with prescription, DME wont upgrade machine

[canyongirl]

Ok.. so i got jipped by the DME (Hampton Homecare). They gave me a respoironics cpap.. great, but not data capable.

Now after reading this forum since starting treatment (last April) i realize i do need a data capable. I want to see my stats, and get better treatment.

85-90 percent of nights are great, but some are not. I traveled with family and they said i snored with mask on, i don't leak too much either. I thought this may be happening, but wasn't sure.

The DME, said that even with a new perscription, they would most likely not get me the data capable version of my machine. The office said they had to check with the "owner" of the company.

So i get that they buy the lowest standard machine (since no helath care # exisists for different machines) and now they don't want to have to buy another for me (which the lease to me).

My doc will write me a script for the data capable auto cpap, but the DME fights me.

2 Questions:
1. How can I get them to get me the machine?
2 . what info does my general practioner need to write on the script for it

if all else fails, i will fire them, then get the machine thorugh cpap.com.. any thoughts?

this is the bet place to find answers. i don't always log in, or post, but i do read daily.. thanks for all the help in advance

[sleepycarol]

Because many times there is a capped rental on the machines they are reluctant to change out the machines, especially if you have had it for a while.

You can pay for an upgraded machine from cpap.com with your own funds, but the insurance will in all likely hood not reimburse you so soon again after purchasing the one you have.

If you can afford it I would buy a data-capable machine from cpap.com or cpapauction.com and then keep the one you are currently using for a back-up.

[Wulfman]

Ok.. so i got jipped by the DME (Hampton Homecare). They gave me a respoironics cpap.. great, but not data capable.

Now after reading this forum since starting treatment (last April) i realize i do need a data capable. I want to see my stats, and get better treatment.

85-90 percent of nights are great, but some are not. I traveled with family and they said i snored with mask on, i don't leak too much either. I thought this may be happening, but wasn't sure.

The DME, said that even with a new perscription, they would most likely not get me the data capable version of my machine. The office said they had to check with the "owner" of the company.

So i get that they buy the lowest standard machine (since no helath care # exisists for different machines) and now they don't want to have to buy another for me (which the lease to me).

My doc will write me a script for the data capable auto cpap, but the DME fights me.

2 Questions:
1. How can I get them to get me the machine?
2 . what info does my general practioner need to write on the script for it

if all else fails, i will fire them, then get the machine thorugh cpap.com.. any thoughts?

this is the bet place to find answers. i don't always log in, or post, but i do read daily.. thanks for all the help in advance

This is where I would START......not "if all else fails". Depending on where you and your insurance provider are with your "rental" situation......it may be financially feasible to keep your "cheap" machine for a backup and buy what you want from CPAP.COM, outright. I would think that since you've been on therapy for that long, your existing machine would be about paid for.

In order to get the attention of these money grubbers, you have to get their attention, financially......that's all they understand.

Den

[BarryKaraoke]

The DME, said that even with a new perscription, they would most likely not get me the data capable version of my machine. The office said they had to check with the "owner" of the company.

Then I would reply that: "Most likely, I will be returning the machine to you and going with another provider who CAN give me the exact machine prescribed by my Doctor, so please make sure "The Owner" knows this as well.".

If you don't like the mechanic.....find another mechanic.

[GumbyCT]

My understanding is that if the DME gives a machine that No longer meets YOUR needs - the DME is obligated to provide you with an upgrade. I would find out who the local licensing authority is for your area and ask them questions - they do have a license right? At the very least the DME should be providing you with whatever your new script says.

So get the doc to write it exactly that way - including the words "NO Substitutions".

If you have been reading daily then you have seen the posts by Slinky regarding your exact Q?

Suggested Specific CPAP Equipment Scripts (Slinky) (Diagnosis and Prescription)
cpaptalk-articles/CPAP-machine-prescription.html

[bap40]

Your problem sounds a lot like the one I had... I could get no-where with my old DME "BAD LADY" Luckily I was only starting my 2nd month and took my machine back and fired her. I went to my doc and had him write me a script for EXACTLY what machine I wanted. I got it an even better one from my new DME without any questions either. My old DME was horrible and kept giving me reasons that I did not need a data capable machine and as a matter of fact she did not have the means to even read the cards. I got madder and madder about it. I went to my local hospitals home care and found out from them what they could provide and what kind of prescription to get for the machine I wanted. I didn't ask for the A/Flex but was asking for an auto c/Flex. I really wanted the A/flex though. Low and behold, my RT came out with that exact machine and said that he thought I would like this one better..... My dream machine with not even asking. I do believe that my old DME was privately owned also, and they did not have any machines other than the very basics, where as the hospital had all kinds of them on hand.

I do believe that insurance is required to provide another machine if the one you are using now is not doing you any good. There was a post last week or so where someone's script changed 3 times in a very short period and they ended up with 3 machines, and insurance paid for all of them due to doc's orders changing. So I would say that your DME is one of the BAD ONES, but is possible also not going about it in a legal way. Keep pushing and get a script for the exact machine you want. There are some sample prescriptions, I believe that are available under the yellow lightbulb.

