Can you believe what the DME told me? A little humor..

[SmilingSharon]

Hello all~
I just want to share my experience with the DME I used in town. They are a DME chain. Please tell your friends to do these first 4 things before they go into any DME. Then enjoy a few of my conversations below.

Before stepping the first foot into the DME store in December 2012:
1. I researched CPAP machines and chose everything I wanted. I printed off the ResMed comparison chart, masks and all.
2. I called my insurance company to ask what my coverages were for CPAP machines, masks and all.
3. I asked my insurance company if I could purchase the machine or if I had to rent it (I could purchase it. I did not have to rent. Since I had met my deductible, I wanted to purchase.)
4. I called my insurance company 3 separate times to get 3 different representatives to make sure I was told the same information about my coverage. I was. * I was prepared... or so I thought. *

Here is a reduced summary of what happened with my DME:

Subject: INSURANCE
ME: "I would like to purchase my machine, not rent it."
THEM: "No, your insurance company requires you to rent it."
ME: "No, I already checked. My insurance company will allow me to purchase."
THEM: "We'll have to call your insurance company to check into it."
ME: "Please do."
THEM: "Oh, yes, you are right. You can purchase it."

THEM: "We have the paperwork from your insurance company and you have a 10% copay, so that will be $39.22"
ME: "First of all, I do not have a 10% copay. After some major family surgery this year, we've reached the out of pocket limit. The company is paying 100%.
Secondly, how do you know what the 10% would be? I haven't even told you the machine I want. And I know there is a price difference in machines.
THEM: "We're looking at the paperwork and you owe this amount."
ME: "Call the insurance company again. I am positive I don't owe anything. And, I want to see that paperwork."
THEM: "Okay, we have it straightened out. You don't owe any deductible.

(upon receiving the insurance paperwork that said I owed 10%)
ME: "Ms. DME, look at this insurance form. Please read what it says here, here, and here."
THEM: "The insured has reached 100% out of pocket maximum. Insureds responsibility is 0.
ME: "Huh.. you all see these forms for a living. This is my first time reading such a form. Can you explain to me what this means? I must be missing something."
THEM: "Well, we messed up."
ME: "I still don't understand about the $39.22. How did you come to that number?"
THEM: "That's the 10% we charge everyone no matter what machine they get."
ME: (to shocked for words)

Subject: MACHINE
ME "I would like a Resmed S9 AutoSet."
THEM: "Our company requires your doctor to write a prescription for a ResMed machine. Make sure the doctor specifies the exact model. We carry some other brands that you can get without the doctor's written prescription."
ME: "Really? Why do I need the doctor to write a new script with this model on it? I am the consumer and my insurance company said that I can have any machine I want."
THEM: "Our company requires it. I don't know why."
Under the table talk, the DME person said... "I think it's because the ResMed's are so expensive and our company doesn't make as much on them."
ME: "Wow.. honesty." (Called doctor. New prescription was faxed in that day.)
THEM: "Here's your new machine"

(The next morning, after the first night of sleep, I looked closely at the machine.)
ME: "Great day in the morning! They sold me the Resmed Escape Auto, not the AutoSet!" I took the machine back in.
THEM: "We did sell you the right machine. See, it's the Escape AUTO."
ME: (Sigh) "Okay, let me show you the ResMed chart and explain the differences in CPAP machines."
THEM: "Oh, we're sorry. We'll have to order that one."
ME: "Okay."
Solution: I now have the correct machine and love it.

Subject: MASKS
ME: "I know I will want to try a variation of masks relatively quickly since it is December and I have met my deductible. I already spoke with my insurance company and they said I don't have to wait 30 days or any amount of time to try multiple masks. I am covered.
THEM: "Oh no. We want you to try it for a few weeks before making a decision."
ME: (dear in the headlight..stunned..) "What?"
THEM: "We think you need to work with the mask before switching it out."
ME: "My goodness. Help me understand. I'm the consumer. I want to purchase a product. I am covered. How can you possibly deny me masks if I want them?"
THEM: "blah, blah, blah, blah."
ME: (thinking to myself) "I'm just going to have to talk with a manager."

MANAGER: "How can I help you?"
ME: (Sigh) "Where do I begin?"
I calmly told her everything that happened above and posed many questions. Her staff led her to believe that the insurance form was something I brought in to prove I didn't owe anything. I corrected that thought. She was not happy to learn that her staff misled her and missed the boat on so many issues.
It's important to keep your cool. When you blow up, even rightly so, you are the one that ends up looking like the fool.

