SOLVED - Problem with DME over Trilogy

Madalot wrote: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.

I am so happy for you Madalot. I definitely know what it is like to deal with people who seemingly have no brains and then miraculously find the one who does. It is amazing how often this seems to occur.

I will be you are greatly relieved.

Very happy to hear about the good outcome. Yeah... the idiots walk among us.

YAHOO!!!! Way to go Maddie.... you stuck to your guns and you WON!!!!
Cheers
Nan

I hope you got her name and number in case the idiots strike again so you can call her. Glad you got it resolved.

Madalot wrote: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.

Madalot, I am going to envision and really SEE you keeping that machine, and trusting that things will work out as they are supposed to, when they are supposed to.

Good luck!
Jill

I'm not sure that not making co-pays is a breach of contract. Providers have the option of "accepting assignment"--that is accepting what the insurer pays as "payment in full". It used to be commonplace for providers to accept assignment.

squid13 wrote:I hope you got her name and number in case the idiots strike again so you can call her. Glad you got it resolved.

Oh, you know I did! Her name, number and extension. I wrote it all down.

Part of this is that from the day I got the Trilogy (Feb 2010) things have been royally screwed up. My DME had little clue about the machine and the RT had such a superiority complex that it was ridiculous. She made mistakes (which I am okay with) but refused to acknowledge them or learn from them. She was right even when she was wrong.

I had been on cpap & bipap and failed both, but was told they were both a rent to own situation. They never said a thing about the Trilogy and it wasn't until I got a bill for 8 months worth of copays that they informed me it was a perpetual rental and that my copay was $300 per MONTH. Then they accused me/my insurance of not paying a large copay on my wheelchair, even though *I* had proof they had paid. They got it, but somebody made a mistake and didn't credit it to my account.

Then when the DME sold out, the NEW DME had never seen a Trilogy and was totally clueless about how it worked, how to change settings, how to bill it, etc. It was a NIGHTMARE. But in the end I had patience with them, TAUGHT their RT how to use the damn thing and worked with them after they went through a rollercoaster of "you own it, no you don't, you own it, no you don't" --

I think Janknitz is right in that they have the ability to accept insurance payments and waive copays. And the reasoning behind it, in my situation, is sound and makes perfect sense. With ALL other Trilogy patients, they are on call 24/7 for ANY issue, question, concern, SETTING CHANGE, etc. With me, I do all that myself, rarely contact my RT except when she notifies me it's time for my quarterly visit & supply drop off.

They bill my insurance every month for the rental and do very little to earn it.

It's just finding and getting to the right person to have them actually listen, think then act on the facts.

So, I'm good for now - until next time. And it will happen again as their personnel changes and I'm again popped back into the finance department and told that my waiver isn't applicable again.

I fear that eventually, I won't be able to find THE RIGHT person. But I suppose I'll cross that stupid bridge when I come to it.

Can't you buy a used machine and bill the insurance for out network? Anyone tried billing the insurance for out of network cpap machines lately?

borgready wrote:Can't you buy a used machine and bill the insurance for out network? Anyone tried billing the insurance for out of network cpap machines lately?

If I need to go off the Trilogy in the future, I would probably try to find a used AVAPS machine to purchase outright (assuming I'm still using AVAPS that time). Trying to buy a used Trilogy? I don't know about that one.

Do I recall correctly that you have a neuromuscular disease? Something like MS or MD? Next time this happens, ask the manager how they would like the headline in the local paper to read "DME takes ventilator away from patient with a neuromuscular disorder."

Janknitz wrote:Do I recall correctly that you have a neuromuscular disease? Something like MS or MD? Next time this happens, ask the manager how they would like the headline in the local paper to read "DME takes ventilator away from patient with a neuromuscular disorder."

Officially, I have a neuromuscular disease of unknown etiology. The first "educated guess" was Myotubular Myopathy, then a new doctor thought Limb Girdle Muscular Dystrophy. Now, the "educated guess" is Mitochondrial Myopathy with a Myasthenic Syndrome.

Still no word from the research study at Children's -- blood work was sent 2-3 years ago - I can't even remember now.

At least for now, I've got it settled where I am back in their system as they accept insurance as payment in full. I've made it clear that if they don't leave me under that status, they need to come pick up their equipment. Usually when I say that (and I DO mean it) is when they figure out a way to fix it (once I get someone with a brain on the phone).

But yeah -- can you imagine the publicity on that one?

Madalot wrote: I've made it clear that if they don't leave me under that status, they need to come pick up their equipment. Usually when I say that (and I DO mean it) is when they figure out a way to fix it (once I get someone with a brain on the phone).

But yeah -- can you imagine the publicity on that one?

"Come and pick it up and be prepared for a photo op with the local newspaper."

BlackSpinner wrote:

Madalot wrote: I've made it clear that if they don't leave me under that status, they need to come pick up their equipment. Usually when I say that (and I DO mean it) is when they figure out a way to fix it (once I get someone with a brain on the phone).

But yeah -- can you imagine the publicity on that one?

"Come and pick it up and be prepared for a photo op with the local newspaper."

Well, truth be told. I wouldn't do that unless absolutely necessary. It's not my way.

This is based on nothing but a gut feeling I have, but I think they are a little concerned about getting sued as well. The way I have been handled on the Trilogy, since DAY 1, has been wrong. How in the world do you switch a patient from bipap (with a rent to own contract) to the Trilogy and never once mention that it's a perpetual rental and your copay will be upwards of $300 per month??? And the way you notify the patient is to wait 6-8 months then smack them with one humongous bill?

Additionally, it's blatantly obvious that they jumped from bipap to Trilogy without ever giving ASV or AVAPS machines (again, rent to own) a try BEFORE saddling the patient with this PERPETUAL RENTAL.

Then you don't bother telling the patient you're selling your company and the new company has no effing clue what to do with you so they do tons of different things and bounce you all over the place, financially, until you're ready to jump off the roof?

It's been one wild ride, that's for sure.

Thank goodness. I was beginning to get a cramp in my fingers from holding them crossed for so long.

Must have been the suit of armor. (Private joke.)