DME ripping me off?

[alpha752]

So I was looking over the paperwork from my DME (im only on my 2nd week of cpap). They gave me a Respironics (Thanks Pugsy) S1 SE, and it appears it is a 13 month rent to own, and Ill be billed $20.22 a month. My insurance is supposed to cover 80%. Over 13 months I will pay $262.86 for the machine. The exact same one on cpap.com is $288.15.

Something doesn't sound right here. My (limited) experience with this DME has been irritating, mabye I should just buy my stuff from cpap.com.

[Pugsy]

They sold you the cheapest brick they could and they get paid just like it was a full data top of the line machine.

I guess you could say that they are getting a lot of money for their "service"

You would pay the same for a full data machine as you do for the brick...they make a lot more money selling you the brick.
Remember, even cpap.com is making money on their prices too.

BTW it's not a ResMed S1 SE
it's a PR S1 60 series SE...Respironics machine and not ResMed.

[Wulfman...]

Not only that, but they gave you a "brick" (from what I've read about the "SE" model). You got a super expensive machine that doesn't tell you anything but the hours you've used it.

I think I mentioned that before in one of your previous threads.


Den

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[Pugsy]

Why didn't you take the machine back when you found out it didn't offer any useful data?
See this blog
http://maskarrayed.wordpress.com/

and this one
http://maskarrayed.wordpress.com/what-y ... me-part-i/

The longer you wait the harder it is to get the DME to swap it out.

[Wulfman...]

Why didn't you take the machine back when you found out it didn't offer any useful data?

Right! I looked up your previous posts and in the first threads you posted to, you were told that you had a "bridk" by both Pugsy and me.


Den

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[alpha752]

I tried. I called and was told that this was the model they had and that I could get reports from my RT. I tried to argue a bit but obviously wasnt going to get anywhere. Thats one of my frustrations with them. Now that I see I am paying much more then I should, I am even more irritated with them. Thats why Im wondering if I might be better off buying my own stuff from cpap.com, and taking the gamble with the insurance reimbursement later.

[russellms76]

Take it back and demand a refund or a Resmed S9 replacement. Love mine and have helped about a dozen folks find inexpensive used ones. They can normally be purchased locally on craigslist for $100 - $200.

[Bill44133]

So I was looking over the paperwork from my DME (im only on my 2nd week of cpap). They gave me a Respironics (Thanks Pugsy) S1 SE, and it appears it is a 13 month rent to own, and Ill be billed $20.22 a month. My insurance is supposed to cover 80%. Over 13 months I will pay $262.86 for the machine. The exact same one on cpap.com is $288.15.

Something doesn't sound right here. My (limited) experience with this DME has been irritating, mabye I should just buy my stuff from cpap.com.

yes you are being robbed... In more ways than 1.. Take it back

[Pugsy]

They flat out lied to you about the reports...there's nothing to get except hours of use. Big whoopie.

They pushed you and you didn't push back...that's what they do. That's what they were hoping you would do..not push back.

Check with your insurance company to see if there is anyone else in your area that is an approved provider...if so...call them up and find out what they normally dispense. Tell them what you want.
You can ask about online purchase reimbursement but don't hold your breath...it all depends on how they look at online purchases. Some won't pay at all and some might pay at reduced rate for out of network or you might get real lucky and have them pay whatever they would normally pay.
While you are at it...talk about the 13 month rent to own thing. Medicare does that and some other insurance companies mimic Medicare but not all insurance companies do that. Find out directly from the insurance company what your options are...DMEs...well yours is already a proven liar.

[Janknitz]

If you have Medicare you won't get any reimbursement if you buy your own machine online (unless you use one of the online DME's approved by Medicare). If you have other insurance (not a Medicare supplement), it depends on that insurer, so the only way to know is to call the insurer and find out if they will reimburse an online purchase.

Find out what other DME's your insurer will work with. Get a prescription for what you want (make and model). Then call around and tell these DME's which machine you want and ask if they will provide it. Any statements like "your insurance only covers X model" are a lie. What they really mean is that we only want to give you x model because we make more money from your insurance with that one. If they say "your doctor ordered this one" you will have the prescription in your hand and know if they are telling the truth or not.

If you buy your own machine, don't buy yourself the same cheap brick your DME tried to stick you with. You want a fully capable machine. My blog is a little outdated with the Respironics machines, so someone here will supply you with the model numbers for a fully data capable CPAP and APAP machine in that line. Since you already paid for the humidifier on your Respironics, it may be cheaper to get another Respironics so you don't have to buy a new humidifier.

