My DME Sent Me a Bunch of Stuff

[virgo RT]

We all have to accept assignment or we can not bill medicare period. I understand the cost sometimes seems outrageous for cpap machines, but you must understand the cost of doing buisness and having a physical location with employees compared to a internet site which you can not be sure who is on the other side. We also have to fight legislation which continues to cut back our reimbursments by medicare and insurances but expect us to give same devices and care when those cost increase yearly. DME is not an easy buisness i have worked for one that has gone out of buisness, one start up company and am currently at a national company with small town values. Remember there are indications and contraindications lots of education and follow up to initiate cpap and ensure a successful patient use, i just dont think an internet, drop ship program is capapble of doing. as for the 3 wk wait wow... u should look for another company, we do all new setups in 48hrs and special orders in 4 days. I will say my initial reason for coming onto this site was research but in just a few hours has turned into a sort of blog. if only i could get paid for this jk

[JimIllinois]

Way up near the top, there was a comment about paying far more than a product is worth (through insurance).

I just wanted to comment that the insurance companies don't pay anywhere near what the regular invoice price is. Each item is negotiated to a very low level. Is it less than what you or I would pay online? Hard to tell from the outside, but I'll bet it's pretty close.

They negotiate a contract price for group coverage, then work relentlessly to minimize their costs and maximize profits.

[BlackSpinner]

Remember there are indications and contraindications lots of education and follow up to initiate cpap and ensure a successful patient use, i just dont think an internet, drop ship program is capapble of doing.

REALLY? You mean the 20 minutes spent filling out the payment forms? The "here this is the size mask we have, that will be $300", "never heard it could affect the eyes! you're confused" I learned a lot more here and reading the product specs on cpap.com then I ever heard from the DME. Maybe if they actually would provide a SERVICE and KNEW WHAT THEY WERE SELLING the charges would be justified.

[Kiralynx]

Remember there are indications and contraindications lots of education and follow up to initiate cpap and ensure a successful patient use, i just dont think an internet, drop ship program is capapble of doing. as for the 3 wk wait wow... u should look for another company, we do all new setups in 48hrs and special orders in 4 days.

Education.

Hmm. Before I ever had my titration, I had already learned from this website to ask for a mask fitting before the titration so I had a reasonably comfortable mask.

I'll grant you that the RT at the DME did a good job of suggesting what has proved to be the right machine for me.

But: I found the right mask. I found the instructions. I figured out what I needed to know.

The RT did not recommend a full face mask along with my nasal one in case I caught a respiratory infection, which I do regularly. The result was doing without my Bipap for two days while I ordered one through an online DME that you don't have a good opinion of. The brick-and-mortar DME didn't have any in stock. They had to order them, and took 7-10 days.

The RT did not call to see how I was doing -- I had to call her.

Supplies? Well, let's just say I'm not impressed with someone who has to ask ME for the order number of my nasal pillows, and then takes too long to get it AND sends it to me broken.

So, I'm going to ask you: just what DOES my brick-and-mortar DME offer me that my on-line one does not?

B&M: weeks to get supplies
On-line: 3 day free shipping

B&M: rude employees who don't know what they have for sale or how to order it.
On-line: polite employees who are familiar with their equipment.

and so on and so forth. If, in fact, the B&M DMEs offered the services they claim to offer, they might be worth it. But the ones who are "in service" for my insurance do not.

[DoriC]

We went to the DME the first week after we were set up with our equipment to exchange the ComfortGelFF we were given for the UMFF that was used for the titration. When my husband asked to lie down to fit the mask she told him he could lie down on the floor and roll up the jacket he was wearing to use for a pillow. She could see that my husband was disabled and used a cane. Needless to say, we were apalled and let them know it. We didn't want to wait until the next day for them to come to our house for a fitting so we took home the medium and were fortunate that it was the right size. This DME is the largest and most well known in this area so why don't they at least have a cot in the "Mask Fitting Room"?

[virgo RT]

So, I'm going to ask you: just what DOES my brick-and-mortar DME offer me that my on-line one does not?

Its unfortunate that so many of you have had bad experiences, i assure you we are not all the same. It is just like doctors they are not all created equal.
In my city i know we have a least 200 if not more dme's alone. One i use to work for was actually a car sales man, and heard you could make money in DME needless to say my stay was very short, not the company i would want taking care of my family. But i assure you there are good companies in every market and they dont have to be the huge chains but just because they are a large chain doesnt mean there bad, i do work for a large chain but they work individually like the mom and pops with great service and sincerity. You really have to call around, and if you go to meetings locally maybe a better breathers or similar you will find them. They usually like to be involved in the community and sposor better breathers, and other non profit organizations.

best of luck
yvette

[builta]

You know,

You actually have "very good insurance."

Many here will be envious of you.

