CPAP Being Re-Posessed!

Lineman · Post by **Lineman** » Tue Oct 23, 2007 2:19 pm

Yeah, that's right, my DME wants my CPAP machine (and mask) back. It seems my insurance company (Pacificare) has changed to a dedicated DME provider. The DME provider I got my machine from was not the company selected by PC. So they can't get paid for my machine and want it back. I get to keep it until I get another one tho (nice of them I thought). I had no co-pay for this one and they didn't ask me to pay for it now.

The new DME provider called me and asked me if had experience with a CPAP. I said "Yes, I've been using one for about two months". With it established that I wasn't a "newbie user" they cancelled the training session. She said they would just ship me one (set to my pressure). "Umm, ok" I said "but what about the mask? " She gave me a choice of three FF masks but none of them was the ResMed Quattro. I asked about that and was told PC would not pay for the Quattro. "Umm ok, forget the mask. I'll get one myself" was my reply. I love the Quattro and want to keep using it so the cost I will bear.

Now I'm waiting to see what kind of new CPAP I will get (I forgot to ask). I ordered a Quattro from CPAP.com so that is also in the mail. Geeze I hate these medical payment screwups! Life is complicated enough without having to stress out over this kind of stuff.

-LM

dieselgal · Post by **dieselgal** » Tue Oct 23, 2007 2:24 pm

Well if you didn't insist on something else I would say you will probably be receiving the REMstar Plus CPAP Machine. That would be their choice most likely.

DreamStalker · Post by **DreamStalker** » Tue Oct 23, 2007 2:26 pm

It sounds like your new DME wants to give you the shaft.

Call'em on it ... literally call your insurance and ask them why they won't cover the Quattro ... I think you will be surprised by their answer.

I bet the DME is sending you a bottom of the barrel machine too ... you need to get on the phone right away and demand a specific machine like an M series Pro ... or better yet -- call your doc and ask him/her to provide you with a specific RX for an AFLEX machine.

Wulfman · Post by **Wulfman** » Tue Oct 23, 2007 2:47 pm

I can't imagine that they'd want the mask back, too....... I thought that the mask and humidifier were outright purchases at the beginning.

Like the others said........WATCH OUT! This sounds like bad news coming.

Den

6PtStar · Post by **6PtStar** » Tue Oct 23, 2007 2:51 pm

I'd get on the phone right now and find out what kind of machine they were sending so I would not have to pay the postage to send it back. Let them know you won't except a glorified leaf blower. I'll bet it will not be a Pro 2 Tank. If you have the card reader like your profile shows it won't work with anything less than a "M" pro model.

Jerry

tuna · Post by **tuna** » Tue Oct 23, 2007 3:32 pm

dieselgal wrote:Well if you didn't insist on something else I would say you will probably be receiving the REMstar Plus CPAP Machine. That would be their choice most likely.

Or worse a F&P HC234...

Bearded_One · Post by **Bearded_One** » Tue Oct 23, 2007 3:53 pm

I actually like my F&P HC233, it is VERY quiet; considerably quieter than my M auto

Lea · Post by **Lea** » Tue Oct 23, 2007 5:30 pm

Lineman,

Explain to your insurance company that your mask works well and see if they will cover the cost up to the amount they would pay for another mask. They might do that and it's a reasonable request.

Good luck!
Lea

GumbyCT · Post by **GumbyCT** » Tue Oct 23, 2007 5:56 pm

Lineman wrote:"Yes, I've been using one for about two months". With it established that I wasn't a "newbie user" they cancelled the training session.

Isn't that where they let you try on masks to see what fits & what don't? What leaks, where you can ask questions? You have NO questions? Aren't you in the market for another mask? Even a backup freebie? What were you thinking? Really?

Come on now, Surely you could learn something, no?

Lea wrote:Lineman,
Explain to your insurance company that your mask works well and see if they will cover the cost up to the amount they would pay for another mask. They might do that and it's a reasonable request.
Good luck!
Lea

Certainly it is, I am willing to bet you could get your used mask dirt cheap from the old dme. What will you do when you have a problem with your mask and no backup?

Hopefully I have given you a few things to think about.
GumbyCT
ps. I just switched to the VA; I am scheduled for what they call CPAP Acclimation (their words). I have never refused an opportunity to learn, but hey that's me.

kona0197 · Post by **kona0197** » Tue Oct 23, 2007 6:54 pm

Don't you love the health care systems in the US?

