DME Just Called - yikes

Swim_Bike_Run · Post by **Swim_Bike_Run** » Tue Dec 15, 2009 1:20 pm

I just got a call from my DME and thanks to this board, I knew what questions to ask relative to the script my doc wrote. I have a few questions...

He ordered a Swift LT Mask.....I have not ever worn this mask and wore something different during my sleep study. I am not totally against this mask, I just want to be fitted and see what works best...I am insterested in the Swift LT, the Breeze or the Headrest...I am a stomach sleeper so I thought one of these would work best. The DME did say they would be willing to work with me on the mask so that is a good thing.

The machine ordered is a Respironics DS200. After researching it, this is disappointing as this is not a data-enabled machine, which seems pointless...I definitely want to know what is going on with everything. I felt like the DME was very nice and seemed interested in helping but my question is, what if my insurance limits whether or not I can get a data enabled machine? Or is it the problem, the fact that the script was not for a data machine? If that is the case, can I call my doc back and request a script for a data enabled machine?

Thanks for any insight.....

Gerryk · Post by **Gerryk** » Tue Dec 15, 2009 1:24 pm

Call your doc and tell them you want a fully data capable machine and will accept nothing less. It won't cost more, it will just be less the DME gets to keep.
You also want a script written for a mask that states what ever mask pt is comfortable with. Oh, get a copy of those orders too. I scanned mine into my computer and keep them as a PDF. If I need it for any reason I have it and everyone can open a pdf.

Don't settle for less, call them and demand something better.

I am not saying that machine is junk but you want a fully data capable machine.
Gerry

Patrick A · Post by **Patrick A** » Tue Dec 15, 2009 1:29 pm

Also ask your doctor to check dispense as prescribed on the prescription If you want a specific machine tell your doctor and ask for him to write it by brand on the prescription. My doctor wrote the scrip just like that and you should have hear APRIA RIPOFF Squeal like a stuck Pig!!!

carbonman · Post by **carbonman** » Tue Dec 15, 2009 1:44 pm

Swim_Bike_Run wrote: I have a few questions...
Thanks for any insight.....

SBR, what you are about to go through is a Rite of Passage,
into cpap therapy.
Stay calm. Be patient. Don't sign anything until you
are absolutely sure what is happening.
Nothing is written in stone.
Continue to read and educate yourself.
Keep asking questions.
The greater majority of us have been down this path.

It's a journey. You're on the right path.....

Wulfman · Post by **Wulfman** » Tue Dec 15, 2009 2:05 pm

carbonman wrote:
Swim_Bike_Run wrote: I have a few questions...
Thanks for any insight.....
SBR, what you are about to go through is a Rite of Passage,
into cpap therapy.
Stay calm. Be patient. Don't sign anything until you
are absolutely sure what is happening.
Nothing is written in stone.
Continue to read and educate yourself.
Keep asking questions.
The greater majority of us have been down this path.

It's a journey. You're on the right path.....

One more thing......

And, above all, do NOT accept equipment that you do not want. Too many users have been coerced into walking out the door of the DME shop with stuff they weren't sure about. Don't let that happen to you. Don't be a "statistic" of the unscrupulous DMEs who hand out the cheapest equipment in order to maximize their profits.
ALL CPAP machines have the very same insurance code....E0601....whether it's the cheapest blower or the fanciest whiz-bang Auto. Almost all insurance providers pay from THAT code and not the name or functionality of the machine.

Den

Patrick A · Post by **Patrick A** » Tue Dec 15, 2009 2:17 pm

When I got my very first Cpap machine it was a Remstar plus......no bells no whistles nothing. APRIA RIPOFF struck again. I had problems from day one with the machine. Make sure that the mask fits and is the right size. Do not let them walk all over you! Tell them what you want and what you will only accept.

Swim_Bike_Run · Post by **Swim_Bike_Run** » Tue Dec 15, 2009 2:52 pm

Thanks for the info. I just got off the phone with the person at the DME and while he was nice he was not super knowledgable. I had to explain what I meant by data enabled machine....he still did not fully understand and basically said that I will need to have my doc specific the EXACT brand, not DATA ENABLED MACHINE.....does that sound right? He said that the higher level machines cost more and that there might be an upcharge. One thing is for sure, I will not sign anything unless I am 110% satisfied...no worries about that. If I do have to specify what machine I want, are there any recommendations? I think I am opening myself up for a bunch of answers on that one. I am needing a CPAP machine - my sleep tech said my magic # was 10, the morning after my titration, if that helps at all. I have read good things about the Elite 2- Thanks again.

One other thing...can I call my insurance and find out if what DME's I can use in my area, or is this the only one?

carbonman · Post by **carbonman** » Tue Dec 15, 2009 3:33 pm

Swim_Bike_Run wrote: If I do have to specify what machine I want, are there any recommendations? I think I am opening myself up for a bunch of answers on that one.

...you got that right.
I recommend Resmed S8 Autoset II.

Swim_Bike_Run wrote: One other thing...can I call my insurance and find out if what DME's I can use in my area, or is this the only one?

