dme takes its s9 machine back

[splinky]

so, my dme says that my insurer has denied the claim after 3 months and they want their machine back. the dme has provided poor service so i don't feel too awful about this and was really looking forward to the end of the contract and them just turning the machine over to me. when they asked for the machine, i asked how much it would cost if i wanted to buy it outright, they quoted me a price higher than any of the online suppliers would charge for a new machine, for what is now a used machine. between insurance and my copays, they have already received about half the machine's retail value. i told them to come take it away on monday. so what's my best bet for replacing the machine? an auction? just paying full price from an online supplier? getting a copy of the prescription from my doctor shouldn't be a problem. thanks in advance for your ideas

[DreamLady]

Did they take it back because of non-compliance on your part? Most insurances require you to use it a MINIMUM of 4 hours per night on avage.

I always advise calling a local DME or two and explaining that you must pay for it out of pocket. I got my S9 for $850 that way. I wanted a second machine to take and leave at my daughter's so I don't have to lug it back and forth every trip. Now I love my S9 SO much, I'm going to try the whole travel thing with it over Thanksgiving and see how it goes. The S8 Escape Auto may just sit in the closet unless/until an emergency arises.

[splinky]

i missed being compliant by a couple of days due to another medical problem. i'm not complaining about he insurer denying coverage because the rules are the rules, but i am saddened that they would overcharge like that for a used machine. they would not consider charging less for the machine

[DreamLady]

I hear you. That's why I used mine every nigh come heck or high water. I even managed it with a cold and cough. Was rough coughing while masked, but I got through the cold faster than I think I ever have!

[chunkyfrog]

Rules are NOT carved in stone! Regardless of what they tell you, there are ways around their 'rules'--
---especially in case of special medical circumstances.
I would think with the additional medical problem,
your doctor should be able to request an extension or modification to your compliance-related withdrawal of treatment.
If it were me, I'd FIGHT them!

[splinky]

if i have a choice between replacing the s9 elite with an autoset s9 which is better? my pressure is 9cm, i tend to be a side sleeper and i do have trouble with sinus congestion.

[Uncle_Bob]

I'm not sure what good a used machine would be to the DME. Have you thought about making them an offer? Mention the on line price then offer them the difference between that and what you paid?

[jmelby]

if i have a choice between replacing the s9 elite with an autoset s9 which is better? my pressure is 9cm, i tend to be a side sleeper and i do have trouble with sinus congestion.

Since the autoset can do either cpap or apap mode, it would be preferable. You may not need to use the autoset, but the price difference is normally fairly minimal between the two. The advantage of having an apap is that if you ever feel your pressure is not right, you can use auto-mode, along with monitoring your results, to determine a new pressure. Or, as some of us prefer, leave it in auto mode all of the time with a relatively tight range.

[Physician]

so, my dme says that my insurer has denied the claim after 3 months and they want their machine back. the dme has provided poor service so i don't feel too awful about this and was really looking forward to the end of the contract and them just turning the machine over to me. when they asked for the machine, i asked how much it would cost if i wanted to buy it outright, they quoted me a price higher than any of the online suppliers would charge for a new machine, for what is now a used machine. between insurance and my copays, they have already received about half the machine's retail value. i told them to come take it away on monday. so what's my best bet for replacing the machine? an auction? just paying full price from an online supplier? getting a copy of the prescription from my doctor shouldn't be a problem. thanks in advance for your ideas

You should find out the basis for the Insurer's denial. Sometimes it is a clerical error, sometimes a diagnosis code mistake.... Repost here after you learn the precise reason. You can also call the insurance company yourself, and there is an appeal process.

[splinky]

Thanks, I'll keep you all posted on the outcome.

[sleepycarol]

Was the machine new when you got it? If so then if you decide to keep it -- in my opinion it isn't fair for you to expect them to turn around and sell it to you as "used" because it was new WHEN you received it. If you received it as a used machine, then I could see your reasoning for wanting a new machine -- but if not then I don't agree with your reasoning that they should sell it to you at a discount.

[Slinky]

Gotta disagree w/you on this one, Carol. The PAP "is" used now - and they have received at least 3 months rental co-payments on it ... what a they gonna do w/it?? They certainly can't resell it as new at full price. What is the harm of selling it at a more reasonable price than the "billed" amount?

[Uncle_Bob]

Was the machine new when you got it? If so then if you decide to keep it -- in my opinion it isn't fair for you to expect them to turn around and sell it to you as "used" because it was new WHEN you received it. If you received it as a used machine, then I could see your reasoning for wanting a new machine -- but if not then I don't agree with your reasoning that they should sell it to you at a discount.

I also disagree Carol,

The machine became used ONCE the DME asked for it back. Why did the DME ask for it back? Isn't the DME supposed to handle the insurance side of things? Why did they give her the machine without being crystal clear on the insurance rental/purchase policy.

And why did it take 3 months to sort it out? Sounds like a lazy DME billed once and didn't follow up with insurance and give feedback to the patient. Kind of like giving a person negative feedback on ebay without an email to attempt to resolve problems fist.

[LinkC]

i missed being compliant by a couple of days due to another medical problem. i'm not complaining about he insurer denying coverage because the rules are the rules

Guys/gals, this isn't the DME's fault! Clearly explained above. And splinky recognizes that.

If it was me, I'd negotiate with the DME for a fair resolution. They should be willing to come down from the NEW price because she and her insurance have already paid a sizable amount. They also now have a USED machine and few options.

[Slinky]

And also appeal the insurance company's decision w/the backing of the doctor who treated you for the other medical condition.