How do you deal with the DMEs?

johnthomasmacdonald · Post by **johnthomasmacdonald** » Wed Sep 04, 2013 4:37 pm

I've been having problems with mine in that they don't want me touching the settings even though i've got my ahi down to around .2 per night with around 7.5 hours of sleep, while with their settings, i have an ahi around 8.

They keep sending me sd-cards in the mail that supposedly will make the changes on my machine ( to agree with what I've told them I need) but the machine doesn't seem to want to read their card ( i've thought it is probably because the "starting" pressures on the machine are no longer what they thought that they are.

I'd change back to the original settings and have tried but i can't get their new card to work.

My sleep doctor doesn't seem to mind my changing the settings but she also doesn't want to get involved with the DME and of course the only one in the loop anyone really cares about annoying, the insurance company.

So, what is the best way to navigate these waters?

I want to cause the least annoyance as possible and generate no drama but i also need to be able to adjust the pressures as need be.

oak · Post by **oak** » Wed Sep 04, 2013 4:46 pm

the DME can't change settings without your doctors okay, so if you want to fix all this, I would think the best thing to do would be to request that your doctor send a prescription to the DME saying "settings per patient management" or something like that. sounds like you are on a compliance monitoring setup? the DME could check with you (novel thought) on what your current setting are before sending the card back to you, or am I missing something? I probably am missing something since I am a relative newbie..

LSAT · Post by **LSAT** » Wed Sep 04, 2013 4:50 pm

johnthomasmacdonald wrote:I've been having problems with mine in that they don't want me touching the settings even though i've got my ahi down to around .2 per night with around 7.5 hours of sleep, while with their settings, i have an ahi around 8.

They keep sending me sd-cards in the mail that supposedly will make the changes on my machine ( to agree with what I've told them I need) but the machine doesn't seem to want to read their card ( i've thought it is probably because the "starting" pressures on the machine are no longer what they thought that they are.

I'd change back to the original settings and have tried but i can't get their new card to work.

My sleep doctor doesn't seem to mind my changing the settings but she also doesn't want to get involved with the DME and of course the only one in the loop anyone really cares about annoying, the insurance company.

So, what is the best way to navigate these waters?

I want to cause the least annoyance as possible and generate no drama but i also need to be able to adjust the pressures as need be.

Why are you sending your SD card to the DME? If you and your doctor agree that you can manage your own therapy, the DME does not need to be involved. If you are not comfortable with your DME...go somewhere else.

DeadlySleep · Post by **DeadlySleep** » Wed Sep 04, 2013 4:55 pm

They keep sending me sd-cards in the mail

WTH???

STL Mark · Post by **STL Mark** » Wed Sep 04, 2013 5:02 pm

I tell them what they want to hear. Only if the changes are questioned by the DME would I state "The Doctor made some changes to my settings since the last time I saw you" I can get you a script for the current settings if you would like? Assuming your doctor is comfortable with what you are doing they will give you the paperwork when needed.

Stormynights · Post by **Stormynights** » Wed Sep 04, 2013 5:12 pm

Have you opened up the card in Rescan and clicked on settings to see what is on the card? Maybe I am not understanding.

chunkyfrog · Post by **chunkyfrog** » Wed Sep 04, 2013 5:25 pm

Maybe you can format the card--just kidding!

johnthomasmacdonald · Post by **johnthomasmacdonald** » Wed Sep 04, 2013 5:29 pm

Stormynights wrote:Have you opened up the card in Rescan and clicked on settings to see what is on the card? Maybe I am not understanding.

actually i'm guessing why they have sent me a new sd-card - I certainly didn't ask for it - they sent it with a card that has a slot for the current sd card and a paid envelop to return it to them - i initially assumed that it was about compliance but when talking to them they talk about "changing the pressure settings" with the sd-card. And no, i haven't read the 2 sd cards they sent. The only software i have for reading the sd-cards is Sleepyhead for Macs.

oak · Post by **oak** » Wed Sep 04, 2013 5:53 pm

i think your DME is confused. why would they send postage paid return envelopes if they aren't thinking they are to be checking compliance? i think party A is not talking to party B at your DME. I would just call them up and let them know that your doctor agreed that you may do your own setting adjustments and ask them to stop sending the cards.

