Newbie: How do you know if DME is good

[LakeH1042]

I got a list of 5 DME's from my Sleep Dr. (whom I only met once when setting up the sleep study), none of which are particulary close to me. How do I find out how reliable they are in meeting my needs? The results of the sleep study was moderate obstructive sleep apnea which responded well to cpap therapy. (I don't meet with the Dr. for a 2nd time until a month after the titration (spelling?) study, originally it was going to be 2 months-- is this "normal"?) (To give the Dr. his due, the sleep center is owned by him and one other Dr. and it was great. Very professional staff, very responsive.)

Has anyone any recommendations (good or bad) on a DME close to Silver Spring, Maryland? Really would appreciate some guidance. Right now I'm set up with Bay State Medical for later this week, but have no information on how good or bad they might be.

My Rx (actually Sleep Study Result) "Suggest home nasal Auto Cpap trial with 6-12 cm H2O with heated humidification and Resmed FX nasal mask." Would this be enough to argue for a Resmed S9 Autoset with H5i heated humidifier? Or do I need to contact my mystery Dr. and ask for a more specific recommendation? I'd like to get the climate line tubing at the same time under insurance, but would not have a problem with buying that myself. (Insurance is Medicare A&B as primary and Federal Employee's Program Blue Cross/Blue Shield as secondary.)

Any information deeply appreciated.

Thanks

[JohnBFisher]

... I got a list of 5 DME's from my Sleep Dr. (whom I only met once when setting up the sleep study), none of which are particulary close to me. How do I find out how reliable they are in meeting my needs? The results of the sleep study was moderate obstructive sleep apnea which responded well to cpap therapy. (I don't meet with the Dr. for a 2nd time until a month after the titration (spelling?) study, originally it was going to be 2 months-- is this "normal"?) ...

First, welcome to the forum! Glad you are here to ask questions like this. While I can not offer medical advice, I can provide answers based on my own experience.

When I have a list of DMEs, I take the time to research them. For example, I use Google search to see if there are any reviews associated with them. I then review what is written. Of course, I tend to ignore those that appear to be written by a petulant poster who wants EVERYTHING just their way. But if there are serious concerns (about professionalism, approach, manner, etc), then I mark down that DME. I also check the Better Business Bureau. If there are problems with their service it will show up here. Finally, once I've gotten it down to a small group of DMEs (two or three), I call and interview them. I ask things such as "Will you provide a data capable unit?" .. or .. "Tell me about the experience of your Respiratory Therapist." .. or .. "What is your policy on changing masks if the mask does not work for me?" .. or .. "Is there someone I can call if I have problems?" .. or ... you get the idea.

Unfortunately, if I told you that a DME is good here, the same DME company might not be any good in your area .. and of course it goes the other way around. It highly depends on the individuals involved.

... My Rx (actually Sleep Study Result) "Suggest home nasal Auto Cpap trial with 6-12 cm H2O with heated humidification and Resmed FX nasal mask." Would this be enough to argue for a Resmed S9 Autoset with H5i heated humidifier? Or do I need to contact my mystery Dr. and ask for a more specific recommendation? I'd like to get the climate line tubing at the same time under insurance, but would not have a problem with buying that myself. (Insurance is Medicare A&B as primary and Federal Employee's Program Blue Cross/Blue Shield as secondary.) ...

The Resmed S9 is one option. You might want to ask the DME if they can provide the unit .. or the PR S1 compatable unit with their heated tube:

https://www.cpap.com/productpage/pr-sys ... -tube.html

Sometimes a DME has arrangements with just one of the two manufacturers. So, ask and see what are your options.

Hope that helps.

[Janknitz]

Please read my blog post "What you need to know before you meet your DME".

The first step is to understand how your insurer will cover your equiPment. Since you are Medicare it's pretty straightforward unless your supplement acts like a PPO or HMO.

Medicare doesn't care which machine you get as long as its a CPAP or APAP. Medicare will pay the same amount for any CPAP/APAP machine. DMEs make less money on auto machines so they are not happy about providing them.

A good DME is one that will supply the machine you want with no hassle, won't try to upcharge you, and will have a liberal mask return policy. If a DME tells you that you cannot have a particular machine or that you may exchange your mask only once or twice(be sure to ask what their policy is) move on and try another on your list.

Be sure to get a copy of your prescription and you can ask that it specify an auto machine with patient access to ahi AND leak data. That will help you with the DMEs.

[Pugsy]

My Rx (actually Sleep Study Result) "Suggest home nasal Auto Cpap trial with 6-12 cm H2O with heated humidification and Resmed FX nasal mask." Would this be enough to argue for a Resmed S9 Autoset with H5i heated humidifier?

It should be enough because it specifically states Auto with a pressure range to get an APAP machine.
The "trial" thing would bug me..might give the DME an out to supply a temporary APAP machine but doesn't mean that they would for sure do a short term APAP machine.

Brand will likely depend on what they normally dispense. Though they always can order another brand if they really wanted to.
My DME used to do only ResMed machines and complained they couldn't buy the Respironics at a good enough price to make much money ...I never did totally understand that one but last year they changed over to dispensing Respironics machines so I guess they got a better bulk price. When I first met with them and was discussing machines they offered to order me a Respironics machine if that was what I wanted. It turned out I found a new one on the secondary market for less than my insurance co pays so I just bought it. I was wanting Respironics because of a couple of additional data features that the ResMed at that time didn't offer.

