SOLVED - Problem with DME over Trilogy

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Madalot
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SOLVED - Problem with DME over Trilogy

Post by Madalot » Fri Oct 24, 2014 10:03 am

My journey on the Trilogy has been a rocky road with a lot of mistakes and misunderstandings. The phrase "CF" comes to mind. When I was given the Trilogy by my original DME, they never told me that it was NOT the same as the other machines and that it would be a perpetual RENTAL to the tune of close to $1500 per MONTH. The co-pay on it was out of my range and ability to pay. That DME worked with me and we had a verbal & semi written agreement via email, but he sold his company to one of the big DME chains. And I got completely lost in that shuffle.

The new DME inherited me and the Trilogy issues and had never seen a Trilogy. I basically had to train their RT's on where everything was and how to set it up. Because of all the issues and problems, they found a way to "waive" my co-pays through use of a financial "charity" program they have. Plus, I told them flat out that I couldn't pay the copays (at that time is was over $300 per month) and if they didn't waive them, they had to take the machine. I also pointed out that they are making money on me, billing my insurance every month and all they have to do is send an RT quarterly to check the machine and bring supplies. If I need a setting change, *I* do it. I have NEVER called them and asked them to come out (over an hour away) to do anything.

Well, something has changed and their policies & procedures regarding the "charity" cases have changed and I no longer qualify. Not only that, their personnel have changed and to say that are not very nice or friendly is an understatement. What a bunch of idiot robots that can't do, think or say anything other than what they have been programmed. I despise people that are either unwilling or unable to listen to a situation and actually THINK about ways to resolve it.

But my financial situation has changed for the WORSE (go figure why I don't qualify now) and if they insist on my paying the monthly copay on this thing, they're going to have to take it back.

I've got a message into my RT (nice woman who is still there) and I'm hoping she can help me get in touch with somebody higher up with a brain and compassion that will override the financial departments decision. While they could give my Trilogy to someone else (they now have 12-15 of them out there), I am the ONLY patient they have that has a basic understanding and knowledge base about the machine (thank you cpap.com) and can handle most of my own stuff. They bill monthly and have to do very little for it. It would be good business to leave it the way it is.

But I'm not terribly hopeful so cross your fingers please.

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Last edited by Madalot on Wed Oct 29, 2014 8:55 am, edited 1 time in total.

JDS74
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Re: BIG Problem with DME over Trilogy

Post by JDS74 » Fri Oct 24, 2014 10:23 am

Maddy,

What does your insurance company say about the perpetual rental issue? Perhaps they could convert it into a purchase after all this time.

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Madalot
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Re: BIG Problem with DME over Trilogy

Post by Madalot » Fri Oct 24, 2014 12:35 pm

JDS74 wrote:What does your insurance company say about the perpetual rental issue? Perhaps they could convert it into a purchase after all this time.
I haven't asked them. I'm a little hesitant to inform them that I have NOT been paying the copays. It was an arrangement between me and the DME, but I'm not sure how they will react to it.

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BlackSpinner
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Re: BIG Problem with DME over Trilogy

Post by BlackSpinner » Fri Oct 24, 2014 4:09 pm

Madalot wrote:
JDS74 wrote:What does your insurance company say about the perpetual rental issue? Perhaps they could convert it into a purchase after all this time.
I haven't asked them. I'm a little hesitant to inform them that I have NOT been paying the copays. It was an arrangement between me and the DME, but I'm not sure how they will react to it.
It is not really their business because it was charitable arrangement with the former owners of the DME. Your income level was such that you fitted into their definition of someone needing help. New owners changed the definition of levels. Use this concept to call your insurance to discuss this perpetual rental issue. Also get in touch with your doctor and explain that you might need to get off the trilogy due to finances and see if they can arrange something.

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Madalot
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Re: BIG Problem with DME over Trilogy

Post by Madalot » Sat Oct 25, 2014 5:52 am

BlackSpinner wrote:
Madalot wrote:
JDS74 wrote:What does your insurance company say about the perpetual rental issue? Perhaps they could convert it into a purchase after all this time.
I haven't asked them. I'm a little hesitant to inform them that I have NOT been paying the copays. It was an arrangement between me and the DME, but I'm not sure how they will react to it.
It is not really their business because it was charitable arrangement with the former owners of the DME. Your income level was such that you fitted into their definition of someone needing help. New owners changed the definition of levels. Use this concept to call your insurance to discuss this perpetual rental issue. Also get in touch with your doctor and explain that you might need to get off the trilogy due to finances and see if they can arrange something.
You're right, BlackSpinner. I never heard back from my RT. She's awfully busy since they lost most of their RT's a year or two ago -- I guess I should have seen that as a sign. I'll give her Monday and if I don't hear, I'll call the insurance company on Tuesday.

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HoseCrusher
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Re: BIG Problem with DME over Trilogy

Post by HoseCrusher » Sun Oct 26, 2014 5:27 pm

I don't know if it will help but I will cross my fingers...

