Trying to upgrade machine

[randyshipp]

Yep, that's exactly my understanding. A careful review of all the paperwork from when I picked up the CPAP from them reveals NO information about a return/exchange policy. So that's interesting.

[Janknitz]

Good work, Randy!

Yes, "whatever the doctor orders" means that you can get an APAP or a CPAP (since APAP's can be set in CPAP mode if needed). BUT, as we've already said, to avoid arguments, ask your PCP to write the script for an APAP so there will be no issues.

I'm trying to remember off the top of my head--I think it's Rested Gal who suggests you ask your PCP to write the script like this:

"Auto-adjusting PAP machine with patient access to AHI and leak data, integrated heated humidifier, mask of patient's choice".

If your hear is set on a particular make and model, it doesn't hurt to have the doctor actually write that on the script (but be careful that you have him write the correct make and MODEL) and include "dispense as written". Often DME's will say that they don't carry a particular make or model. If you want to do business with that particular DME, you can always ask them to order it. Sometimes that demand "reminds" them that the just happen to have one on the shelf in the back room.

BTW, is this Global Sleep company "in network" or are you going to get a big bill in the mail because they are not?

ALSO, do NOT let them charge you a penny extra for a data capable or auto machine. See "Don't pay that upcharge" in my signature if they try to pull that one on you.

ANd your state should have some consumer advocacy group where you can get info on your rights to a money back return.

[randyshipp]

My reading this afternoon has me doubting whether this is going to work out. You see, I live in Texas, a state notorious for its lack of effective consumer protection laws. One of your articles talked about the fact that 47 of 50 states have made the practice of balance-billing illegal...Texas is one of the proud three, apparently. I also can't easily find anything online that suggests that Global Sleep is required to accept a return. So they might just tell me to get stuffed and not take the machine back, at which point I wouldn't know what to do to pursue the matter further. I guess I won't know until I try. But if they play hardball with me, I'll certainly be spreading the word here and elsewhere about what they're like to do business with, as well as complaining to my insurance company about them.

[mayondair]

Another thought on your situation: hopefully the DME will want to keep your business for supplies, but if not and they balk at the return tell them you will take your buisness elsewhere. The plus would be just fine as a back up/ travel machine. You could pick up a used Sys1auto and use the same humidifier for both. Maybe that wouldn't break the budget, or if no money worries a new one.FWIW, I am very happy with my sys1auto , and wouldnt be without a backup. kathy

[Janknitz]

If they give you a hard time about the return and switch, may I also suggest you write a letter of complaint to the sleep doctor AND your referring doctor?

You might also try the state agency that regulates DME's, if consumer protection laws don't work.

[Breathe Jimbo]

Even if Texas law does not prohibit balance billing, the DME's provider agreement with your insurance company almost certainly does.

[randyshipp]

Even if Texas law does not prohibit balance billing, the DME's provider agreement with your insurance company almost certainly does.

I'm more concerned with the lack of guidelines on returns. Ah well...all speculation. I'm off to the doctor's office.

Thanks for ALL the input. I'll keep ya posted.

[Janknitz]

The lack of guidelines can be used in your favor. If they claim that there are no returns, you certainly weren't informed of the policy. They can't hold you to a policy they didn't bother informing you about.

And if they try to claim that medical items can't be returned (it may be true in the case of the hose, mask, and humidifier, but the blower should not be an issue) ask them to quote you exactly where in the regulations it says that. Make them show you in black and white.

[randyshipp]

OK, saw the doctor today. I kind of got the impression that she doesn't know just a whole lot about this condition, and that she didn't exactly see what the big deal is. Despite that, she readily agree to write a specific Rx for any machine I wanted. So I now have a Rx for a PR System One REMstar Auto machine. That should have everything I need, right? And work fine with my existing System One humidifier?

Now to call Global Sleep back and see if they give me any grief over a return/exchange.

[TalonNYC]

See, THAT's the kind of doctor I would keep. "I don't think you need to monitor this, but if you really want to, and it won't hurt you, here's your Rx"

[randyshipp]

She was a little funny towards the end of our visit. I was explaining that there's only one code for xPAP machines and thus the DME would give you the cheapest machine possible to maximize profit. She made an expression of mock surprise and said, "They would do that?" So, yeah, it was encouraging.

[Janknitz]

I'll be interested to hear how it goes with the DME. Don't be surprised if they still give you a hard time--i.e. "since your prescription is for a fixed pressure you don't "qualify" for an auto machine".

In truth, you do not need to "qualify" for anything, since an E0601 machine at a fixed pressure is just the same as an E0601 machine at an auto pressure range in the eyes of your insurer. That doesn't mean the DME won't try to play this game with you.

Good luck!

[randyshipp]

Promising so far. I just sent over a scan of the Rx. The lady sounded reasonable this time, saying they just need to check stock levels before setting up an appointment to switch. I'll keep updating here.

Thanks to all of you folks for motivating me to follow through on this.

[randyshipp]

She's "going to check if there will be an extra charge for you." Heh...

[Janknitz]

While you're waiting for her to check on the "extra charge", call your insurer and ASK if their contract permits a DME to charge you more than the contracted fee ("balance billing"). Ask them what steps you should take if a provider tries to charge you more. Be ready to respond if they try to upcharge you--even a "restocking" fee.