Remember, all these people work for YOU.
YOU tell them how it is.
If you don't like the service you're receiving, move on.

It is YOUR therapy.
YOU will be in charge of said therapy.

Wulfman · Post by **Wulfman** » Tue Dec 15, 2009 3:41 pm

Swim_Bike_Run wrote:Thanks for the info. I just got off the phone with the person at the DME and while he was nice he was not super knowledgable. I had to explain what I meant by data enabled machine....he still did not fully understand and basically said that I will need to have my doc specific the EXACT brand, not DATA ENABLED MACHINE.....does that sound right? He said that the higher level machines cost more and that there might be an upcharge. One thing is for sure, I will not sign anything unless I am 110% satisfied...no worries about that. If I do have to specify what machine I want, are there any recommendations? I think I am opening myself up for a bunch of answers on that one. I am needing a CPAP machine - my sleep tech said my magic # was 10, the morning after my titration, if that helps at all. I have read good things about the Elite 2- Thanks again.

One other thing...can I call my insurance and find out if what DME's I can use in my area, or is this the only one?

What I put in bold and particularly underlined is a big clue that they may be shysters. There should ABSOLUTELY NOT be an "upcharge". Like I said previously, ALL models of CPAP machines have only ONE insurance code. The insurance companies pay according those codes. The difference is in what the DME profit margin is. Obviously, they don't make as much profit from a more expensive machine. But, that's THEIR problem......NOT YOURS.
You want a machine that has FULL data capabilities.
In the Respironics line, you need at least the "M Series Pro" model.
In the ResMed line, you need at least the "Elite II" model.

Here's a list of some of the models and model numbers that Respironics has sold. Most of these are from the M Series.

REMstar Basic (no SmartCard) - DS100*, DS100H*
REMstar Plus with C-Flex (no SmartCard) - DS200* DS200H*
REMstar Plus with C-Flex and SmartCard - DS200S DS200HS

REMstar Pro with C-Flex - DS400S, DS400HS

REMstar Auto with C-Flex - DS500S, DS500HS
REMstar Auto with A-Flex - DS510S, DS510HS

BiPAP Plus with Bi-Flex - DS600*, DS600H*
BiPAP Auto with Bi-Flex - DS700S, DS700HS

BiPAP autoSV - 1038917, 1040716
Noninvasive Ventilation Systems
BiPAP AVAPS - 1029744, 102970
BiPAP S/T - 1012885, 1014248

*These models only offer phone-in compliance data.

Here are some more links. Some of which have the newer PR1 Series machines.

http://respironicsremstars.respironics.com/

http://sleepapnea.respironics.com/mseries/

http://sleepdevices.respironics.com/PDF ... pGuide.pdf

And......the link to ResMed's site.

http://www.resmed.com/us/

Den

Gerryk · Post by **Gerryk** » Tue Dec 15, 2009 3:44 pm

Your insurance will pay x amount of dollars for a machine. That amounts since they are a preferred provider will cover any cpap machine up to an BiPap. I believe a BiPap is more money and if I am wrong, someone please correct me on that. Do not pay more for the machine or a upcharge. They can take their upcharge and upcharge themselves.

They know you are new and he was playing stupid. That guy knew exactly what you were talking about. The more blood he gets out of the turnip the better for him, and you are his turnip today.

Gerry

timbalionguy · Post by **timbalionguy** » Tue Dec 15, 2009 3:55 pm

Gerryk wrote: They know you are new and he was playing stupid. That guy knew exactly what you were talking about. The more blood he gets out of the turnip the better for him, and you are his turnip today.

Gerry

That said, there have been a lot of reports here of RTs who really didn't know what they were doing. In the case of a few better RT's and DME's, the patient ended up being the educator. The DME's are out to make money off other people's sickness. Only a few seem to really care about their patients.

You need to be firm to assertive with these people from the get-go.

I would take it one step further, and not settle for anything less than an auto machine. The Remstar auto or better. In ResMed, the Autoset II seems to be a favorite. The DeVilbiss IntelliPAP auto is another possible choice. And I am sure there are a couple more among the lesser known brands.

desert rider · Post by **desert rider** » Tue Dec 15, 2009 4:51 pm

How comfortable are you with your doctor? Does your doctor understand your request for a data capable machine? Although everyone does work for YOU, you're at your doctor's mercy to some degree (unless you can afford to spend the time it would take to find another doctor). So convincing your doc to write the right prescription is your biggest hurdle.

Explain to the doc that you travel a lot and need to have a copy of your prescription with you in case you need to replace something in a hurry. Then once you have the script in hand, everyone does work for YOU. Whether the doc specifies a data capable machine or not, explain to the DME that you won't accept anything less. Show up to your appointment with printed pages from online vendors showing prices of the equipment that you're looking for.

One more suggestion. I would save the discussion of the machine for the second half of your appointment with your DME. Start the appointment as nice as can be while you try on their masks. Even if they give you a machine that you don't plan to accept, try on as many masks as necessary so you'll know what's best for you. That way if you end up walking out on the DME you'll at least know what mask you need. (Shopping for masks online is a pain.)

