Yet another DME story to add to the pile...

Rosenkavalier · Post by **Rosenkavalier** » Fri Mar 31, 2006 2:39 pm

I held off on posting this until I had a full resolution -- which happened this afternoon! So I can share my story, which will probably sound familiar to a few folks here...

I posted previously (back here: viewtopic.php?p=64316&highlight=#64316) about my first sleep study, and had my second study (titration) at the start of March. It took about two weeks to get the results back, but my doctor finally gave his order -- a 14. A lot higher than I had hoped.

In the meantime, I had been looking around at some of the DMEs in town, and settled on one of the only ones with Saturday hours (most DMEs here only keep 8-5 M-F hours, making it hard to get there when you work a similar schedule). They started off very friendly, answering my questions, and seemed to indicate that I shouldn't have too many problems choosing the brand or model I wanted to get.

While I was waiting to get a paper copy of my orders (the doctor's office read them to me over the phone), I went to the DME and told them exactly what they said, and indicated that my preference was for a Remstar Auto with CFlex. (I had a printout of the Respironics product page in my hand.) All of a sudden, the tone changed -- unless my orders explicitly stated "Auto-Titrating", my insurance would reject a claim for an auto machine. And unless my orders actually included the word "CFlex" on them, they could not order a Remstar machine with the CFlex option, since that product line was more expensive than other baseline models on the market (and the insurance would only pay for the absolute cheapest unit possible).

My orders were going to simply read "CPAP, heated humidfier, pressure 14." As a result, to get the CFlex option, much less to get the Auto I wanted, I'd have to get my orders modified. Frustrated, I drove over to my doctor's office and saw his nurse (who happened to be available). She was very understanding, and took all of the information. Several days later, they put modified orders in the mail that explicitly stated "auto-titrating" and "CFlex" on them.

I got them last night. However, in the change, the doctor left off the humidifier, so I'll need yet another change. I called the DME again, asking about how to handle the modified order, and they upped the ante: they said that none of the insurance companies were paying for heated humidifiers anymore, just unheated/passover units. And, that they weren't sure if I would be able to get the Remstar Auto on my insurance -- they'd have to "look it up" and see.

By now, I'm realizing that none of this is making any sense. So I call another DME in town (Rhema), who came recommended by one of the techs at the sleep center where I got my study done. (I guess I should have gone there first and saved myself a lot of time.) I walked in the door at 11:15, and walked out 30 minutes later with a Remstar Auto under my arm. All covered by my insurance. And, once my doctor gives me a new order for the humidifier, they'll give me one of those too -- heated.

[I asked the folks at Rhema about having to put 'CFlex' on my orders, and they looked at me funny...they said that for everyone who comes in with a plain vanilla CPAP order, they tend to just go with a Remstar CFlex unit as their baseline machine, unless the patient or doctor asks for something else.]

So I guess this is a bad DME/good DME story. Tonight will be my first night on CPAP, so I'm nervous and excited -- about to become a hosehead!

Amigo · Post by **Amigo** » Fri Mar 31, 2006 3:17 pm

Good for you, Rosenkavalier, and the best of luck joining our hosehead crew.

I only wish more people would/could be as proactive as you were when dealing with such appalling DME's. The horror stories just never seem to stop, and, tragically, many people just give up in utter frustration and end up putting their lives at risk.

We can only hope that this site will help spread the word, and people will take control of their treatment even if it means buying on-line, and avoiding DME's and insurance companies entirely.

Guest · Post by **Guest** » Fri Mar 31, 2006 4:12 pm

Rosenkavalier wrote: I called the DME again, asking about how to handle the modified order, and they upped the ante: they said that none of the insurance companies were paying for heated humidifiers anymore, just unheated/passover units.

Unbelievable! Some of these DMEs are incredibly stupid.

No. They're worse than worthless. They're liars.

wading thru the muck! · Post by **wading thru the muck!** » Fri Mar 31, 2006 4:24 pm

Don't you get the impression that these folks would make up ANY lie that comes to mind and serves their purposes. Just the kind of people that I DON'T want involved in my healthcare.