Good luck and keep pushing. I don't think her refusal to honor a script is legal.

[DreamStalker]

Ok.. so i got jipped by the DME (Hampton Homecare). They gave me a respoironics cpap.. great, but not data capable.

Now after reading this forum since starting treatment (last April) i realize i do need a data capable. I want to see my stats, and get better treatment.

85-90 percent of nights are great, but some are not. I traveled with family and they said i snored with mask on, i don't leak too much either. I thought this may be happening, but wasn't sure.

The DME, said that even with a new perscription, they would most likely not get me the data capable version of my machine. The office said they had to check with the "owner" of the company.

So i get that they buy the lowest standard machine (since no helath care # exisists for different machines) and now they don't want to have to buy another for me (which the lease to me).

My doc will write me a script for the data capable auto cpap, but the DME fights me.

2 Questions:
1. How can I get them to get me the machine?
2 . what info does my general practioner need to write on the script for it

if all else fails, i will fire them, then get the machine thorugh cpap.com.. any thoughts?

this is the bet place to find answers. i don't always log in, or post, but i do read daily.. thanks for all the help in advance

Why have you not fired them already? If your machine is under lease agreement, you should have already told them that you are taking your business elsewhere ... of course, that would mean that you care more about your health than their profits

[sleepycarol]

Best recommendation I can make is contact the insurance company you have and ask if the doctor prescribes a different machine will they honor the exchange and pay for it.

An insurance company may bulk if they have paid for a machine for an extended period of time (even a couple of months) and the machine is nearly equivalent to the "new" machine. An example would be moving from a basic machine to a pro2. Yes, I know the pro2 offers the benefit of data -- but you will probably be told the data is not valuable and they may not go for it.

You don't want to turn your machine in and then find out the insurance is unwilling to work with you UNLESS you are willing to take the chance that you may be out of pocket for the upgrade.

[jules]

There are several issues -----

you are almost a year into treatment - I expect any rental period is over (or will be soon) and the machine is yours


does insurance consider making this change medically necessary? Insurance balks at data capable or APAP, let alone Cflex and EPR. Machines can't be traded just for those reasons with out a letter of medical necessity being turned in. The DMEs know that and use it to their advantage. A trade made in the first month they handle better as they don't have this year old cpap to figure out what to do with.

If you needed to move up to a Bipap that would be a change from a machine that no longer meets your therapy needs to one that does, but DME's will probably not consider a change from a straight cpap to another straight cpap with data or even an APAP being something requiring a change in therapy needs.

This is where you, the patient , and them, the DME, have differing opinions. You were given a machine to meet your medical needs. You have had it for almost a year. It's going to be hard to convince the DME that you now need a different machine with the same coding.

As has been mentioned, probably the best way to get a data machine is to get the Rx and buy one online from cpap.com. It might be cheapest (especially if they want to start a new contract at the DME if they were to give you a different machine) and it should also be less frustrating. Don't forget all the time you will save by not calling the DME twice a day getting on their case trying to find out what they are going to do, and of course all the frustration you won't have when you find out each call they haven't done anything yet.

If you buy a machine you might be able to get by without buying a humidifier and use the DME one you have now - just get the machines matching brands etc.

This is from my coverage - on pg 3 of the pdf file below -

CIGNA HealthCare covers C-FLEX or auto-titrating PAP (APAP) as medically necessary for the treatment of OSA for patients who meet the criteria for CPAP but demonstrate intolerance, either at the time of CPAP titration or during an appropriate trial.

CIGNA HealthCare does not cover APAP to diagnose and treat OSA in the absence of an in-laboratory PSG because it is considered experimental, investigational or unproven.

CIGNA HealthCare covers bi-level positive airway pressure (BiPAP) as medically necessary for the treatment of OSA for patients with coexisting central hypoventilation or for patients who require, but prove intolerant to, high pressures of CPAP, C-Flex or APAP.

Cigna Policy pdf is this link

http://tinyurl.com/3axetn

[canyongirl]

thankyou all for your ideas..... i have an appointment with my gp in 2 weeks,,,,, im talking to another DME company (since i can't buy one online unless i didn;t pay health insurance for 2 months) and i will update you ina few weeks as i do more work to get what i need...

you should always be given a data capable machine or offered the option...but now i am wiser

[CarrieS]

Not sure how your DME does it but my insurance makes 6 payments and then the machines mine - so after that I couldnt change if I had wanted to since my insurance only offers 1 machine every 6 years. However I was lucky enough that my DME did swap out based on scripts early on when I upgraded to data capable.

[Wulfman]

thankyou all for your ideas..... i have an appointment with my gp in 2 weeks,,,,, im talking to another DME company (since i can't buy one online unless i didn;t pay health insurance for 2 months) and i will update you ina few weeks as i do more work to get what i need...

you should always be given a data capable machine or offered the option...but now i am wiser

I'm not sure I understand that, but if you have your prescription (a simple CPAP prescription will do) and the money, you can buy whatever CPAP or APAP you want......online.....any time.

Den