Finding a good DME?

[Stormynights]

See if your insurance provider will reimburse you for out-of-pocket purchases (like if you buy from an online seller like CPAP(dot)COM).
That's what I did (eight years ago) and my insurance provider reimbursed me at their standard "in-network" rate of 80%. I purchased all of my initial equipment setup out-of-pocket (credit card) and then made out an invoice (duplicating CPAP(dot)COM's invoice) and sent it to my insurance provider......and they sent me a check for it. It saved both of us some money.......and, most people are looking to save money these days.


Den

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How long did it take to get the reimbursement?

[sawinglogz]

Wulfman, thanks for the idea, but they definitely won't. They require the DME to wirelessly monitor compliance for the first 90-day rental, after which they purchase the machine, so there are only a few DMEs they'll work with.

I reckon you may have to play naive and not let them know you are aware. If it were me, I would just let them rattle on.

But then, when I say, "Great, I'd like the ResMed S9 AutoSet with heated humidifier & heated hose," aren't they going to feel like I've led them on?

[Wulfman...]

See if your insurance provider will reimburse you for out-of-pocket purchases (like if you buy from an online seller like CPAP(dot)COM).
That's what I did (eight years ago) and my insurance provider reimbursed me at their standard "in-network" rate of 80%. I purchased all of my initial equipment setup out-of-pocket (credit card) and then made out an invoice (duplicating CPAP(dot)COM's invoice) and sent it to my insurance provider......and they sent me a check for it. It saved both of us some money.......and, most people are looking to save money these days.


Den

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How long did it take to get the reimbursement?

Not long. I dunno.....30 - 45 days or so......whatever their bill payment cycle was.
I was prepared to go out-of-pocket all the way (rather then deal with a local brick & mortar DME) if they had balked on reimbursing me. But, I talked to them beforehand and made sure they would be agreeable to it before I went through the paperwork and billing them. Worked for me. I was also in a PPO.


Den

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[Wulfman...]

Wulfman, thanks for the idea, but they definitely won't. They require the DME to wirelessly monitor compliance for the first 90-day rental, after which they purchase the machine, so there are only a few DMEs they'll work with.

I reckon you may have to play naive and not let them know you are aware. If it were me, I would just let them rattle on.

But then, when I say, "Great, I'd like the ResMed S9 AutoSet with heated humidifier & heated hose," aren't they going to feel like I've led them on?

I guess they figured (based on parts of a conversation I had with them) that since I put my money upfront, that I was going to be "compliant" with my therapy and therefore I didn't have to fulfill any of those requirements.

If you already haven't, be sure to get your prescription (the physical document). It can definitely come in handy in the future.

Den

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[Suddenly Worn Out]

Ive heard a ton of bad stuff about Apria, but my local Apria is not bad actually. They are nothing great but they are not bad either. If you are in Charlotte, NC area, a really good DME is called Hometown Oxygen. At least they USED to be good. I have not used them since 2008. They were the ones who got me started and they were excellent.

I prefer to buy my machines myself off the Internet and then get my masks and hoses and filters from my DME now.

Ive had one good offline DME, my first. Apria that Im using now is decent. I used two in between that should not have been in business. This outfit that supports this forum I have bought three machines from and some masks and hoses. They are good. Ive found when I pay direct myself, I get better quality service and get what I want or need without the hassles.

For just straight CPAP, its a lot easier to use regular DMEs. For those of us who use APAPs or BIPAPs it gets more complicated to use DMEs and again, I prefer to pay direct out of pocket.

Eric

[sawinglogz]

One thing I might add, is that when you do get a company on the phone, ask to speak to the person who handles the CPAPs. When they answer, say something like the following: "My doctor has ordered a CPAP, can you tell me just briefly what that is and why it's so important for me to get one?"

The answer to that question is going to reveal how much they know and how far they will go to help someone. If you asked me that question, for purpose of comparison, my answer will go between 5 and 15 minutes.

Thank you SO MUCH for that advice!

I called the local Apria, who answered immediately and seemed fine, though brief. She volunteered that they'll swap out the mask within the first 30 days if I don't like it. (I asked if that was a one-time thing, and I didn't get a clear answer.) She got a few details of my insurer's coverage wrong. She said it might take a 3-4 days to set up an appointment, and I have to go there to meet with the RT. Total call time: 6 minutes.

Then I called the company my doctor recommended. At first there was no answer at their customer service department, which worried me. But I called back half an hour later.

WOW, what a difference. The woman apologized that, being a customer service rep, she couldn't necessarily answer everything (exactly what physiological "levels" CPAP would improve), but she spent nearly 20 minutes walking me through what to expect, answering questions, and even raised the issue of vent air blowing on my wife (and that I should mention that I side-sleep to the RT so we can take that into consideration during mask fitting). Not bad for a non-RT!

She knew which machines they carry, volunteered that "they're both auto" before I could even ask, she knew the details of my insurance coverage (rental period, deductible, etc.), knew the hospital's preference (ResMed), etc. She also didn't mind at all when I asked to put her on hold to answer another call! (I'd have ignored it, but it was the hospital confirming my upcoming sleep study. I apologized.) I asked whether it was the S9 AutoSet or the Escape Auto, and she wasn't sure, she thought the Escape Auto was the S8 perhaps. (I know it's not, but she didn't seem to know.)

She didn't have any appointments this week, so it might be 1-2 weeks. They'll come out for the initial appointment, or I can go there. She said they'd have a greater selection of masks at their office, assuming I didn't just want to go with whatever we used in the titration study.

She said it usually takes a couple of weeks to get used to sleeping with something on your face, but if the mask really isn't working after a couple of weeks, they'll try to find something that will fit better.

So that seems pretty definitive. As Janknitz put it, the amount of time and effort their customer service rep just put in for someone who doesn't even have the script yet gives me a great "feel for how they roll". Hooray!

(As another happy postscript, the hospital RT just called and said that they always request machines that do both auto and CPAP, and they always request heated humidifier and tubing, given our climate.)

[Janknitz]

Sounds great. The one caution is to MAKE SURE it's the ResMed Autoset, NOT the Escape. Other than that, it sounds like you've got a good DME there.

[SleepWellCPAP]

Hello Sawinglogz,

Wonderful! So glad to hear you made some progress and are comfortable with your company. Many many great replies to your question on this thread!

Please keep posting as to how well you are doing, this blog really is a fantastic source of information. Certainly look forward to see how things are going.

Jim

[sawinglogz]

Sounds great. The one caution is to MAKE SURE it's the ResMed Autoset, NOT the Escape. Other than that, it sounds like you've got a good DME there.

I did wonder about that, but I checked my insurance provider's requirements for therapy providers, and they require devices that provide "reporting capability of compliance, usage, leakage." I double-checked ResMed's site, and the Escape doesn't provide leakage, so it must be AutoSet.

[Janknitz]

I did wonder about that, but I checked my insurance provider's requirements for therapy providers, and they require devices that provide "reporting capability of compliance, usage, leakage." I double-checked ResMed's site, and the Escape doesn't provide leakage, so it must be AutoSet.

It sounds like you have a good DME who won't do this, but SOME DME's would STILL give patients an Escape!

Just be sure to double check before accepting the machine.

[sawinglogz]

An amazing postscript to this story:

Yesterday they managed to schedule me for an in-home appointment the day before I travel (which was already a victory in itself).

Today they said due to emergency they couldn't make that appointment, but they remembered I was traveling, so they offered to send somebody out a day earlier (even better)!

How's THAT for service?!

[edited to clarify that this is a good thing]

[jdm2857]

ResMed machines have a time travel setting, but you have a PR, so that offer won't work for you.