Do I really need a local DME?

[YogaKitty]

I have my prescription from my doc and a list of in network DMEs. I know I need to start calling them but I dread it. I dislike salesmen and playing games. If my insurance will pay could I get by just ordering from cpap.com? I know there are fit issues and such, but I sure would like to avoid all the hassle! I am a newbie and have never used cpap except at my titration study.

[Xney]

The main advantage of going through a (good) DME is they can let you try out masks quickly and help you get it right (hopefully). Otherwise, if your insurance will reimburse you when you buy it on your own, there's no benefit. They're basically a value-add.

They do tend to be good at filling out insurance stuff to get their money.

[chunkyfrog]

Usually, online means higher co-pay for you, often an UNGODLY deductible.
Cpap.com needs all the money up front--from you, Insurance is 'supposed' to reimburse
you for whatever is their responsibility--(their schedule, their rules: be prepared to wait)
If you can wangle the right machine on your RX, and get the local yokels to fill it correctly
(without an upcharge), they might be more affordable, or at least easier to swing.
You have to do your research--it's different everywhere.
They are just people--If your RX is EXACTLY what you need, it is way better than a vague scrip.

[LoneStar]

I don't have a local DME and I'm doing fine.

I have a high insurance deductible. So I did the math and it was cheaper in the long run to order from CPAP.com. And, as you said, I didn't have to deal with the DME morons/salespeople. As far as masks go, I just pay for mask insurance when I try a new one. I've been lucky in that I found a mask I can tolerate fairly quickly.

Lisa

[J-Mac]

I don’t use a local DME - haven't for 10 more than years now - and all is fine here. I have insurance but I pay for all my equipment myself. My first three years on CPAP I used the DME mandated by insurance, and they were definitely not good "neighbors"! They gave me a machine that was off the market for a few years, didn't not allow me any input at all on what type of mask or machine I used. Basically they gave me the cheapest they could scrounge up. I decided that I would rather pay for it myself and then get what I wanted and needed. And have had no more problems.

Jim

[msla]

I don’t use a local DME - haven't for 10 more than years now - and all is fine here. I have insurance but I pay for all my equipment myself. My first three years on CPAP I used the DME mandated by insurance, and they were definitely not good "neighbors"! They gave me a machine that was off the market for a few years, didn't not allow me any input at all on what type of mask or machine I used. Basically they gave me the cheapest they could scrounge up. I decided that I would rather pay for it myself and then get what I wanted and needed. And have had no more problems.

Jim

To borrow from the ad, "... and peace-of-mind with no aggrivation, priceless."

[chunkyfrog]

I think I may have met my in-network deductible this year--all out of network!
I don't plan to get any cpap supplies in-network this year.
I've gotten way better prices, fantastic service, and a return policy I don't have to fight for.
My stuff arrives in about half the time, and I don't have to drive across town--
in a hurry because the DME closes within a half hour of when I get off work.
I don't have to wait three months for a new mask; and I don't have to listen to lies.
Once I retire, it will depend on which (if any) contracted Medicare providers are
willing and able to provide what I need.

[brucifer]

You need to do the math and weigh the costs. Since I have met my deductible this year, it was a no-brainer for me to go with a DME supplier since ALL online CPAP vendors are out-of-network with CIGNA. The difference under my plan was going with a DME supplier and paying 15% co=pay, or going out-of-network and waiting to be reimbursed 60% (40% co-pay). I was fortunate that I found an excellent DME provider that worked with me. You may find one like that too.

As for next year, I may just pay out of pocket for my CPAP supplies until my deductible is met once again. I have to get an annual brain MRI, so that pretty much eats up my deductible every year.

[YogaKitty]

Well, those are all good points from everyone. I HAVE already met my in network deductible for this year, but probably not the out of network. I will check on that. Going to start calling my list of DMEs this morning

[chunkyfrog]

In my case, I got my sleep studies and first machine early in the year;
so I had all year to use the DME for supplies--only paying co-pay.
Of course, they were such jerks, I fired them and hired a new DME--not much better.
I am free of them for a while; but looking down the throat of Medicare,
I need to find a new DME that will sell me the masks and supplies I need.
And if the election results in Medicare not covering CPAP, I am preparing for that too.
PS: I have never said an unkind or angry word to any DME, so if I need them,
they will still welcome my business.

