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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Pugsy
 
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Re: Surviving DME with Medicare

Postby Pugsy on Wed Apr 05, 2017 10:38 am

Guest wrote:Your actions show what you don't say.


Sorry you feel that way. You are wrong but certainly entitled to believe whatever you wish.

If I attributed something someone else said to you...my apologies.
I went back and edited my response to say it was AirPump that I was referring to.

Get over it and move on. That's what I am going to do.

_________________
Machine: AirCurve™ 10 S BiLevel Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Actually using the AirCurve 10 ST but using it in S mode...have the S9 Adapt for backup right now.

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Comfortably Numb
 
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Re: Surviving DME with Medicare

Postby Comfortably Numb on Mon Apr 10, 2017 9:40 am

My follow-up doctor's appointment is tomorrow at which time I will get a copy of my sleep study and my RX. I just called the DME that I would prefer to business with to see if an appointment is required. She said that my doctor typically sends his orders directly to the DME and then they run everything through insurance before scheduling an appointment. I told her that I may want to visit as many as 5 DME's--would my doctor need to send an order to all of them!!? She said that might send up a red flag with Medicare if several DME's were contacting them about me simultaneously. I smelled BS. After a few minutes of discussion, I got the impression that I wouldn't have any trouble getting exactly what I want (I told her in great detail). But I still don't like the idea of my doctor sending an order to "the DME of my choice." Why not just give me the order and RX and let me hit the streets? I don't want to have to return to him for a new order every time I get pissed off. Maybe I'm just overreacting in advance, but this is a new glitch that I think I should be prepared for. Any thoughts?

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chunkyfrog
 
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Re: Surviving DME with Medicare

Postby chunkyfrog on Mon Apr 10, 2017 9:47 am

Stick to your guns. There is no excuse for the closed corridor between doctor and DME.
To me it suggests collusion--something Medicare does not tolerate.
CPAP is not a controlled substance (like narcotics), as long as you pay for the extras yourself.

_________________
Machine: AirSense™ 10 AutoSet™ For Her CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Backup: Devillbiss Intellipap Autoadjust
Link to medicare suppliers, by zip code: https://www.medicare.gov/supplierdirectory/search.html

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Pugsy
 
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Re: Surviving DME with Medicare

Postby Pugsy on Mon Apr 10, 2017 9:51 am

Tell your doctor you haven't decided who will get your business yet.
Tell him you want to just hand carry the RX to the DME when you interview them to see if you want to do business with them.

_________________
Machine: AirCurve™ 10 S BiLevel Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Actually using the AirCurve 10 ST but using it in S mode...have the S9 Adapt for backup right now.

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Hang Fire
 
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Re: Surviving DME with Medicare

Postby Hang Fire on Mon Apr 10, 2017 1:44 pm

Comfortably Numb wrote:Maybe I'm just overreacting in advance

Yes, you are.


Comfortably Numb wrote: I told her that I may want to visit as many as 5 DME's

This is a ridiculous and unnecessary way for you to do business. You remind me of a person shopping for a car the wrong way. They go to five dealers. After the fifth one, they realize the first one had the best deal. Now they go back, totally fatigued. The salesman senses this and takes advantage of them. They don't figure it out until they have driven the car for a week.


Comfortably Numb wrote:After a few minutes of discussion, I got the impression that I wouldn't have any trouble getting exactly what I want (I told her in great detail).

Well, there you go. You have conducted a telephone interview and found what seems to be a good supplier. Let the doc's office send them an order and a copy of the Rx. It's not really a contract that commits you to anything. Make sure you get a copy of your Rx. If you don't need it right away, you may want it later to buy masks or a backup machine.

What is your diagnosis? Which model machine are you getting?

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Re: Surviving DME with Medicare

Postby Guest on Mon Apr 10, 2017 2:40 pm

Comfortably Numb wrote:She said that my doctor typically sends his orders directly to the DME and then they run everything through insurance before scheduling an appointment.
I can tell you from personal experience that even when you bring a copy of the Dr's Order to the DME they will then contact the Dr directly and have them fax a copy directly to them. It is some kind of protocol prob to reduce fraud or something. Should you go to another DME just have them contact your Dr.

Comfortably Numb wrote:She said that might send up a red flag with Medicare if several DME's were contacting them about me simultaneously.
Now that is BS IMO and intended to spook people who don't know. But the DME will have to contact Medicare to make sure you are covered and didn't get one last week or last month so Medicare will not send up flag of any color. Not to worry.

