A Miracle has Occurred in my Life

Babette · Post by **Babette** » Thu Jun 14, 2007 1:29 pm

Well, first you have to know that my DME experience has been right up there with all the other horror stories. This weekend I received two EOB's from my insurance -one for a month's rental and purchase of supplies - billed 3 days after the first month's rental and purchase of supplies - AND... FULL PURCHASE OF MACHINE AND HUMIDIFIER. Please note that nothing occurred 3 days after the first bill was sent by DME. I did NOT get any new supplies. Nada. Zip. Likewise, I have not had any contact with them subsequently to get more supplies, nor told them I was ready to purchase the machine. Nor did the Sleep Doc.

I blew a gasket. 1) I did not want to purchase this machine (see profile), I wanted to purchase an APAP Pro. 2) They billed two months rent and full purchase price when I'd only had the machine 6 weeks. GRRRRRR!!!!!!!!!!!!!!

I spent several hours yesterday yelling at the insurance company, screaming at the DME, and hollering at the hospital that sent me to that DME.

Today was my follow up visit to the Sleep Doctor. After all that yelling, I knew I had to get my ducks in a row and be ready for this AM. I got online, I downloaded CWSFANSFOR's letter to his BC/BS insurance (I have BC/BS too), and editted it for my situation. I addressed it to the doc.

I also wrote a 3 page letter to the insurance company, outlining why I think the DME committed fraud in their billing, and faxed that and the EOB's to the insurance fraud dept., and to the hospital customer service dept.

I then got online and got some very nice advice from a VERY NICE FORUM GENTLEMAN (Blows Kiss) about how to conduct the interview with the doc in the AM to get the machine I wanted. "Get her on your team." Excellent advice indeed!

So, I get up today, loaded for bear, grab my files, head out to the car.... and the battery is dead. I lose it totally. I freak out. I know there isn't time to call AAA, and I don't dare re-schedule this appointment, given what's going on with the DME. I need the doc NOW!!!! I wake up my nice elderly neighbor lady, and she very kindly jump starts my car. Hurrah!!!! I got there on time. (Note to self - need to buy her flowers)

Less than 15 minutes after getting to the docs office, I was sitting in my car, shaking all over, speechless.

I never got to hand her the letter. She asked me how I was. I said how well I'd been doing. I explained the problem with the DME, and how I wanted a different machine, and how I wanted to go online to buy it because of the problems with the DME. She commiserated, and promptly began writing me a scrip. She asked "You want a Pro, right?" and I nearly swooned. I said yes, and then said, "Could I... could I please... May I please, ma'am, have an auto-titrating machine?" She said yes. Just like that. No questions asked. I assured her I would run it in CPAP mode, but that I was losing weight.... and... and...

She kept nodding and smiling. She wrote the scrip exactly as asked. I asked for a Letter of Medical Necessity, in case I needed it, and she said to try this first, and if I still needed it, to let her secretary know and she'd fax me one promptly.

She then very kindly gave me some more samples of the Provigil that's been helping me along, and told me to come back and see her in 3 months.

No pain. No tears. No gnashing of teeth. I'm still speechless. Not type-less, apparently, but speechless.

AND I told her I wanted to find an RT to read my reports, and she said she didn't care WHO I went to, as long as they sent her the info when it was needed. I could go to Seattle, I could online, wherever I wanted. She said she had a card reader, but it was just so much easier if I could work with an RT and send the reports over.

I'm still shaking a bit.

THANK YOU ALL!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! I clearly must have said all the right words. And if I did, it's all because of you dear people!!!!!

Now to wrestle with the DME and the Insurance....

Oh - BTW, I got through so early, I had the battery checked at my favorite local dealer right after. He says it's fine and he thinks I might have drained it leaving the overhead light on. Blast that slider button! It's getting duct-taped tonight...

So, as I was walking into my office after all that - the cell phone rings, and it's the Insurance. I talk to them about all the charges, and they tell me they are going to INVESTIGATE and get back to me. YIPPEEE! More than they offered to do yesterday.

I may still have to buy this APAP out of my own pocket, but at this point, I'm so grateful to have the scrip, that I can contemplate doing that without much pain. What's plastic for, anyway?

Many many many thanks!!!!!!!!!!!!!!!
Barbara

DreamStalker · Post by **DreamStalker** » Thu Jun 14, 2007 1:45 pm

Very glad you got what you wanted but so sad that patients have to endure such stress to get the service they pay for ... these people are suppose to work for the patient not the other way around ... it is the patient who pays the bills.

Anyway ... best wishes with your new machine.

Babette · Post by **Babette** » Thu Jun 14, 2007 1:50 pm

THANK YOU MY FAVORITE VAL KILMER IMPERSONATOR, YOU!
Big Hugs,
B.

BrianRT · Post by **BrianRT** » Thu Jun 14, 2007 1:55 pm

OMG...I believe that's in the Book of Revelations as a sign of the Apocalypse

Anyway...CONGRATS!!

An educated patient is a compliant patient.

tangents · Post by **tangents** » Thu Jun 14, 2007 1:55 pm

Babbette,

I'm doing the happy dance for you right now! Perhaps I'd better notify the nearest seismology center in case they notice the disturbance...

I agree with DreamStalker, this isn't right. Why are there so many instances of doctor/patient abuse going on? And I really think it starts with the doctors, not the DME's. I believe they have the power to change things, but choose not to.

Anyway, no negative thoughts right now. Shine on, baby, shine on!