CONCLUSION
The manager was extremely apologetic. At one point I was ready to just go to another DME, but because she was so helpful and sincere, I stayed with this company. Why not? I think I have them trained! Now they can more properly read insurance forms and are educated on CPAP equipment. (smile)
I ended up receiving the proper equipment, to include three masks.

MORAL
We all must take responsibility for our own health. If we can't understand some of the issues, find a trustworthy friend to help. Always walk into a situation with as much knowledge as possible. Be polite and respectful of those in their profession, but don't be afraid to stand up for the truth.

Even though I currently have a good relationship with this DME and I have all the correct equipment, I sincerely hope your experiences were better than mine.

[Pugsy]

Well done.

I tried being nice with my first DME...well actually was just trying to get them to dispense a Respironics machine (never got into which model) and they just flat out refused. It was take their crappy base model F & P machine which only collected hours of use and not full data (they lied and said it collected full data but I knew my models) or leave it. I guess I surprised them when I said I was leaving. They said "we will have to tell your doctor you are refusing the equipment" and I told them "Oh, I am not refusing anything except to do business with you"...so they got fired. BTW this was a local branch in small rural town of the big company Lincare or as I call them "lin i don't care".
So they thought I was a bitch I guess though I tried to be polite but I am sure they understood "the look" they got for what it meant.

So I switched DMEs and while doing that I stumbled onto a brand new machine on craigslist local that was just exactly what I wanted and the price was just a little below what my copay would have been if I used insurance. So I bought it and went to DME #2 about 12 miles away and walked in and said I have my own machine but I want you all to do the mask and supplies business.
He asked what machine I had...At the time it was the top of the line Respironics APAP...he said "that's a great machine and we will do whatever we can to help you make this therapy a success." Their mask allowance was fairly liberal for a DME. I had 60 days to find a keeper mask and I could try as many as I needed within the 60 days. I already had a good idea what I wanted..the Swift LT (the FX wasn't available back then) and it worked perfectly.

He knows I do the software thing. He said "where did you get it" I laughed and said the internet of course and he said "I suppose you know how to change all the settings so you won't need me for that"...I laughed and said yes, they were already changed.
Then last year when I got my bilevel machine (craigslist again) I went in for a mask and told him what I got and he said "how did you get that machine , you know that needs a special RX" and before I could answer he just laughed and said "the internet again".
He's cool with me doing what I do. When I was still having some morning headaches and wondering if it were apnea events headaches or my arthritic neck acting up he let me do an overnight pulse ox test to see if I was having any desats and didn't even charge me for it. I need to go see him tomorrow and see if he knows about the new Respironics Wisp....I am going to try to get him to give me a demo mask from the rep...he does that for free if I give a review. I might get lucky and he may have one.

So there are some good DMEs out there. Rather scarce though and some we have to train.
Sounds like you have yours well trained now. Good job.

[kaiasgram]

Love your story, Sharon!

Can I throw one in? My cousin just started on cpap a few weeks ago. These are some of the things her DME rep has told her:

* The only way the pressure can be changed is "via the SD card" and the DME will have to handle it (she has an S9 Elite).
* There are no cpap machines that have a heated hose.
* (When confronted with the correct info about heated hose) The hose doesn't do anything more than the humidifier already does by itself.
* (Upon learning that she changed the pressure herself) She has "corrupted" the SD card by changing her pressure and now all her time on the machine is "lost."
* He meant to "lock" the SD card when he first gave her the machine.
* If the Opus nasal pillow mask didn't work well for her, there is no other nasal pillow mask that will work.
AND
* Her nostrils are too small and the air pressure will cause nasal pillows to fly out of her nose. (Note: Her pressure is a whopping 7.)

This could turn into quite an entertaining thread.

Edit: Pugsy, same outfit as your DME #1.

[Pugsy]

Edit: Pugsy, same outfit as your DME #1.

The Lin i don't care people? Idiots. While I was there telling them I didn't want the brick and wanted Respironics and she had to call her manage to see if they would order one I asked about buying the Swift LT mask..they had them.
"Oh no, you can't buy one until you have a "fitting"...well can I get a fitting now? "Ummmm no, you have to make an appointment for a fitting.'" Oh really...I was the only patient in the office and 3 people were pushing papers. Finally they got through to the manager who flat out refused to order any Respironics machine because they had heard they weren't good reliable machines.
Bull crap. It cost more than their plain jane base F & P machine that didn't even have exhale relief...cheap, cheap.
So I said I would just buy all my masks and supplies elsewhere. Sad thing about it....they really didn't care. They were rather snotty towards me and talked down to me and anyone who knows me knows that is not the way to treat me.
I don't like being treated like I don't have a brain in my head. Makes me real mad real fast.