Interview your possible choices and ask which machine they would supply based on the RX. Ask if it would be temporary or if you will keep it long term.... Just to avoid that "trial" thing giving them an option to switch out to a lesser machine after a suitable "trial" period.

[LakeH1042]

Thanks for your suggestions, I appreciate any and all hints. I followed your suggestions, had my doctor's office fax me the material they sent to Bay State and then called Bay State to see if they carried the Resmed S9 Autoset with heated humidifier (they do), and checked on their mask return/swap policy (as long as within 30 days of when you got it). So far so good It looks lik I will be able to get the machine that I want from them given the doctor's orders.

Now my puzzlement I checked for user reviews and only found a few, which were mixed but not in a good way. They were either terrible (1 out of 5) or supper (5 out of 5). There were no reviews that contained "this was good, but that was bad, and this was so-so" So my question now is if you aren't getting continuing support that you need from the DME where you initially got set up, can you switch to another?

[Janknitz]

Reviews can be mixed for a DME for a lot of reasons, not the least of which is that people don't know what they don't know. In other words, a DME can be terrible with CPAP stuff, but if the individual never checks out a forum like this, they may think their inability to sleep with the CPAP, constant leaks and discomfort, lack of data about EFFICACY because they are stuck with a brick are normal. They may give the DME a high rating because he or she arrived on time and was polite. They may give a good DME a low rating because they were so confused to begin with that they didn't understand that their DME was acting out of the norm by following up or taking the time to do a good mask fitting when all they wanted was to be left alone.

Whether you can change DME's or not depends on how your insurance works. Medicare and many insurers do a sort of "rent to own" program called a "capped rental" for anywhere from 12 to 14 months. Instead of paying the entire cost up front, they pay a partial payment every month until a certain number of months--at that point the machine is yours forever. If you switch DME's, the new DME doesn't get to start the rent to own clock over--he has to pick it up where you left off. So after the first month or two, you won't be very attractive to a new DME because if they supply you with the machine they are only going to get a partial payment for it. It will be nearly impossible to get a DME to supply you with a new ResMed S9 auto for only 10 rental payments instead of 13.

However, you can order your supplies (masks, hoses, and filters) from whomever you want. Again, some DME's don't think you're worth their time if they did not supply your machine (where most of the profit is), but if you encounter that you don't want them as your DME either.

[Suddenly Worn Out]

If your DME is purely respiratory focused, like all they deal in is sleep apnea gear, respiratory gear and oxygen, they are probably good. If your DME is a generalist DME, they probably are just so so or even poor. The best DME I used was my first and they were purely respiratory focused.

[LakeH1042]

Thanks all - I feel better but will continue to be nervous until I see how things work out over time. Guess there are no guarantees in this life (As I like to say, "It's not paranoia if THEY really are out to get you"

[zoocrewphoto]

Have you asked anybody you know if they know anybody with sleep apnea?

I am really surprised to find out that a lot of people I know have it. Most are not local, but my mom is. She doesn't use her equipment as often as she should, and I know that the reasons are mainly her own fault. She has been happy with the place she gets them from, and it happens to be about a 10 minute drive.

When I first learned I would probably be getting a machine, I did contact a few places. One sounded nice and has a nice selection, but they do not accept insurance. They give you paperwork to give to your insurance company for reimbursement. This is not an option for me, as I am living paycheck to paycheck. No way I could come up with $500+ to get a system. Their cheapest machine was $400, and the mask I wanted was $185. And that is nothing compared to what I actually just got yesterday. So, I was glad when I contacted my mom's DME, and they told me they do an insurance verification process to make sure I am covered for what I need. I also called my insurance company, and they explained that medical equipment is covered like a doctor's appointment, so 85% covered, billed to insurance first, and then to me.

The DME also made it very easy for me. They told me to give my doctor their fax number. The doctor sent in my prescription and insurance info. The DME called to let me know they received it and would start the verification process which normally takes 24-48 hours. They called back 2 hours later, ready to schedule the appointment. I had my doctor appointment Thursday afternoon, and got my apap machine Monday afternoon.

They already had my machine set up. (my doctor chose the actual machine type) I got a demo of the machine, how to use it, take care of it, etc. He asked if I knew what type of mask I was interested in. I told him I hoped they had the same kind I used in the sleep study. I had a paper with a photo of it. I checked my size and came back with the exact model I wanted. I was very pleased with the experience overall. I haven't gone any further in the process, such as asking for help, or ordering supplies.

[swrinfla]

It may be too late to really cover your concerns, but others may benefit.

Criteria established by our support group are essentially:

1] DME must be local, but with national affiliations

2] DME must offer truly personal service, to include

a] monthly calls to see how you're doing

b] personal, at home, sessions to fit you to your mask or pillows

c] personal concern for your over-all well-being

3] DME must always have the equipment and supplies you want/need

4] DME must understand completely and be able to cope with Medicare/private insurance "issues"

Please understand that as Medicare "rules" evolve, and thus so do other insurance "rules," dealing with the bureaucratic red tape will become more difficult, thus more stressful. So, keep a low-key, cool outlook!

More power to all xPAP folks!

SWR

[chunkyfrog]

If they have a sleep lab on the premises, I would think twice.
Also, be very wary if they have a really BIG display of scooters and lift chairs.