Poor DME care; how should I approach the doctor?

hopeforsleep wrote:Just got off the phone with my DME, Apnea Care, wanting to know what my options are for getting a better machine. They told me that 1. Even though the script isn't written for a particular machine, I would need a new script to specify 'autotitratoon machine' in order to get a better model, and then I would have to pay $160 extra because those machines are more expensive and 3. She would have to speak to her supervisor because I had been renting the machine since September and I would be getting a brand new one (which I thought was the point of renting).
Does this make sense or am I being snowed? I have a doctors appointment on Friday.

I called my insurance company and they couldn't give me a straight answer, said I would have to wait until I got a new script and they would review my case.

Check with your doctor's office to find out what other DMEs are available - they should have a couple at least, in your area. Another may be more agreeable. Or the first might be if he thought he might lose your business.

As far as getting a new prescription from your doctor, that should be easy. There is no downside to having an auto machine, except maybe less visits to the doctor and the DME! $150 is not a bad charge if it gets you a decent machine, but I don't know if you're talking about a rental or purchase and for how long. To find the real price of machines vs the inflated list price, visit our sponsors site at https://www.cpap.com.

I think your best bet is to convince your doctor on Friday that you want to be an active participant in your therapy and want to be able to look at the data and see how you did the previous night. Those of us who have auto machines can tell you that it varies the pressure frequently throughout the night to adjust for many things including sleep position, sleep stage, etc.

The insurance company will normally go along with whatever the doctor says.

hopeforsleep wrote:Just got off the phone with my DME, Apnea Care, wanting to know what my options are for getting a better machine. They told me that 1. Even though the script isn't written for a particular machine, I would need a new script to specify 'autotitratoon machine' in order to get a better model, and then I would have to pay $160 extra because those machines are more expensive and 3. She would have to speak to her supervisor because I had been renting the machine since September and I would be getting a brand new one (which I thought was the point of renting).
Does this make sense or am I being snowed? I have a doctors appointment on Friday.

I called my insurance company and they couldn't give me a straight answer, said I would have to wait until I got a new script and they would review my case.

First, get the prescription for an auto-titrating machine with heated humidifier and heated hose. Your primary physician (family doctor?) is the best source for this. FWIW an APAP is the same billing code as a CPAP, and they are not usually viewed as therapeutically different. Put it in your hip pocket for negotiating, and remember your prescription is yours for life. Don't let anyone tell you "we need another sleep study". Your sleep apnea isn't going anywhere.

Get the facts on your current rental and when it converts to full ownership, and at what cost to you. If the costs of renting an APAP resets, or is too much money out of pocket, consider the used market. Craigslist and Secondwind are your friend for a better price. It's shocking how many people get a top of the line machine, and never use it.

I, also, didn't realize there were options in where to get CPAP equipment. My doctor gave me my sleep study results over the phone and then said someone would be calling me about getting a CPAP machine. I didn't realize I could go elsewhere. They said I have to rent it monthly and, because my insurance deductible started over last month, it's all out of pocket. I like my machine but maybe I can just purchase the same kind elsewhere? How do I go about doing this? My doctor never gave me a prescription, just handed me off to the CPAP supply company.

EmilySleeps wrote:My doctor never gave me a prescription

Call his practice, ask for the medical records department and request that they email you a copy of your prescription. Legally they are required to give your copies of any medical record you request.

Don't talk to the doctor or nurse or technician because they may start asking questions and delay the process. The records people have routinely handled requests like this.

Contact your doctor and get the prescription, you have a legal right to it.

As recommended above get your prescription in writing. Contact your insurance carrier and request a list of DMEs that have contracted to provide services for your insurer in your area. This is no business of he prescribing physician and he may just be handing you off within his network. You have other choices. While on the phone with your insurance carrier ask if they allow for a purchase of a CPAP/APAP machine rather than rental. You need to know THEIR rules for acquiring the machine.