Getting a different machine from DME, advice?

[RoboLobo]

Thanks for posters Pugsy and NateS for convincing me (in another thread) to request a better (i.e. data capable) machine from my DME (Sleepmed). Yesterday I sent an e-mail requesting a swap out of my basic Phillips machine for the REMster Pro. Does anyone know much about the machinations involved as to give me some insight as to how this is going to go down? I feel like I am walking back onto the used car lot, which is not my idea of fun. If it matters, I have Blue Shield PPO (have yet to see my 20% co-pay bill from anyone), I signed a rent-to-own contract, and the only other tidbit I have is that my sleep doc says Sleepmed is a big company that bends over backwards to make people happy. So he says Can Sleepmed swap this out with taking a financial hit and a minimum of hassle such that I can reasonably push them to do this for me?

I am too nice sometimes. That's what my wife will probably put on my tombstone after I don't wake up some morning

[SneakerPumpernicle]

have your Dr. request it for you as a change in treatment, they cannot deny. I'm on my third machine. system one, system one with cflex, s9

[Janknitz]

They might bend over to make your doctor happy. So use him as your ally. Asks him to write a SPECIFIC RX for the machine you want and write "dispense as written".

I have some tips in my blogpost "help, I'm stuck with a brick".

You should understand that the DME unloaded the brick on you and it's now a used machine. Unless they are worried about keeping your doctor as a referral source they have ZERO incentive to accept back this used machine to trade it for one that cuts into their profit margin.

If your insurer allows you to use other DMEs, your best bet is to find one who is willing to give you the pro and dump the current DME by returning the machine.

[Pugsy]

The difference in cost between the basic Plus machine and the PR S1 Pro might be $100 comparing the two models and online prices. I have no doubt that their profit margin can easily absorb that little bit of difference.

Don't be afraid to stand up for yourself with this one. If you were diabetic would you not want to check your blood sugar on your own?

[BlackSpinner]

I feel like I am walking back onto the used car lot, which is not my idea of fun.

Now really, used car sales people are much nicer and more knowledgeable about their products the most DME's so don't insult them like that.

[chunkyfrog]

Expect a fight.

[sleeptimeinNY]

I am in your same shoes... got the basic S9 Resmed Escape machine. It's been more than a month that I have been trying to get a new one. Luckily my doctor is willing to work with me and I basically told him what to write on the script. It's all faxed in so now I have to wait to see what insurance and the equipment company does. He doesn't understand why I want the autoset, but was willing to prescribe whatever I want. So hopefully your doctor is just as cooperative.

Good luck!

[edm_msu]

It is possible the DME can take back the used CPA without a problem. My DME (MedEquip) has a fleet of CPAPs that they use for the first three month compliance period. After the compliance requirements are met, the DME puts the CPAP that I've been using back into the fleet and gives me a brand new machine. The fleet CPAP is given to another new patient for their three month requirement.

This is a good system for the patient (me). I've already switched from the System 1 to the ResMed S9. I just found out that PR came out with the 60 with heated hose. I'm going to switch back to the System 1 for the remaining two months of my compliance period and then they'll give me a new 60 with heated hose. They do not have any 60's in their fleet yet.

My original prescription was for a regular CPAP so they were going to give me a regular CPAP. I had my doctor send them another prescription for an auto CPAP so now they are required to give me an auto CPAP. They recomended I get another prescription for a heated hose to assure I could get the new 60.

BTW, these requests were outside the expertise of my primary care doctor. She wanted to help, but couldn't. I went to a sleep specialist and everything worked out.

Ed M.

[dllfo]

If you are a "nice guy", ask them how high you have to escalate your problem to get it resolved in your favor? If they are smart, they will hand you over to the person who can really help you.

If you don't get satisfaction, PM me. BTW, I keep notes in MS Word every time I call Apria. Name, date, even the minute I called. 64 pages now. They know I keep these notes and don't even try to argue with me. It is my health, not theirs, at stake and I will fight for it. I am not the most popular person at Apria, but I get the correct equipment in a timely manner. Good Luck......Dave

[RoboLobo]

Back at ya folks! My DME finally got back to me and let me know that they would upgrade my brick to the REMstar Pro for $250, no less. What do you think? Curent backdrop:

1) Still in first 30 days of rental contract with my brick, not sure if I have leverage by threatening to cancel said contract (can I?) and go to different DME;

2) Not sure if $250 would have to be paid up front or if it can somehow be paid over time (factored into my portion of the CPAP monthly rental?)

Or am I still being too nice?

[BlackSpinner]

Back at ya folks! My DME finally got back to me and let me know that they would upgrade my brick to the REMstar Pro for $250, no less. What do you think? Curent backdrop:

1) Still in first 30 days of rental contract with my brick, not sure if I have leverage by threatening to cancel said contract (can I?) and go to different DME;

2) Not sure if $250 would have to be paid up front or if it can somehow be paid over time (factored into my portion of the CPAP monthly rental?)

Or am I still being too nice?

Call your insurance to see if they are allowed to charge an "Upgrade"
With only 30 days in your rental contract you have lots of leverage - 12 months of payments leverage, you can dump the brick back into their hands.
Call other DME's and get their "price" for what you want. Like shopping for a used car.....You check out more then one lot and compare prices.

[edm_msu]

From Janknitz's signature: What you need to know before you meet your DME http://tinyurl.com/2arffqx

[Janknitz]

Actually, see "Help, I'm stuck with a Brick" and "Don't Pay that Upcharge" in my signature below.

No surprise they are trying to squeeze you for the money--now they will have a used machine to deal with. And less profit. That won't make them happy. But it's not your job to make them happy, it's your job to get the best possible equipment for YOUR needs within your insurance coverage.

Charging more for a machine within the HCPC definition (in other words, your Plus has the same billing code as an auto machine) is known as "balance billing". In most cases that's not permitted under the contract with your insurer and it's often illegal.

Try to get a specific script from your doctor for what you want, that goes a long way in making the next part of your job easier.

Then start calling other DME's (as long as your PPO doesn't limit your choice of providers) and see if anyone wants your business (with the understanding that they've lost out on at least 1 month's rental). If you can find another DME who will give you the machine you want without an upcharge, be as polite and nice as you want when you return your brick to the old DME. Tell them you really appreciate their help, but So and So DME has promised you a machine with EFFICACY data for no upcharge, so you prefer to go with them.

Don't let them make you sign anything saying you're refusing treatment--do get a receipt in writing that you have returned the machine. They won't take back the humidifier, hose or filters, BTW.

Be nice, but remember, you have to sleep with this thing for the next 5 or so years. Get what you need for YOUR health.