Check out cpap.com and cpapauction.com to get a good idea of pricing. Your DME won't even come close, but if they're actually friendly and professional then it's worth paying a little more. Just remember that you can probably buy the equipment outright from cpap.com for as much as or less than your copay to the DME. So the only value to the DME is the convenience of having a local vendor to help fit you with the right mask and answer your dumb questions if/when they arise. You might get dumb answers from them though. In most cases you can find all the help you need right here.

secret agent girl · Post by **secret agent girl** » Tue Dec 15, 2009 6:04 pm

Swim_Bike_Run · Post by **Swim_Bike_Run** » Tue Dec 15, 2009 6:58 pm

Whoa! Great info here - thanks a ton. I am a little confused on the script - DME - Machine choice process. As it stands, I got a call today from the DME....they told me I can go with any mask that I am comfortable with, per the script. The script for the machine, however, specified only one in particular and it was the Respironics DS200. When I explained to the DME person that I would need a different machine, he said it would help if the script was very specific, instead of telling the doc I need a script for a "data enabled machine" since there was so many to choose from. I said ok and felt like I need to make a decision asap since I want to get my EQ and get setup before I go away to travel next week on Christmas. I called my doc back and spoke with my doc's nurse and told her that I would need a new script for a Resmed Elite 2 with heated Humidifier, after reading up on that one a little. She said she would talk to him and call me back. My question is, is it possible to just get a script for any machine that I am comfortable with or do I need the script to be very specific, listing make and model? Is it hard, like someone above mentioned, to get a copy of the script in hand?

If the doc says no dice, then can I take my sleep study results and go see a new doc? My insurance does not need a referral so I am tempted to say see ya if he will not comply. My relationship with this doc is ok at best. He is treating me for my Pulmonary Embolism, which I acquired from shoulder surgery back in August. He is super smart, but he is also of international descent and just has no personality. Plus, I know he gets tired of me calling every week with questions about my lung clots (most are exercise related - what I can and can't do). So I have no issues leaving him for a second opinion on the sleep medicine...I will continue to stay with him for my Pulmonary Embolism, since I have been with him for 3.5 months now, but have no issues talking to another sleep doc to get the right EQ.

SBR

Wulfman · Post by **Wulfman** » Tue Dec 15, 2009 9:03 pm

Swim_Bike_Run wrote:Whoa! Great info here - thanks a ton. I am a little confused on the script - DME - Machine choice process. As it stands, I got a call today from the DME....they told me I can go with any mask that I am comfortable with, per the script. The script for the machine, however, specified only one in particular and it was the Respironics DS200. When I explained to the DME person that I would need a different machine, he said it would help if the script was very specific, instead of telling the doc I need a script for a "data enabled machine" since there was so many to choose from. I said ok and felt like I need to make a decision asap since I want to get my EQ and get setup before I go away to travel next week on Christmas. I called my doc back and spoke with my doc's nurse and told her that I would need a new script for a Resmed Elite 2 with heated Humidifier, after reading up on that one a little. She said she would talk to him and call me back. My question is, is it possible to just get a script for any machine that I am comfortable with or do I need the script to be very specific, listing make and model? Is it hard, like someone above mentioned, to get a copy of the script in hand?

If the doc says no dice, then can I take my sleep study results and go see a new doc? My insurance does not need a referral so I am tempted to say see ya if he will not comply. My relationship with this doc is ok at best. He is treating me for my Pulmonary Embolism, which I acquired from shoulder surgery back in August. He is super smart, but he is also of international descent and just has no personality. Plus, I know he gets tired of me calling every week with questions about my lung clots (most are exercise related - what I can and can't do). So I have no issues leaving him for a second opinion on the sleep medicine...I will continue to stay with him for my Pulmonary Embolism, since I have been with him for 3.5 months now, but have no issues talking to another sleep doc to get the right EQ.

SBR

I'll break them out here:

Q. Is it possible to just get a script for any machine that I am comfortable with or do I need the script to be very specific, listing make and model?

A. Depends on your doctor and where you're purchasing your equipment. Generally speaking, for CPAP equipment, "generic" is better than "specific" for purchasing from an online seller, as you can purchase any type of CPAP or APAP you want. If purchasing from a local, brick & mortar DME who wants to be a jerk/butt-head, it may have to be machine-specific. Some DMEs are better than others, so there are no hard and fast rules. Doctors can be jerks, too.

Q. Is it hard, like someone above mentioned, to get a copy of the script in hand?

A. The prescribing doctor is obligated to give it to you. It's yours, you paid for it and it's good for "life" if you want to purchase your equipment from an online seller (some brick & mortar DMEs seem to have time limitations on them). If they refuse to give it to you, they're in violation of HIPPA laws. You NEED to have the physical document for any future purchases or emergencies (if you're not near your regular DME).
It's just like eyeglasses. The optometrist is obligated to give you your prescription for those, too. You're not bound to purchase your glasses from them (although they probably hope you will).
Same thing with any other pharmaceutical prescription. You're free to choose the pharmacy.

Den

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