My DME is Insane!

[Wrenna]

It's the only possible explanation, the poor lady is seriously disturbed. Most of the time she seems like such a nice and helpful person doing her job the best she can. And then she says things like this: "You'll have more AHI episodes on an AutoCpap. It won't stop you from having episodes like a straight Cpap will. You'll never notice the difference between C-flex and straight Cpap at your pressure." And finally, the clinching example of insanity: "Your insurance won't cover an AutoPAP machine, they're $3,500!"

Um? Excuse me?? $3500?? HOW??? Is there some sort of platinum plating involved?? Is this normal behavior for DME's?? How can they possible claim this stuff costs so much? Do they actually believe what they're saying??


So as you might have guessed, I came home with the same straight cpap machine I went to my appointment with. Well, looking on the bright side... At least I got her to raise my pressure to 8cm. My 1-month rental period will be up in a few weeks and I'll have my doctor's appointment then. I'm going to insist on him physically handing me my prescription so I can fill it myself. But then again, we've seen how successful I am at insisting.

So... any suggestions on how to grow a backbone?

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): cpap machine, C-FLEX, CPAP, DME, AHI, Prescription, AutoPAP Machine

[JeffH]

She's right about this. from my experience.

"You'll have more AHI episodes on an AutoCpap. It won't stop you from having episodes like a straight Cpap will

Don't set your expections too high for what an APAP will do, or you will be disappointed like I was.

I own an apap, but run it in straight cpap mode.

[Panhandler]

Hmmm, I think sleep deprivation contributes to the spinal condition you've described!

The only way I can imagine that an APAP wouldn't clear obstructions as well as a CPAP is if it's set wide open, i.e. a pressure range from 4-20, and that may be the only way she knows to set them. As to costing $3,500, yeah, maybe with her markup. The insurance company doesn't care if you get an auto. They'll pay just the same for an auto as for a bottom of the line cheapo blower. They just won't pay her more for the auto.

If you can give the doc some reason to write you for an auto, she'll have to comply or lose the sale. Do you have problems with aerophagia (swallowing air)? Do you shift positions throughout the night? Do you have complete data on which to evaluate your performance, including leaks and AHI?

As to the C-flex, I certainly can tell the difference at 9 or 9.5. If you've tried 8 without it and are at all uncomfortable, I think you should push for it. The overall statistics on compliance are so miserable (~50%) it's the least the industry can do to help us get along with CPAP and it seems beneath a reasonable standard of care to withhold it.

[Snoredog]

It's the only possible explanation, the poor lady is seriously disturbed. Most of the time she seems like such a nice and helpful person doing her job the best she can. And then she says things like this: "You'll have more AHI episodes on an AutoCpap. It won't stop you from having episodes like a straight Cpap will. You'll never notice the difference between C-flex and straight Cpap at your pressure." And finally, the clinching example of insanity: "Your insurance won't cover an AutoPAP machine, they're $3,500!"

Um? Excuse me?? $3500?? HOW??? Is there some sort of platinum plating involved?? Is this normal behavior for DME's?? How can they possible claim this stuff costs so much? Do they actually believe what they're saying??


So as you might have guessed, I came home with the same straight cpap machine I went to my appointment with. Well, looking on the bright side... At least I got her to raise my pressure to 8cm. My 1-month rental period will be up in a few weeks and I'll have my doctor's appointment then. I'm going to insist on him physically handing me my prescription so I can fill it myself. But then again, we've seen how successful I am at insisting.

So... any suggestions on how to grow a backbone?

They assume patients are ignorant and some truly are actually believing that line of crock like you will have fewer events with CPAP, that is because they cannot see them!!

I think you should go back and recreate your visit again asking all the same questions like you have never been there before but this time wear a hidden camera, then put the video up on YouTube, wouldn't that be a riot.

[Pineapple]

And finally, the clinching example of insanity: "Your insurance won't cover an AutoPAP machine, they're $3,500!"

Did you try calling your insurance provider to verify this? I think I'd do alittle verification with my insurance provider first. "What is my coverage, what machines are covered - specifically mention APAP, which DME am I required to use, do I have the option of buying on-line and being reimbursed?" Make sure your DME is not misinformed.

It seems to my memory that you were given an extremly inflated estimate of epuiptment cost in the first place - sounds to me as if your DME thinks they have the corner on the market. BTW the Remstar Auto M series w/humidifier (wasn't that what the doctor first gave you) is listed as "Required Min Pricing" on cpap.com at $1069.00. If you buying out of pocket, let your DME know she's pricing herself out of the market.