If you don't need some of the items so often, then by all means tell the DME. I bet that they will do exactly what you want. But, if you don't tell them, how are they to know?

If then don't abide by your requests, then, by all means, just report them to your insurance company (and find a different DME for your supplies).

Maybe I have been blessed but, my DME actually tries to help me (and of course, stay in business).

[timbalionguy]

Sure, the DME's might have overhead from having a building and employees. The online providers have those as well. And the one I used 9the sponsor of this site) was on top of things and answered my questions correctly the first time. Stuff was shipped promptly and order was filled exactly....and they post my feedback on how my order was handled for all to read. To me, this is customer service.

And most of us here do not worship our doctor, but work with them in a two-way agreement. And we manage our own therapy, despite threats from some DME's that 'changing your own pressure is against the law'.

IMHO there is more pork in the traditional doctor/durable medical equipment/insurance scam than there is in a sausage plant.

[jdm2857]

OK, Ms. Professional, please explain to me what exposing a humidifier chamber to water does to rigid plastic, stainless steel, and silicone that renders it unfit for use after 6 months.

But don't tell me about some anecdote that a friend of of a friend told you about his grandmother. Give me a scientific explanation of what can happen to a normally used water chamber that a bit of detergent and water, and maybe some vinegar and a brush can't fix.

And don't quote the manufacturer's either. They want to sell chambers almost as much as your boss does.

[Kiralynx]

You really have to call around, and if you go to meetings locally maybe a better breathers or similar you will find them. They usually like to be involved in the community and sposor better breathers, and other non profit organizations.

There's been one AWAKE meeting in my city in the last year. There were some very nice, small DME folks represented at it, and I've bought a few incidentals from them on an as-needed basis.

But not one of them is covered by my insurance, so getting masks and so forth from them is not viable because their price is anywhere from 3-5 times what I have paid on-line.

When I came down with a respiratory infection and needed a full-face mask desperately, I called the DME which supplied my machine. They were uninterested in the problem, and I was told laconically that it would take 5-7 days to order a mask for me. (By that time, I wouldn't need it any more!)

So I went on-line and got a list of covered B&M DMEs and called every single one of them. Not one had masks in stock that I could just come and pick up -- all 5-7 days to order a mask for me.

I called some of the smaller, non-covered ones. They didn't have masks in their stores that I could just come get -- they'd have to get them from their warehouses and it would take at least 24 hours. Their prices were more than ordering, with overnight delivery, the mask I needed from the sponsor of this Forum.

I don't doubt from what you say that you are one of the people who cares about her patients. But the brick-and-mortar DME business in general has a serious problem with customer service. If it didn't, you wouldn't be hearing from so many of us about bad experiences.

The problem is that as customers, we aren't really allowed an option of where we shop, unless we are paying cash. The B&M DMEs know this, and therefore, in general, have no reason to provide optimum service, because they know we'll be back no matter how horrible they are.

There ARE exceptions -- and people have reported having a great experience with this facility or that. Regrettably, they are the exception rather than the rule.

Not so long ago, I had a form letter from my B&M DME. "Dear Customer...." it began. And then it told me that I would begin receiving automated phone calls about how my therapy was going, and I would have an automated opportunity to order supplies. To opt out of this dehumanized "service," I had to wait almost 20 minutes on the phone, listening to the DME's recorded panegyrics about how wonderful and caring they were.

Not so long ago, I had a minor complaint here. I dashed off an e-mail, and the issue was resolved within a couple of hours.

Far, far too many of the B&M DMEs are like the one referenced in the first post: they set up a schedule, and send supplies, whether needed or not, and bill for them. In fairness, when many of us first come to this therapy, we may need a schedule to remind us to order things because we are so sleep deprived. But we don't need to be put to the hassle of receiving supplies, and then, if we don't need them, getting to the post office, to UPS, or to the DME to return them.

[Billy6]

It sounds like an insurance racket to me. If you have great insurance, you're a DME's best friend. If you are self pay and only order up stuff when its necessary, you're just a piece of chopped liver to them

[virgo RT]

Quote...."The problem is that as customers, we aren't really allowed an option of where we shop, unless we are paying cash. The B&M DMEs know this, and therefore, in general, have no reason to provide optimum service, because they know we'll be back no matter how horrible they are."

You are a customer and are allowed where to shop, yes your insurance may limit who you can go to. But we are all the same when it comes to product we all carry or have the ability to order the same products. The only thing that sets us apart is our costumer service... Believe it or not. So rant and rave and make them change and the biggest kicker is if you complain to your doctor about a DME they usually stop using that DME which leaves the better DMEs. Its the only way you as a whole can weed out the bad ones and keep or make the good ones better.

