requirement for a new rx yearly?

[Perrybucsdad]

Most doctors that I have dealt with will renew a rx with just a phone call. I take warfarin for my mechanical heart valve, and I home test my blood clotting. Each year I am required to send a new rx in to buy supplies. I just give my doc a call and he sends me a new rx. No visit necessary. My ENT told me he would do the same thing if it came down to it.

My DME on the other hand told me recently that the lifetime rx for them is fine. We'll see about that next year I guess. I wish I had that in writing though.

John

[yardbird]

This got me to thinking..... (sometimes dangerous) .... could this be a regulation to prevent insurance fraud?

I mean, think about it. You give a DME a "lifetime" prescription. Then you move, or get mad at the DME and "fire" them. They still have that lifetime prescription on file. Can they continue to bill the insurance company periodically for supplies they aren't actually supplying any more?

Just a thought.

Personally I'm on board with the "My OSA isn't going away" crowd so I wish they'd stop jerking me around. Script for a machine? OK. I can see that.

Now tell me again why I need a script for a mask. I mean what would I do with a mask if I didn't have the machine?
I need a script for a hose? For filters? Are you freaking kidding me?

[NCHawk]

This reminded me that I need to call my neurologist to get a renewal for some medicine; last year when I needed the renewal she called the pharmacy and gave them a prescription instead of specifying a number of renewals just said "renew until XX/XX/XXXX" which meant that I could get refills as often as my insurance would allow it.

When I had to replace my broken CPAP last February Apria and BCBCNC both required a prescription. Since my original sleep study had been done back in Chicago, and my copy of both the study and the original prescription were packed away somewhere, I was afraid that my neurologist might want to order a new sleep study. I wasn't that concerned about doing the study, just the additional delay this might involve. Fortunately, she took my word for what my pressure was and just wrote up a new prescription and faxed it to Apria, and I had my new machine a week later.

[Perrybucsdad]

I need a script for a hose? For filters? Are you freaking kidding me?

You don't need a rx for a hose or filters. If you go to cpap.com all the items that need an rx say so. Nothing stated for hose or filters. I bought mine from them (and the water tank) and have yet to send them my rx.

[TalonNYC]

It's been less than 1 year for me with the machine, so haven't run into this rule on that front, but I HAVE run into it for other RX's. My chronic insomnia has me on Ambien every night, and I do need to get an annual checkup each year so the doc can renew the Rx for that. Same for my ashtma medications. I'm not sure if that's a New York State thing, or just my own doc being cautious, I will have to ask her next time I go in.

I'm not sure it's such a bad thing that we check in with a doc once per year. Yes, it's an expense, and yes, sometimes it's an expense we can't afford - special consideration should be made for that problem. However, in general, speaking with an expert once per year is not exactly a negative. Technology and medicine change, there might be better options available, new insurance regulations, etc.

I will NOT be going back to the sleep doc I went to early this year, but I wouldn't mind going to a different sleep doc and getting his/her opinion once a year. Mind you, my insurance covers nearly all of such visits, and I recognize that I'm quite lucky in that. Not everyone will be able to afford annual visits, and I'm unsure what to do to make that anual visit possible for them =(

[yardbird]

I've never been much one for goin' to a doctor if I'm not sick, but as I get older (I'll be 60 next year) I have to say I'm not against getting a check-up once a year. Catch things when they're early or small and before they become a big problem. My regular doc did give me a script for a machine when mine broke and my sleep doc at the time gave me an appointment THREE MONTHS OUT. I've since fired that sleep doc. My regular doc recently gave me a script for a new mask, but she said it's really not proper for her to do this and that I need to get hooked up with a specialist. She gave me a referral and I have to say that anyone she's referred me to in the past, I'm still using. I see the new sleep doc on the 15th so we'll see how that goes.

I APPEAR to have found a DME that won't jerk me (or my insurance company) around. I'll know more next week when I get my new mask. But I'd LIKE to get on a schedule of regular replacement of pillows, mask, filters, etc because I can see I am tending to let things slide too much.

So HERE'S a question for you...

The machine I have now, AND the one I had before that were both purchased out-of-pocket. Insurance was not involved. My current machine, while still working splendidly is now past its warranty period and I don't have a backup machine. For all the insurance companies know, I'm still using my original Remstar straight CPAP from about 17 years ago. Think this new doc might be inclined to write me a script for a new machine? When I called my insurance company to ask about coverage for CPAP equipment, they told me I'm 100% covered from in-plan providers and everyone I'm dealing with so far is "in-plan". Sounds too good to be true that I might be eligible to get a new machine out of this basically for free.

