Changing DMEs

snowdog · Post by **snowdog** » Tue Oct 18, 2005 6:22 am

I just got the word yesterday that I have to change DMEs. My insurance company apparently went though all the DMEs that they had contracts with and decided to cut a bunch. The one I've been using didn't make the cut. I can't say that I'm upset because I haven't had any contact with them since the first week.

What this does mean is that my machine goes back and I'll be getting a new one from the new DME.

Thanks to the folks and information I've picked up on this site I'm going to fight like heck to get an APAP this time around. Maybe I'll even get a new mask.

Guest · Post by **Guest** » Tue Oct 18, 2005 2:27 pm

Good luck snowdog, give 'em one for the gipper and one for all of us at cpaptalk!

wading thru the muck! · Post by **wading thru the muck!** » Tue Oct 18, 2005 3:11 pm

Did they say that you are to return your machine and get another from a different DME? Or is your DME no longer on the list of approved providers? I would assume that your insurance negotiated a rental contract with your current DME through the end of the rental period.

IllinoisRRT · Post by **IllinoisRRT** » Tue Oct 18, 2005 6:22 pm

In my very limited experience, most private insurance companies and Medicaid (basically, everything besides Medicare) purchases CPAP machines outright- was yours not purchased for you? At the very least, maybe your new DME will be a little better at contacting you!

Jan in Colo. · Post by **Jan in Colo.** » Tue Oct 18, 2005 10:17 pm

"In my very limited experience, most private insurance companies and Medicaid (basically, everything besides Medicare) purchases CPAP machines outright- was yours not purchased for you?"

The RT at my DME said my machine was being rented. I asked when would it be purchased for me and she said it would be after 3 months and only at my request. She then went on a spiel that I should NEVER request a purchase because why buy a machine that would soon be outdated? I should just have the insurance rent from them forever.....geez loueez, was that a transparent bid for the DME to make more money or WHAT?

Jan in Colo.

Geocom · Post by **Geocom** » Wed Oct 19, 2005 4:21 am

Snowdog,

Can't you just purchase your equipment from a place like cpapman.com or cpap.com and submit the receipt to your insurance company for reimbursement?

George

wading thru the muck! · Post by **wading thru the muck!** » Wed Oct 19, 2005 4:25 am

Geocom wrote:Snowdog,

Can't you just purchase your equipment from a place like cpapman.com or cpap.com and submit the receipt to your insurance company for reimbursement?

George

George,

Yes! that is exactly what I did.

snowdog · Post by **snowdog** » Sun Oct 30, 2005 10:06 am

Hi everyone, I've been off the boards for a few days so haven't had time to get back to everyone's questions.

Here we are,

My current (old) DME is no longer on the list of approved providers. Like I said before, no great loss. The insurance company doesn't buy the machines outright, they rent for the first six months then buy them. It makes sense when you think of how many people give up in the first few months. The old DME is supposed to pick up my current machine and the new DME is supposed to deliver another. I've got to call the insurance company again tomorrow (Monday) because of course they haven't gotten back to me on when this is supposed to take place. I could probably get a machine through CPAP.com but trying to get reimbursed through the insurance company is more of a headache then I need in my life right now. I also don't have the available cash to front for a machine then wait for the reimbursment to happen. I've had enough experience with insurance companies to know if you don't do things exactly like they want then they will give you problems just out of spite. When we've got a week I'll tell you my story about a major auto insurance carrier out of Northbrook, Illinois that begins with an All and ends with -State. If you've got 'em pray you never get into an accident, even if you're rear-ended while at a stop and no way it's your fault and the person who hit you has already admitted fault...

Does it show I hate insurance companies?

rested gal · Post by **rested gal** » Sun Oct 30, 2005 10:23 am

The old DME is supposed to pick up my current machine and the new DME is supposed to deliver another. I've got to call the insurance company again tomorrow (Monday) because of course they haven't gotten back to me on when this is supposed to take place.

snowdog, I have no experience with medical insurance stuff at all, but you might want to call your doctor right away (well, early Monday, anyway ) and get him to fax an Rx to the new DME for the specific autopap machine you want.

I'd think that without a new order from the doctor, the new DME is just going to go by your original Rx, and do what the old one DME did regardless of what YOU request. I'd bet they'll bring out another straight cpap machine for you, unless a new Rx from your doctor for an autopap catches them before they pull what they want to give you off their shelf. And even then, there's no guarantee that they'll bring you an autopap.

Now's your best chance of it happening, though...but if it's going to work at all, it will take the doctor's Rx for "autopap" specifically, I do believe. Time's of the essence!

sleepyinsunnyvale · Post by **sleepyinsunnyvale** » Sun Oct 30, 2005 11:23 am

I just went through the same thing. My insurance company is changing DMEs. That was OK with me since the first one never did anything for me except to give me a APAP, pat me on my head and send me off.
However, dealing with the new DME was worse. In preparation for getting the new machine I made several calls to the new DME and spoke to a new person each time. On the second call I was told that besides the Rx I needed a "Letter of Necessity". No problem as I have one from the start to my treatment 4 years ago that states the treatment is indefinite. One person said not good enough need a new one. The next person said the old one was fine but by the way, don't forget a copy of the sleep study. After getting all that straight they gave me a fax number. But before I could fax the stuff to them they wanted my doctor to call them!! Like that's going to happen!
Anyway I called my insurance company and they had no problem with my buying my machine from cpap.com and send a claim form in. They did say that my portion would be 40% rather than 20% since it was out of network. I figure it's a wash. The DME would change my insurance company twice what I paid at cpap.com so my out of pocket is the same either way.

Happy to say I now have my new APAP fro cpap.com and life is good again.

limpy · Post by **limpy** » Sun Oct 30, 2005 11:53 am

The only DME switch that you should make is from your current DME to BillMyInsurance.com. Who else will give you an auto? Who else talks to you at the time of sale about when you want your reminder calls - and that actually calls?

*climbs off soap box*