Battling DME

Hello all,

Right now I have a CPAP, however, my doctor prescribed a 420E P&B Auto back on Nov. 29. Now my DME carries ResMed exclusively so I'm getting a major run-around. They keep trying to pawn off a ResMed machine on me. Yesterday I even had to say, Robin (the therapist) you don't have Sleep Apnea and I do. I've done the research with my fellow hoseheads and the P&B or even the Remstar Auto is what will work best for my needs. I've even heard the sob story that their supplier wants to bill them 900 supposedly for the machine itself. They apparently don't want to pay that so are trying to work out a deal. In the meantime, I'm left waiting...waiting...waiting. On the prescription the DME has it clearly states the CPAP is not working for me. Anyway, I got a major song and dance on Friday with my DME and I'm pretty fed up. I have a 10 month rental and have 6 left to go so it leaves me in a bit of a pickle. If I try to go to another DME, I then have to start the 10 months all over again. Plus, I am job hunting so am hoping to have a new job within the month. This means new insurance, etc.

Ok, now to the help I need. Right now I'm breaking down the costs they tried to bill the insurance, the amount the insurance accepted, and what I'm paying out of pocket. On top of that I'm putting the prices cpap.com charges (AWESOME PRICES JOHNNY) and looking at those comparisons does make one pretty sick. Anyway, can someone pm me and give me another reputable online provider so I can get costs from them. I don't want the DME to come back and say oh that's just one online company and isn't the norm. From there, I'm going to see if they will get my machine. If not, I will more than likely buy one from cpap.com and be done with it. I've bought a couple of things from cpap.com and have been very happy with the service. Hope you don't view this as disloyalty to you Johnny because it isn't.

Anyway, thanks for the help.

Melinda

SleepLady,

Thanks for your post. Keep fighting and get what YOU want!

In no way is your post disloyal or out of line. Your goal is to make this treatment work for you. My goal on cpaptalk.com is to help you go in the right direction (but it seems you've done your homework and already know exactly where that is!). My goal as a business man is to create offers that are better than the ones you are getting from your local provider.

Maybe cpap.com makes sense for you and maybe it doesn't. All I do is make the best offer I can and hope for the best!

I'd also mention that since you already have a machine through insurance, it'll be some 5 years until BillMyInsurance.com can help you get another one. However, if you want to try out the newest CPAP Supplies at very low costs, you may want to consider checking out BillMyInsurance.com for your supplies.

Good luck! Please keep us posted on your saga.

Johnny

Thanks Johnny. The prices and level of service on cpap.com is wonderful. I wish I could go through billmyinsurance.com. I called them and they were great in answering my questions very quickly. Unfortunately, my insurance won't participate, nor will they reimburse if I buy online. So that's why I've tried to work with my DME. I'm getting to the point where it's more trouble than it's worth sooooooooooo if I can't get what I want from them this next week I'll be going in another direction.

I'll keep you all posted.

Melinda

Milinda,
Does your insurance company REQUIRE a 10 month rental? I had my auto machine for 2 months after having a straight cpap for 2 months and called them and said THIS is the one I want, THIS is the one working for me. I had to do a compliance test, using the smart card and having the DME send it to them then the insurance company saw I was using it regularly and agreed to purchase. It is to their benefit also, the DMEs charge so much for rental that in the 10 months the insurance company could have bought it outright a lot sooner. Try calling your insurance company armed with the knowledge you have and see if they'll work with you even in switching to a new DME for a shorter wait period before purchase. The DME I worked with was inept, rude and had no knowledge of cpap therapy other than to sell what THEY had available and thought best for you. Their might be some good ones but I believe the majority of them really don't care about of concerns and needs of us, just a sale. Good luck.

Sorry to be so blunt - but that's CRAP that your insurance company will only work with a DME. I had a somewhat similiar situation with my DME, actually with less substatiation that you - and I just walked out of their offices with my prescription in hand.

When I scheduled my appt I worked with a lovely woman and we agreed on everything I would be getting from the DME - and the amount of my co-pay. Although it was not the machine I had wanted, it was an acceptable one to my way of thinking. When I showed up that woman was not there, and they gave me a total run around. They kept trying to give me a different machine, with less functionality that was much bulkier and heavier (I travel a lot - so that is important to me) for the same price!!! I spoke with a supervisor who was unwilling to say anything helpful - so I asked for my prescription and left.

I then called my insurance company - told them what happened - told them the DME was trying to rob both of us etc. I then asked if they would reimburse me if I purchased what I needed on line. For once I got someone reasonable at the insurance company - she agreed and documented that agreement in my file.