I always think it is funny when these DMEs say the "insurance" won't allow an APAP. The billing code for APAP is the same as the one for CPAP... the insurance company won't even know that you got an APAP. The REAL reason is that the DME pays more for the APAP but can't get more than the maximum allowable reimbursement for it for it.

yardbird · Post by **yardbird** » Sat Apr 01, 2006 6:30 am

I blame the DMEs and the doctors who seem to have so little training in patient care when it comes to sleep apnea and treatment options. And a large part of our problems starting out have some basis in ignorance on the part of the patient. We don't KNOW any better. Once diagnosed, the whole apnea thing is a new adventure that most of us go into without much knowledge so we tend to accept what we're told by the "professionals" and take our equipment home and try to learn this whole new routine. I know that's how I started and I don't normally consider myself ignorant, but in this case this seemd like such a common ailment..."Lots of people have apnea that isn't diagnosed. Treatment is simple" ...I believe those were the words of my sleep doc. Well if the treatment is so simple then it's probably the same for everyone.

WHAT WAS I THINKING?
Apnea treatment is NOT simple. Not only does apnea appear to have many causes so one cause does not fit all, but it appears to have many treatment options. Some of which work for SOME folks and some of which work for OTHERS.

Now you add in the evil DMEs and the less-than-helpful insurance companies (I'm being kind) and you have some really terrible patient care out there. And every time I hear another story I get drawn one step closer to starting a sleep apnea counseling service. FREE. I don't want their money. I just want people to get good treatment and the horror stories out there really tick me off.

GarthsWorld · Post by **GarthsWorld** » Sat Apr 01, 2006 8:53 am

"and the best of luck joining our hosehead crew"

Amigo... thank you for my first laugh of the day! I hadn't heard that name but it's so apropos!

Wulfman · Post by **Wulfman** » Sat Apr 01, 2006 10:39 am

Rosenkavalier,

Congratulations on making it through the DME "mine field" and becoming a "hosehead".

The stories about the DMEs never cease to amaze me. I just pity the people who haven't done their homework on sites like this and blindly follow what the "EVIL" DMEs dish out to them. When the DMEs DO encounter an "informed" user, they just don't seem to know what to do other than spewing out BIGGER lies.

GarthsWorld,

I did a search on this site on the word "hosehead" and the first recorded uses were in a couple of posts by "Tim_D" and "Judy Ann" on Oct 05, 2004.

Best wishes,

Den

ozij · Post by **ozij** » Sat Apr 01, 2006 12:03 pm

Wulfman wrote:

GarthsWorld,

I did a search on this site on the word "hosehead" and the first recorded uses were in a couple of posts by "Tim_D" and "Judy Ann" on Oct 05, 2004.

Best wishes,

Den

hose +head

Tue Sep 21, 2004 , snufflenose.

O.

Wulfman · Post by **Wulfman** » Sat Apr 01, 2006 12:13 pm

ozij wrote:
Wulfman wrote:

GarthsWorld,

I did a search on this site on the word "hosehead" and the first recorded uses were in a couple of posts by "Tim_D" and "Judy Ann" on Oct 05, 2004.

Best wishes,

Den

hose +head

Tue Sep 21, 2004 , snufflenose.

O.

OK, "Smarty pants"......ya got me again.....

But, I did the search on the one-word version as it was used by Amigo.

Take care, Ozji.

Best wishes,

Den

deedster · Post by **deedster** » Sat Apr 01, 2006 12:19 pm

Welcome to another Texan (I'm in Arlington)! I am so thankful that I found this site before I got my machine. I told the Dr. specifically what I wanted on my Rx for a machine, humidifier, and mask and he wrote it exactly that way. I had no problems from the DME since it was all spelled out, nothing they could argue with.

Be determined and patient. You didn't get where you are overnight and you won't get better overnight. But it will happen. I am so glad that all it took to treat all the problems I was having was some air blowing in my nose!

ozij · Post by **ozij** » Sat Apr 01, 2006 12:36 pm

OK, "Smarty pants"......ya got me again.....

