Lack of Communication, Doctor & DME

[chunkyfrog]

Unfortunately, I have less than a year to find a local (or close enough) DME that is CONTRACTED with Medicare
to provide my specified supplies at the Medicare approved prices. (even with a road trip)
Most of the DME's here reserve the right to upcharge, and sign no contracts with Medicare.
One that does, carries no machines--just masks.
Others have a reputation for removing the extra pillows bundled in with masks by the manufacturers.
My last DME tried to sell me a mask with a MISSING PART.
The previous one tried to sell me one marked, 'NOT FOR HOME USE"
That DME is not even a medicare provider--apparently they are unable to meet even Medicare's meager standards.

[pats]

I just wanted to reply on lack of communication, doctor and DME. I did not read all the comments but got the idea. In defense of DME's, we spend much of our time and money, gathering the orders from the doctor's office, then correcting their orders, and then getting it approved by the patient's insurance. 3 places that an order can be mishandled. It happens all day long. If one number/letter is transcribed incorrectly we have to go back to the doctor to fix it. That takes FOREVER. If the doctor does not know the insurance laws (which they don't) we call the office and educate them. I don't know about all DMEs. In fact there are many crooked ones. But our DME works for the patient. (The go between from the doctor to insurance). Insurance makes so many cuts that this year we may not break even and we often lose money on equipment. There is never one side to a story. Always 2 and in the case of DMEs, doctors, insurance, and patients it gets very complicated. I am sorry that you had problems, however. And I do know of DMEs that are dishonest. They actually seem to be getting ahead right now to us. But behind some DMEs there is a hard working, honest owner who answers to patients, doctors, insurance and the government all of which can be a very motley crew.

The whole DME business troubles me a lot. I don't want a third party "educating" my doctor, or dealing behind my back with an insurance company. I want to manage those relationships myself, and know what is going on. The business selling me equipment should be in the business of selling equipment and only that.

Currently, I have no DME insurance, which makes my OSA treatment really simple and easy. I just get on-line to e.g. cpap.com, upload a prescription, and order anything covered by the prescription. I use Provent for travel, and also use it enough at home to stay in training. Nobody cares about the resulting gaps in my APAP use. My sleep doctor only cares that I'm using one of the treatments he has prescribed each night and using APAP most of the time.

However, in less than two years I'll be eligible for Medicare, and probably transitioning to a plan that includes DME. I'm really worried about the hassles and lack of control that may result. Some of the reports I've seen in this forum suggest that it could take a lot of work on my part to get what I want while keeping my out-of-pocket costs significantly under the total cost of buying on-line and avoiding delays. Buying equipment with DME insurance should be as quick and simple as buying the equipment myself with one added step of filing an insurance claim for anything covered by insurance, but it seems to be much messier than that.

[123.Shawn T.W.]

Mine just told me when I called ... "I was just going to call you ... And there is a $250 upcharge since that is upgraded model"

[Jwoody]

I have the 450P. The 30 days isn't a trial period as in use it to see if you want a better one. According to the Phillips rep I spoke to the machine was designed to test your tolerance and desired pressure for two weeks to 30 days. The technician programs the device to shut off autopressure after the diagnostic phase. They did not design the machine to be fully automatic then turn into a brick after 30 days. Doctors..not the vendor prefer the machine NOT to be automatic. It can be reprogrammed anytime. Automatic was not inteended to be a permanent use function.

I called Phillips at 1-800-722-7313 to verify these facts.

[chunkyfrog]

Pinocchio on his worst day probably was a DME.

[azpilgrims]

I have the 450P. The 30 days isn't a trial period as in use it to see if you want a better one. According to the Phillips rep I spoke to the machine was designed to test your tolerance and desired pressure for two weeks to 30 days. The technician programs the device to shut off autopressure after the diagnostic phase. They did not design the machine to be fully automatic then turn into a brick after 30 days. Doctors..not the vendor prefer the machine NOT to be automatic. It can be reprogrammed anytime. Automatic was not inteended to be a permanent use function.

I called Phillips at 1-800-722-7313 to verify these facts.

I will tell you from my experience during the 30 day trial period my AHI Average was roughly 11.59 on the 450P. I started on my new APAP 03/21/2012 and kept the same pressure settings through 08/23/2012 and for 156 days it dropped to an average AHI of 2.26 - I decided to adjust my pressure in August and since then my AHI Average is now down to 1.10 - so my point in replying is even though the 450P maybe called Auto for the period of time, it does not function the same as a true APAP Machine.