dme takes its s9 machine back

[splinky]

the dme is not willing to lower the price for the old machine and they failed to pick it up last week. it's sitting near the door waiting for them to show up. i ordered a brand new s9 autoset machine and it arrived today. thanks to everyone for your suggestions and advice. will let you know if i can work things out with the insurance company. i'm excited to see if having the autoset helps me keep the mask on for more than 4 hours at a time. now i just have to figure out what range the pressure settings should be. my prescribed pressure is 9cm and cpap.com set the autoset at 4.0 cm-20.0 cm. that seems like too big a range. i'm open to any suggestions on a good starting range for the first night.

[Janknitz]

Start with 9, go up 3 cm to 12, and see how you do. Try it for several nights to get an idea of trends--you shouldn't make daily adjustments because it's hard to tell what factors may be affecting your nightly AHI.

Be sure to get the software so you can track your progress and do any necessary problem solving.

[splinky]

Start with 9, go up 3 cm to 12, and see how you do. Try it for several nights to get an idea of trends--you shouldn't make daily adjustments because it's hard to tell what factors may be affecting your nightly AHI.

Be sure to get the software so you can track your progress and do any necessary problem solving.

Thanks! is 9 the start pressure and 12 the set pressure?

[Slinky]

9-12 is your suggested pressure range instead of 4-20.

[splinky]

9-12 is your suggested pressure range instead of 4-20.

thanks slinky. i figured it out i forgot to change the pull down menu from cpap to apap. doh!

[Janknitz]

Don't use the ramp unless you have to. You shouldn't if you've been using CPAP at straight 9.

[sleepycarol]

In my opinion, and it is strictly my opinion, it wasn't the DME's fault she was noncompliant. She accepted the machine KNOWING what the charges would be and the issue about having to be compliant.

Otherwise, in my opinion, everyone should just "become noncompliant" and expect to get a discount on their machine when purchasing from a brick and mortar DME in this manner. From a business stand point, I doubt that many DME's could afford to do this when it isn't their fault that she isn't compliant according to the insurance.

If for example, the DME neglected to bill the insurance company and let things slide and THEY were at fault I would totally agree that they should discount the machine.

It would be like renting a new car driving it for awhile, not making the payment, then expecting the dealer selling it to you at a discount cause it is "used". In my mind same difference. In this case it was due to not making the payment, and in the above cause she didn't use the machine as necessary to keep it.

[Janknitz]

Splinky said:

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

My understanding is that the insurer will pay the rental during the compliance period, but will not pay beyond that period if the compliance requirements are not met. So Splinky was not "stealing" anything. And sounds like the compliance was beyond her control, yet she's not complaining.

[splinky]

Splinky said:

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

My understanding is that the insurer will pay the rental during the compliance period, but will not pay beyond that period if the compliance requirements are not met. So Splinky was not "stealing" anything. And sounds like the compliance was beyond her control, yet she's not complaining.

thanks for the vote of confidence, i definitely i haven't tried to steal anything, i'm just trying to figure out what to do to make the best decision about how to proceed. real life simply got in the way of my being strictly compliant and within the the first 90 days i missed a few days in a row that would have met the requirement.

i offered to buy the machine from that dme, since the insurance wasn't going to continue paying, just as i had paid my co-payments. i was surprised that given the amount they had already been paid by both myself and the insurer that they still wanted to charge more than full price. this wasn't some big evil plan, i just happened to find out that i might be terminally ill in the middle of starting with the new machine and wasn't able to use it every single night during the compliance period.

things happen in life and sometimes people can't be compliant, despite their best intentions, i don't think that makes them evil or a thief. i certainly hope that sleepycarol never finds herself in a similar situation.

the dme doesn't have a problem with taking the machine back, in fact they never asked me to purchase it, i asked them what it would cost if i wanted to keep it, even though the insurance would no longer pay. it turned out to be a ridiculous amount about equal to what they had already been paid and the total would have been about double what i just paid for a brand new autoset machine. so basically, i'm not complaining, the dme is not complaining, the insurance company is not complaining. no felonies were committed. the only one complaining is sleepycarol, but i'm not sure that i understand why.

[sleepycarol]

As I said the thoughts I expressed were my own.

I am just a skeptic that a note from a doctor stating that there was a medical reason for the noncompliance wouldn't have taken care of the issue. If insurance refused to accept legit medical reasons from a doctor - then that would have put a different slant on things. I didn't read in the post that this was attempted and insurance denied it.

[Hose_Head]

the dme is not willing to lower the price for the old machine and they failed to pick it up last week. it's sitting near the door waiting for them to show up.