Your current DME is treating you like you are stupid, and at this point you are letting them. Stand firm, don't wimp out!

[alpha752]

I think thats great advice, to call the insurance company and see what other options they cover. I was kind of hoping that this DME would work well with me, seeing as how its all part of the company I work for. I work for a very large hospital, so our insurance covers our own services very well, we are so big we have our own DME/Respiratory care @ home program, which is what I am using. I was hopeful, but apparently I was wrong.

Pugsy- Another layer of icing on the cake, I called my RT (4 days ago!) about switching my mask because I was having leaking issues at the corner of my mouth (as previously posted). She called me back today, and told me "looking at your data, it doesn't look like youre having leak issues, out of 12 days youve been compliant for all of then except 4." She made it sound like she was seeing a big report on my leak data, but she was really just looking at my usage hours and comparing it to the 4 hour compliance requirement. I dont think she cares about actual effectiveness. She went on to tell me that if I wanted to change my mask, I could, I just had to call yada yada number and make an appointment with so and so to schedule a fitting, etc. But she is my respiratory therapist... why should I have to make an appointment with someone else?

The whole thing just has me uneasy. Ill be calling the insurance company tomorrow and seeing what other options I have. Im not a real aggressive guy, I dont want to strong arm the company into giving me what I want, its just not my personality, if it comes down to it, I would just rather pay for it and not have the hassle.

[djhall]

I called my RT (4 days ago!) about switching my mask because I was having leaking issues at the corner of my mouth (as previously posted). She called me back today, and told me "looking at your data, it doesn't look like youre having leak issues, out of 12 days youve been compliant for all of then except 4." She made it sound like she was seeing a big report on my leak data, but she was really just looking at my usage hours and comparing it to the 4 hour compliance requirement. I dont think she cares about actual effectiveness.

Your instincts are correct, and unfortunately this is very common. Your interests are not their interests. They get paid a fixed amount as long as you actually use a machine. They don't get paid any more for getting you get a better machine, or helping educate you, or for making your treatment more effective. Conversely, they don't get paid any less for giving you the cheapest piece of crap they can find, blowing off your calls and concerns, or executing a treatment regimen that is not effective. They get a fixed amount of money if you wear a mask 4+ hours a day with a machine turned on... you actually getting effective treatment is irrelevant to their business.

[Pugsy]

Im not a real aggressive guy, I dont want to strong arm the company into giving me what I want, its just not my personality, if it comes down to it, I would just rather pay for it and not have the hassle.

I kinda figured you weren't an aggressive kind of person...no problem you aren't the first and won't be the last.
While I could tackle a grizzly bear and win..not everyone wants to get in the middle of a ruckus.

Sometimes the "no hassle" thing is worth the money so you get what you want when you want it and don't have to fight.

Having someone flat out lie to me about a non existent leak line...I wouldn't give those people another dime...and it wouldn't matter if I worked in the same hospital as they did or not.

Since you aren't the hell raiser that I am...why not just buy a PR S1 60 series full data machine that will work with your existing humidifier? Save you having to buy another humidifier.

You will want either a PR System One 60 series Pro CPAP..model 460...that's the straight cpap model which is what your current brick does.
or the PR System One 60 series Auto CPAP..model 560...that model has both straight cpap and apap (auto adjusting) modes available.

The model names are sometimes hard to figure out when looking at the machine itself so that's why I stress model numbers for the Respironics machines.
Model numbers are on the bottom of the blower unit...a 3 digit number usually preceded by DS or REF.

To buy online you will need a copy of your RX.

Private party buying...I would stick with local Craigslist unless you know the machine models really well and get real familiar with the models of machines. Long distance Craigslist and dealing with a seller who has no idea what they have might be a bit much for a newbie.

Secondwindcpap.com has some gently used machines and they also have some new open box specials on zero hour machines.
They will want a copy of the RX though.
CPAP.com our forum host is another online source....great people to work with.

So if you don't have any DME close to you that will get you what you want...and you don't like to get up in the face of this one who lies to you...then just avoid the hassle and buy your own.

[Guest]

If you have Medicare you won't get any reimbursement if you buy your own machine online (unless you use one of the online DME's approved by Medicare).

please list any online dme's approved by medicare
that would be a great help
thanks

[chunkyfrog]

Use the link in my signature.
Maybe you can find something I can't.