OK, Ms. Professional, please explain to me what exposing a humidifier chamber to water does to rigid plastic, stainless steel, and silicone that renders it unfit for use after 6 months.

leaving water in any chamber exposed to air will cause bacteria or fungus to grow. Whether you see it or not does not mean it is not there. Plainly these chambers that are provided can be reusable or disposable, but don't think they are sterile because they are not. The reusable ones can be taken apart and washed and can last if regularly taken care of. But the truth is most do not take them apart and wash them regularly. As you may be the minority we can not assume that all do as you. Which can lead them to use and reuse chambers riddled with bacteria for way too long and especially in a population that may have more than just osa and can be immuno-compromised... why take that chance!!!

sincerely
yvette

[jdm2857]

In one sentence the patient is the customer who gets to choose their DME. Then it's the doctor who chooses which DME to "use". You contradict your own point, if you indeed have one.

And, if you are going to assume that the patient does not maintain their water chamber by cleaning it, then it could well be full of microorganisms in way less than 6 months, no? After all, some bacteria, given favorable conditions, can double in number in 20 minutes or so. So maybe you should be recommending daily chamber replacement. Or even, heaven forbid, teaching your patients how to maintain their humidifier, to protect their health that you care so much about.

But oh, excuse me, I forgot you can't bill for that.

Back to your "costumer service". A health care professional's outfit for Halloween, maybe?

[Kiralynx]

You are a customer and are allowed where to shop, yes your insurance may limit who you can go to. But we are all the same when it comes to product we all carry or have the ability to order the same products. The only thing that sets us apart is our costumer service... Believe it or not. So rant and rave and make them change and the biggest kicker is if you complain to your doctor about a DME they usually stop using that DME which leaves the better DMEs. Its the only way you as a whole can weed out the bad ones and keep or make the good ones better.

Yvette,

My doctor didn't send me to a DME. I don't have a sleep doctor. I was diagnosed by a pain management specialist after the pain from my cancer surgery wouldn't go away. While there, I asked her about the hip pain I'd had for around seven years. She sent me for a sleep test. It was positive. She wrote a prescription. I asked where I filled it. She told me to ask her front office. They didn't know. They sent me to the sleep center where my tests were done. The sleep center told me, "Your insurance covers _______. Here's is their number. We'll fax your studies and prescription over to them."

I haven't seen the doc who wrote my prescription since she wrote it. She told me to have my PCP take care of anything else, as she wasn't a sleep specialist, and there was no point in my paying the co-pay for her when my PCP could handle things as well as she could.

So, none of my doctors care where I get a prescription filled. Only that I do.

And, since my insurance uses specific DMEs, no, I didn't have a choice. And unfortunately, the DME knows this, and their customer service shows it.

I've been in customer service related work since 1979. I can tell you that if I behaved towards my customers the way the DME employees treat me, I would have been fired a couple of thousand times.

One of the owners of a small DME (not covered by my insurance) used to work for my DME. Their behavior was why he quit and started his own company. So yes, there are good ones out there -- and again, I have to give credit where credit is due: the RT who recommended my specific machine for me did a good job, and I give her credit for that.

But I don't like being trapped by the DME.

I regret if my comments came across as an attack on you because of your profession. But, as you've seen, there are quite a few very intelligent, very capable, very stubborn people here who deeply resent being patted on the head and told to be good little children and do whatever we're told.

I fired my last PCP for that attitude. My gynecologist, my oncologist, and my PT all know better -- they work with me, instead of against me. It is, after all, my life and my health.

If more DMEs would work WITH their customers, there'd be quite a bit less hostility.

[virgo RT]

In one sentence the patient is the customer who gets to choose their DME. Then it's the doctor who chooses which DME to "use". You contradict your own point, if you indeed have one.

And, if you are going to assume that the patient does not maintain their water chamber by cleaning it, then it could well be full of microorganisms in way less than 6 months, no? After all, some bacteria, given favorable conditions, can double in number in 20 minutes or so. So maybe you should be recommending daily chamber replacement. Or even, heaven forbid, teaching your patients how to maintain their humidifier, to protect their health that you care so much about.

But oh, excuse me, I forgot you can't bill for that.

Back to your "costumer service". A health care professional's outfit for Halloween, maybe?

Yes bacteria grow in matter of minutes and chambers should be emptied daily and refilled with clean water. That is what we teach, and should be taught by all.

As to the comment of me contradicting myself. Yes you are limited to whomever your insurance is contracted with, but most insurances have at least 10 options. And yes if you do not specify to your doctor he will choose for you, but if you are not happy most cpap machines are rentals and can be returned and yes you may actually go to another provider. It is your choice, unfortunately its just not always given to you up front by your doctor. We as DME would love for patients to choose which would actually allow the best DME to prevail.

And another tidbit of information is that all insurances do not reimburse RT/DME for any education or visits only for the equipment provided. The problem is not the RT, believe it or not but what the insurances dictates and sets the standard for. Including medicare and medicaid.