Lack of Communication, Doctor & DME

[ems]

It certainly sounds like the DME lied! How do these companies get away with this? It's illegal don't you think? Aren't they concerned they will be shut down and out of business?

I'm so glad you persevered and got a new machine! Maybe that's the problem... few do anything so they continue to get away with being dishonest.

[NateS]

It certainly sounds like the DME lied! How do these companies get away with this? It's illegal don't you think? Aren't they concerned they will be shut down and out of business?

It's all the way up to the top - read today's Op Ed in the New York Times:

Why I Am Leaving Goldman Sachs
By GREG SMITH
Published: March 14, 2012

http://www.nytimes.com/2012/03/14/opini ... sachs.html

Regards, Nate

[ems]

That this is now happening at Goldman Sachs doesn't surprise me in the least!

Nate, I'm quite sure you are a lot younger than I am. I observed this happening years ago where I worked. None of what is happening at GS is new to me.

Now, with DMEs, I believe it's another story. It seems to me that not filling a prescription correctly is illegal... not to mention unethical and plain wrong... and in many cases, getting away with it. I don't understand how this is happening.

[Drowsy Dancer]

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.

It shouldn't have had to be this hard for you!

Good job on sticking to your guns and getting the machine you actually need. And were initially prescribed. Let us know how you like the Model 60--I'm kind of lusting after that built-in heated tube myself.

[azpilgrims]

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.

Thanks, I will be checking the hours for sure

[azpilgrims]

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.

Thanks, I am not a person that likes to be screwed around with and sounds like you are the same way. I will find another DME, my Doctor told me most of them up here are this way unfortunately. I am hoping SleepyHead will work with the new machine, will definitely post the results. I hope I do get the clinical manual as well. My Wife was not too happy having to basically pay for two machines, but I told her I wanted a spare to keep around anyways and she was fine with that.

[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.

It shouldn't have had to be this hard for you!

Good job on sticking to your guns and getting the machine you actually need. And were initially prescribed. Let us know how you like the Model 60--I'm kind of lusting after that built-in heated tube myself.

It should have gone like this, we are sorry for the mistake on our end Sir, we will get the correct machine ordered and delivered to you right away. I will post a write up on the Model 60 after a few night of use, being a newbie to therapy I will do my best to describe the differences.

[Pugsy]

I need to find a source for the clinical manual online...so if anyone finds a download site...please share it with me so that I can put it with the others.

If OP gets one and has a scanner..we can scan it and have it for sending to someone or just put it on a host site. A bit of work though.
I have one source that has all the new clinical manuals. Perhaps when they start selling the 60 series they will have it available. I will watch.

[Janknitz]

The lesson here (besides buyer beware) is that if possible get the doctor to advocate for you because the DME only cares about referrals.

There is NO Medicare requirement that an auto be justified as medically necessary over and above the requirements for a regular cpap, nor do other insurers who pay by HCPC codes require that. An auto is the same E0601 code as a dumb brick CPAP.

If the DME didn't want to fill the doctor's order for an auto for the reimbursement rate paid by the insurer, they should have said so up front instead of playing bait and switch with a fake auto. If the insurer was Medicare and the DME refused to accept assignment, they should have issued an Advance Beneficiary Notice BEFORE delivery so the patient could choose to go elsewhere to a DME who wants his lifelong business. This DME was dishonest and money grubbing and deserves to lose all referrals from this doctor.

Even better if the doc checks I on all the other patients he referred for autos to serif they got what was ordered--wouldn't that be great? I see a consumer tv report on your local newscast!

[azpilgrims]

I need to find a source for the clinical manual online...so if anyone finds a download site...please share it with me so that I can put it with the others.

If OP gets one and has a scanner..we can scan it and have it for sending to someone or just put it on a host site. A bit of work though.
I have one source that has all the new clinical manuals. Perhaps when they start selling the 60 series they will have it available. I will watch.

I will be glad to scan it to a PDF if it comes with the manual.

[azpilgrims]

The lesson here (besides buyer beware) is that if possible get the doctor to advocate for you because the DME only cares about referrals.

There is NO Medicare requirement that an auto be justified as medically necessary over and above the requirements for a regular cpap, nor do other insurers who pay by HCPC codes require that. An auto is the same E0601 code as a dumb brick CPAP.

If the DME didn't want to fill the doctor's order for an auto for the reimbursement rate paid by the insurer, they should have said so up front instead of playing bait and switch with a fake auto. If the insurer was Medicare and the DME refused to accept assignment, they should have issued an Advance Beneficiary Notice BEFORE delivery so the patient could choose to go elsewhere to a DME who wants his lifelong business. This DME was dishonest and money grubbing and deserves to lose all referrals from this doctor.

Even better if the doc checks I on all the other patients he referred for autos to serif they got what was ordered--wouldn't that be great? I see a consumer tv report on your local newscast!

I hope my Doctor checks his past patients to make sure they have the correct machines, and yes I agree with everything you wrote above.

[DME Busines]

I just wanted to reply on lack of communication, doctor and DME. I did not read all the comments but got the idea. In defense of DME's, we spend much of our time and money, gathering the orders from the doctor's office, then correcting their orders, and then getting it approved by the patient's insurance. 3 places that an order can be mishandled. It happens all day long. If one number/letter is transcribed incorrectly we have to go back to the doctor to fix it. That takes FOREVER. If the doctor does not know the insurance laws (which they don't) we call the office and educate them. I don't know about all DMEs. In fact there are many crooked ones. But our DME works for the patient. (The go between from the doctor to insurance). Insurance makes so many cuts that this year we may not break even and we often lose money on equipment. There is never one side to a story. Always 2 and in the case of DMEs, doctors, insurance, and patients it gets very complicated. I am sorry that you had problems, however. And I do know of DMEs that are dishonest. They actually seem to be getting ahead right now to us. But behind some DMEs there is a hard working, honest owner who answers to patients, doctors, insurance and the government all of which can be a very motley crew.

[123.Shawn T.W.]

AZPilgrims,

I hope this was not Arête /STARS ... I'm still waiting for a phone call from them ... Been over a week since they ordered my PR S1 60 Auto ...

Name names ... The rest of us should know!

[azpilgrims]

The DME I had a problem with was: "AMES" - Arizona Medical Equipment & Supply LLC - they have a location down in Phoenix and one in Prescott.

[Janknitz]

. If the doctor does not know the insurance laws (which they don't) we call the office and educate them.

Unfortunately, too many DMEs translate that as "if the doctor doesn't know we make a smaller profit on an APAP machine, we call and educate them to leave the machine choice to us to choose what is best for our bottom line". Most insurers pay by HCPC code, there is no heightened criteria for APAP . If the doctor orders CPAP or APAP, then there should be no insurance "issue" to "educate" the doctor about as long as the basic diagnostic criteria for OSA is met.

I'm sure your company is a good patient advocate, DME Business, but every day we see examples of DMEs who are not, right here on these pages. This particular thread wasn't even a particularly egregious example, I'm sorry to say.