Janknitz · Post by **Janknitz** » Thu Sep 05, 2013 12:01 am

Assuming your compliance was met and documented to the insurer (was it?), the insurer doesn't care if you touch your settings. They don't even care if the machine works for you or not. They just want to know you met the compliance requirements.

So tell the DME that you don't need them to send you anymore cards and to bug off. They are probably charging you through the nose (wow, I didn't even mean that as a pun, but there you go!) each time.

JamesAllen828 · Post by **JamesAllen828** » Thu Sep 05, 2013 12:14 am

In my experience they are either checking you for compliance or are trying to cover themselves because you are changing your pressure settings. We would have to notify the MD and insurance companies if we had someone changing the settings. We would have to get several downloads showing that we set the machine to the prescribed pressure and that the pressure was changed without our knowledge and without a prescription. It's a way to cover themselves from liability. I had a lady on a pressure of 20. Her husbands pressure was 9. His machine broke so he just used hers claiming it was his. The higher pressure damaged his lungs and he tried to sue our company because the pressure was on 20 not 9.

RogerSC · Post by **RogerSC** » Thu Sep 05, 2013 1:44 am

It doesn't sound like your DME knows what they are doing...can you just get your own card, format it and it won't have anything on it that sets the pressure. And go forward from there, set the pressures as you need them to get your .2 AHI and just cut the DME out of the loop for setting your machine pressures? Is there some reason that the DME has to set pressures instead of just getting you equipment and supplies Iike normal?

This has me really curious. My DME just set the initial pressure according to my doctor's prescription, and I took over after that. I'm the only one that's changed the pressures on my machine since I first got it...

kaiasgram · Post by **kaiasgram** » Thu Sep 05, 2013 2:19 am

John, could it be an incompatibility between the software they're using to program the SD card and the firmware version of your machine? I encountered this issue last year -- called ResMed's tech support people and they explained it to me.

The control of your machine's pressure settings via the SD card is likely a separate matter, I know of other cases where it's set up that way with ResMed machines. Very annoying. But once you're out of compliance monitoring you will no longer have to deal with that. You can do what Roger said, get a new card, let your machine format it, and take over the machine settings yourself.

RogerSC · Post by **RogerSC** » Thu Sep 05, 2013 2:31 am

kaiasgram wrote:John, could it be an incompatibility between the software they're using to program the SD card and the firmware version of your machine? I encountered this issue last year -- called ResMed's tech support people and they explained it to me.

The control of your machine's pressure settings via the SD card is likely a separate matter, I know of other cases where it's set up that way with ResMed machines. Very annoying. But once you're out of compliance monitoring you will no longer have to deal with that. You can do what Roger said, get a new card, let your machine format it, and take over the machine settings yourself.

You know, for me the initial compliance thing was done by my doctor, it's just whether I'm using it the required number of days over 4 hours, nothing to do with pressure. And he still verifies to this day for Medicare that I'm compliant via coming in to see him every few months. So I'm wondering what the DME has to do with compliance for the OP? This sounds like a confusing way of doing things, like the doctor has given at least part of their role of controlling this process over to the DME.

Talking to the doctor about this situation might help the OP, he could ask the doctor to direct the DME not to use the SD card to change the pressure. Just let the OP set it, and get the DME out of the pressure-setting loop. Might take some talking, but once it's done, you're there, and the OP won't have to screw around any more after that.

Just a thought...

DeadlySleep · Post by **DeadlySleep** » Thu Sep 05, 2013 5:46 am

JamesAllen828 wrote: The higher pressure damaged his lungs

Bull excrement

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