DME Ignored Doctor's Prescription

I was recently diagnosed with sleep apnea. Last week I picked up my equipment from the DME. (RES MED S9 AUTO/Nasal Pillows). I had a lot of trouble the first five nights so I contacted my doctor. He told me that the DME did not give me the equipment he ordered...PR System One REMstar Pro CPAP Machine with C-Flex(I think is what he said I pick it up tomorrow)with a modem so he can remote in and make adjustments as needed. Needless to say I am furious. The DME flat out lied to my face and told me the doctor didn't order a modem and that my insurance wouldn't cover it when I asked them about it, aside from giving me different equipment. Besides, what right do they have to give me equipment that wasn't ordered and then bill my insurance company for it? Unfortunately the DME is the only one in my area that accepts my insurance so I have to get the machine there. I will order supplies online from someone else.

drwten wrote:I was recently diagnosed with sleep apnea. Last week I picked up my equipment from the DME. (RES MED S9 AUTO/Nasal Pillows). I had a lot of trouble the first five nights so I contacted my doctor. He told me that the DME did not give me the equipment he ordered...PR System One REMstar Pro CPAP Machine with C-Flex(I think is what he said I pick it up tomorrow)with a modem so he can remote in and make adjustments as needed. Needless to say I am furious. The DME flat out lied to my face and told me the doctor didn't order a modem and that my insurance wouldn't cover it when I asked them about it, aside from giving me different equipment. Besides, what right do they have to give me equipment that wasn't ordered and then bill my insurance company for it? Unfortunately the DME is the only one in my area that accepts my insurance so I have to get the machine there. I will order supplies online from someone else.

Maybe try calling your insurance company and talking to them directly? Get names of who you talk to and a direct number if possible.

My DME is a local pharmacy. They have two store total, and I always talk to the same two or three people. I would have rather had the Resmed S9 myself, but I am happy with the Remstar 60 Series they give me. I chose them because they are who I use to fill prescriptions that cannot be filled at the Navy Hospital on base. I guess I just lucked out with my experience with them. My doctor did not ask for a modem, and the DME did not charge Tricare for a modem, but I have one so they can track my compliance without having to ask me to bring in my card.

Actually, the DME gave you a more expensive machine (and possibly a more capable machine - I have a hard time remembering which RemStar machine does what - and they all have such similar names) than the one the doctor ordered (not counting the modem). Personally, I wouldn't be too thrilled about having my doctor make remote (possibly unannounced) changes to my settings - but that's just me.

Nick Danger wrote:Actually, the DME gave you a more expensive machine (and possibly a more capable machine - I have a hard time remembering which RemStar machine does what - and they all have such similar names) than the one the doctor ordered (not counting the modem). Personally, I wouldn't be too thrilled about having my doctor make remote (possibly unannounced) changes to my settings - but that's just me.

Ditto! A ResMed S9 Autoset and no modem -- Woo Hoo, yay!

Actually, he said Resmed S9 auto. He didn't say Escape auto or Autoset, so we don't know which one he really got. And if the doctor prescribes a particular brand in order to use the software, then it could be a big deal if this is one of the better doctors. I know my doctor prescribes the autoset because he prefers the ResScan software and actually looks at the data.

I would take the S9 if, it is an autoset, any day over the machine the doctor recommended. The modem is a pain in the butt. You don't want the doctor changing things remotely . The S9 allows you to make your own changes. Since the billing code to insurance is the same for both machines, the DME would have made more money if they had given you the machine the doctor ordered. They gave you a better one.

So, did you go back and insist on a change?
If so, how did that work out?

I suspect the modem is more for monitoring compliance than adjusting therapy although your doctor could certainly do that.

Zoo is correct. Look at the name of the model near the on/off switch. If it says Autoset, the DME may have done you a favor. If it says Escape Auto, keep being angry.

You didn't get a copy of the prescription?

This is the second time i have seen a problem such as the OP speaks of.
Up here, in Canada, if i don't take a prescription it is put into my file at the office and i can pick it up anytime i wish. If i just want a copy, I simply ask for one, or I have them fax it to my drug store.

The only time a doctor cannot fax a prescription through and it must be picked up, is if it contains narcotics. Which of course CPAP equipment doesn't.

I know for a fact, without any doubt that this is correct for a good friend of mine is a pharmacist and owns a great pharmacy that I use and sometimes when his second pharmacist is ill, on vacation etc, he's called me into help out for a month or so and i am involved in all of it when there so i know the rules.

I can't understand why its so hard to just phone the doctor and get a copy of the prescription and if the DME refuses to comply with giving the right equipment, it would be then escalated to the medical board.
The wrong equipment COULD potentially kill someone, not that it will in this OPs case but..........I always thought that Americans were litigious by nature?


(that is not an insult before someone incorrectly assumes it to be)

ShelaghDB wrote: I can't understand why its so hard to just phone the doctor and get a copy of the prescription and if the DME refuses to comply with giving the right equipment, it would be then escalated to the medical board.

It can be a real pain in the posterior to get a hold of the doctor. I tried that route. The number I had for the doctor was a number in New Jersey. I live in Wisconsin. Try...1,000 miles away? I called the number listed. It was disconnected. The DME was being a major roadblock. Things can be more difficult than they SHOULD be. And a lot of people want to avoid the headache, so try to do on their own instead of even POTENTIALLY running into this kind of snag.

Assuming the OP is factual in his post, it doesn't matter if the DME gave him/her a better machine of not. The doctor wrote a prescription for a very specific machine and the DME is obligated by law to fill the prescription AS WRITTEN. By not filling the prescription as written, they are in the wrong.

This would be the same as a pharmacist giving a patient a different HTN medication to a patient than what was prescribed and saying "It's OK, this medication is better than what the doctor wanted." The pharmacist in this example (or the DME in the OP's case) doesn't have a clear and total picture of the patient's help and CANNOT substitute their own judgement for the doctor. Making changes to the doctor's prescription could potentially have very adverse effects on the patient's health