You should have even less of a problem since your doctor prescribed specific machine! I would call the insurance company tell them what's going on - and tell them the net result is that you are not getting the medically prescribed treatment you NEED. Then tell them the price differences, etc. if all that doesn't work - ask for a supervisor. I'll bet you'll find someone reasonable at some point.

If the DME is still holding your prescription - go back and get it!!!! It is YOUR prescription.

Good luck.

Hey Guys...I really don't have a dog in this fight but a couple things to remember. First, it's your medical needs that need to be met. If the DME your working with isn't meeting them...walk and tell your doc. Second, with online companies; just keep in mind that if you have a problem with your machine (pressure change, breakdown, downloads, etc.) you will not have anyone locally to fix it. Personally I'd much rather have a therapist standing in front of me than deal with someone in a cubicle in Timbuktoo (is that how you spell that?) who doesn't know me from Adam.

Good Luck

Guest,
As I stated in my previous post here most DME are not there for you. I remember asking mine about software to do readouts at home and was told there was "no such thing and if there was it would cost thousands of dollars." When I wanted an auto machine I was told that I could not have one they were for "special circumstances". When I asked for further explanations of that I got none. If they can't follow a scripted sales pitch they are lost.

Johnnygoodman had been extremely helpful by PHONE when I had a multitude of questions in dealing with my DME and machines in general. He spent time answering questions, explaining things I knew nothing about. (and he speaks english ) Unfortunately my insurance would not deal with on line purchases. He was not going to make a sale from me but still took time to help me. In many posts here I have read how people who have bought from Cpap.com are very happy with the service and having their needs met by informed, caring people.

I truly believe there needs to be a whole new outlook and revision by insurance companies when it comes to OSA treatments and equipment. More and more people are taking charge of their treatments and we know our bodies and our needs best when we become educated. I for one am glad I have this forum and it's knowledgeable people as opposed to a DME who's only function is a sale.

I agree with BONNIE 100%!


steve,
ufo13

Hi all, thanks for all the advice and help. I do have a copy of my prescription everyone. I didn't ask the DME, I went directly to my doc and asked her nurse to mail me a copy for my records and I also got a copy of my sleep study.

Bonnie - My insurance does require a 10 month rental. After that the machine is mine. My DME is pretty inept too. When I first asked about an APAP when I needed my pressure increased, she had the nerve to say those didn't exist. THEN after she had the prescription for my APAP and I told her no I wouldn't accept her machine but needed what I was prescribed, plus the software she got all huffy. She said oh the software will cost so much money and it's best left to us. I said really? Well since my prescription is for the P&B 420e, I can get the Silverlining software online for $99. Her response...ohhhhhhhhhhh. Even this last friday, she kept asking me why I couldn't go with the ResMed machine she had. I said with all of the capabilities the 420e or even the Remstar will work best for me. I also mentioned she didn't have Sleep Apnea and I did. It's my life and my treatment. My insurance is pretty adamant about the 10 month rental period. I'm thinking of calling them again this week if I don't get the right answer from my DME. I'm pretty disgusted with this whole process of dealing with DME's. It's ridiculous...I mean they have a script that clearly says the CPAP doesn't work for me, but here I am stuck on it because they want to keep their costs down.

Tosleepperchance...

I agree, it is CRAP. IF I have to call them this week I'm going to try to talk to the medical division and see if I can wiggle out of them an ok to buy online. If not, then I'm doing it anyway and will have to eat the cost. I figure, with the aggravation and stress AND my loss of good treatment right now, the extra cost will be well worth it.

Hi Guest, thanks for the input. I'm going to walk this week IF they won't deal with me. I do plan to tell my doctor AND the insurance company. Heck, if I could turn these people in somewhere I would. Now if I go the online route, I am taking a slight chance if it breaks down. Guess I'll deal wtih that as it comes. As for the pressure changes, I can do that myself. If the guide isn't included in the machine, I'm sure I can find someone who can help me set my pressure to the range it needs to be per my doctors recommendations.

I'll fill you all in as the saga unfolds.

Melinda

SleepLady:

Just to let you know that you aren't alone, I am going through the exact same experience you are as we speak.

I walked out of my DME appointment without any equipment and vowed to find a way to buy my APAP directly through the internet.

I contacted my insurance company (who originally told me I had to go through a DME and had to rent before I could buy) and kept pushing until I got the answer I wanted. I used the logic that the insurance company would have reimburse my DME over $100 per month for just the CPAP. They would have to buy the humidifier outright for $250. And purchase other related accessories (hose, mask, headgear) outright for well over $100 as well. I can purchase the APAP that has all the features I want (including humidifier and hose) for $760. This would amount to the same cost as 6-7 months of rental. I told them I would be saving the insurance company and myself money, and would also get a much better machine that would allow me to participate in the management of my sleep apnea. I also told them that I would be more than willing to divide my costs and submit my claim monthly over the minimum number of rental months (10 months in your case) if that would make them happy. At the end of the day, they indicated I could go ahead and purchase the machine directly and submit my claim and they would pay me up to the maximum allowable costs they would reimburse the DME. I am picking up my prescription today (I also got my Doc to write it for an APAP) and will order my equipment shortly thereafter.

