Ok here is the deal from the rant I made this morning:

episodic · Post by **episodic** » Tue Aug 08, 2006 3:43 pm

viewtopic.php?t=12046

Above link from this morning:
Ok here is the NEW deal.

I don't want to use company names, as I don't need any trouble. Let us just call this one company - company 1.

Company 1 talked to me on the phone, and the guy seemed like he would be helpful. He tells me as soon as I faxed the scrip and sleep study (which I did yesterday, I could be set by Friday).

So I call that afternoon to find out the out of pocket totals. A woman answers with no clue and she proceeds to tell me she is the manager, and this other guy is a salesman that really didn't know what he was talking about. She says my handwritten doc's script isn't good enough. She will have to fax for a scrip on their form, as well as get the 'complete' sleep study, not just the section with the titration information. On top of that they have to fax my insurance information to the corporate office for a decision."

I ask how long and can I get it by Friday as promised - probably not the reply.

Then I query her about how much my out of pocket will be - to which she says it depends on your insurance. I said well if you buy a machine for 1000$ - my insurance pays 80%. Just tell me what you are selling me the machine for and I'll do the math. This makes her mad, and they keep repeating about how it depends on the insurance.

So. . . I just say nevermind forget it cancel it. . .and hang up.

So I call the only other DME in my area's driving distance. The lady at company 2 insisted CPAP's and automatic CPAP's were the same thing. I told her they were not and quoted model numbers. She said she'd call her super and call me back which she did a moment ago with a curt reply that they don't do APAPs.

So I call our state capital 2 hours away. They take my info over phone, said don't worry about faxing it, made an appt for tommorow evening, and promised that I'd walk out with the machine and mask of my choice. She the proceeded to ask me if I'd hold for the amounts I'd be responsible for, and ended up transferring me to the RT which asked me if I knew my size and titration so they could have the machine there ready to go, then transferred me back to the billing who told me everything I needed to know.

It seems I have to pay a like 160$ up front then like 15$ a month for 12 months, then I own it. I've quoted the machine name to them the mask name to them, and asked if it were new or refurbed. They gave me all the right answers. They said it would not be that much, but my insurance doesn't cover the heated humidifier.

If I drive 2 hours tommorow and this turns out to be a farce, I'm going to be one pissed off puppy.

Sigh - this should not be this hard.

Wish me luck tommorow.

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CPAPopedia Keywords Contained In This Post (Click For Definition): humidifier, Titration, CPAP, DME

krousseau · Post by **krousseau** » Tue Aug 08, 2006 4:07 pm

Call your insurance and make sure they won't buy (with a copay) the humidifier even if they won't pay for a rental-mine paid outright but didn't pay for rental like the xPAP-reason-who knows. Also call the DME in the AM and make sure they know you are driving two hr each way and has anything changed-do they have all the equipment on your list waiting for you. Get the name of the person you talk to. BTW-if you don't mind-where DO you live?

Guest · Post by **Guest** » Tue Aug 08, 2006 4:36 pm

Why didn't you go with the first company? It sounds like she was trying to be very helpful and just wasn't willing to commit to a dollar figure without having all the information?
Maybe I'm missing something? I just don't see any reason to drive 2 hours away when you've got a company right there that's willing to work with you!

Guest · Post by **Guest** » Tue Aug 08, 2006 4:44 pm

Anonymous wrote:Why didn't you go with the first company? It sounds like she was trying to be very helpful and just wasn't willing to commit to a dollar figure without having all the information?
Maybe I'm missing something? I just don't see any reason to drive 2 hours away when you've got a company right there that's willing to work with you!

oh shut up already, have you had that new surgery to have your lips surgically removed from the DME's behind yet, or that other almost as good surgery to have your head pulled out of your butt? if not it sounds like you really need to have one or the other performed, maybe even both.

RedThunder94 · Post by **RedThunder94** » Tue Aug 08, 2006 4:48 pm

Anonymous wrote:
Anonymous wrote:Why didn't you go with the first company? It sounds like she was trying to be very helpful and just wasn't willing to commit to a dollar figure without having all the information?
Maybe I'm missing something? I just don't see any reason to drive 2 hours away when you've got a company right there that's willing to work with you!
oh shut up already, have you had that new surgery to have your lips surgically removed from the DME's behind yet, or that other almost as good surgery to have your head pulled out of your butt? if not it sounds like you really need to have one or the other performed, maybe even both.

Guest · Post by **Guest** » Tue Aug 08, 2006 5:25 pm

Anonymous wrote:
Anonymous wrote:Why didn't you go with the first company? It sounds like she was trying to be very helpful and just wasn't willing to commit to a dollar figure without having all the information?
Maybe I'm missing something? I just don't see any reason to drive 2 hours away when you've got a company right there that's willing to work with you!
oh shut up already, have you had that new surgery to have your lips surgically removed from the DME's behind yet, or that other almost as good surgery to have your head pulled out of your butt? if not it sounds like you really need to have one or the other performed, maybe even both.

