Is my DME is commiting insurance fraud???

[MiPilot]

Hi all,

Well here is the scenario.

I was originally set up with S9 Elite mid January and it was working pretty good until the last 3 weeks. Since then my AHI has been climbing. I called the sleep lab and talked to a tech and expressed my concerns. One of which included that I was going in for a pretty significant surgery next week and wanted the most benefit I could have from my cpap. After working with him on the data he decided that I could benefit from an Autopap.

He said that I may not be able to upgrade as I was past my first 30 days. I told him that my insurance paid on a rent to own basis and with that he called my DME to check if it was possible.

He got back with me and stated that it wouldn't be a problem. I was jazzed.

So here is where it gets interesting.....I make an appointment with my RT to change out the machines....I get there and she already has it set up ready to go. As I sit there and look at it it was obvious that it was a used machine. When I asked her she turned really defensive and eventually confirmed that it was used. At this point she turns pissy and says "you didn't really think you where going to get a new one did you". I said since my insurance pays on a rent to own basis ....YES I do expect it to be new. She says what if you need to go to a bi-pap. I said big deal...until then I expect a new unit....not one that comes out of someones home whom I don;t know. She then said "well they put new filters in and I was told and in ten months when my rent to own is complete I can have a new machine". Then she tells me that my Elite was a used machine.....I was so pissed by now....I said and when were you going to tell me ...to which she didn't answer.

Then she hands me a new climitline hose and says you are past 30 days you can have a new one! I never asked for or need it.

This woman is a complete scatter brain and I don't have any desire to work with her anymore. I had trouble with the headgear size on my nasel mask and asked her to order me a large. What to I get...a Resperonics headgear...to fit my Resmed softgel. I said I am having problems with leakage when I sleep on my side can I change out the softgel cushion for a Activa LT cushion...Sure...What do I get? The old style activa cushion. I asked about a full face mask as we are approaching allergy season...You cant have a new mask until April or you will have to pay 280.00 for it on you own.

So I called another DME and asked a few questions one of which what was there policy on rent to own machines. I was asked if I had private insurance and since I do they told me they can only supply a new machine.

The good news is that my insurance company will allow me to switch dme's and I will be doing that tomorrow.

So What do you all think....Is this fraud as I feel it is or is this typical?

And if anyone was wondering where I am located....I am in the "MidMichigan" area !

[scrapper]

I'm not sure it's fraud or not, but it's certainly shabby service that I hope you'll outline very clearly for your insurance company, and more importantly, others who require cpap supplies in your area.

Once you find the right equipment needs, it's so nice to utilize the online services like cpap.com..........where prices are appropriate and service is excellent!

[anvil]

I am new to all this but I wonder what the rent to own fee is and how much the machine will cost paying for it that way ? I bought a brand new top of the line fully auto machine with heated humidafyer hose and mask for less than 500.00 on line. I wonder how many times they resell those machines. I bet yours gets sold to the next guy the same way it was sold to you.

[Slinky]

Whew! I'm in mid-Michigan too. My local DME provider's office is in Saginaw. My first provider was a sheister too. But not THAT bad!!!