Lack of Communication, Doctor & DME

[robysue]

I know what I would do but then I am known to be a bitch...

Yes me too. I would be in there breathing fire! They did NOT fill the prescription! They really have no option but to replace it with what the doctor ordered.

That's what I told them, this is not an Auto Machine - this is Auto for 30 days and then turns into a single pressure machine. She said this is what she always fills for my Doctors Patients,

I'd let the doctor know that this DME is routinely not filling his Auto CPAP prescriptions as written. He will then have the option to quit sending folks to this particular DME.

Good luck in getting the machine switched out for what your prescription actually says for the machine.

[azpilgrims]

Just got off the phone with my DME and my blood is boiling

They said there will be an upgrade charge to go with the Auto Machine of $ 350.00, I said you have to be kidding me - this machine costs about $ 70.00 more than my current machine. My insurance through Blue Cross Blue Shield pays quite well on CPAP Machines, Mask, Supplies, etc. - their Allowable is quite a large profit, they pay 70% and I pay 30% of the allowable. I let them know that I know what these machines sell for online and they are making a handsome profit with the Insurance Allowable. I also let them know that they made the mistake, this is not my problem and they need to fix it. I should let you know the person I am talking to is my Respiratory Therapist, she is the middle man in all of this communicating information from their billing department and the owner of the company. I finally told her that I am a very nice person, but can also make life for them very unpleasant with the Better Business Bureau, Arizona Corporation Commission, State Attorney General, Blue Cross Blue Shield, as well as my Doctor who I would gladly let know that they are not prescribing machines per his RX and the ordeal I am going through. So I told her to please let the owner know of this conversation, he needs to call me to let me know that they are going to take care of this mistake - if not I will start making phone calls and complaints to the various organizations.

Seriously I cannot fathom doing business this way, I am a business consultant (focus on technology) and these people are out of their damn minds to try to make me pay an "upgrade fee" when they damn well know the billing code is the same for cpap/apap and my insurance pays the same amount either way - AND they made the mistake, not my problem.

If this is not remedied, I will post their name on the forum so that other folks from Arizona will know how they do business

[Pugsy]

Question...have you checked with your insurance company to find out if the "up charge" is even allowed per the contract that they have with DME?

[BlackSpinner]

Just got off the phone with my DME and my blood is boiling

They said there will be an upgrade charge to go with the Auto Machine of $ 350.00, I said you have to be kidding me - this machine costs about $ 70.00 more than my current machine. My insurance through Blue Cross Blue Shield pays quite well on CPAP Machines, Mask, Supplies, etc. - their Allowable is quite a large profit, they pay 70% and I pay 30% of the allowable. I let them know that I know what these machines sell for online and they are making a handsome profit with the Insurance Allowable. I also let them know that they made the mistake, this is not my problem and they need to fix it. I should let you know the person I am talking to is my Respiratory Therapist, she is the middle man in all of this communicating information from their billing department and the owner of the company. I finally told her that I am a very nice person, but can also make life for them very unpleasant with the Better Business Bureau, Arizona Corporation Commission, State Attorney General, Blue Cross Blue Shield, as well as my Doctor who I would gladly let know that they are not prescribing machines per his RX and the ordeal I am going through. So I told her to please let the owner know of this conversation, he needs to call me to let me know that they are going to take care of this mistake - if not I will start making phone calls and complaints to the various organizations.

Seriously I cannot fathom doing business this way, I am a business consultant (focus on technology) and these people are out of their damn minds to try to make me pay an "upgrade fee" when they damn well know the billing code is the same for cpap/apap and my insurance pays the same amount either way - AND they made the mistake, not my problem.

If this is not remedied, I will post their name on the forum so that other folks from Arizona will know how they do business

Upgrade fees maybe illegal depending on your insurance. Check with them.

[azpilgrims]

Question...have you checked with your insurance company to find out if the "up charge" is even allowed per the contract that they have with DME?

I spoke with my insurance company at length a couple weeks ago to get their allowable for the billing codes that the DME had on my paperwork, they can only bill by these codes and there is no difference on the billing code between a cpap and apap, different code if you go to a bipap, etc.

[azpilgrims]

Just got off the phone with my DME and my blood is boiling

They said there will be an upgrade charge to go with the Auto Machine of $ 350.00, I said you have to be kidding me - this machine costs about $ 70.00 more than my current machine. My insurance through Blue Cross Blue Shield pays quite well on CPAP Machines, Mask, Supplies, etc. - their Allowable is quite a large profit, they pay 70% and I pay 30% of the allowable. I let them know that I know what these machines sell for online and they are making a handsome profit with the Insurance Allowable. I also let them know that they made the mistake, this is not my problem and they need to fix it. I should let you know the person I am talking to is my Respiratory Therapist, she is the middle man in all of this communicating information from their billing department and the owner of the company. I finally told her that I am a very nice person, but can also make life for them very unpleasant with the Better Business Bureau, Arizona Corporation Commission, State Attorney General, Blue Cross Blue Shield, as well as my Doctor who I would gladly let know that they are not prescribing machines per his RX and the ordeal I am going through. So I told her to please let the owner know of this conversation, he needs to call me to let me know that they are going to take care of this mistake - if not I will start making phone calls and complaints to the various organizations.

