This IS a cheese shop, isn't it?!

Is anyone else familiar with Monty Python's famous cheese shop skit?
More to the point...Does anyone else feel like they are IN the cheese shop skit when they are dealing with the trained professionals at their local DME?

for those not familiar with the skit, a guy goes into a cheese shop to buy some tasty and exotic cheese from this specialty cheese shop. The owner keeps coming up with excuses as to why he doesn't have THAT particular cheese available. The customer tries other exotic varieties, then gets plainer and plainer and finally asks for plain cheddar cheese.
"Nope, sooooory, all out. Don't have it." the shop owner replies.
"What do you mean you don't have cheddar cheese???!!! Its only the most common and popular cheese in the entire western hemisphere?"


Well, I am pushing up against 4 WEEKS now, TRYING to get an insurance covered standard size Activa mask from my local overpriced DME. The Activa is not a new mask style, its not a rare one, its not one that only works on few people. Its pretty much the cheddar cheese of the mask world. The DME finally told me to quit bugging them and they will call me when it comes in.
Not a word from them since the last time I called them. Not even a "Sorry, we are working on it, thanks for your patience." Originally I was told it would be a "couple of DAYS" for them to get it.

Apparently the DME will get hold of anything you want, so they can keep putting up those "customer service awards" that line their walls. What doesn't show up in those awards is how they work to discourage you from "wanting" anything but the one machine and one or two masks THEY consider to be their standard offering.

It took 2 weeks to get the PB420E w/humid through them, and that was only through much groveling and pleading, or it would have been an extra week.

They told me they would throw in the silver lining software and cable with the $2000 machine, because they had that "laying around the office"....which they didn't and I am still waiting to find out if that, which is now a "special order", is still going to be "thrown in" or if that was a bait and switch. I am certainly not going to sign for some insane billing pricing for the software and cable unless they give me a SEPARATE WRITTEN and signed "not to exceed" reasonable price for that, since the insurance company will probably NOT pay for the software as a separate item.

And I have had my machine for almost 2 weeks without a clue as to what my results are from the machine and interfaces I am using with it. The DME set it WRONG to begin with, which is all the more reason I want to check my results.

and people wonder why DME's have such a bad reputation on this forum? Its because we share stories and about 9 out of 10 of the DME stories are negative.

and still I wait.....

I feel like walking into their office and saying...

"This IS a CPAP supplier, isn't it?"

Unfortunately I would only be talking to a receptionist and they keep the other people there carefully shielded from customer contact in person or phone.

And this IS the "better" DME in our local vicinty. I have tried one other and might yet have to try another.

Howdy snork1,

What kind of insurance do you have? Have you checked out BillMyInsurance.com? They ship Activa masks to those whose insurance is In Network.

Here's the link:

http://www.billmyinsurance.com/productS ... ery=activa

They can give you a copay quote or let you know that your out of network in a few hours.

Johnny

I am definitely going to check out billmyinsurance for next time, or maybe this time if something doesn't happen soon.

This fiasco with my DME started before billmyinsurance and I figured it was just going to run its course.

I am concerned that billmyinsurance would be considered "a non-preferred" source and might not be covered as well, although maybe SOME is better than none at this point?

I also heard some mention that billmyinsurance can't get certain products, which is where I am already, and the "main" part of my order was a PB 420E.

I certainly WILL be checking into it and my story should also be inspiration to others to check into alternatives.

Snork 1,
The treatment provided by your DME makes mine sound pretty good (although mine seems more like a distant relative who just keeps asking for more money)! My insurance isn't so hot. It pays 80% of any DME (in network or out) so basically I can go wherever I want. Once I have used the services of my DME (renting and finding out the best machine for me), I plan to get my very own system on-line. I do hope you get what you want real soon. What a hassle you are going through.
FF

Johnny,

I just ordered a mask through cpap.com out-of-pocket, even though insurance said they'd get me another but none of the approved-DMEs carry it, because cpap.com's customer service said they don't deal with Empire Bluecross. Is that true? If it isn't, could you guide me through how to do it now that it's on its way?

Thanks.

Greetings,

I also heard some mention that billmyinsurance can't get certain products, which is where I am already, and the "main" part of my order was a PB 420E.

Untrue. BillMyInsurance carries all popular products. It does not carry Hans Rudoph masks, as those masks tend to fit most users poorly. It does vend APAP machines of all kinds as well as every popular mask. For a full listing of products it offers, please visit:

http://www.billmyinsurance.com/findProducts.php

I am definitely going to check out billmyinsurance for next time, or maybe this time if something doesn't happen soon.

