes after a sleep study, fortunately, because I usually don't have a physician visit to get the results of the sleep study and CPAP Rx. I have had 4 sleep studies since 2009, 2 in the last few weeks. Fortunately, my DME didn't even ask for the results of those last 2 sleep studies, as the results were worthless and a prescription based on them was also completely worthless. Fortunately, my primary care dr. was willing to write a CPAP order based on the results from the last 2 years of CPAP/ APAP data.

The DME said they would be sending my doctor a form to sign before they issued the prescribed equipment. The dr. has said in the past that the form asks something like 2 simple questions that she already answered. Perhaps the DME wants confirmation from the dr. that they actually wrote the prescription?

Thanks MarylandCPAPer. Glad you didn't have to put up with this BS.

Yeah, maybe the DME thought I forged the prescription. I mean, I gotta get my high somehow, you know.

49er

[MarylandCPAPer]

I practically DID have to forge my current prescription, but my primary care doctor signed it. She uses CPAP too, not sure if she is as up on things as the people on this forum are, but evidently my prescription didn't sound outlandish to her. I sent her recent printouts I got from my SD card covering the last 2 years to back up the settings I wanted, which were similar to what I have been using for the last 5 years. Two recent sleep studies were incompetently done and the sleep center prescribed a fixed pressure and a machine that is obsolete, when I use a pressure range and wanted a current CPAP machine with Autoset.

When I first started with my current DME, I think I did have to provide notes from a recent physician visit mentioning sleep apnea and CPAP use. I had to make an appt. with my primary care dr. for that purpose. I had to switch to my current DME because of a change from CareFirst insurance to Medicare. The DME wanted my initial sleep study, my initial compliance data, doctor prescription and a recent dr. visit notes. I forgot about the notes. This DME does not impress me as wanting to make any more work for themselves than necessary to get insurance/Medicare to pay, so the dr. notes may be a requirement, particularly if you are not newly diagnosed.

[49er]

I practically DID have to forge my current prescription, but my primary care doctor signed it. She uses CPAP too, not sure if she is as up on things as the people on this forum are, but evidently my prescription didn't sound outlandish to her. I sent her recent printouts I got from my SD card covering the last 2 years to back up the settings I wanted, which were similar to what I have been using for the last 5 years. Two recent sleep studies were incompetently done and the sleep center prescribed a fixed pressure and a machine that is obsolete, when I use a pressure range and wanted a current CPAP machine with Autoset.

When I first started with my current DME, I think I did have to provide notes from a recent physician visit mentioning sleep apnea and CPAP use. I had to make an appt. with my primary care dr. for that purpose. I had to switch to my current DME because of a change from CareFirst insurance to Medicare. The DME wanted my initial sleep study, my initial compliance data, doctor prescription and a recent dr. visit notes. I forgot about the notes. This DME does not impress me as wanting to make any more work for themselves than necessary to get insurance/Medicare to pay, so the dr. notes may be a requirement, particularly if you are not newly diagnosed.

Oops, I stand corrected about your being subjected to alot of BS. Yeah, one DME I contacted also wanted compliance data from my sleep physician in addition to everything else. I quit providing a card because it was quite obvious, she never seriously looked at it and it was just an exercise in frustration.

Anyway, I will see if the other DME is satisfied with just a copy of sleep study and the prescription. If they are, I will start with them. If not, I will find out the best way to get this particular DME the physician notes. Hopefully, I can get the office to fax them because the thought of making another appointment with this physician is not very appealing since it is hard for me to get to and she is always very late.

49er

[Sheriff Buford]

49er: I don't read too much into the request, though I would ask them why. Be ready for a fight. You know how them DME's can be.
So you finally found a mask you like? I've been eyeballin' that mask. What do you like about it?

Sheriff

[MarylandCPAPer]

If your physician visit is sufficiently recent and mentions your medical condition that necessitates the use of PAP equipment, a fax of the notes from the doctor's office should satisfy the DME. I hadn't been to the doctor recently enough to satisfy the DME/ Medicare, but I didn't have to go to a sleep specialist. I did need notes from a dr. appointment after the Medicare coverage started to satisfy the DME/ Medicare requirements, but the notes regarding sleep apnea and CPAP basically said that I had OSA and used CPAP, nothing detailed.

It took several weeks (maybe a month) to get set up with the DME after I started on Medicare and provided a printed copy of all the documentation they required, so it was not the fastest way of getting a mask and supplies until they submitted things for my doctor to sign and then verify Medicare coverage, if I was willing to pay out- of- pocket to someplace online. I think I needed a new mask at the time, because Breeze wasn't made any more (at least not them) and my mask headgear broke. The urgency of my need for a mask did not speed up the process of getting things set up with the DME and Medicare to actually get a new mask. Once things were set up, however, supplies were covered and easy to obtain on the schedule set by Medicare.

