DME nightmare(S)

[retrodave15]

One thing that burns me is that Brad from Lincare in Sierra Vista told me that he WOULD NOT order it because BCBS wouldn't pay enough! When I questioned him as to wether it was that BCBC would to cover that machine or not, he said that it was that they would not pay ENOUGH to make it worth his time.

Not surprising that Lincare puts PROFIT over patient care. Try checking around if there is a DME that is connected with a hospital in your area. I use a DME that connected to Ohio Health that is a Methodist hospital system, I have found as a Non-profit, organization they are a bit easier to work with. I tried to get a full auto, but we met in the middle on an AutoIQ machine from Phillips Respironics.

[123.Shawn T.W.]

Dave, I called all the ones in FOUR counties that are in the PPP network of BCBS ... Over 40 phone calls ... Most were a real waste of time, one place the woman who answered the phone had not finished chewing her snack when she answered, of course that didnt stop her from talking! She then transferred me to some one else as she didn't know if they carried ResMed products ... Then I was transferred back to her again, still crunching, sounded like chips! All together on that one call I was transferred SEVEN times, to finally discover "no, we don't carry those"!

[123.Shawn T.W.]

Welcome to DME Hell. I know there are good ones out there but what you are experiencing seems to be what a lot of people experience much more often than the good experiences.
Stand your ground and someone will eventually want your business enough to give you the machine you want.
They make money on them....just not as much as they want.
It would help things greatly if your doctor would be specific and write the RX with machine make and model along with DAW but sometimes they get their panties all in a wad too.

Don't go into all the software and your viewing your reports unless you just want to wave a red flag in their face. I think they feel like their authority is somewhat challenged when we know how to do things only they are supposed to know.

What is "DAW"?

[123.Shawn T.W.]

Does anybody know if I will need the Dr to write the Rx with a 12v power convertor on it to get one?

Or will Ins even cover that?

I work for a company with over 10,000 truck drivers, plus office support staff and maintenance crews. So ... I'm hoping that they will understand that a truck driver has 12vdc in the truck, and that we don't stay at home much ...

[dragon672]

Wow I'm really glad my DME set me up with a good machine. I didn't find this forum until after I had received my machine. I've also got BCBS and they are pretty particular on stuff. I hope you get everything straightened out. My DME said she provides the cord for truckers all the time. I bet you can buy that online without a RX.

[RandyJ]

That is because DMEs have decided that they must make a profit of 350-400% on EACH customer. It's disgusting. They will give you a bottom of the line machine that cost them $250, if they can get away with it, and bill your insurance $900-$1000. If they can't do this, as he told you, it isn't worth their time.

The S9 Autoset with humidifier might cost them $600. In that case they would only make $400 on you. A mere 150% profit isn't worth it, not when they are used to making double that.

[RandyJ]

DAW=Dispense As Written

[123.Shawn T.W.]

That is because DMEs have decided that they must make a profit of 350-400% on EACH customer. It's disgusting. They will give you a bottom of the line machine that cost them $250, if they can get away with it, and bill your insurance $900-$1000. If they can't do this, as he told you, it isn't worth their time.

The S9 Autoset with humidifier might cost them $600. In that case they would only make $400 on you. A mere 150% profit isn't worth it, not when they are used to making double that.

Part of me just for spite ... Once I get my Rx written right is to have my Dr send it to him!

Then if he refuses, I'll sic BCBS on him!

Unfortunately I don't have a lot of time ... I'm scheduled to get home Sun, and leave Tue ... Not a lot of time to waste playing games ...

[sleepycarol]

I feel for you. My hubby drives over the road and it can be a real pain. He is still using paper log books at this time and said he hopes he never has to go to the electronic ones.

Hold your guns and we will keep our fingers crossed.

[GumbyCT]

Does anybody know if I will need the Dr to write the Rx with a 12v power convertor on it to get one?

Or will Ins even cover that?

I work for a company with over 10,000 truck drivers, plus office support staff and maintenance crews. So ... I'm hoping that they will understand that a truck driver has 12vdc in the truck, and that we don't stay at home much ...

Chances are your Ins. will not cover a DC adapter but you should ask them.

For DC use you would be much better of with a Respironics machine since their humidifier also will work on DC AND the DC adapter is about 1/3 of the re$med price. Also you could buy the parts you need at Radio Shack or any auto parts store to make your own DC cord for a Respironics.

You won't do that for a re$med.

You might want to buy a machine for yourself on CraigsList. Also worth noting that because of the DME markups, many times it can be cheaper to just buy from cpap.com You should compare your costs each way.

O and in the words of Bruce Willis - "Welcome to party Pal"! The fun never ends.

[Meecalii]

Wow. my DME(apria healthcare) went face to face with the doctor and sleep lab because my ins wanted certain writing on the Rx and i got the call the day my ins cleared my Rx and got set up with a new PR system one. with the humidifier and a great mask... I had heard apria gets dirty machines and kinda cleans them up but i watch them take mine out of the box and unwrap it.

[kaiasgram]

Kaiasgram, You don't know the half of it!

God, Shawn, my heart goes out to you, seriously. I don't know what else to say, except that feeling the way I still do, I cannot tolerate the slightest perturbation at this point -- I just don't have any resources left -- so I can only imagine how hard this day must have been for you.

I'll keep good thoughts that everything gets straightened out soon and you're soon sleeping comfortably with your S9.

[retrodave15]

Does anybody know if I will need the Dr to write the Rx with a 12v power convertor on it to get one?

For DC use you would be much better of with a Respironics machine since their humidifier also will work on DC AND the DC adapter is about 1/3 of the re$med price. Also you could buy the parts you need at Radio Shack or any auto parts store to make your own DC cord for a Respironics.

I agree that the DC set up with a Respironics machine is simple. I have a few trucker friends and that is the only CPAP brand they will use in the truck. He had an S8 and it did not care for the vibrations in the truck and it died, he has never had an issue with is PR S1 machine. I have the 12V cable for mine and use it in the camper all the time. As for insurance coverage - a 12V cable is a convenience item and not covered by insurance.

FYI - look at the prices for a DC cable, as the Resmed is around 84 on our host site and the Respironics is 23. If your on a tight budget, this might be of help. Beware of the F&P Icon machines as they are 120V only and you will need a pure sine inverter for those, which can get really pricy, unless your rig has an inverter.

[GumbyCT]

FYI - look at the prices for a DC cable, as the Resmed is around 84 on our host site and the Respironics is 23. If your on a tight budget, this might be of help.

Ok 1/4 of the re$med price then.

Gumby - who is bad at math

[123.Shawn T.W.]

Yes, but my understanding is the new Respironics don't work with MAC machines ... That is what I have at home ... I do have a old laptop in the truck that is Windows ... But it is old and on its last leg ... That's why I'm using my iPhone!

And I just bought my wife an S9 AutoSet ... Don't really want two different machines ...