This fiasco with my DME started before billmyinsurance and I figured it was just going to run its course.

Each insurance company has different policies on mask replacement frequency. If you get your mask from the DME, make sure its the exact on you want, you may not be able to get a new one for 3-6+ months through insurance.

...because cpap.com's customer service said they don't deal with Empire Bluecross. Is that true? If it isn't, could you guide me through how to do it now that it's on its way?

It is very easy to find out if BillMyInsurance is a good solution for you. Simply fill out this form:

https://www.billmyinsurance.com/copay-quote.php

Johnny

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CPAPopedia Keywords Contained In This Post (Click For Definition): 420E, cpap.com, DME, APAP

I believe, although I could be wrong, that Empire Blue is the HMO for New York state plans. Is it an HMO? If so, only 'preferred providers' will show as in network making any other provider unattractive.

I believe, although I could be wrong, that Empire Blue is the HMO for New York state plans. Is it an HMO? If so, only 'preferred providers' will show as in network making any other provider unattractive

.

NE'er, I'm not following you on that. Could you please explain? Thanks.

I don't think BillMyInsurance will penetrate the Kaiser Permanente fortress, Sigh!

Apria is the worst DME and Kaiser does not know any better, they keep signing contracts with Apria to ONLY supply their members with 4 crappy unpopular Respironics masks and for nasal use, only the Breeze. I can get the Swift from them but for a $130 fee.

I will let Apria send me the Breeze and either sell it new in it's box and use the proceeds to get a Swift or swap for a Swift as I already have two Breeze purchased earlier before I discovered the Swift.


Kermit

Kermit,

I guess individual branches of Apria are the same as masks when it comes to CPAP. What works for one doesn't for another? I love Apria. They have been so helpful and easy to deal with. I have never had a problem getting anything, including my choice of what type of machine I wanted when it came time for my insurance company to buy one for me. The only negative I've had so far is, they don't carry the Aura and can't order it, so I just did that out of pocket. None of my insurance-approved DME's carried it.

Sorry to hear you're having such trouble with your branch. Maybe you can call the one I deal with on Long Island and have them send you what you need.

PS: Mine had Swift in stock for me...and they carry Breeze, Activa, and all the other popular masks. Maybe it's just the location you're dealing with.

Sleepless,

I am sure my branch can order the Swift it's just that Kaiser contracted to get the Respironics masks and Breeze I mentioned.

Yes my Apria branch is the worst as I have had nothing but headaches with them, but this time it's my insurance company, Kaiser, that went along with Apria's cheap mask package when contract negotiation time came.

When I finally conviced Kaiser to get me an auto, it wasn't easy, they gave Apria the go ahead. Despite me telling Apria that I wanted the Remstar Auto, they shipped me the Virtuoso. That's like ordering a BMW and getting 10 year old Kia. The Virtuoso is a snore detector with ancient technology and not worth a dime, but Apria has a bunch they can't give away.

I sent it back and raised hell. Apria hates me but I made them order me the PB 420e. This year I waited 5 months and made many calls to get the 420 paper filter that was always in the mail.


Kermit

Kermit,

That really, excuse my French, sucks! I don't use that word except when I can think of nothing better to fit the occasion. This is definitely one of those times.

Is your insurance job-related? I think I already know the answer to that or why would you stay with them? I guess it will just take someone within your company who has input into what insurance you have or what options are involved to be diagnosed with OSA or a SBD for them to realize how important having choices regarding your treatment is. I am so sorry you are going through this. I though it was Apria you were having a problem with, when in fact it's your insurance company who's pulling the strings.

Empire Blue is a Health Maintenance Organization (HMO) plan which covers only services extended by providers who are directly contracted with that specific plan (Empire Blue). Therefore, if a provider is contracted with Blue Cross Blue Shield but NOT a part of the Empire Blue network, that provider will show as Out of Network (OON) for Empire Blue. If a consumer of medical services elects to receive goods or services outside of the Empire Blue group of providers, that consumer will most likely have to pay 100% of the cost themselves. Hence, a provider of services who is not in the Empire Blue plan is 'unattractive' to consumers.

This is the website: http://www.empireblue.com/about_empire/index.shtml

NE'er,

Oh, exactly right. I didn't understand what you were saying in the first post. Yes, if I decide to go OON, then I pay for it out-of-pocket. I asked them if I could get it OON and submit and bill and the answer was negative.

Apria was the REALLY bad DME I changed from to get THIS one.

I could REALLY go off on all the problems I have had with Apria!

Thats why its dissappointing this new one really isn't THAT much better. Makes me think its trend for 90% of the DME's out there.