[Guest]

She's lying about the APAP costs!
Do you see any codes on the following list for APAP? NO!
CPAP and APAP have the SAME code.....E0601.

Also, the Minimum Advertised Price is not necessarily the REAL price. Go to this link and hold your pointer over the machines and there will be an "arrow" that will allow you to "Get our price". (the manufacturers are making the Internet sellers play "games" since imposing their MAP policies)

https://www.cpap.com/advanced-find-cpap ... ting-CPAPS

Check with your insurance provider to see if they will reimburse you if you purchase out-of-pocket.
Don't take the word of the DMEs. Check with your insurance provider and make sure you have your prescription for your machine.....it's good for life.

Den


What are CPT codes for CPAP and Bilevels?

Codes have changed as of January 2003. These are updated codes are used to bill insurance and government plans for CPAP items.

* E0601 RR is CPAP rental.
* E0601 NU is CPAP purchase.
* A7034 is CPAP nasal mask, including all nasal masks, Nasal Aire, Breeze, Spiritus.
* A7032 is CPAP nasal mask cushion.
* A7030 is CPAP Full Face mask.
* A7031 is CPAP Full Face mask cushion.
* A7044 is CPAP Full Oral Interface.
* A7046 is CPAP Humidifier Chamber.
* A7037 is CPAP tubing, long and short hoses.
* A7038 is CPAP disposable filter.
* A7039 is CPAP gross particle (foam) filter.
* A7035 is CPAP headgear.
* A7033 is CPAP nasal pillows.
* A7036 is CPAP chinstrap.
* E0561 NU is CPAP Passover Humidifier
* E0562 NU is CPAP Heated Humidifier
* E0470 RR is BiPAP rental.
* E0470 NU is BiPAP purchase.
* E0471 RR is BiPAP-ST rental.
* E0471 NU is BiPAP-ST purchase.


Other CPAP items are listed under E1399, which is miscellaneous.

[pratzert]

Wrenna,

Who is your DME company ?

Those quotes sound like something that may be in the APRIA training manual.

Tim

[alnhwrd]

Sounds like she is signed up with the fine folks at Squeezemtilltheyredry Care.

[Wrenna]

My DME is part of the sleep disorder center, just like my doctor. It seemed like a good thing at first glance, the DME person can consult directly with the Doctor and vice versa. But with these outrageous prices, I'm starting to wonder just how neutral the doctor is since I believe he gets part of the overall clinic's profits.

I sent an email to my Insurance company. Surely they'd prefer I bought online? Heck, I can afford it without insurance, if it comes right down to it. It's just a matter of getting the Doctor to give me my prescription and letting me hand this machine back at the end of the rental period. Maybe I should get my husband to come to my appointment with me as an external backbone.

Worst case I suppose I could just buy one at auction.


ETA: At least I got her to look through all my charts. I do not have a problem with mouth breathing or leaking air from my mouth. So that's good. No need for a fullface or tape!

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): DME, Prescription

[schleima]

She's lying about the APAP costs!
Do you see any codes on the following list for APAP? NO!
CPAP and APAP have the SAME code.....E0601.

I thought A0601 was AutoCPAP and E0601 was regular CPAP.

[jum001]

What the doctor writes, they have to provide. In my case, I had two reasons for needing an auto. First, my weight is changing as I am on Weight Watchers. Second, I sleep alone so have no way of knowing if the treatment is effective unless the machine can monitor the results. No problems getting the Rx I needed as there were sound medical reasons for it. The questions others have asked re aerophagia and position changes are trying to point you in that direction also, Give the doc a reason to write the Rx other than just I think it would be nice to have.

[Guest]

She's lying about the APAP costs!
Do you see any codes on the following list for APAP? NO!
CPAP and APAP have the SAME code.....E0601.

I thought A0601 was AutoCPAP and E0601 was regular CPAP.

Nope. Only E0601.


Den

[Country4ever]

The DME can ask for a million dollars for a machine, but if they have a contract with your insurance company, they will only get what the insurance company thinks is reasonable. You won't be responsible for the rest.

[snoregirl]

If you run into troubles with your sleep doc providing info, get your GP or Family doc to ask for your records to be transferred. Then have him/her write what you want. Then walk out of the sleep center and run like H.......

[schleima]

The DME can ask for a million dollars for a machine, but if they have a contract with your insurance company, they will only get what the insurance company thinks is reasonable. You won't be responsible for the rest.

This is not entirely true, as I am currently finding out.

viewtopic/t31014/People-with-DME-experi ... -CPAP.html