Do I need to break my machine? **UPDATE **

[brucifer]

*** UPDATE ***

I spoke with BCBS today & explained my situation. They said I am absolutely entitled to a new machine....no argument, no fuss. Funny how the DME claimed that they "spoke to my insurance company" and they didn't approve a new machine. Really?!?!?

BCBS also said that all machines and supplies are directly billed to BCBS if the provider is in network so I should NOT pay for anything out of pocket.

It's amazing how someone can be a healthcare provider (ie DME), lie and / or take advantage of patients and still sleep at night.

Thank you everyone for all the great advice.....I was getting close to throwing in the towel.

Nice to hear you had a positive outcome. As others have mentioned, your current DME supplier doesn't deserve your business. If it is possible to go with a different DME supplier in your area who is also in network, it may be worth your trouble to forge a new relationship. I can't stand liars, so it would be tough for me to continue doing business with someone such as your current DME supplier rep. Anyway, it's your call. Hope you have smooth sailing from here!

[Janknitz]

It goes to show that you can NEVER take your DME's word for what your insurance will or will not cover. ALWAYS check for yourself.

Some DME's lie outright, other's simply can't keep everyone's various insurance plans straight because there are so many. And, back in my health professional career days, I found that there were a lot of myths--"insurance legends" that became facts in people's minds because they never checked out the facts. It may be in your DME's case that a new machine wasn't covered for one of their clients who may have had a different insurance than you do, and they had to eat the profit. So now they are wary of all.

But lying to you about checking with your insurer is egregious, in my book. Not acceptable. Who wants to do business with a liar???

I wholeheartedly agree with finding a new DME and letting that DME know why they lost your business--in writing--be sure you CC it to the parent company if it's a chain, AND your doctor, so that she will think twice about giving them any more referrals

[akcpapguy]

I can’t count how many times I have witnessed this same scenario play out.

I am not here to take sides only to make you aware. Your DME “MAY” have called your insurance and was told exactly what they told you about the replacement of your CPAP. I have been told those exact words by insurance reps countless times only to have the customer come in the next day with the complete opposite answer from thier insurance. Ofcourse it’s also completely possible that they DID NOT call your insurance and only went on an assumption based off a previous answer from a different client with the same insurance. We used to telephonically verify auth for CPAP/BiPAP replacement, now we only do paper verification (pre-auth). This eliminates all of the guess work and finger pointing about who lied to whom, or didn’t do their job. Not only that but I WANT you to qualify for a new CPAP if you come into my office, I will sell you a new CPAP every year if you want one and your insurance will pay for it. When I first started working for this company I had to reinforce that to all the customer service staff, for some reason there was a lot of resistance to the idea that a customer getting a new CPAP was a benefit to both the customer and our business.
Anyway good luck with your new CPAP!! Keep us updated on how all the billing turns out.

[chunkyfrog]

I wish I could find a DME as conscientious as you.
Can I take you home?

[akcpapguy]

Haha thanks CF, however the airfare from up here is expensive for one let alone two AND i'm a tad to large for a carry-on.

[ems]

I'm now into my second year. I started CPAP in July, 2011. I'm on Medicare with UHC as my supplement.

I didn't have many complaints with my DME the first year. They certainly weren't wonderful by any means, but they did come through when my doctor pushed them a bit. I recently found out that my doctor has some type of affiliation with them... still don't know in what capacity. Also, it helped that my DME was a five minute car drive and that if I didn't hear from them in a reasonable amount of time, I'd show up there.

I like the sleep specialist I use... she has no problems with me asking questions and giving me answers. She appears to be as concerned about my health as I am. I also like her receptionist very much... always calls me back in a reasonable time frame.

What I am finding interesting is now that the DME no longer gets paid for my machine, I get routed to a different place when I call. I no longer get calls to see if I need something - which is strange, because they certainly would profit if I bought something from them. Thinking seriously about finding a new DME. Fortunately, there are two not far from me. Very stupid on their part.

I just find their way of doing business so wrong. DMEs should absolutely know which insurance companies pay what. And, when an insurance company suspects them of lying, or being plain wrong over and over, they should be taken off the list of DMEs they use. These type of problems are constant and all across the US. There has to be a way of putting an end to this.

[Still tired]

Why can't we have a rating system for DME's ? Use stars or something to indicate our pleasure / displeasure for them, heck even smilies would work. Just a sticky thread would do it. My DME is fantastic. I've told everybody i know about how well I'm treated. I couldn't ask for a better supplier or Insurance Co. I have HAP health ins. use Henry Ford Hospitals and their Doctors and go through Henry Ford Health Products as my DME. Five Smilies !

[brucifer]

I can’t count how many times I have witnessed this same scenario play out.

I am not here to take sides only to make you aware. Your DME “MAY” have called your insurance and was told exactly what they told you about the replacement of your CPAP. I have been told those exact words by insurance reps countless times only to have the customer come in the next day with the complete opposite answer from thier insurance. Ofcourse it’s also completely possible that they DID NOT call your insurance and only went on an assumption based off a previous answer from a different client with the same insurance. We used to telephonically verify auth for CPAP/BiPAP replacement, now we only do paper verification (pre-auth). This eliminates all of the guess work and finger pointing about who lied to whom, or didn’t do their job. Not only that but I WANT you to qualify for a new CPAP if you come into my office, I will sell you a new CPAP every year if you want one and your insurance will pay for it. When I first started working for this company I had to reinforce that to all the customer service staff, for some reason there was a lot of resistance to the idea that a customer getting a new CPAP was a benefit to both the customer and our business.
Anyway good luck with your new CPAP!! Keep us updated on how all the billing turns out.

You bring up a good point because the insurance-company reps sometimes get it wrong and convey conflicting information. For example, when I was first inquiring about which CPAP machine to purchase, I called my insurance company (CIGNA) and asked about getting the S9 Autoset. The CIGNA customer-service rep told me that I could get the machine if I were willing to pay an additional upcharge. That answer was pure nonsense. I later called CIGNA back, and a different customer-service rep told me that I could get any CPAP machine that my doctor ordered, and that there would be no upcharge at all. The last rep was correct, and the first rep had it wrong.

Also, my sleep doctor was less than truthful when she told me that my insurance company required that I demonstrate compliance. I called CIGNA to confirm this, and they told me that they do NOT require compliance verification. Consequently, I have fired my sleep doctor and now work through my PCP. Sometimes it is difficult to determine who is being honest and who is lying. It's really too bad that so many people today consider integrity and honesty an option when doing business. It sure makes it tough for the consumer.

[chunkyfrog]

Don't forget; ignorance is another option.
I used to work in retail, where I was specifically told not to be too knowledgeable and helpful to customers;
as it reduced "productivity" (translation: their bottom line)
It is common in retail to limit training to concentrate 100% on making the sale and handing out credit app's.
Creating loyalty is not even considered by far too many managers.
PS: I left retail over 23 years ago.