Need some advice on working with a DME

[jdm2857]

No bikes in the tunnels; you'll have to go up to Fort Lee and take the George Washington Bridge.

And I can be bribed into revealing Dori's exit.

[DoriC]

Bump
Dans, we've been having some fun but I know how frustrating this is for you. Hope you get it squared away quickly. Do we have any other New Yorkers here?

jdm, I know I can trust you...or can I? What happens in Jersy stays in Jersey, right??

[chunkyfrog]

good luck!
We had United Heathcare with the county up until there were so many complaints
our union DEMANDED we change insurance companies.
Like I said,"good luck".

[yawnny]

Hi, I'm not from New York but, went thru similar issues in quest of my "dream machine" in the past few weeks. I have been researching a replacement machine for a couple of months and came to the same conclusion as yourself, Resmed S9 autoset. I called the DME that had provided my last CPAP, a S7, about 6 years ago and was told that if I could get a script for an APAP they could provide me with a S8 autoset. When I told them that I wanted a S9 because the S8 was rapidly closing in on obsolescence they told me that it would not be available to them until September (yeah right). Then I called a local office of a national DME and was told by a sales rep that no way would insurance cover a new machine unless the old one was totally trashed beyond repair and in no case would give me an APAP, even though I knew this was not true (wtf??). After that I called the DME that operates out of my Sleep Doctors medical building, all they would offer was a low end Respironics machine. I finally found a local DME that did not stock this machine but would gladly order it for me. As a further curiosity, when I called my previous CPAP supplier to tell then that I was switching, they told me that they could have gotten me a S9 autoset after all--too bad so sad.

Anyway, the bottom line is, for what ever reason, DMEs don't necessarily have your best interest at heart, keep calling others until you find one that does.

[Gia]

Call your insurance company FIRST. Here are the questions you want to ask:


Sometimes it is better to order online and pay out of pocket (it is the RARE insurance company that will reimburse you for an online purchase) or you may want to do it if you can afford to just to avoid the hassle. BUT, if you have good insurance, it may be worthwhile to do a little sluething and put up with some nonesense to get most of the machine paid for--after all, you paid for the insurance!

Actually it depends on the type of product - if you have out of network benefits - then there is no legal reason they should refuse payment. An out of network brick and morter DME is the same as a web-based DME provider. You may have to jump through more hoops to get all the required data (provider TIN code, completed claim form, etc). But as long as the provider is licensed (if it is required where the provider is located - although to be honest - a lot of plans do not go through that requirement), you should be able to get the claim paid. If you have OON benefits, and they refuse to pay, ask specifically where web based (also known as remote providers) are not a covered provider. Chances are it is not in the contract. If they still refuse to pay after you have followed the appeals process - then file a complaint for your state's department of insurance.

[nosenabook]

When I first got a CPAP we had United, too. When you are on the phone with them, you can ask for a supervisor or someone who can tell you what you need to know - and the person on the phone should know who that is.
It's worth being patient AND persistent, with doctors and DMEs as well as insurance, but you know that by now.
And it's good to know you have alternatives!