Don't wait too long for them to pick it up. Experience on this board is that most DMEs are not very organized and many are downright unethical. If they wait long enough (unintentional or not), then they may complain that YOU didn't return it, or that YOU didn't tell them to pick it up, and that because some deadline has passed, that YOU are now responsible for continuing co-payments.

Tell them in writing and phone them daily until it is picked up. Registered mail is best.

Just my humble opinion.....

[splinky]

As I said the thoughts I expressed were my own.

I am just a skeptic that a note from a doctor stating that there was a medical reason for the noncompliance wouldn't have taken care of the issue. If insurance refused to accept legit medical reasons from a doctor - then that would have put a different slant on things. I didn't read in the post that this was attempted and insurance denied it.

i'm not sure what there is to be skeptical about or why you're so bent on assassinating my character, when you don't even know me. noone said that a note from a doctor wouldn't have taken care of the issue and i'm not sure what that has to do with anything. i'm sure that i don't owe you any explanation but in my original post, i asked about the best source for a replacement machine, not for assistance with my insurance. i've paid cash for the new machine and paid all the copays to the dme and my insurance paid the dme rental for the initial use period and i paid for the insurance. i looked into paying the dme cash for title to the old machine but it the dme and i couldn't come to terms on a price and the rental contract (which has been paid in full) was ended. basically, everyone's been paid in full. i don't think anything that i've written suggests that i was ever looking not to pay or to get something for nothing. the dme never suggested a doctor's note and they knew in advance that i wouldn't meet the compliance requirement. i suppose they could have been more helpful in guiding me to request a doctor's note and some sort of extension of the initial period, but they weren't and at the time of the non-compliance, i had more pressing concerns than saving a few pennies on a machine rental.

having said that, i do want to thank everyone else for their advice and suggestions, this forum is such a wonderful resource.

[splinky]

the dme is not willing to lower the price for the old machine and they failed to pick it up last week. it's sitting near the door waiting for them to show up.

Don't wait too long for them to pick it up. Experience on this board is that most DMEs are not very organized and many are downright unethical. If they wait long enough (unintentional or not), then they may complain that YOU didn't return it, or that YOU didn't tell them to pick it up, and that because some deadline has passed, that YOU are now responsible for continuing co-payments.

Tell them in writing and phone them daily until it is picked up. Registered mail is best.

Just my humble opinion.....

i hear you. they've already missed 2 pick up appts.

[Hose_Head]

the dme is not willing to lower the price for the old machine and they failed to pick it up last week. it's sitting near the door waiting for them to show up.

Don't wait too long for them to pick it up. Experience on this board is that most DMEs are not very organized and many are downright unethical. If they wait long enough (unintentional or not), then they may complain that YOU didn't return it, or that YOU didn't tell them to pick it up, and that because some deadline has passed, that YOU are now responsible for continuing co-payments.

Tell them in writing and phone them daily until it is picked up. Registered mail is best.

Just my humble opinion.....

i hear you. they've already missed 2 pick up appts.

If it's not too much trouble, it may be worth it for you to deliver it to them. Just be certain to get a receipt for it, and refuse to sign anything that says you are refusing treatment (some have reported that DMEs will try this to protect their a$$e$).

Good luck!

[jonquiljo]

I am just a skeptic that a note from a doctor stating that there was a medical reason for the noncompliance wouldn't have taken care of the issue. If insurance refused to accept legit medical reasons from a doctor - then that would have put a different slant on things. I didn't read in the post that this was attempted and insurance denied it.

Well, I have BS of California - pretty mainstream - and I have never been able to talk with them about anything but payments. I am serious. They talk around the issue when I can get a hold of them. Most of the time - I never get to speak to a human. Sure, they will talk about claims in terms of billed vs. payment - but when it comes to any issue of coverage it is complete double-talk! When it comes to medication coverage they will never talk to a human - at least when I call or a pharmacy does. The pharmacy gets a computer to talk to - nothing more. I get nothing. Do you really think DME benefits will be handled any differently?

So do you really think that any insurance company will read a letter from a Dr. about anything? I surely doubt it. It's always "bill-allow-pay", etc. Dollars and cents discussions only. Nothing involving any judgment or interpretation of your policy guidelines. The only time you can deal with a coverage issue is to file a complaint with the state insurance board (Calif. is very good about resolving health ins. claims). Even than you only get to write a complaint - and generally most of the documentation sent never gets read.

The only people they care about giving good customer service to are the people who never make claims. If you are one of those people, you never need to talk to them.