Seriously I cannot fathom doing business this way, I am a business consultant (focus on technology) and these people are out of their damn minds to try to make me pay an "upgrade fee" when they damn well know the billing code is the same for cpap/apap and my insurance pays the same amount either way - AND they made the mistake, not my problem.

If this is not remedied, I will post their name on the forum so that other folks from Arizona will know how they do business

Upgrade fees maybe illegal depending on your insurance. Check with them.

The DME said I would be responsible for the fee, not my insurance as the upgrade fee is theirs.

[pharm30]

I'm in Phoenix, having problems with my DME as well.
I have an ASV machine...I have to "rent to own" pay extra $100/mo for 13 months?
I believe that is my 30%?

[BlackSpinner]

The DME said I would be responsible for the fee, not my insurance as the upgrade fee is theirs.

Yes and this is illegal - tell your insurance company about that.

[Pugsy]

The DME said I would be responsible for the fee, not my insurance as the upgrade fee is theirs

Yes...but some insurance companies don't allow upgrade fees or balanced billing. It depends on what the contract states.
http://maskarrayed.wordpress.com/dont-p ... -upcharge/

[GumbyCT]

I finally told her that I am a very nice person, but can also make life for them very unpleasant with the Better Business Bureau, Arizona Corporation Commission, State Attorney General, Blue Cross Blue Shield, as well as my Doctor who I would gladly let know that they are not prescribing machines per his RX and the ordeal I am going through.

In many states the DME's & RT's have to be licensed with the Health Dept. Your AG should know.

As already mentioned, it may be against the insurance contract to charge an "up-charge".

This all happens because others before you have turned their heads.

Don't give up and Do keep us posted.

[Janknitz]

In addition, I think this was already mentioned but you should get your doctor involved because his order was not filled as written. They don't care one bit about you but when a prescribing PHYSICIAN gets involved they stop playing games unless they want to lose him as a referral source.

[azpilgrims]

The owner of the DME called me to discuss the "problems" I am having with the machine, this guy is a crook - says I will be upgrading from a Chevy Malibu to a Cadillac and the $ 350.00 upcharge will be billed to me. I stated everything to him in this thread that they did not fill my Doctors Prescription, this is not an Auto Machine. He says they have the ability to substitute based upon the subscription, I said no you do not, there is nothing on the prescription that says or even indicates this. Finally he offered to cut the upgrade fee in half, I said No, you did not fill the prescription and this is not my problem, you need to fix this. I have left a message for my Doctor to call me back and will be having a discussion with my Insurance Company.

[azpilgrims]

My Doctor called me back, explained everything, he was not happy and said it is medically necessary that I am on an Auto Machine. He said what this guy was telling me is wrong and that he would call the owner of the DME.

20 Minutes passed by and my phone rang, the owner of the DME stating he spoke with my Doctor and they will be giving me the Auto Machine with no up-charge. He stated he did not have the necessary documentation from my Doctor in the beginning stating I medically needed an Auto (Insert big fat liar here), I called him out on his lies, he says I am trying to call him a crook, said if the shoe fits wear it, then he tells me he does not want a customer who calls him a crook. I told him for the last three days you have had every opportunity to make this right and even call my Doctor yourself, but no you kept saying $ 350.00 up-charge over and over. Well I am picking up my machine Monday from them and will be done forever afterwards, I did go ahead and order a machine through Cpap.com - they treated me great and have the Newest PR Auto with Heated Tube on its way as well.

This DME will probably not get much referrals from my Doctor in the future, he was not happy with everything.

[GumbyCT]

Well I am picking up my machine Monday from them and will be done forever afterwards,

I am happy for you. Good for you for sticking to your guns.

Be sure to read up on how to check the hours on this "new" machine.

[Pugsy]

Well done. You did what I would have done. Don't blame you for never wanting that DME to have your business again. You might shop around for another DME that works with your insurance though...handy to have them for masks and other supplies using your insurance.

When you get the new machine from cpap.com....would you do me a favor? We assume that SleepyHead will work just fine with this new model but we don't know anyone who has one yet....so looks like you will be the first (at least from the forum) and would you give SleepyHead a try to make sure that it works just fine with the new heated hose machine? We would sure appreciate it.

Cpap.com usually sends the provider/clinical manual when they ship machines. I haven't seen an online source yet for the new 60 series machine. I suspect the only difference will be the added stuff for the temperature and humidity controls.