CPAP Basics - 8 - Dealing With Difficult DME's

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mollete
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CPAP Basics - 8 - Dealing With Difficult DME's

Post by mollete » Sun Apr 21, 2013 3:00 am

There's certainly a lot of scenarios here, and obviously where one is in the process, so this will be a Living Document (admittedly, it is likely that all of these occur on a regular basis, and successful solutions exist in here somewhere, so please add good ideas).

As soon as you're told you need CPAP:

Get a copy of your prescription.

Ask (and check yourself) to see if your insurance allows you to pick any DME you want, or if you have an exclusive contract with a particular DME (BTW, an office sending you to a particular DME against your will and/or not allowing you make the choice can get them in BIG trouble).

Consider why you need a DME in the first place. See if the Sleep Center will work with you on stuff (masks, downloads, etc.) if you buy from a warehouse.

Difficulty getting initial equipment:

If the phone thing doesn't work, go down to the office during their busiest/most difficult time (probably Monday morning) and start screaming how lousy the service is.

Call the Sleep Center and have them intervene. They have more pull.

Wrong equipment:

Make sure machine is data-compatible, probably APAP and current model.

Check for hours of use.

Check for current software version.

There are all kind of mask-guarantee programs. Get details from vendor and manufacturer.

Difficulty in follow up:

Follow-up for what? Consider going back to sleep Center for issues (and telling them why you're bothering them instead of the DME).

Buy products from warehouse.

Find out what your insurer's policy on replacement frequency is. Mark on your calendar when you're due for new stuff.

Make sure you're talking to the right person in the DME. There are receptionists, therapists, supervisory personnel and service representatives. You may have the best luck in dealing with the service representative.

In really big-deal issues, resort to "I'm telling Mommy". All DMEs are reviewed by somebody, so find out who that is and give them a call or email. Some entities could include The Joint Commission, State Department of Health, Insurance Commissioner, and/or the AASM.

Financial issues:

Price compare.

Have Sleep Center perform functions like D/Ls, settings changes etc. (DWing is your business)
Last edited by mollete on Tue Apr 23, 2013 3:04 am, edited 1 time in total.

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StuUnderPressure
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Re: CPAP Basics - 8 - Dealing With Difficult DME's

Post by StuUnderPressure » Sun Apr 21, 2013 10:57 am

mollete wrote:As soon as you're told you need CPAP:
Get a copy of your prescription.

Make sure machine is data-compatible, probably APAP and current model.

Check for hours of use.

Check for current software version.
IMHO, the above 4 items are THE most important of your very good list.

The only thing I might add would be to LEAVE the DME withOUT accepting anything - if you are not given what you request.

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Re: CPAP Basics - 8 - Dealing With Difficult DME's

Post by Drowsy Dancer » Sun Apr 21, 2013 11:36 am

mollete wrote:Difficulty getting initial equipment:

If the phone thing doesn't work, go down to the office during their busiest/most difficult time (probably Monday morning) and start screaming how lousy the service is.
This would be a lot of fun, I admit, but less effective than:

Keeping a contemporaneous phone log of all calls made, noting date, time, and name of person spoken to.

Getting the fax number of the DME.

Sending fax confiming requests, reciting dates of previous unsuccessful requests, and cc'ing sleep doctor or sleep center on fax.

More effective would be creating a website or complaining via social media. #Apriasucks, anyone?

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Re: CPAP Basics - 8 - Dealing With Difficult DME's

Post by kaiasgram » Mon Apr 22, 2013 12:22 am

mollete wrote:Check for hours of use.
And total run hours, yes?

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Re: CPAP Basics - 8 - Dealing With Difficult DME's

Post by chunkyfrog » Mon Apr 22, 2013 3:21 pm

Most cellphones have a live voice recording function.
Just turn it on and lay it on the table between you.
If someone objects, just tell them your memory sucks and you don't want to miss anything.

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Re: CPAP Basics - 8 - Dealing With Difficult DME's

Post by Master_P » Mon Apr 22, 2013 10:59 pm

Having dealt with two horrible DME's, and now having a great one, I'll chime in with how I dealt with them.

I fired them.

Seriously though, it can be tough dealing with them, but you have to fight to get what you want. You are the customer. You are the one who's paying - even if you have insurance... you pay premiums!!! Expect the best, and if they aren't giving you what you need, look elsewhere.

