Who do you see when your CPAP tech goes bad?

[janilee]

First, the problem. I have a, probably permanent, deep and painful crease in the bridge of my nose. This is a result of trying to stop the leaks that blow into my eyes. I'm wondering if it might partially be due to the fact that I have a small full face mask, but what appear to be straps that would more properly fit that of Whatsisname the Giant?
Now, the reason I don't just go visit my friendly CPAP professional: he's unprofessional and unethical. I have registered complaints with the pulmonologist's office, and with my insurance company. I don't know how seriously it was taken by the doctor's office, but I work for the insurance company and I can sneak and look at how my complaint is being handled.
Needless to say, my actions have further degenerated what little relationship I had developed with the CPAP guy.
Since you ask, I told them I wanted the CPAP to go through the insurance company as a DME rental/purchase. He said I didn't want that because the paperwork was such a mess and it would help him out a lot if we just put it down as a purchase and then I could pay the copay as if it had gone through the insurance company, in 10 installments. Being a nice and helpful little idiot, I agreed.
When the resulting paperwork didn't look right, I contacted the CPAP office. They said the guy had no idea what he was talking about and they were pretty tired of people, like myself, who arbitrarily decided that enough had been paid by the insurance company and then "hit the dusty trail", never paying the copay!?!?!?! I said that was pretty strong language to use on a patient and told them they needed to just refile the claim as I had originally requested and that would be that. They refused, in my best interest, of course. The insurance clerk proceeded to explain to me that, should they file as a rental with the insurance company, I would end up paying a double copay because 10 months ran beyond the end of the year and I would be responsible for a second $340 copay at that time. Huh?
I tried to explain where all they had gone wrong and how many people would be hurt if they continued to use this incorrect explanation. They didn't buy in. I reminded them that I worked for the insurance company and, something they didn't know, handled inquiries generated when something like what I was experiencing happened. As a matter of fact, I frequently handled CPAP inquiries. It went downhill from there and they ended up hanging up on me. Not because I ever got rude (because they could report me, as well), but, I felt, because they all began to feel frightened. Why on Earth did they pick on a claims analyst on which to try that cooked idea? I ended up filing the complaints because I could just imagine the people who couldn't afford to fork over the $340 in a lump sum and would end up without their devices. As for my own case, I showed them! I paid the entire amount with a credit card I'll now end up paying for more than 10 months. That's telling them, huh?
So.....that's why I can't go back there and ask that they do something about my mask problems. They would likely give me the "cyanide mask". Now, how do I go about finding, on my own, whatever it takes to get as much comfort as possible?
Sorry about that. I guess I need to change my name to " '53 Rambler".
janilee

[oldgearhead]

I dropped the DSMs five years ago, it is less costly and less stressful. to do it myself. I discovered OSA is a self-treatable illness.

[Guest]

Hi Janilee!

Sounds like you have certainly been through the ringer! Hopefully, you can find some relief soon. I have a couple questions for you:

When the resulting paperwork didn't look right, I contacted the CPAP office.

I'm going to guess you are referring to a DME company and the DME companies head office?

The insurance clerk proceeded to explain to me that, should they file as a rental with the insurance company, I would end up paying a double copay because 10 months ran beyond the end of the year and I would be responsible for a second $340 copay at that time. Huh?

It sounds to me like they were using a poor choice of words to explain that the rental would go into the next year which would mean a fresh deductible for the year that would have to met? I dunno, but that's what it sounds like to me.

I paid the entire amount with a credit card I'll now end up paying for more than 10 months.

From what I've read here, it sounds like almost every insurance company either does the rental then purchase thing or more often purchasing outright. I don't think I've ever seen anyone mention that they had a choice of one or the other. I wonder if that might be part of the confusion.

I certainly don't think I would go back to that company now though, after how those conversations went! Since you work for the insurance company, maybe you can just look and see what other companies in your area are in network for you. It sounds like contacting another company and seeing if you can work with someone new and get a fresh start might be a good choice.
It can't hurt to try that's for sure.

[Mile High Sleeper]

Is there another DME tech in the same office?
Is there another branch office you could use?
Better yet, does your insurance plan allow for a different DME? Ask a hospital sleep lab for DMEs they recommend.
Consider using another reputable DME for mask fittings and/or sales.
Order equipment through cpap.com or billmyinsurance.com.
Do the local hospital sleep labs or for-profit sleep centers do mask fittings and sales? Search for local sleep centers on the Internet.
How can you apply your findings to help other victims of bad DMEs?

[krousseau]

Janilee-check the responses on your first post (as Guest) too.

As for a comfortable mask...one of the problems is finding a DME that will allow you to try on the masks. That said-from reading posts here none are perfect. So often people just end up getting a different mask each time they are due for a replacement -until they find one that works OK for them. While you are searching for the "best mask"-you try to modify the one you have. Moleskin-an adhesive flannel type material is often used on the mask to fill in gaps where the mask doesn't fit your face. Putting an extra strap on is another way to get a better fit.