Am I being screwed by my DME?

[NoSleep4u]

I checked with my insurance company and I am definitely supposed to be getting a new machine. I called Apria and the first question they asked was "How do you know it is used?". Then they claimed that they don't deal with used machines and they have no idea how this happened...blah, blah, blah.

The supervisor was supposed to call me yesterday morning...still no call. Looks like I may to get a little meaner.

[ems]

I think the BPAP machine the doctor switched me to was used also. I thought so from the first day... not in a box/clear plastic wrap, etc. I'm sure I was right b/c it wouldn't show any data on the SD card even tho a new card was put in. My doctor called them and they quickly exchanged it for a new one. I think they do whatever they think they can get away with. It wasn't Apria tho.

[mcdover]

A lot of advice is being given here without knowing the particulars. What is the insurance? What are the guidelines for payment for the insurance?

Take Medicare, for example. Medicare requires that all CPAP's are rented for a maximum of 13 months. You must prove, not only compliance, but also that the machine is benefiting you. Sounds simple, but it's not. Data has to be downloaded from the machine, your DME does not have the power to MAKE you comply. You have to meet Medicare's definition of compliance, that means using it according to then. You have to return to your prescribing doctor and he/she has to document that the machine is benefiting you. The DME can't make you go see your doctor and it can't make the doctor write what is required by Medicare. If any of these are not met to Medicare's satisfaction, then the claims are denied.

Now take that into consideration when you walk into a DME with a RX in hand. You don't want to pay out of pocket for the whole thing, but you want a new, never used machine. Your problem is not with the DME, it's with your insurance. If Medicare purchased outright and did not have all of these hoops to jump thru, then used machines on DME's shelves would be extremely rare.

[KoalaBear]

So, we should call our insurance company to find out what our insurance terms are? How does one know if the machine given to us has had previous users?

My 2nd dilemma/Question--my vendor gave me an apap 7 months ago. At the time of "orientation" i asked what happens if an apap doesn't work, and we needed a diff type of machine. She told me they'd "swap" it out. however she didnt' tell me in detail that the money i've been billed monthly will/will not count towards the new machine.

A few months later when I updated her that I've been having trouble tolerating apap and working w/ a diff sleep specialist, she then told me to return the machine then. And that a NEW contract will be executed for a new (diff) machine. This was not told to me during orientation and i was under the assumnption it would be an "even swap". well i didn't return the apap machine, until i got to get a 2nd asssessemnt(for a bi-level) and so a couple more months passed by b/c I was waiting for my appt. And i certainly didn't want to return the apap after speaking to the sleep specialist (and this wasn't possible til i had my 2nd assesssment). anyway, i've now got only 2 more months on the apap (which has only been used less than 100 hours). I just feel so cheated . what the heck am I to do with a machine that essentially doens't work for me and i had to spend hundreds and hundreds of dollars on, plus all the accessories aren't even returnable, including the humidifier? I also asked during the orinetation if we find that the machine isn't tolerated and the specialist suggests an oral appliance what do i do? Is this common practice for all the vendors? if you switch machines, you basically start a new contract and 0 dollars get applied to a machine that works for you? i think this is so wrong.

[Guest]

So, we should call our insurance company to find out what our insurance terms are? How does one know if the machine given to us has had previous users?

My 2nd dilemma/Question--my vendor gave me an apap 7 months ago. At the time of "orientation" i asked what happens if an apap doesn't work, and we needed a diff type of machine. She told me they'd "swap" it out. however she didnt' tell me in detail that the money i've been billed monthly will/will not count towards the new machine.

A few months later when I updated her that I've been having trouble tolerating apap and working w/ a diff sleep specialist, she then told me to return the machine then. And that a NEW contract will be executed for a new (diff) machine. This was not told to me during orientation and i was under the assumnption it would be an "even swap". well i didn't return the apap machine, until i got to get a 2nd asssessemnt(for a bi-level) and so a couple more months passed by b/c I was waiting for my appt. And i certainly didn't want to return the apap after speaking to the sleep specialist (and this wasn't possible til i had my 2nd assesssment). anyway, i've now got only 2 more months on the apap (which has only been used less than 100 hours). I just feel so cheated . what the heck am I to do with a machine that essentially doens't work for me and i had to spend hundreds and hundreds of dollars on, plus all the accessories aren't even returnable, including the humidifier? I also asked during the orinetation if we find that the machine isn't tolerated and the specialist suggests an oral appliance what do i do? Is this common practice for all the vendors? if you switch machines, you basically start a new contract and 0 dollars get applied to a machine that works for you? i think this is so wrong.

Yes, it is ultimately YOUR responsibility to know what YOUR insurance terms are. As far as knowing if its used, I would simply ask upfront and if told that it is unused, I would have that documented on the delivery paperwork that you will sign.

Your 2nd dilemma is 100% on you and your doctor. You walked into a DME with an RX in hand. They gladly filled your Rx as per your doctor's instruction, then months later, you find out it wasn't the best treatment for you, so your doctor goes down another path. Why is it that the DME is supposed to eat the difference? Your condition, your doctor, but the DME takes the loss? Why is it that the DME is the bad guy for this, but if your doc prescribes you an antibiotic and it doesn't work, you don't demand credit towards the new drug? Same difference.

[BlackSpinner]

And i certainly didn't want to return the apap after speaking to the sleep specialist (and this wasn't possible til i had my 2nd assesssment). anyway, i've now got only 2 more months on the apap (which has only been used less than 100 hours). I just feel so cheated . what the heck am I to do with a machine that essentially doens't work for me and i had to spend hundreds and hundreds of dollars on, plus all the accessories aren't even returnable, including the humidifier? I also asked during the orinetation if we find that the machine isn't tolerated and the specialist suggests an oral appliance what do i do? Is this common practice for all the vendors? if you switch machines, you basically start a new contract and 0 dollars get applied to a machine that works for you? i think this is so wrong.

Pay the two months and keep the machine and sell it on craiglist

[NoSleep4u]

After a few more phone calls, I finally got the new machine today. They even gave me a new slimline tube (they gave me a standard one previously). I ran it through a full check when I got it home (I had to at least take it since I did not want to be out of a machine all together). i now have a newer Autoset that still has the 0602 software and has 174 hours on it. The question is, do I just keep this one of continue to pursue the issue?

According to my insurance, I am renting to own a new machine. This one is certainly newer looking.

A note on packaging: We, as users, are never going to get to see a brand new machine coming out of the box. We will only get the new machine after it has been set up by the technician. The only way would be to insist on seeing the device (and noting the serial number) before the tech configures the device.

[robysue]

We, as users, are never going to get to see a brand new machine coming out of the box. We will only get the new machine after it has been set up by the technician. The only way would be to insist on seeing the device (and noting the serial number) before the tech configures the device.

When I picked up my machine, the RT opened the sealed box in my presence, made sure all the parts were there, plugged the machine in and set it and then gave it to me.

[squid13]

When I got my machine it was new also straight out of the box with no hours on it.