Congrats,
Cathy

Babette · Post by **Babette** » Thu Jun 14, 2007 2:01 pm

Oh BrianRT, that's PRICELESS!!!!!!!!!!!!!

I really need to tell that to my Seventh Day Adventist boyfriend who is the leading authority on the Book of Revelations (according to him, of course).

Cathy, from my conversations with this doc, she has never had any personal dealings with this DME. I'm not sure HOW they became the "preferrred provider" for this hospital system, but if I have my way, they will be losing that status. I've had some very serious talks with everyone involved, and I hope something comes of it.

She did give me a line on a great RT that is located at a "big name box franchise" DME closer to my home. I'm going to call and see if he still works there, and maybe set up an interview and find out how I might like them. If they make me happy, I'll send them my business. If not, I might just use the RT services, and still buy stuff online.

I was very happy to learn that she had no problem with me hunting down the DME of my dreams. I appreciate that. My insurance as "in network" and "out of network" tiers, but at this point, I really could care less. Good service is too important to me.

You are all right - this should NOT be this hard!!!!!!!!! Thank god SOMEONE in the system is doing the right thing. I really am so happy right now with the sleep doc and the sleep lab and their staffs. Now if I can just find me the optimum RT/DME combo, I'll be set.

BTW, I plan to buy a Respironics Series M Auto Pro w/Aflex. I think I got that right.

Keep dancing Cathy! Happy dances don't cause earthquakes - they cause karma-quakes!

Hugs,
B.

JeffH · Post by **JeffH** » Thu Jun 14, 2007 2:06 pm

Glad it worked out for you Babette. It's the good karma from keeping us all laughing here on the forum.

JeffH...LOL

oceanpearl · Post by **oceanpearl** » Thu Jun 14, 2007 2:23 pm

You go gal!!!

Slinky · Post by **Slinky** » Thu Jun 14, 2007 2:41 pm

I don't think the Pro is an auto. I think what you want is just the M series RemStar Auto w/C-Flex. Or maybe its just M series Auto w/C-Flex.

Sounds like you've got a great doctor who is INTERESTED in your CPAP therapy progress. Perhaps next you talk to her you should suggest that she writes her scripts in a manner to ensure that all of her patients get a fully data capable xPAP.

Babette · Post by **Babette** » Thu Jun 14, 2007 2:46 pm

Whoa! Slinky! That RADICAL TALK THERE! That could get us all in trouble! Branded COMMUNISTS or WORSE!

THE 2007 CONGRESSIONAL CPAP HEARINGS - SPONSORED BY RESPIRONICS AND RESMED!

Senator: You're saying that you believe that all patients have the right to their own data?

Patient: Yes Sir!

Senator: TERRORISTS! Clap them in irons! Black list them! Send them to Guantanamo Bay!

LOL,
B.

LyleHaze · Post by **LyleHaze** » Thu Jun 14, 2007 2:54 pm

Awesome!! Way to Go!!

You, it's the "M-Series Auto" that you're looking for I think.
That's my machine as well.

I'm so proud of you for deciding you have the power!
I had to fight a bit too, but I was lucky enough to refuse the machine they wanted to send me home with.

We are responsible for our own health. We pay the bills, and we suffer the consequences. I WILL be an informed patient.

Happy for you,
LyleHaze

gasp · Post by **gasp** » Thu Jun 14, 2007 3:04 pm

Babette wrote: No pain. No tears. No gnashing of teeth. I'm still speechless. Not type-less, apparently, but speechless.

Triple YEAH!!! Good job. I'm thrilled for you that it worked out. Better than driving so far to my DME - although I would have loved to see you for lunch.

BTW, I got my machine yesterday. Finally. Can you believe it? I'll post my saga - which includes that I was prescribed the A-Flex.

Babette · Post by **Babette** » Thu Jun 14, 2007 3:08 pm

Oh Gasp, you're not off the hook yet. You promised me Potato Salad, remember? Lots of mustard for mine...

I've been MEANING to ask you what's going on! I thought you got your machine last week?

Do post and let us all know, or PM me. You got my home addy - write me there anytime!

Still wanna go to Camlann Faire!!! Or would you like to do the big drive and go to Port Gamble on the 23rd? Civil War event there I'm thinking of going to.

Hugs,
Barbara

DeltaSeeker · Post by **DeltaSeeker** » Thu Jun 14, 2007 3:14 pm

LyleHaze wrote:I had to fight a bit too, but I was lucky enough to refuse the machine they wanted to send me home with.

We are responsible for our own health. We pay the bills, and we suffer the consequences. I WILL be an informed patient.

Same here. They tried to send me home (after 2 faxes and numerous calls to be sure they had the right equipment) with a Respironics DS something or other - bottom of the barrell useless piece of junk! Or at least for someone who's a control freak, like me...

tiredofbeingsleepy · Post by **tiredofbeingsleepy** » Thu Jun 14, 2007 4:48 pm

BrianRT wrote: An educated patient is a compliant patient.

I wish my RT thought that way......she looked at me like I had two heads when I told her I wanted a machine that could monitor my therapy. My DME is all about "we determine if your settings need to be changed by how you are feeling". After many phone calls back and forth with the "supervisor" (who was quite condesending), I finally got a Remstar Pro2.

Congrats, Babette, on your machine!

Mask

Additional Comments: Equipment isn't correct, S9 ASV w/H5i

Mask	Humidifier

Additional Comments: Pursleep, Padacheek, Regenesis™ Pillow, Neti Pot, Travel Buddy hose hanger

A Miracle has Occurred in my Life

A Miracle has Occurred in my Life

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