1. Make them earn your business - one thing DME's will do is push their work on you. Don't fall for it. If they ask you to get pre-authorization from your insurance, ask them to do it.
2. Copy their executives on your e-mails to them. Everyone has a boss. If the boss values their company, they won't tolerate indolence. Use phrases like, "I was quite surprised" or "This was disappointing", or "...to me, that is unacceptable".
3. Write reviews online. Yelp.com is a popular one. Search for "CPAP" in your city, and share your experiences.
4. Be vigilant in your dealings with them. It's easy to stop asking for the best treatment when you've been with a supplier for some time. Culture can change at a company... or your awesome DME supplier might have hired a lousy employee from a lousy supplier. Always remember that there's always a company that wants to earn your business.
5. Be direct. Tell them what you want, and ask them if they can accommodate you. I was once bold enough to ask them for the names of their competitors. That changed their tune!!

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Re: CPAP Basics - 8 - Dealing With Difficult DME's

Post by arnppulm69 » Sat Apr 27, 2013 2:39 am

"5. Be direct. Tell them what you want, and ask them if they can accommodate you. I was once bold enough to ask them for the names of their competitors. That changed their tune!!"

LOVE that one .
I am a pulmonary provider who SENDS business to my local DME, I am also a CPAP consumer myself. I fired 3 local companies for crappy service and am about to fire another one. It's hysterical to me how they don't even care about getting my future referrals. The rep brought my supplies to me cause I'm busy as hell, wrong supplies. She brought different ones, wrong again. I am on the phone constantly with DME on behalf of patients because I know their pain. DME's here are probably calling me the dragon lady. I give all my patients a list of replacement protocols, tell them if the DME gives em any crap to call me LOL. I was in hospital for 22 years, just moved to office setting 4 months ago, what a wake up call to see what these people try to get away with if they can. Advice:
Get your provider to write EXACTLY what you want on initial script. Heres an example of my orders:
Exact machine model I/and the patient agree on, with heated humidity and heated tubing, and full compliance data including AHI, blah blah, and mask of pt's choice, "RT TO FIT" (THIS is important so you don't have a subcontracted measure and send by mail"), replace (I list each item and put replacement time in). I include exactly what kind of chin strap too, otherwise they give a crappy one .

Also, when I write for titration study, I write to try each type of face mask, i.e. nasal, full, pillows, so they don't just slap what they have on you and you think those are the only options. Trying them while on therapy is important,

just my 2 cents.

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Re: CPAP Basics - 8 - Dealing With Difficult DME's

Post by Sheriff Buford » Sat Apr 27, 2013 6:29 am

I'll say this till my dieing day... DME's are there to give you equipment and supply you with supplies in the whatever interval your insurance will allow. That's it. Ok... there are a few that will actually assist you and fewer that are knowledgeable enough to help you.... but they are far and few in between. The problem is that we go in (as a newbie) expecting some knowledgeable help, because we don't know, and we assume they know about the disease and the products they sell. When we find out they don't care, have no clue and really have no idea of the disease, we get mad... We need to look at them the same as we would Wal-Mart. Sell me what I want (and request) and get the heck out of the way. Come here for assistance and we'll help you thru your cpap journey.

Sheriff

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Re: CPAP Basics - 8 - Dealing With Difficult DME's

Post by arnppulm69 » Sat Apr 27, 2013 7:30 am

Sheriff, agreed, but your medical provider is equally responsible for getting you the equipment you need, they are slacking. I just joined the office based part of our practice, people are coming to me saying they've had the same mask and liner and tubing and FILTER for 3 years..... how come the provider didn't know this 2 years ago lol

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Re: CPAP Basics - 8 - Dealing With Difficult DME's

Post by StuUnderPressure » Sat Apr 27, 2013 12:31 pm

Sheriff Buford wrote:I'll say this till my dieing day... DME's are there to give you equipment and supply you with supplies in the whatever interval your insurance will allow. That's it. Ok... there are a few that will actually assist you and fewer that are knowledgeable enough to help you.... but they are far and few in between.Sheriff
My feelings exactly !

When I order anything from my DME, I give them the Name / Description of the item along with the specific manufacturer brand AND the manufacturer's Item number. Hell, I even give them the insurance code to bill it under.

I have still gotten the wrong items even while doing all of that.
But, then I have proof & "politely" (well, as politely as "I" am capable of) tell them it was "their" fault they got it wrong & how can they make it right.

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Re: CPAP Basics - 8 - Dealing With Difficult DME's

Post by ogg » Fri Apr 25, 2014 10:23 am

mollete wrote: Ask (and check yourself) to see if your insurance allows you to pick any DME you want, or if you have an exclusive contract with a particular DME (BTW, an office sending you to a particular DME against your will and/or not allowing you make the choice can get them in BIG trouble).
I'm new to this DME / CPAP thing, and i was annoyed and surprised when i was given no choice in my DME provider by my doctor, my insurance does allow me to choose, i would like to know 1. what kind of trouble are we talking about? 2. How do i get out using my current DME (Pulmonary Solutions), e.g., who do i need to talk to, and what do i need to watch out for?