[YogaKitty]

It's always better not to burn your bridges!

[J-Mac]

It's always better not to burn your bridges!

Oh, I wouldn’t say "always"! Some bridges are better off burned.

Jim

[purple]

Despite all the negative experiences of those on the board, I have only had really good experiences with DME's. That is multiple DME's in different states.

My first sleep doctor told me that it was my choice as to which DME to use, and then gave me a list of DME's listed in order of the reports of patients as to how good the DME was. All of them charge the same price for Medicare/Medicaid.

When one first starts with xPAP therapy a DME (that accepts Medicare) can be very useful. My first DME let me try several different masks, and brought them to my front door within 36 hours of my asking.

My current address is in a small town, my DME being over an hours drive away. Their RT has driven by my house to set my machine. Told me if I had any problems, she would come back over to help. By the way, she is very competent, working for the DME as a second job, her first being in a hospital wing devoted to people who need respiratory equipment.

When I had a mask that needed to be replaced, I called, and had a new mask before bed time the next day. When I wanted to try another mask, and Medicare did not say I was entitled to a mask, as the one I was using had not been used for three months, the DME sent me the right mask before bedtme the next day, No Charge. After a few days I called and said that one did not work. I got another mask type, again I received it within 24 hours, no charge. Although that time I chose to drive to the DME office so I could meet with the RT to ask some questions. The RT is not available to come to my house just any day. When I needed another set of head straps at three months, and Medicare says I could not have new headstraps but once every six months. Before sleep time the next day, new headstraps, No charge. (They retail for about sixty dollars).

In truth I owe my current DME a bunch of money for the co-pay of items I received months ago. Still I get everything on time. If I need something and do not have money to pay, it is still no issue. They just send it.

CPAP.com is cash in advance. If you at the end of the month, and your money, then you can not get anything from CPAP.com. My brick and mortar DME is right there with the goods. No hassle. No delay. Pay whenever I can.

For a newcomer who can benefit with little bits of advice, a good DME is the better choice than the internet. The reality is that why Medicare requires we buy through a real DME, not an internet DME. So we can get help when we need it. Just some brick and mortar DME's behave like internet suppliers.

IF you have had experience with doing your Sleep Apnea treatment, and never need advice. Then one might be better off financially to buy off the internet.

But do what you want.

[YogaKitty]

I called six DMEs this afternoon. One was snotty, one couldn't seem to accept I had possession of my own script, one had no RRT on staff, one just wasn't helpful and none of them carried Resmed. The other two were nice and carry Resmed but the RT was out at the time. These were the local Apria and Lincare - the ones I expected the least from. Lincare is supposed to call me back and I need to call . I still have a bout four more I can call also.

[purple]

Not carrying Resmed might be a term for, we do not have a Resmed on the shelf at this moment. If one wants a Resmed, then it is best to have the doctor specifically write Resmed on the prescription and add, dispense as written. Typically the DME can get a Resmed in a day or so.

Most of supplies actually come not from the town nearby (altho all the no charge stuff they sent me did start there). The company has a national central warehouse that is geared to supply a huge geographic area.

My first DME did their own local warehouse for everything. Near the end of my time with them, their management got into trying to make a bit more money by trying to keep fewer things on the shelf, and reducing the workforce. They were still nice, just getting some things took a few more days. The large central warehouse is pretty good. Just whatever is shipped from the central warehouse must be paid for. Whereas my local guys are happy to help.

If you look at the cpap.com site for prices for similar machines between Resmed and Phililps Respironics, we see the similar Respironics machines are a lot lot less expensive. All of my Sleep Doctors preferred that I have a Respironics machine, because the sleep docs preferred the software which is provided by Philips.

Not having an Respiratory Therapist at DME office, all the time is not unusual. A lot of the fitting of masks can be accomplished by an experienced person who cares that you get the right mask.

Apria has been referred to on the board as Crap aria, because of their policies and often personnel who are low paid, and seem overworked, and do not much care for helping the patient.

Then again, I have never used Apria.

Some of the biggest chain DME's are the kinds we complain about. They are typically the ones who can get the insurance carriers to require they be the only supplier, because they sell for less.