Pooh105 · Post by **Pooh105** » Tue Aug 08, 2006 7:18 pm

I actually did not use a DME and just went through billmyinsurance.com. They took all the insurance information, my prescription and "I" got to choose what I wanted! I have to admit that the folks there are fantastic! The hell with DME's. From what I have read on here they seem like sharks looking for blood!

Later,
Pooh

Ric · Post by **Ric** » Wed Aug 09, 2006 1:38 am

Anonymous wrote:Holy cow!! Where did that come from?!
The woman tells him (correctly) that a titration report will not get a cpap covered by an insurance company. Think about it for a second - the whole point of us being put on a cpap is to have this problem fixed. If they send off the report where I have an AHI of 1.0, I think it's safe to say the cpap isn't going to be covered.

Doctor writes a prescription for insulin, because he has determined the patient has diabetes. Doctor prescribes a specific form of insulin and a specific dosage. Patient submits the prescription to the pharmacist. Pharmacist DEMANDS to see the glucose tolerance test, because hey! what if the doctor doesn't know what he's talking about, NO WAY will insurance cover that. Patient insists. Reluctantly, pharmacist calls the clerk at the insurance office, who just HAPPENS to have an advanced degree in cost accounting and actuarial science. Lucky for you. They discuss your case. Pharmacist and clerk concur that you don't really need insulin, the numbers don't really warrant that. But to keep you happy they agree to fill your prescription ANYWAY. Lucky for you. But instead of insulin, you get a year's supply of cherry-flavored gingko biloba throat lozenges in the shape of a bunny, and a FREE digital thermometer, because the stupid doctor really doesn't understand diabetes as deeply as the pharmacist, or the clerk, and CERTAINLY doesn't know the first thing about insulin. That stuff can be DANGEROUS !!!!

I see your point.

Snoredog · Post by **Snoredog** » Wed Aug 09, 2006 3:16 am

life is way too short for all that hassle, I prefer not dealing with those idiot insurance games from the local DME. It took me like 10 minutes tops to order my setup from cpap.com. Then in a few days UPS driver dropped it off right at my door, all I had to do was pick myself up off the floor

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap.com, DME

Guest · Post by **Guest** » Wed Aug 09, 2006 4:39 am

Ric wrote: I see your point.

Heh, I like the scenario you lay out. It does seem like that half the time to be sure!
However, you did miss the point I was making.
The insurance companies have determined that they will not pay for a cpap bipap whatever based off a titration report.
It's really that simple. It has nothing to do with a dme deciding anything.
It's cut and dry. The insurance company has said they flat out won't pay for it.

Guest · Post by **Guest** » Wed Aug 09, 2006 4:41 am

Snoredog wrote:It took me like 10 minutes tops to order my setup from cpap.com.

Nice picture! Why doesn't my UPS driver look like that?!
Just as an aside, I bet if you were paying cash at a dme I bet you would be out the door in 10 minutes too. Again, it's just a guess, but it sure seems like it's insurance that mucks everything up.

Snoredog · Post by **Snoredog** » Wed Aug 09, 2006 8:05 am

Anonymous wrote:
Snoredog wrote:It took me like 10 minutes tops to order my setup from cpap.com.
Nice picture! Why doesn't my UPS driver look like that?!
Just as an aside, I bet if you were paying cash at a dme I bet you would be out the door in 10 minutes too. Again, it's just a guess, but it sure seems like it's insurance that mucks everything up.

cpapjack · Post by **cpapjack** » Wed Aug 09, 2006 8:24 am

Snoredog wrote:you ought to see my FedX driver

Well, let's see.

KansasRT · Post by **KansasRT** » Wed Aug 09, 2006 8:32 am

For any insurance to cover a CPAP you have to have copies of any sleep studies. You have to show both the treated and untreated portion of the sleep study. There is no way around that. It is not the DME being a pain, that is the insurance industry being difficult. Also, because every insurance plan is different, it is difficult to tell someone upfront exact to the dollar what their portion will be. With everyone's individual insurance contract there are different write-off amounts. Everyone is at a different point in meeting their deductable and co-insurance max. Some insurance companies will tell a company where patients are on the deductable and co-ins, but because of HIPPA there are more and more that will not. Also, a handwritten script from a Dr is not enough for a lot of insurance companies. They require a length of need for the equipment and it must have the patients date of birth and address. It has to state a diagnosis(even though DUH--sleep apnea) and list every supply needed. I know some DME people just try to be difficult, but insurance companies make it very difficult. If all of the steps are not followed in order, your insurance company may not cover your CPAP at all.

Wulfman · Post by **Wulfman** » Wed Aug 09, 2006 8:59 am

That's what held up my therapy for almost a month......sleep doctor and/or their office didn't send my sleep study to my insurance provider.....then somebody lost it or didn't get it (for whatever reason) and it had to be faxed AGAIN. THEN, the insurance provider had to have their doctors look at it and approve the purchase.

Had I taken my prescription to a DME shop (and committed to them) the day I got it from the doctor (as he suggested), I'd have been screwed.....because the paperwork hadn't been completed.

Den

Ok here is the deal from the rant I made this morning:

Ok here is the deal from the rant I made this morning:

Man what problems!