Dr.'s rant on DME... advice for my next step???

[pratzert]

Snoregirl,

For me it is a $300 deductable and THEN Cigna covers the remaining at only 60%.

And don't forget, the amount of covereage is whatever their "Allowable" U&C charge is based on.

The 100% coverage is ONLY if I used THEIR contracted DME supplier who is Apria.

As long as they cover the cost at the entire $725.... then my deductable at $300 leaves $425 times 60% = $255 they would reimburse me. SO I get stuck with the rest of it... $470.

But... I DID still order my Mirage Activa Mask from them... so that cost was paid at 100% by Cigna. And I will order any additional supplies, such as hoses, filters etc. from them.... but even THAT is painful.

I "could have" gone through all the headaches of using the CPAP first and then having the Doctor write another medical necessity letter saying I was intolerant of plain CPAP.

But I did not want to wait another two or three months to start my therapy.

Tim

[pratzert]

I also want to say that I think it really stinks that, at a time when most APNEA sufferers at at their lowest, is when all you have to start playing the "Game" with your Insurance companies and DME providers.

You are first learning about your condition and how serious and dangerous it is and have been suffering with it for a long time. You are tired as Hell and maybe even depressed. All of the sudden you learn that there "IS" hope for improving your Quality of Life with the use of a machine.

You get excited and look forward to starting your therapy and feeling better, not to mention all of the other improvements in your health that go along with therapy.

THEN.... you hit the DME/Insurance company BRICK WALL !!!!

Thank God I was able to afford to pay for my own machine, but many are not as lucky and must dance the dance. It just makes my blood pressure rise with a picture in my mind about a bunch of Insurance Executives sitting around a table and giggling about how they just denied some poor slob the medical treatment needed, and now they have saved enough for a down payment on that new BMW.

As Johnny Carson might say to the DMEs/Insurance Co.: " I wish for you to suffer the bites of a Thousand Fleas in your Armpits and hope you always have sand in your shorts ! "

[Guest]

I am a Respiratory Therapist that works for a local DME Company in Topeka,Kansas and it breaks my heart that you all are having so many problems with your DME companies. It should not be this difficult for you to obtain treatment. I always keep at least one or two types of every machine is stock so that no one has to wait even one day to begin treatment. I cannot believe that other companies are making you wait that long to obtain treatment. In some rare cases insurance companies require a precertification process. I feel for all of you and I wish I was in your area. I would take care of you today so that you could all begin to feel better.

[guest236]

Of course Apria wouldnt give you less oxygen if your doc ordered 5lpm...That is a little different than what type of cpap machine you can get. Also, Apria is going to give you what they are going to get paid for. Cigna will only pay for Remstar plus's, not Resmed S8's or auto-titrating machines. I am sorry, I understand your frustrations but Apria is a business. You cant go to a car dealership and pay for a Ford Escort but drive away in a Mercedes. Also keep in mind if you have Cigna it is their requirement, not necessarily Apria's.

[guest236]

As Johnny Carson might say to the DMEs/Insurance Co.: " I wish for you to suffer the bites of a Thousand Fleas in your Armpits and hope you always have sand in your shorts

WOW! Real mature...
Apria employees are people too! Just doing what they are told to do by thei bosses/insurance companies.

[Wulfman]

You cant go to a car dealership and pay for a Ford Escort but drive away in a Mercedes.

BUT, the DMEs can bill the insurance providers for a "Mercedes" and you get to drive away in a "Ford Escort".

Den

[Offerocker]

WULFMAN: EXCELLENT RESPONSE!!!!!

...AND IT MAKES PERFECT SENSE, AT LEAST TO ME...

[RedThunder94]

no kidding.

[rkedge]

I have just read some of the horror stories of how long it took some of the DME'S to deliver or respond to a problem.I work for a DME company in New Braunfels, TX. and as soon as we get an order from the doctor we deliver same day delivery. I'm appauled at the response time of some of these DME'S. I guess we are doing something right!!

[Offerocker]

[quote="rkedge"] I guess we are doing something right!!

Yes, you are, and please keep it up! Oh, and Thank you!,,,"wish you were HERE"

[Darth Vader Look]

Wulfman, you are so right it makes you but then you want to Always 2 sides to the DME coin.

[Guest]

As Guest points out above, DME's are a business for profit....perhaps that is why so many of them are willing to sacrifice our health for their bottom line. Yes, there ARE some decent DMEs, and the bad ones are't entirely to blame for pricing, at least. A system that has only one reimbursement code for all CPAP machines guarantees that DMEs will make more money on cheaper machines than on more expensive ones, thus making it in their interest to push the cheaper machines. What DME's ARE to be held accountable for are their own policies, the ones not dictated by insurance companies: mis-information, lack of promptness, refusal to inform patients of settings that can be made at home, deliberate setting of options that will require the patient to return to the DME to change something as simple as ramp time or c-flex on/off, etc.

[Bookbear]

That post immediately above was me.... sorry, didn't realize I wasn't logged in.

[birdiebaby]

Followup -- It took one month to get the machine, and they had to UPS the mask to me. They said the delay was due to having to get corporate approval for the special order.

I was not fitted with the mask. I was not told about cleaning procedures or filter replacement schedules. I felt very sad for people who aren't hooked into to other Pt.'s by these forums. How would they know?

I asked about why I didn't have a humidifier, and they said, "One wasn't ordered." Dr. says -- we ALWAYS Rx for a humidifier. So now the fight for the last two weeks has been to get the humidifier. Unreal. I've called the dr's twice and the DME twice. I am so frustrated and still having problems with my asthma. I really want to cry.

I liken this situation to walking into a pharmacy with a prescription for a brand name drug & being told... well we don't stock anything from that manufaturer, but we can order it. It has to go through corporate approval so it might take a few weeks' time.

Granted, my apnea is only moderate, but I think it's criminal to make patients wait because of corporate ordering policies.

[guest236]

I wanted to apologize for my posts yesterday. I was having a horrible day and for some reason I was curious about this website. I took it personally the badmouthing the DME companies even though I shouldnt. Lord knows I don't make the rules at my job. I am just a data entry person at a centralized DME call center so my opinions dont count too often. I really am not evil though. I am sorry you guys have had such bad experiences, it makes me really sad. i wish I could help all of you. I actually am starting to hate my job and I am always depessed lately. It has nothing to do with what I do, it has to do with my upper management. I will try though to take even better care of those of you I have entered orders for. Sometimes its hard to remember the golden rule but I do try. I just wanted to apologize for yesterday and to let you know I am not evil and I care about you. That's why I came back here.