HELP!!! I think the DME is lying to me again!

[cowlypso]

So my machine malfunctioned over the weekend. I took it in to the DME today and they surprised me by saying that they'd be happy to exchange it for a new one, no problem at all. I was hopeful to get one of the newer firmware versions that would have the silent mode option, because the beeping drives me up the wall.

I get called back to the little room and there's the "new" machine sitting on the table. The carrying case next to it was filthy. As in it looked like it had been sitting in somebody's garage or basement for years. The machine itself was clearly used (the finish was rubbed off in areas). I told the lady that I wanted a new machine, not an old used one, as I'm going to be stuck with this machine for 5 years.

I was told by the respiratory lady and her supervisor that, because my insurance requires a rental rather than an outright purchase, they can only give me a machine from their "rental pool", and all of those machines are used. It is their policy to only give out brand new machines to patients who are making an outright purchase. They told me that my insurance company, by requiring the rental, is not paying for a new machine.

I took my current machine and walked out. It malfunctioned Saturday night, but worked okay Sunday and Monday, so I'm taking my chances until I can get this figured out. Is there any truth to what they are telling me? Also, is there any way to change DMEs at this point? I'm 5 or 6 months into the rental period, so I'm doubtful that there's any way to switch to a new DME, but if there is I'd do it.

[STL Mark]

DMEs tend to only lie when they open their mouth. I think I would call insurance and find out what other DMEs in the area are acceptable. (Or call the DMEs and find out if they accept your insurance). Seems like it is a good time to end your rental period with that DME and start up with a new one.

[MsBea]

Call your insurance company. Find out what their procedure really is and go from there.

[jnk]

Rule #1 of the DME: The cheaper the machine the DME can get the patient to accept, the more money that is made by the DME.

There is no Rule #2, or 3, or 4, or . . .

[Lizistired]

I'm missing something here. If your machine is malfunctioning and you are on rent to own... why don't they have to fix/replace it? Or they want to replace it with a used machine?

[cowlypso]

Yes, they want to replace it with a used machine. A visibly worn, dirty, used machine. But they had no problem with replacing it. I could have walked out of their office today with the "new" machine.

I called my insurance company, and they said that they have no directive as to whether the DME is required to provide me with a new machine or a used one. Which means that it's the DME's policy that they don't give out new machines.

I asked my insurance company about changing DMEs mid-rental, and she said that she couldn't find anything in the contract that specifically addressed this. All she could tell me is that the follow medicare guidelines.

I also asked about reimbursement if I purchased from an online supplier. She said that they would reimburse at a monthly rate. Meaning that I'd pay out of pocket up front, and then get reimbursed by them over the course of 12 months. I'm not sure about how that works with participating providers, networks, preauthorizations, etc. But it's an option I might explore. I'd definitely need to get something in writing from the insurance company about that before I did it, though. I'm currently living off of student loans and can't afford to purchase a machine myself.

[xenablue]

Yes, you can change DME's mid-stream. I did so, just a couple of months after the first one lied, cheated, lied some more, then didn't send a report to my neuro - that did it!

Only difference is that I 'own' my machine, but your insurance company will set you straight on whether the DME can dump a very used machine on you if yours malfunctions.

Good luck!

Cheers,
xena

[LSAT]

Your machine is under warranty. Tell them to send it in for repair to the manufacturer. They can give you a loaner until yours comes back.

[retrodave15]

Call your insurance company, find out what their replacement policy is. I had a DME outright lie to my wife, we thought it was a lie and they insurance company confirmed it. The insurance company then helped up switch to a new DME.

[BlackSpinner]

Call the manufacturer and tell them what is happening and if they can refer you to a repair place which will allow you to rent a temporary one.

[Pugsy]

You mention Medicare guidelines. Are you on Medicare or is it that your insurance company uses Medicare guidelines as their own guidelines?

Isn't the machine still under manufacturer warranty? Was it brand new when you got it? If it is still under warranty doesn't Respironics factor in this somewhere? Like sending the machine back..having Respironics fix it if they can and if they can't then they supply the new machine. At least that is what I have read from a few members here that had a warranty problem come up. Other than DME doing the sending back, they weren't involved with the warranty.

[cowlypso]

I am not on medicare... my insurance company (aetna student health - worst insurance ever!) just uses their guidelines.

I honestly have no idea if the machine was brand new when I got it. I assumed that it was, because it's a medical device that I was buying (through a rent-to-own agreement). But I never looked at the blower hours or anything. I do know that I got the machine in May but there was a sticker from the DME on the side that said it had been tested in March. I just assumed that's when they received it from the manufacturer and it had been sitting on a shelf since then. But, given this DME's apparent policy on rental machines, I probably assumed incorrectly.

So, I have no idea what happens to the warranty with PR if the DME continually turns over machines to different patients. Sending the machine in under warranty was definitely not mentioned as an option today. This whole thing just blows my mind! How can they sell you a used machine without telling you???

[snuginarug]

Ummm... OK... I don't know much about this particular business, but it seems reasonable for any situation in which your are renting TO OWN, you are essentially BUYING a new machine. THAT machine. Not some other machine. So if there is a problem with YOUR machine, it stands to reason that YOUR machine, under warranty, must be serviced or replaced by the manufacturer. NOT by the DME. I think if the insurance company knew and understood exactly what was happening, they would not like it very much. Perhaps you need to speak to a more experienced person at the insurance company who is familiar with the exact policies on rent-to-own durable medical equipment. I think you did the right thing by not surrendering your machine.

I am pretty appalled at what you describe. It sounds like outright, bare faced lying of the most despicable kind. Once you get this sorted out, I suggest you report them to the Better Business Bureau. Furthermore, if your insurance company determines which DMEs you can do business with, make sure they know what bandits theses guys are, so that they can be taken off the list of DMEs your insurance company approves.

Good luck. Stick to your guns and get what you are entitled to.

Oh, we were posting at the same time. Yes, according to Medicare guidelines and policies, when you start out, the machine MUST be new.

[Pugsy]

Look on the bottom of your machine (remove water tank first) there will be a sticker with a code that is the manufacture date. It will start with the year...Example 20110315 March 15, 2011
Respironics has a 2 year warranty...at least from that date which would indicate true age and sometimes from the time the DME received the machine.

[cowlypso]

My machine has a manufacture date of January 6, 2011. The "condition and safety check" performed by the DME was on March 28, 2011. I did not get the machine until May. Which definitely makes me wonder if there was another user in there somewhere.