I still am interested to see how it will ultimately work out with the insurance company. I think I pretty much wore them down with logic that they couldn't seem to respond to. Anyway good luck in your battle and don't give up and never give in.

Hello all,

Thanks again for all the advice and letting me vent. Let me update you on what's been happening.

Last Monday after updating you guys I decided to call the head office of my DME. Apparently they do all the ordering. I know who the person in charge is, so I gave him a jingle. Boy was he surprised to be talking to me instead of a fellow employee. I was very nice and simply asked if he had heard anything and what was going on with my case. He tried to give me a song and dance about his profit margin getting affected, having to bill into the cost of the machines the techs who come out and set up the systems, etc. I said you know you are charging my insurance 1250 for the simple CPAP machine I have. I could get it online for 330. Ok, insurance didn't ok that huge amount, though they ok'd 860. That is a major profit %. Plus, I never have a tech come to my house. He asked if I would accept the ResMed. Again I said absolutely not and explained my reasoning and the fact I'd done my research and talked to other hoseheads that use these machines. He then asked what I would do if he couldn't get the machine and I said I'd go elsewhere. I also casually mentioned I had been a tad frustrated the week before and began looking at other DME's that participate with my insurance. In the end I said listen, if you work with me you may have me as a customer for the rest of my life, I'm only 34. Think about it, Sleep Apnea won't go away. Sure I may be able to lower my pressure if I lose weight, but the chances of being totally cured are slim to none. I said all of this very nicely and we had a great conversation. He did say he'd been sitting on this quite awhile and so had his rep.

On Tuesday I got the news that I'm getting the machine that was prescribed to me specifically by my doctor and the one I want. I'm hoping it'll be in at my DME's today. Of course, I'm not getting too excited until I get the call.

It's amazing at how these DME's are. You truly have to be up on everything and have the fortitude to walk and not back down in any little way. I mean the guy at the corporate office had also tried to talk me into the ResMed machine. Only when he heard from me on my reasoning and that I was ready to walk did he jump and get me my machine.

Hopefully by the end of this week I'll be the new owner of a PB 420e APAP and on the road to tweaking my treatment and feeling less tired.

Melinda

nice job sleeplady! .. don't let the DME push you around.
I had the same problem with my DME .. but my DME actually recommended the 420E, then called to tell me that he was bringing the ResMed machine instead.
I tried out the ResMed, and although it's a nice machine, I felt like he got the best of me. So, I called him back and asked for the 420E. He didn't argue and brought one over within a couple of days.
Here's the good part .. While he was setting it up, I noticed that the 420E had some dings on it and the LCD screen was a bit scratched. I said "This thing is used!" and he replied. "It may have been demo'd, but it probably doesn't have more than a couple of hours on it". This was early in the morning, so I just kinda brushed it off .. until I looked at the running hours on the config screen after he left. 1170 hours!?!? if my math is correct, that's about 5 months used compliance everynight. I literally hit the ceiling, this guy knew that I was savvy about this stuff, then has the nerve to bring me a used machine?!?
Needless to say, I called him back and demanded that he bring me a new one ASAP .. so far, it's 2 strikes for this guy. And believe me, I'll let him know because I don't have to go through him or his company.

Best of luck .. it's good to know that you're not alone .. thanks CPAPTALK

It's truly amazing how DME's take people for being stupid. And the things they try to get away with. I wanted a APAP from Respironics with C-flex and heated humidifier. The girl from the original DME tries to tell me that the APAP is one pressure. I say yes but it varies over a range. I call another DME and tell them I want the Remstar Auto with C-flex and they tell me Remstar doesn't make an Auto. Right I say, Respironics does, the model is Remstar. Then she goes on to tell me that C-flex isn't offered on this model. That's when I stroked her off my list. DME's should be forced to read message boards like this one to understand that they truly are the stupid ones if they think we will let them away with what they want. Unfortunately, there are a lot of non computer people out there that don't have this info available to them and hence have to take what they get. Boy do I feel for them.

When pressed to tell me how to get into the Detailed or Clinical menu as it is sometime referred to my DME said I wasn't supposed to go there and he didn't know how to get there. DUH. Wonder who set it up?? Had him out the following day to reset the ramp time and asked if he had taken a crash course overnight. Needless to say we are the best of friends. Were that is.
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