And I live here too!!

jennmary · Post by **jennmary** » Tue Oct 23, 2007 7:06 pm

I think you are being scammed.....by both DME. The mask and humidifier ARE outright purchases at the begining. It is only the machine that is one a capped rental. Plus the new DME sounds like it is lying outright. The insurance company does not care which mask you get, and the quattro is not any more expensive than many of the other options that are out there. I woudl bet money that if left to do what they want you will end up with the crappiest machine on the market. I would seriously get on the phone. Let them know that since you have been on CPAP you know what machine you want. The machines are all coded the same to insurance....so insurance WILL pay for a better machine with compliance data. If the DME tells you otherwise they are LYING. Unless you are getting a bipap (which is coded differently) all of the CPAPs on the market have the same insurance code.

I will keep you in my prayers.

sleepycarol · Post by **sleepycarol** » Tue Oct 23, 2007 7:18 pm

BCBS paid rental on the humidifier on my first cpap from the crooked DME I had at the start. They did not bill it as a purchase but as a rental along with the CPAP.

I dumped that DME due to them not giving me an APAP that was prescribed but substituted the M series Plus. I didn't know the difference when I accepted the Plus but soon found out from this forum I was getting the shaft and so gave the unit back along with the humidifier.

The DME I am now using DID charge the humidifier as a purchase and rental on the M series APAP that I am now using.

I would check with the new DME to see which machine I was getting. Since you have the Pro I would think you would want to stick with at least that model or upgrade.

allergyridden · Post by **allergyridden** » Tue Oct 23, 2007 7:19 pm

Haven't you received any statements from your DME? I get them showing what my insurance has paid. Your mask should have been paid for by now. I would call the insurance company and let them know what you've been told. They will tell you what they will and won't pay for.

Slinky · Post by **Slinky** » Tue Oct 23, 2007 10:13 pm

Man! I'd be calling PacificCare and asking them just exactly WHAT my DME benefits were. And how they worked. How much will they pay for the CPAP itself and how much they allow for a mask and for a humidifier.

Most likely this first DME hadn't even yet sent a bill to PacificCare for your current equipment since you've only had the equipment two months. I don't know of any local DME's who bill until well after the first month just to be sure the patient doesn't just turn it all back in and refuse to stick with CPAP therapy. And Resmed will replace the Quattro to this DME for free if they fill out a form and return it w/in 30 days. Ooops. No, they won't. You've had it 60 days.

I'd go back to my doctor who ordered the equipment and ask him/her to rewrite the script specifically for a Respironics M Series Pro w/C-Flex and Resmed Quattro mask. And do it ASAP AND GET IT INTO THE NEW DME EVEN FASTER!!!

Lineman · Post by **Lineman** » Wed Oct 24, 2007 7:21 pm

Slinky wrote: I'd go back to my doctor who ordered the equipment and ask him/her to rewrite the script specifically for a Respironics M Series Pro w/C-Flex and Resmed Quattro mask.

That's what I did (sort of). I asked the doc what kind of machine was specified to the new DME. Answer: REMSTAR M-series Pro and a ResMed Quattro mask.

I already mentioned what the DME said about the Quattro but they did ship me an M-series PRO !

I got the customer copy of the billing statement with the machine. It does not list a price for the CPAP machine but does show everything else. Yeah, everything INCLUDING THE MASK (the one I didn't take)! That has a hand written statement saying I refused the mask but the billing total includes the price of an Ultra Mirage FF mask and headgear.

I am going to make some calls about a) keeping the Quattro mask I already have and b) the mask charge on the new billing statement to PC.

Now that I have the new M-series Pro, I have to decide which machine to use. I confess to some trepidation about the new (unknown) machine I was waiting for after reading the replies here. A neighbor had a REMSTAR AUTO machine very similar to the PRO 2 I am giving back. It belonged to her mother (deceased) and had less than 50 hours on it. I bought it for $250 (with heated humidifier). I changed the operation to CPAP mode and to my settings. Works just fine. Now I have a backup CPAP (whichever one I decide that will be).

Is the M-series really any better (or worse) than the "Classic"?

-LM

CPAP Being Re-Posessed!

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