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Paralel
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Re: BIG Problem with DME over Trilogy

Post by Paralel » Mon Oct 27, 2014 3:30 am

Madalot wrote:
JDS74 wrote:What does your insurance company say about the perpetual rental issue? Perhaps they could convert it into a purchase after all this time.
I haven't asked them. I'm a little hesitant to inform them that I have NOT been paying the copays. It was an arrangement between me and the DME, but I'm not sure how they will react to it.
I would definitely make sure they do not found out you have not been paying your copays, that is a HUGE breach of contract between the DME and the insurance company, to which you were a party, since you knowing went along with it. They are absolutely 100% required to collect copays unless you have met your Out of Pocket Maximum for the year, then your insurance company picks up your copays. The DME could get in very serious trouble with the insurance company if they find out, and your policy could actually be terminated with the insurance company since you were involved with what the insurance company considers maleficence with regard the terms of your policy with them. They could even do a rescission, where they find out when you stopped making copays, and then cancel your policy retroactively, making you pay them back for every penny they spent from that point forward for your care. I'm really not blowing this out of proportion, insurance companies take not collecting copays in a situation like this deadly seriously.

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Madalot
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Re: BIG Problem with DME over Trilogy

Post by Madalot » Mon Oct 27, 2014 4:36 am

At this point, I'm mentally preparing myself to loose the Trilogy. The new management of my DME doesn't seem overly concerned about patient well being.

I'm still going to try to work with them, but assuming my concern becomes reality, I'm not sure what I'll be doing. Haven't gotten that far yet.

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BlackSpinner
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Re: BIG Problem with DME over Trilogy

Post by BlackSpinner » Mon Oct 27, 2014 8:57 am

Paralel wrote: I would definitely make sure they do not found out you have not been paying your copays, that is a HUGE breach of contract between the DME and the insurance company, to which you were a party, since you knowing went along with it. They are absolutely 100% required to collect copays unless you have met your Out of Pocket Maximum for the year, then your insurance company picks up your copays. The DME could get in very serious trouble with the insurance company if they find out, and your policy could actually be terminated with the insurance company since you were involved with what the insurance company considers maleficence with regard the terms of your policy with them. They could even do a rescission, where they find out when you stopped making copays, and then cancel your policy retroactively, making you pay them back for every penny they spent from that point forward for your care. I'm really not blowing this out of proportion, insurance companies take not collecting copays in a situation like this deadly seriously.
I am sure that the DME covered their ass "not pay my copays" is how she interprets their move. They could simply have set up a "charitable fund/ legal entity" where the copay was transferred from. It is just accounting. Perhaps she could use the term "A charity covered my copays"

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Madalot
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Re: BIG Problem with DME over Trilogy

Post by Madalot » Mon Oct 27, 2014 9:06 am

My goal, right now, is to try to get a human being, with half a brain, at the DME on the phone. I DID get one woman who said she understood I didn't want to repeat my story/situation 3-4 times and did some research to try to find me a MANAGER that I could at least begin with. Naturally that manager wasn't in, but I left her voicemail. Let's hope she calls back and after hearing my saga, agrees that they should continue our relationship without any changes AND has the power to make it happen.

If not, I still might call my insurance, but I don't have much hope that will accomplish much.

I've got too much else going on my life to have to deal with this crap. And it's pissing me off.

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Madalot
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Re: SOLVED - Problem with DME over Trilogy

Post by Madalot » Wed Oct 29, 2014 8:59 am

I FINALLY got someone on the phone with a brain. Wonderful woman who listened to everything I had to say, looked up my account, AGREED with me 100%. She said she needed to make a couple calls and would get back to me. Ten minutes later -- YES, 10 minutes, she called me back and said it was taken care of.

What I don't understand is why, when I spoke to the people in the financial department and asked if there was ANYONE in management that might be able to override the decision, they (more than one person) just kept saying "no" -- idiots.

But -- I got it taken care of, thank goodness.

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Re: SOLVED - Problem with DME over Trilogy

Post by Pugsy » Wed Oct 29, 2014 9:04 am

Whew....that's a relief.

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Madalot
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Re: SOLVED - Problem with DME over Trilogy

Post by Madalot » Wed Oct 29, 2014 9:12 am

Pugsy wrote:Whew....that's a relief.
It took a HUGE weight off my shoulders. Honestly, I would have been up ****'s creek without a paddle if I hadn't gotten this woman on the phone. While I dealt with too many idiots, it did restore my faith that there ARE still people with brains that can use them for the greater good.

These people that can do NOTHING but exactly what they are told -- scare the crap out of me.

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Mask: FlexiFit HC431 Full Face CPAP Mask with Headgear
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JDS74
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Re: SOLVED - Problem with DME over Trilogy

Post by JDS74 » Wed Oct 29, 2014 9:17 am

Wonderful news!
Now I can stop thinking about how to make a different machine into a fake Trilogy.
I wasn't making much progress.

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BlackSpinner
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Re: SOLVED - Problem with DME over Trilogy

Post by BlackSpinner » Wed Oct 29, 2014 9:25 am

I am so glad you managed to have that resolved.
I have battles like that too with regard to my mothers care. It is so hard to deal with because one is already under stress due to the issue.

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71. The lame can ride on horseback, the one-handed drive cattle. The deaf, fight and be useful. To be blind is better than to be burnt on the pyre. No one gets good from a corpse. The Havamal