DME has my Rx & is waiting for insurance approval!

[carolaz]

I called my sleep doctor's office to ask when I should be expecting my machine, and they told me they had faxed over my prescription and records to a DME on Monday. They gave me the phone number of the DME and I called them about the status of the order. They do have the order and are just waiting for my insurance company to approve it, which they say only takes a couple of days. Not much longer now!

I asked them what machine I'm going to get. They said it will be a "Respironics M series RS DS100S." They said it has a Smart Card and a heated humidifier. My pressure is going to be 9, so my insurance company won't cover C-Flex, and that if I wanted that, I'd have to pay $250 out of my own pocket. When they did my titration study, the tech said I didn't seem to have any trouble exhaling.

Some questions:

1. Since it has a Smart Card, is the machine I'm getting fully data capable? I did leave a message with the sleep doc's nurse asking for a fully data capable machine.
2. Do you think it's worth it for me to pay $250 for the C-Flex feature?
3. What model is "RS DS100S?" I see DS100, but not that.
4. I know it's a highly individual thing, but what accessories do you think I need right off to make things more comfortable right from the start?
5. I spoke to my insurance company a few days ago and they told me I could go to any DME, yet my sleep doc sent my prescription to this particular one without asking me which I prefer. Is this typical?

Thanks so much for all the information in this forum. I'm determined to make this work for me!



Carol

[GumbyCT]

I called my sleep doctor's office to ask when I should be expecting my machine, and they told me they had faxed over my prescription and records to a DME on Monday. They gave me the phone number of the DME and I called them about the status of the order. They do have the order and are just waiting for my insurance company to approve it, which they say only takes a couple of days. Not much longer now!

I asked them what machine I'm going to get. They said it will be a "Respironics M series RS DS100S." They said it has a Smart Card and a heated humidifier. My pressure is going to be 9, so my insurance company won't cover C-Flex, and that if I wanted that, I'd have to pay $250 out of my own pocket. When they did my titration study, the tech said I didn't seem to have any trouble exhaling.

Some questions:

1. Since it has a Smart Card, is the machine I'm getting fully data capable? I did leave a message with the sleep doc's nurse asking for a fully data capable machine.
2. Do you think it's worth it for me to pay $250 for the C-Flex feature?
3. What model is "RS DS100S?" I see DS100, but not that.
4. I know it's a highly individual thing, but what accessories do you think I need right off to make things more comfortable right from the start?
5. I spoke to my insurance company a few days ago and they told me I could go to any DME, yet my sleep doc sent my prescription to this particular one without asking me which I prefer. Is this typical?

Thanks so much for all the information in this forum. I'm determined to make this work for me!

Carol

1.No
2.No
3.THE very cheapest- NO useful data-ONLY Compliance
4.A New DME
5. Then cancel xmas STOP the show - DO NOT sign anything. You need another DME. Start calling around - get a copy of your script from your doc (IN Your Hand).

[jules]

Get a new DME - one with fewer lies.

http://encore.respironics.com/type.aspx

On that chart you will see that the DS 100 has no card.

[carolaz]

Thanks. I'm so frustrated!

I talked to my insurance company, who assured me that as long as I have a prescription for a certain machine and features, they'll pay for it. I then called and left a message with my sleep doc's office, begging them to write me a new prescription for a Respironics M-Series Pro because I really, really want my therapy to work and I want the data to prove that it's working. We'll see how they respond.

So, let me get this straight: the sleep doc probably prescribed me something like "CPAP, heated humidity, pressure 9" and then faxed that over to the DME, then the DME is just giving me the most basic machine that will comply with that prescription. Where is my say in all of this, me who has to sleep with this machine night after night for who knows how long?

Surprisingly, my insurance company has been the least frustrating aspect of this whole thing. They say they will pay whatever the DME charges for the machine.

What's my next step if my doctor won't change my prescription? When the DME calls to set up an appointment for me to pick up my machine, should I then refuse to sign anything until they give me the machine I want? Or is it the sleep doc I should be pushing?

[jules]

check with your insurance and ask them for "in network" DMEs

then start calling around on that list

also get your Rx and a copy of your sleep study

sounds like you have two problems - one with the doc picking a DME for you and the other with the DME he picked - pick your own DME

[pitrow]

the sleep doc probably prescribed me something like "CPAP, heated humidity, pressure 9"

I would think that if that's what's on the script, then you should be able to get any cpap machine of your choice. You didn't say in your original post, but have you asked the DME for a different machine?

[carbonman]

Thanks. I'm so frustrated!
Where is my say in all of this, me who has to sleep with this machine night after night for who knows how long?

What's my next step if my doctor won't change my prescription? When the DME calls to set up an appointment for me to pick up my machine, should I then refuse to sign anything until they give me the machine I want? Or is it the sleep doc I should be pushing?

carolaz, YOUR say is the final say.
You are the BOSS.
NOT the doctor.
NOT the DME.

It's YOUR therapy.
....are you sensing a theme here?

Get an Apap. Mseries apap or whatever auto pap, so you can adjust YOUR therapy

as you learn. An A pap will give you all the options.
In addition to your RX, in your hand, get a copy of your sleep study and
if need be, find a new doc that will work with YOU.
Fight the fight now and be done w/it.

Edit after continued outrage:

When they did my titration study, the tech said I didn't seem to have any trouble exhaling.Carol

What a load of crap. the tech said you "didn't seem to have any trouble exhaling."
How would he possibly know that??
What a load of crap.

Do not trust what he "seemed" was right for you.
Get the BEST for you.

[GumbyCT]

What's my next step if my doctor won't change my prescription? When the DME calls to set up an appointment for me to pick up my machine, should I then refuse to sign anything until they give me the machine I want? Or is it the sleep doc I should be pushing?

You have several options.
1. Any doc can write the script. You have a friendly Primary doc? Will likely need a copy of your sleep study. You are entitled to it.
2. Find another Sleep doc
3. Find another DME
4. Buy Online
5. Last but not least you need to get busy reading - "Where a Newbie Should Start" and the Light Bulb "Our Wisdom" are both good places to start but you need to start. So maybe this should be Number 1.

NO I wouldn't sign anything (knowing what I know now) - unless or until they gave me what I wanted. Else YOU will be legally obligated to pay for what you don't want. Your call.

Is some of this sounding familiar?