Comfortably Numb wrote: I don't want to have to return to him for a new order every time I get pissed off.
Not much else you can do just roll with it.

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Re: Surviving DME with Medicare

Postby Guest on Mon Apr 10, 2017 2:45 pm

For some reason someone didn't want you to see this so Spam Deleted it...
Guest wrote:Some additional thoughts... Should you strike out with all of the Medicare providers and need to pay OOP. Cpap dot com is certainly a good choice. There is also Craigslist, check under health and beauty, or Amazon but you will need to know not only exactly what make/model you want but the reasonable pricing for that model. Esp. when some think they can get what DME's bill insurance.

For online suppliers there is also Verus Healthcare who is a Medicare supplier so you can get supplies from them but I don't think they can bill Medicare for a cpap bc Medicare does require an RT come to the house and set up your equipment. But once you are established and no longer need an RT you can get supplies mailed to the house, which I find very helpful and time saving.

It was posted immediately after this...
by Guest on Wed Apr 05, 2017 6:36 pm
Pugsy wrote:
Guest wrote:Your actions show what you don't say.


Sorry you feel that way. You are wrong but certainly entitled to believe whatever you wish.

If I attributed something someone else said to you...my apologies.
I went back and edited my response to say it was AirPump that I was referring to.

Get over it and move on. That's what I am going to do.

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chunkyfrog
 
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Re: Surviving DME with Medicare

Postby chunkyfrog on Mon Apr 10, 2017 8:11 pm

Medicare DOES NOT require an RT to visit your home.
Walk in service is available for those who ask for it.
Even at Apria. I saw someone pick up their brick when I was there. (I was SO tempted . . . )
I suspect a home visit is billable for more money, so they push it.

_________________
Machine: AirSense™ 10 AutoSet™ For Her CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Backup: Devillbiss Intellipap Autoadjust
Link to medicare suppliers, by zip code: https://www.medicare.gov/supplierdirectory/search.html

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Re: Surviving DME with Medicare

Postby Guest on Mon Apr 10, 2017 9:02 pm

chunkyfrog wrote:Medicare DOES NOT require an RT to visit your home.
Walk in service is available for those who ask for it.
Even at Apria. I saw someone pick up their brick when I was there. (I was SO tempted . . . )
I suspect a home visit is billable for more money, so they push it.

Maybe when you got your cpap they didn't have to. If you ask Apria they will say no.

I had to pick up mine too. It wasn't until I filed a complaint that I found out and you know the face-to-face is required every 6 months now too?
Maybe call Medicare yourself and put this to rest but that is what they told me. They haven't been to my house since either. I think the idea is to make sure it is set up correctly and you have what is needed to meet compliance.

SewTired
 
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Re: Surviving DME with Medicare

Postby SewTired on Mon Apr 10, 2017 10:12 pm

Just want to comment that the DME often doesn't want to set up the appointment until they have ALL the paperwork. For Medicare, it isn't just the RX, it is also the sleep study and the doctor notes. The best time for them to get all the stuff is before they set up the initial appointment so that they get paid, which is what they care about. So, that is the problem with 'going to visit 5 different DME's'. It's very annoying.

I also agree with Chunkyfrog. Medicare does not require a home visit for cpap unless the patient is homebound. The face-to-face requirement hasn't changed either - you need something in the doctor's notes before placing an order and then a face-to-face visit that discusses your usage within the compliance time period after you receive your machine. After that, it's a little up in the air for supplies. Supposedly, Medicare is going to require an annual face-to-face, but there is no evidence on the Medicare page on that for supplies. My bro has a 99 year prescription and so far hasn't had to revisit the doc on the issue.
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Okie bipap
 
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Re: Surviving DME with Medicare

Postby Okie bipap on Tue Apr 11, 2017 11:13 am

The required face to face meeting with the doctor must be documented before the sleep study is requested. My first sleep study was scheduled based on observations made while I was in the hospital following surgery. Since there was no face to face meeting documented, Medicare refused the machine request. I had to do the whole thing again.