But, I did the search on the one-word version as it was used by Amigo.

Take care, Ozji.

Best wishes,

Den

I know. And I was confused because I knew I had run into the word (or expression) in my first weeks on this forum.... and that was longer ago than October 2005.

Have a nice weekend!
O.

Guest · Post by **Guest** » Mon Apr 03, 2006 7:46 pm

I will let you know that I personally work for a DME company and I am by no means an EVIL person. Of course we have to have specific orders on prescriptions and try to keep in mind that every insurance company is different as far as requirements on rx's and sleep study's. I feel really bad that some of you have had such bad experiences because I truly care about my patient's and try to make things as easy as possible for them but of course like every job i have rules I have to follow. My philosophy is to take care of the patient first and do all I can to help them out. I am actually a Christian and not even a little bit evil. I work for a very large company and I love my job so it does upset me to be called EVIL, although I know it is meant towards the company itself and not me personally. I hope you all have a better experience next time.

NightHawkeye · Post by **NightHawkeye** » Mon Apr 03, 2006 8:08 pm

Guest wrote:I will let you know that I personally work for a DME company and I am by no means an EVIL person.

Welcome, Guest. I, personally, am glad to see your post, and hope that you will continue in discussions here on this forum in order to interject some sanity from the "other side" into the discussions on this subject.

It is sad isn't it that some policies and practices of these organizations are so obviously contrary to the benefit of those who people like you are sincerely trying to help. .

Regards,
Bill

Wulfman · Post by **Wulfman** » Mon Apr 03, 2006 8:11 pm

Anonymous wrote:I will let you know that I personally work for a DME company and I am by no means an EVIL person. Of course we have to have specific orders on prescriptions and try to keep in mind that every insurance company is different as far as requirements on rx's and sleep study's. I feel really bad that some of you have had such bad experiences because I truly care about my patient's and try to make things as easy as possible for them but of course like every job i have rules I have to follow. My philosophy is to take care of the patient first and do all I can to help them out. I am actually a Christian and not even a little bit evil. I work for a very large company and I love my job so it does upset me to be called EVIL, although I know it is meant towards the company itself and not me personally. I hope you all have a better experience next time.

It's good to hear from you. Of course there are good DMEs out there....and many here have made mention of them when they've dealt with them. Personally, I didn't go through a local DME and purchased all of my equipment from CPAP.COM, so I haven't had any bad experiences. My reasons were primarily cost-related. I've also acknowledged that I think the local DMEs in my area DO provide pretty good service (from what I've heard). Unfortunately, many people here have told many, many horror stories about dealings with theirs.....THAT is a shame, and casts a shadow of suspicion on that profession/industry.
If you have any ideas on how to resolve some of the problems that many of these "hoseheads" have experienced, please stick around and share your thoughts.
I also realize that "storefront" (local) DMEs carry a lot more things than just CPAP equipment.

Best wishes,

Den

Rosenkavalier · Post by **Rosenkavalier** » Tue Apr 04, 2006 1:02 pm

Guest wrote:I will let you know that I personally work for a DME company and I am by no means an EVIL person....I work for a very large company and I love my job so it does upset me to be called EVIL, although I know it is meant towards the company itself and not me personally. I hope you all have a better experience next time.

First of all, I do understand the experience of working for a large company (in my case, a large government agency), and the feeling of being "judged" by how people perceive both the single entity that I work for, as well as the sector in general. It's unpleasant, but understandable.

Second, I want to go back to my original post that started this all and reinforce something that might have been missed: while the bulk of the message was about how the first DME was, at best, unclear regarding procedures involving my insurance (and, at worst, incompetent or unethical), the silver lining was that I found a second DME that did everything right.

That's why I ended by calling my story a "bad DME/good DME" tale -- because there are both sides to be told. I'm still extremely pleased about the way Rhema has dealt with me so far, and while there's still the possibility that something might go wrong down the line, all in all I couldn't be happier. I do want to make sure my point on this matter doesn't get lost.

Yet another DME story to add to the pile...

Yet another DME story to add to the pile...

Re: Yet another DME story to add to the pile...