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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
MaskingtheNightAway
 
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Re: Why is it necessary to have a support team?

Postby MaskingtheNightAway on Sun Dec 27, 2015 6:24 pm

From reading the last post, it confirms my suspicions that Sleep Labs and DME's are just in it for the money.

I've got my own equipment and now I'm having trouble finding a DME that will sell me mask's and tanks thru my Employer's Insurance Plan.

There seems to be a code that if you go "Outside" the system or process, no one wants to help you.

Teaching me a lesson, EH?

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LSAT
 
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Re: Why is it necessary to have a support team?

Postby LSAT on Wed Dec 30, 2015 7:40 am

MaskingtheNightAway wrote:From reading the last post, it confirms my suspicions that Sleep Labs and DME's are just in it for the money.

I've got my own equipment and now I'm having trouble finding a DME that will sell me mask's and tanks thru my Employer's Insurance Plan.

There seems to be a code that if you go "Outside" the system or process, no one wants to help you.

Teaching me a lesson, EH?


Call your insurance company and ask which suppliers (DME) are in their network.....By the way....what business is not in it for money?

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Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: S9 Autoset...APAP Settings 11-15
Last edited by LSAT on Sun Jan 03, 2016 10:12 pm, edited 1 time in total.


S9 Autoset with another as back up
Back up mask is another Quattro FF mask
Buckwheat Hull Pillow (CPAPfit) from http://www.pur-sleep.com/


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Roman Hokie
 
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Location: Central NY
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Re: Why is it necessary to have a support team?

Postby Roman Hokie on Fri Jan 01, 2016 6:32 am

LSAT wrote:
Call your insurance company and ask which suppliers (DME) are in their network.


Exactly. My new insurance provider has 3 levels of coverage. Affiliated (I work for a hospital), in network (non-affiliated), and out of network. So, I called the insurance company and they report that my Sleep Doc is affiliated (I can look that up on the hospital website) and they weren't sure about the DME because he's not a Doc. So, they had to call him to find out who his distributor is for the hardware. They are listed as being "in network" which is still 100% covered without copay/coinsurance/deductible.

However, they cannot complete a prior authorization with the patient; they have to confer with the DME provider. It's the DME's job to secure their prior authorization (agreement) that the item is covered. So, even if the DME is in the network, the DME will need to secure approval. Generally (and I have to do this at work at times for my own patients), it takes 1-3 days, sometimes as little as 20 minutes from the initiation of the phone call, but voicemails and whatnot..

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tlohse
 
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Location: West Bend, Wisconsin
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Re: Why is it necessary to have a support team?

Postby tlohse on Mon May 30, 2016 6:05 pm

A support team is very important. You need to have a team that supports you through this disorder other wise you will often fail. I have been a CPAP user since 2013. Im 38 and doing great with my machine. and my sleep doctor and family and DME support me all the way.

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Mask: Mirage™ FX Nasal CPAP Mask with Headgear
Humidifier: PR System One Heated Humidifier
Additional Comments: First became a cpapper June 11, 2013 pressure setting 10cmH20. DX: Severe Sleep Apnea with Hypersomnia. REF# 450P
Thomas Lohse
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