I'm about to have "one of those conversations" with my DME!

[lanndi]

I'm waiting for a return phone call from a supervisor at the DME. My allergy doc didn't get a revised script in with a pressure range, so they don't want to give me a machine until there is a pressure range instead of a straight pressure -- even tho the cpap version of machine could be set that way.

I'm taking a deep breath, and hope to start conversation with a "I'm sure you want me to have the best results possible". Make DME a "partner" with me and my doc in resolving my sleep issues. Will only use threat of changing DME's if playing nice doesn't work.

[yardbird]

How was the prescription written? If it said Auto, then you should get an auto. The DME's job is to dispense as written, not to try to outguess the doctor as to what you need.

[Catnap]

Good luck...I still flinch when thinking about conversations with DMEs! Hope yours goes well and you're able to start your therapy SOON.

[KengEsq]

I'm waiting for a return phone call from a supervisor at the DME. My allergy doc didn't get a revised script in with a pressure range, so they don't want to give me a machine until there is a pressure range instead of a straight pressure -- even tho the cpap version of machine could be set that way.

I'm taking a deep breath, and hope to start conversation with a "I'm sure you want me to have the best results possible". Make DME a "partner" with me and my doc in resolving my sleep issues. Will only use threat of changing DME's if playing nice doesn't work.

Here is an idea. Tell you DME to deliver your APAP set in the CPAP mode at the pressure fixed in your script by your MD. After your DME leaves you the machine, change the settings yourself. Just a thought.

[sam1234]

I have found that most DME's don't care whether or not they have my business. So, threats of leaving don't seem to matter.

I switched DME's because of service and billing processes, and have found that my new DME is not very proactive either. You think that they would be interested in selling supplies and making money.

If I could stop dealing with DME's altogether, I would.

[GumbyCT]

I have found that most DME's don't care whether or not they have my business. So, threats of leaving don't seem to matter.

I switched DME's because of service and billing processes, and have found that my new DME is not very proactive either. You think that they would be interested in selling supplies and making money.

If I could stop dealing with DME's altogether, I would.

I tend to agree. But am interested to see how Lanndi made out.
Dealin' w/Dme's is never a fun time.

[GumbyCT]

I tend to agree. But am interested to see how Lanndi made out.
Dealin' w/Dme's is never a fun time.

I guess we'll never know?

[lanndi]

I tend to agree. But am interested to see how Lanndi made out.
Dealin' w/Dme's is never a fun time.

I guess we'll never know?

Sorry about delay. I knew this would be a long post and haven't had the time/energy to update.

Skipping the back and forth phone calls, the result of my conversations w/ DME #1 (Wright & Fillipis) and my insurance company, it seems that DME#1's contract with my insurance co doesn't cover apaps. So my ins co referred me to DME#2 (Binsons) and I had #1 fax over Rx to #2.

THey sound like they will responsive -- even claim they can have machine out on Monday for me! HOWEVER, they claim the insurance co won't pay for an apap unless AHI is 15 or higher (I'm 13.7). But looking at my results makes it clear that I have significant positional apnea so I really believe an Apap is best for me. This call happened the end of Friday.

But since I'm dealing with an allergy doc rather than a sleep doc (1st appt in Aug), I doubt she knows the details of xpap treatment.

So I will be back on the phone first thing Monday to be sure Binsons got the Rx, has checked with my ins company and will follow up w/ my doc if they need more info. I JUST WANT TO GET SOME SLEEP!!!!!

[DoriC]

I know how frustrating this is for you, and if it helps, a lot of us have been there, but in the end it will be worth it to get what you need for the best therapy. Good luck and don't give up.

[Gerald]

Sounds like DME #2 simply has a different way (than DME #1) to jerk you around.

Probably the smartest thing you can do is to chunk 'em all.....buy your own machine with software....and work on getting reimbursed directly by the insurance company.

Right now you're trapped in the La Brea tar pit of medical fraud.....and you need to escape.

Take charge of your own therapy.....you can do it.

Gerald

[lanndi]

Argghh!!

OK, I get it now about dealing with DME's. Here I am, fairly educated by you guys, aware that this is going to be an issue, and still I can't get what I want.

How do you get past the argument "your insurance will only cover these machines?"

At this point, it looks like I'm going to get an Intellipap c-pap w/ SmartCode. That was not one I done much research on. Is it any good?

[FatiguedMe]

Hi Lan,
I don't know anything about this machine, I see on cpap.com it is listed as a travel machine. Perosnally I would start a new topic asking about the Intellipap I am sure you will get MORE answers. I am sorry you are having such a hard time getting setup. Plus you should enter Intellipap in search up top and see what you can learn.
Keep us posted.

[lanndi]

Topic continued in new thread: viewtopic/t42528/DMEInsurance-giving-me ... ughts.html

[Pugsy]

How do you get past the argument "your insurance will only cover these machines?"

Your insurance will pay for whatever your doctor prescribes. To confirm it go directly to your insurance carrier.
If your prescription allows leeway in your personal choice then that is also what the doctor prescribes. DMEs bill by equipment code. The code is the same for all machines so they want you to take the least expensive model so they make more money. Typical DME BS.

Check with your insurance company as to how much out of pocket expense you would incur if you bought it and submitted for reimbursement. I put a pencil to mine and I had a 20 % copay no matter who supplied it. Over the 13 month rental copays and humidifier costs, it was a wash for me.

Intellipap seems to be a very good brand so nothing wrong with that part of it. Your DME is being a tightwad. Intellipap offers other models including auto units and software capabilities which was more in the lines of what I believe you were wanting.

Get a copy of your actual prescription. Exactly what does it say?

[lanndi]

Topic continued in new thread: viewtopic/t42528/DMEInsurance-giving-me ... ughts.html

Pugsy -- I responded in the new thread!