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Re: CPAP Basics - 8 - Dealing With Difficult DME's

Post by chunkyfrog » Fri Apr 25, 2014 10:40 am

Sounds to me like conflict of interest. I was informed the law does not allow this.
--unless you are in an HMO--but it sounds like you are not.

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Re: CPAP Basics - 8 - Dealing With Difficult DME's

Post by robysue » Fri Apr 25, 2014 12:46 pm

ogg wrote:
mollete wrote: Ask (and check yourself) to see if your insurance allows you to pick any DME you want, or if you have an exclusive contract with a particular DME (BTW, an office sending you to a particular DME against your will and/or not allowing you make the choice can get them in BIG trouble).
I'm new to this DME / CPAP thing, and i was annoyed and surprised when i was given no choice in my DME provider by my doctor, my insurance does allow me to choose, i would like to know 1. what kind of trouble are we talking about? 2. How do i get out using my current DME (Pulmonary Solutions), e.g., who do i need to talk to, and what do i need to watch out for?
I'd start with a multi-pronged approach.

1) Request a copy of the script in writing from the doctor. You have the right to your own medical records, which includes copies of your prescriptions. If they balk, tell them you will inform your insurance company of your complaint against the doc a and file a grievance with the appropriate state office that oversees doctors and their licensing.

2) Get a list of alternate DMEs from the insurance company in writing. Also find out how you make a formal complaint about both a doctor and a DME to the insurance company. Since you have already accepted equipment from Pulmonary Solutions, but that equipment is not fully paid for, you will also need to speak with a case manager at your insurance company about what your options are for returning the equipment to Pulmonary Solutions and getting new equipment from a DME of your choice. Be specific in your complaints to the insurance company and put things in writing. Keep copious notes of all conversations you have with anybody at the insurance. At a minimum, you need to know the full name of the person you are speaking to, their title or position, date of the conversation, and a summary of what you were told to do.

3) As soon as you have names of some alternative DMEs, go ahead and start calling them. Ask them questions about what they will need from you in order for them to supply some or all of your equipment. (Note: I was surprised that when I had to switch DMEs to get the mask of my choice that the new DME had to have a copy of my original diagnostic sleep study.)

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Re: CPAP Basics - 8 - Dealing With Difficult DME's

Post by ogg » Fri Apr 25, 2014 1:29 pm

robysue wrote:
ogg wrote:
mollete wrote: Ask (and check yourself) to see if your insurance allows you to pick any DME you want, or if you have an exclusive contract with a particular DME (BTW, an office sending you to a particular DME against your will and/or not allowing you make the choice can get them in BIG trouble).
I'm new to this DME / CPAP thing, and i was annoyed and surprised when i was given no choice in my DME provider by my doctor, my insurance does allow me to choose, i would like to know 1. what kind of trouble are we talking about? 2. How do i get out using my current DME (Pulmonary Solutions), e.g., who do i need to talk to, and what do i need to watch out for?
I'd start with a multi-pronged approach.

1) Request a copy of the script in writing from the doctor. You have the right to your own medical records, which includes copies of your prescriptions. If they balk, tell them you will inform your insurance company of your complaint against the doc a and file a grievance with the appropriate state office that oversees doctors and their licensing.

2) Get a list of alternate DMEs from the insurance company in writing. Also find out how you make a formal complaint about both a doctor and a DME to the insurance company. Since you have already accepted equipment from Pulmonary Solutions, but that equipment is not fully paid for, you will also need to speak with a case manager at your insurance company about what your options are for returning the equipment to Pulmonary Solutions and getting new equipment from a DME of your choice. Be specific in your complaints to the insurance company and put things in writing. Keep copious notes of all conversations you have with anybody at the insurance. At a minimum, you need to know the full name of the person you are speaking to, their title or position, date of the conversation, and a summary of what you were told to do.

3) As soon as you have names of some alternative DMEs, go ahead and start calling them. Ask them questions about what they will need from you in order for them to supply some or all of your equipment. (Note: I was surprised that when I had to switch DMEs to get the mask of my choice that the new DME had to have a copy of my original diagnostic sleep study.)

Thank you this sounds like a good path to follow.

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Re: CPAP Basics - 8 - Dealing With Difficult DME's

Post by grayghost4 » Wed Aug 27, 2014 10:22 am

After reading these posts .... I check the machine that the DME delivered to my wife 5 weeks ago, and discovered that it has 35 extra hours on it beyond the use time my wife used it. It was supplied under medicare and billed to them ... is it legal to supply a used machine and bill as new ... without informing us?
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