DSM Order mixup or fraud?

[hayeswildrick]

Just a little thing that's bugging me.

Last week I called my DSM. I had broken the hook where the headgear attaches to my Mirage Liberty, so I asked for (ordered) just the hard-plastic shell to replace the damaged part. The headgear, cushions, and pillows are all otherwise in excellent shape. I also ordered a couple of the white anti-allergy air filters for my machine.

What I got, a few days later, was a complete new Mirage Liberty mask, including headgear and fancy carrying case. I also got a new hose (which I didn't order, but which they once told me I "Need" every 3 months), and a set of two filters including one of the kind I did order, plus another gray filter (washable and lasts forever) that I didn't.

I'm thinking it's time to call my insurance company, because they are paying for a lot of stuff I didn't order and don't think I need. That's how all of our premiums go up.

But I'd sure like to get feedback from the rest of the group.

Jeff

[Bookbear]

You are certainly correct about that being one of the reasons for increased insurance premiums!

If the manufacturer lists the part with a separate number and price, the DME should be able to order it, and it alone. On the other paw, their policy (as opposed to the manufacturer's) may be not do so, so as to maximize their profits.

There ARE some masks that to not have replacement parts listed separately. The manufacturer only sells units. Cushions are almost always available separately. You might call the manufacturer to see if separate parts are available and then inform the insurance company

[Bookbear]

You are certainly correct about that being one of the reasons for increased insurance premiums!

If the manufacturer lists the part with a separate number and price, the DME should be able to order it, and it alone. On the other paw, their policy (as opposed to the manufacturer's) may be not do so, so as to maximize their profits.

There ARE some masks that to not have replacement parts listed separately. The manufacturer only sells units. Cushions are almost always available separately. You might call the manufacturer to see if separate parts are available and then inform the insurance company

[GumbyCT]

I understand what you are saying about the money - it's certainly not free.

But, If I were you, I would prefer to have the entire mask so I will have a spare plus parts to fix if something else goes wrong.

You didn't say who your DME is but I would prefer to have them send me ALL of those parts then mine does, in dribs & drabs. But hey thats me.

[dsm]

I swear it wasn`t me - can prove I wasn`t there

DSM

[rtkeat]

I work in an dme.... thats fraud, but typically the type of fraud that goes unnoticed or un-complained about. They are only supposed to send what you ask for. If they cannot get a replacement part and have to send a whole new mask they are supposed to notify you and get permission before they send the mask. They are shooting themselves in the foot you see if you call your insurance company and tell them what happened they wont pay the claim and typically will not be allowed to bill you (becareful with that rule as I have seen people sent to collections that were never supposed to be billed)

[Bearded_One]

cpap.com sells the shell separately, so they probably shouldn't have sent a whole new mask.

The filters and hose are not really that much of a problem, and you really should have spares. The foam filter lasts for a long time but not forever. Hoses can develop holes without warning

[Slinky]

My first DME (the sheister), of course, billed EVERYTHING separately that they could possibly get away with - BUT - when I needed a new simple nasal cushion for my ComfortLite 2 they tried to BS me that Medicare wouldn't pay for it. Their RT wasn't happy when I marched in w/a printout of the part number and Medicare reimbursement schedule for that simple nasal cushion. Not even an apology or an "I didn't know that" (as if I would have believed her). It took 3 weeks for them to get it in. (My cat had put a hole in my original and I'd had the CL2 for some 3 months by that time).

They also conned me and told me that Medicare wouldn't pay for the Nebulizer my doctor scripted. I didn't know much then and so bought one out of pocket.

There were other "sins" and "sins of omission" and "less than the truth" that I caught them in and often brought in proof of otherwise just to rub their nose in it. But I managed to complete my CPAP capped rental and then dumped them along w/sending them a very honest evaluation of what I thought of their "services" and a listing of every "sin" they committed.

I can be a crochety ole broad that way. On the other hand, my current DME supplier I take some home made treats into at Christmas time and make it a point to tell them every now and then how much they are appreciated as compared to that first sorry excuse for a DME supplier.

I'm loyal to those who treat me well and not at all bashful about letting a business and everyone else know when I'm treated badly or cheated or lied to.