When I need a new mask or machine, I go to the DME's office, so if they come up with something that doesn't work for me, I can ask for whatever obscure mask I may have learned about here or elsewhere online that they would never bring with them.

Good luck finding a DME that you like. They are not all bad. I have had good experiences with two that I have dealt with over the last 5.5 years.

[49er]

Thanks, I saw sleep doc in June so hopefully, that will suffice. Yeah, I learned it isn't a good idea to ask a DME for a mask yesterday

If your physician visit is sufficiently recent and mentions your medical condition that necessitates the use of PAP equipment, a fax of the notes from the doctor's office should satisfy the DME. I hadn't been to the doctor recently enough to satisfy the DME/ Medicare, but I didn't have to go to a sleep specialist. I did need notes from a dr. appointment after the Medicare coverage started to satisfy the DME/ Medicare requirements, but the notes regarding sleep apnea and CPAP basically said that I had OSA and used CPAP, nothing detailed.

It took several weeks (maybe a month) to get set up with the DME after I started on Medicare and provided a printed copy of all the documentation they required, so it was not the fastest way of getting a mask and supplies until they submitted things for my doctor to sign and then verify Medicare coverage, if I was willing to pay out- of- pocket to someplace online. I think I needed a new mask at the time, because Breeze wasn't made any more (at least not them) and my mask headgear broke. The urgency of my need for a mask did not speed up the process of getting things set up with the DME and Medicare to actually get a new mask. Once things were set up, however, supplies were covered and easy to obtain on the schedule set by Medicare.

When I need a new mask or machine, I go to the DME's office, so if they come up with something that doesn't work for me, I can ask for whatever obscure mask I may have learned about here or elsewhere online that they would never bring with them.

Good luck finding a DME that you like. They are not all bad. I have had good experiences with two that I have dealt with over the last 5.5 years.

[Kam23]

Counting my blessing! My DME has been more than helpful, especially with masks. When I was first prescribed cpap all I needed was the prescription. No requests for doctor notes. If I need supplies I just call and they either mail them out or I stop by and pick them up.

In fact I called and requested to try a mask that was just coming out. They were thrilled for me to be the first one to try it. I basically was their test subject.

I think part of the reason I have had an overall good experience is the DME is an independent company and not part of a chain.

[49er]

Counting my blessing! My DME has been more than helpful, especially with masks. When I was first prescribed cpap all I needed was the prescription. No requests for doctor notes. If I need supplies I just call and they either mail them out or I stop by and pick them up.

In fact I called and requested to try a mask that was just coming out. They were thrilled for me to be the first one to try it. I basically was their test subject.

I think part of the reason I have had an overall good experience is the DME is an independent company and not part of a chain.

Glad you had a great experience as a newcomer since getting off to a good start is so important. The two I am still dealing with are part of local chains but hopefully, that isn't an indication of how helpful they will be.

49er

[LSAT]

HIPPA rules protect your privacy in regard to medical records. I don't believe DMEs have any right to see your records. A prescription from your physician is all that is required.

[Mynah]

DMEs asking for physician notes

Something may have happened one time where they were told they should have looked at the physician notes. So they probably wrote this into their procedure manual and training program a long time ago when it sounded like a good idea.

Now the bureaucracy keeps it alive forever, whether it makes sense or not.

"IDK, we've always done it like that."

[49er]

LSAT, I was wondering about the issue of HIPPA so thank you for articulating what I was thinking but couldn't quite put into words. As a result, I just emailed the contact who was asking for the notes and reiterated the points you made. When the office reopens on Monday, I will call to followup on this issue.

Mynah, exactly, the old we have done it for a million years excuse so we need to keep doing it.

[Krelvin]

Recently asked the DME for a new mask (for a backup) and they asked why I hadn't got anything from them since the initial machine pickup.

Told them I got filters from somewhere else and stopped using the heated hose. I still have 3 heated hoses brand new in packaging.

All they have on file is the RX. They don't have the sleep study because they don't need it. The RX has all the info they need to know.

[49er]

Recently asked the DME for a new mask (for a backup) and they asked why I hadn't got anything from them since the initial machine pickup.

Told them I got filters from somewhere else and stopped using the heated hose. I still have 3 heated hoses brand new in packaging.

All they have on file is the RX. They don't have the sleep study because they don't need it. The RX has all the info they need to know.

Agree Krelvin. But then there is reality. I can live with having to send a copy of the sleep study in addition to the prescription but I do have a problem with having to send physician notes.

The joys of DMEs.