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Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ F20 Full Face CPAP Mask with Headgear
Additional Comments: IPAP 20, PS 3, no ramp, Sleepyhead software
Aircurve 10 bilevel set at 20 cm water, 3 pressure support, using ResMed F20 mask

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Comfortably Numb
 
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Re: Surviving DME with Medicare

Postby Comfortably Numb on Wed Apr 12, 2017 8:57 am

My meeting with my doctor went very well yesterday. My diagnosis is moderate OSA; my overall AHI was 23; and, the best CPAP level "appears to be 9 cmH2O." I presented him with a list of the exact equipment that I want: Airsense 10 Autoset with heated humidifier and heated tubing (Tri-Pack); and Amara View full face mask. His Rx stated, "start auto PAP 5-9 cm; heated tubing with medium Amara View hybrid mask." There was some other scribbling that was illegible to me. When I told him about my "bait and switch" concerns with the DMEs, he chuckled and said he'd had problems with all of them. Apparently there was an over-abundance of DMEs in my area at one time and now there are only 5. Most have more work than they can handle and this causes backups. He was very supportive of me shopping around, and I had no problem getting a complete copy of my file, including Rx and physician's notes.

At check out, the lady asked where I wanted her to send my information. I told her the name of the business and she immediately sent the information. She said they would be contacting me to set an appointment. She said if I had problems with this DME, to contact another one of my choice and have them request my information. Apparently all of the DME's are going to get the required info directly from the doctor even if you carry it in with you.

My plan now is to wait on the call. When it comes I'm going to read them the precise list of equipment that I expect to get (I already know they carry everything I want) and tell them I want verbal confirmation that I will get it before setting an appointment. If they are unwilling to do that, then I'll move on to the next DME and let them know up front what the deal will be. Stay tuned and thanks.

By the way, the doctor I've been using for all of the examinations and testings is with SleepMed. I highly recommend this group from start to finish. That is all they do and they do it very well.

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Pugsy
 
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Re: Surviving DME with Medicare

Postby Pugsy on Wed Apr 12, 2017 9:14 am

Comfortably Numb wrote:My plan now is to wait on the call.


Don't wait too long. They don't need weeks to verify Medicare coverage. 2 or 3 days is more than enough...actually 2 or 3 hours is more than enough. :lol: :lol: Don't get me started on why DMEs take so long to do anything and blame it on "your insurance" when it is their laziness that is the culprit.

Comfortably Numb wrote:Apparently all of the DME's are going to get the required info directly from the doctor even if you carry it in with you.


Yes...there is more needed to get Medicare (or other insurance for that matter) to verify they will pay than just the RX.
There's diagnosis codes and sleep study results that are also needed but having the RX makes it easy for the DME to know who to contact for the other stuff that is needed.
Plus if you ever want to buy something online like from cpap.com that requires RX...the RX is all that you need because insurance isn't involved.
That other stuff is only for when the DME is billing the insurance in lieu of payment.
I have Medicare and I can only get a new complete mask once per 6 months because the 3 month Medicare allowance for a new mask doesn't include headgear...and my DME won't just let the headgear cost slide. Some DMEs will let it slide but mine doesn't.
So sometimes I have wanted to try a different mask that cpap.com has...usually brand new to the market and the DME doesn't have it anyway. So I use my RX to try a new mask....happy to pay for it myself and not involve insurance because sometimes I just don't want to wait. :lol:

_________________
Machine: AirCurve™ 10 S BiLevel Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Actually using the AirCurve 10 ST but using it in S mode...have the S9 Adapt for backup right now.

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chunkyfrog
 
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Re: Surviving DME with Medicare

Postby chunkyfrog on Wed Apr 12, 2017 9:28 am

The longer they make you wait, the more suspicious you should be.
Insist they plug it in and show you the RUN hours; or do it yourself--right there.
Know what MODEL they are selling you-- never accept less than what is your RIGHT.
They may be hoping if you are good and desperate, they can get away with anything. :twisted:
They are not to be trusted . . .

_________________
Machine: AirSense™ 10 AutoSet™ For Her CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Backup: Devillbiss Intellipap Autoadjust
Link to medicare suppliers, by zip code: https://www.medicare.gov/supplierdirectory/search.html

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Re: Surviving DME with Medicare

Postby Guest on Wed Apr 12, 2017 10:57 am

Comfortably Numb wrote:My plan now is to wait on the call.
Do not wait. Call them to confirm they have received the fax and have everything they need. Some play the "fax didn't come" game for some reason and there is the back n forth delay. Then ask what happens next. Write this down and don't be shy about calling back on the day they said something should happen. Don't snap just ask questions of you have to call back.

DME's do get lots of faxes and things tend to get lost in the pile. Call today.

You can prob upload the papers you have to cpap dot com now if you even think you may want to buy something from them at a later time.

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