[chunkyfrog]

Dh and I just received appointment cards from our resp. doc.
15 min. apart. Hmm. Yeah.
I never heard back from them after I sent summary data for a month last spring--
I wanted a specific RX for a ff mask (ins. req to cover out of schedule) --never got said RX.
Apparently their only concerns are about feeding the money mill.
I would call and tell them, "No thank you."; but we are so close to Medicare, I don't want to jinx it.
Besides, my work insurance covers it; and we need to sell a house before I can retire.
So, for the time being--playing their little game.
It also gives me a chance to confront them about IGNORING ME last year!
Or I could try to find a better doc, but other patients here are less informed than we are.
Where would one go to find an honest referral?

[Perrybucsdad]

..

The machine I have now, AND the one I had before that were both purchased out-of-pocket. Insurance was not involved. My current machine, while still working splendidly is now past its warranty period and I don't have a backup machine. For all the insurance companies know, I'm still using my original Remstar straight CPAP from about 17 years ago. Think this new doc might be inclined to write me a script for a new machine? When I called my insurance company to ask about coverage for CPAP equipment, they told me I'm 100% covered from in-plan providers and everyone I'm dealing with so far is "in-plan". Sounds too good to be true that I might be eligible to get a new machine out of this basically for free.

Talk with your doctor, but I don't see why the insurance company wouldn't pay for a new machine. I think they would care if THEY paid for one within 5 years, but that has long since passed with you.

[yardbird]

Where would one go to find an honest referral?

I have a really good relationship with my primary care doctor. She's the same age as me, we both have 2 dogs (rescues), etc. She gives me the best referrals. For example, I needed to have a couple of suspicious areas looked at on my forehead. She gave me a name and said, "I wouldn't refer anyone I wouldn't want working on ME." I saw the guy and he looked at the ones I pointed out and said they both looked rather non-threatening, "But can you see this one here in the edge of your hairline?", he said. "I think that one is far more interesting and bears attention." .... so... He spotted something I HADN'T spotted and I go in Monday to have it removed/biopsied.

Now this referral HAPPENED to coincide with the fact that I had to go into my primary for a regular physical exam anyways, but that may be a good place to start. I guess it depends on your relationship with your primary.

Oh and that plastic surgeon? He has an Australian Shephard (I have a pair of australian shephard/beagle mix... brother and sister from the same litter) AND his dog is in training for search and rescue. I fly radio control airplanes and have started getting into aerial photography and video. I asked him if any of the search and rescue teams had drones that could overfly an area to help them with the search. He said, "No, but that's a very interesting idea." .... so I might be a volunteer with search and rescue if I can get a couple of planes together for the spring. Things sometimes just work in weird ways

Sorry.... didn't mean to hijack. I just talk a lot.
But try your primary care physician for referrals to good specialists.

[idamtnboy]

At the very least, it could be a simple way to weed out the bad DME's

One of my nieces works at a care center, so naturally they are in contact with DME providers all the time. She said a Medicare rep for the Northwest told them that because of fraud and abuse by DME suppliers they are clamping down. One of the new requirements will be that only certain DME suppliers will be allowed to supply Medicare paid-for DME equipment. The list of suppliers will be dramatically reduced in size from what it is now. I haven't seen any evidence of that yet as far as getting my CPAP stuff, but I have no reason to discount what she said.

The one-year renewal requirement is quite possibly a result of Medicare fighting fraud and abuse by DME providers.

I wonder if cpapauction.com got caught up in the push against fraud and abuse. I don't see why it would have, but we'll never know. There's probably a lot more going on behind the scenes between Medicare and suppliers than we will ever know. Tight budgets prompt auditors to bring out a lot of magnifying glasses.

[chunkyfrog]

It's too bad they have make it so tricky.
Sometimes even care givers and providers can't figure it out.
Then again, maybe it's just another gate-keeping strategy.

[2flamingos]

Update -

Talked with insurance (again) - new rx/certification of medical necessity not a requirement for them.

Checked with state DME board - not a state requirement.

Checked back with DME supplier - supposedly, the person I talked to (twice) "made a mistake", the annual rx only applies to MediCare. They said they would be sending my supplies and I should have them by the end of the week. I'm not holding my breath - oh, wait, I might be when I sleep if I don't get my supplies!

[Lizistired]

I called my sleep doc's office today and asked about getting a renewed script. They said they cannot write them for indefinately but they are going to mail it to me. Done. I'll have it to provide to the DME if they ask.

[2flamingos]

Still waiting on supplies. Insurance has received the claim from DME, but I have not received the supplies. Hopefully they will be in the mail today. If not......

it is crazy how difficult everyone makes healthcare!

[pratzert]

Still waiting on supplies. Insurance has received the claim from DME, but I have not received the supplies. Hopefully they will be in the mail today. If not......

it is crazy how difficult everyone makes healthcare!

Unfortunately.. it's only going to get worse when Obama-Care kicks into full gear.