[kaiasgram]

The Lin i don't care people?

Mm hm. The LC guy I'm hearing about doesn't sound snotty (yet), he just sounds like someone who was hired off the street -- he knows nothing about what he's doing or saying. What's funny to me is that after telling her that she had corrupted her SD card, he nevertheless told her to save it.

[RogerSC]

Just had to deal with my DME today. They've been flubbing my transition from employer provided insurance to Medicare plus Supplement plan for 3 months now. I've done everything that they've asked and they have the paperwork and all my information, and they're still asking me to do those things. The one good thing that came out of the call is that they realized that they were behind on making money on me, so they promised to send me new tubing, mask, etc. So I'll at least have a spare of pretty much everything for a change. I tend to order things as I need them, but don't mind having one spare of things that I can use immediately if something wears out or breaks.

I don't know how they can keep their business going with their level of incompetence. I guess that they have little enough competition in this area that they can get by.

[MrStein]

[quote="kaiasgram"
This could turn into quite an entertaining thread.
[/quote]

I agree...great post! My story:viewtopic.php?f=1&t=83759&st=0&sk=t&sd=a

[jujubee]

I live in the same area as Puggsy and so was able to use the same DME she does. They are great! Even though the tech does not have apnea, he uses cpap on occasion to experience new masks and to be able to relate to our issues. He even "loaned" me a F&P Pilairo to try out. What a relief to get a good DME when you're just starting out. Not to mention the wonderful help from Puggsy and all you other caring folks on this forum. I can't begin to say how much I have appreciated and benefited from reading here. Thank you all so much!!

[Sheriff Buford]

Yes... this is a great thread! It needs to be put in the Newby section... under the announcements.

Pugs... I bet you are a pistol... my kinda gal...

SmilingSharon: you go gal...

Sheriff

[2flamingos]

I have heard a lot of horror stories about DME's, but that was about the worst.

I am fortunate in that I have dealy with only three DME's and One has been exceptional so far, and the other two were OK. I just changed to my current DME after discussion with my new sleep doc. He didn't push, but had heard from other patients about similar issues with my two previous providers, and suggested I give these folks a try. When they got my rx, the only question was "what machine do you want?" ummm, my jaw dropped to the floor! After I recovered, I told the RT the machines I was considering and we discussed pros and cons of each. When I told her I wanted the S9 Autoset, she said that it was what she WOULD have recommended. When it came in (Yes, they had to order it because they have just recently started the PAP services - she is a registered ?RPT? (I think right acronym - Any how, she use to work in a sleep lab), she delivered it, spent over an hour going over it with me, brought different 3 masks for me to try, AND was really interested in my ZEO and the amount of data it provides. I NEVER received anything like this from my other DME's.

She has called three times just to check on me (well, once was because a tornado did significant damage very near my house on Christmas day, and she wanted to make sure I was ok).

With service and caring filks like this - I think I will continue to do business with them.

[chunkyfrog]

Every time LinCare hires a new oxygen guy; my brother has to help train him.
My brother is a welder.

[Pachyderm's Nose]

Speaking of oxygen, on my way to pap my cardiologist had me do an overnight oxymeter which showed levels far lower than he wanted to see so he had Lincare supply an oxygen concentrator which they finally delivered a full week later! Seems they only deliver to my town one day a week, of course there are two other DMEs in town who could have delivered the same day. Well when I got apap and did an overnight oxymetry with pap soxygen levels were good so I called Lincare to get the concentrator out of my house they told me they couldn't remove it without a doctors orders. So after some more phone tag with doctor and Lincare they finally scheduled a time to pick it up, as you can guess it wasn't until the next week as they only deliver once a week. Thankfully I got my S9 and my pap supplies from one of the in-town DMEs so I can just drop by and pick up what I need. This one only has a 3 day mask return policy though. Luckily I started with a Swift FX which worked ok and when I asked about the Respironics Optilife she said they didn't carry it but she would order it. Now they carry it and the cushions so good for now.

[Sheriff Buford]

Every time LinCare hires a new oxygen guy; my brother has to help train him.
My brother is a welder.

I said that to a newbie one time. I said, "Oh great, I gotta train a new one," I ended up workin' for him...

Sheriff

[Janknitz]

SS, you did everything EXACTLY right. What a great, succint summary of how to do this this right way!

Unfortunately, so many people come to CPAPtalk AFTER they've been to the DME and they had no idea what they were in for.

[Journeyman]

You go girl. Awesome, thats how to look after yourself. Everyone should read this and take that kind of confidence with them before their first visit.