Taking charge (I hope)

bap40 · Post by **bap40** » Tue Mar 04, 2008 8:43 am

The last straw for me and my dme was last week when she replaced my trial opus system and only gave me the one size of pillows and I know it is supposed to come with all 3. Tomorrow on my day off, I am going to hit the hospital home medical equipment place to see what they have and what they can do for me, in reguards to what I want. I can deal with the plain ole CPAP, but I want it to be data capable. So wish me luck and I will keep you all updated.

Slinky · Post by **Slinky** » Tue Mar 04, 2008 8:49 am

GOOD LUCK, Bap! Be diplomatic, but firm, about what you want and go for it!

Nodzy · Post by **Nodzy** » Tue Mar 04, 2008 9:17 am

Bap,
Be sure to tell'em that:

It's proven that proactive patients, ones who understand their therapy and sleep events are more adherent to the therapy and get better results. And that better therapy results for patients makes the med-types look good.

And that: I (you) need a data capable PAP in order to get great therapy on every night -- It’s my health at stake.

If push comes to shove, tell'em that:

The lack of being able to closely monitor your (my) therapy stats daily or even weekly is a hindrance to your (my) therapy success, and ultimately a roadblock in your (my) efforts to protect your (my) health.

But, avoid this following part if you can. And that by blocking patient involvement in monitoring their own therapy data.... could put them in liability stew.

Nodzy

Wulfman · Post by **Wulfman** » Tue Mar 04, 2008 9:43 am

Where are the anonymous "guests" who proclaim that everybody should get all their stuff at the local brick & mortar DMEs......when you "need" them. (to read these stories)

Good luck, bap40.

Den

Nodzy · Post by **Nodzy** » Tue Mar 04, 2008 12:06 pm

Bap,
I overlooked the Opus point above. Now, keep in mind I'm not a lawyer.

The mask as a complete package is what is charged to you (insurance), therefore you are entitled to the entire package, even the clear shipping bags if you want them. Not just one size of pillows.

They, in clearly illegal action, ripped you off from having what they charged to your care. And I do mean.... ILLEGAL action on their part. They illegally kept parts of your mask kit.

You might want to mention to them that they don't have the legal right to charge a whole mask package to you and give you only part or parts of the package.

Or, you might want to inform your insurance company about receiving only part of the mask kit from the DME. And ask if that's the policy of the insurance company to make sure you don't get the whole kit they are charged for by the DME. LOLOL.... that would stir some mud. But, if you don't have options for other DME's... it could cause you to be flagged in their files... cryptically, of course.... as "that a**hole."

Me? I'd shove the mud they made up their exit orifice by making their practices known to the insurance company. Because in reality, the DME is potentially interferring with the possible success of your therapy by keeping those parts, charged to you, from you.

I mean.... IMHO, of course. And now I'll go snack on another pound of 10-penny nails.

Nodzy

sososleepy · Post by **sososleepy** » Tue Mar 04, 2008 12:18 pm

Hi Bap,
My dme sent my opus ups and it did include all nasal pillows, i think 3 pillows but i would have to check to be sure.
Good luck to you.. Also i wanted to mention that my opus works much better when i use nasal strips. It really doesn't work at all for me unless i use them. Just wanted to share that incas it could be of some help to you.
Good Luck!! Sososleepy

dieselgal · Post by **dieselgal** » Tue Mar 04, 2008 12:24 pm

I have heard that if you know you want an OPUS for example you should get your Dr. to write the prescription to say OPUS with all size pillows or something to that affect. It really irks me that since they feel like you need size medium they don't give you small and large as well because many times down the road you will find another size works better for you.
It is just the DME's way of fleecing you for lots of dough and then selling the extra parts you have already paid for once. I think that is double dipping...or maybe another word that fits is theft by deception.???

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CPAPopedia Keywords Contained In This Post (Click For Definition): DME, Prescription

bap40 · Post by **bap40** » Tue Mar 04, 2008 1:23 pm

I did make a call to the DME I am planning on changing to. They were very helpful and said that they could put me into a data capable machine with no problems. I am dropping off my paperwork a little later today so they can do the insurance bit and are going to give the reason for a change as to the BAD LADY..

I also plan on blowing the whistle on this BAD LADY's practices of not giving me the entire contents of my Opus. I am aware of this as being insurance fraud and do plan on taking care of that as soon as I have returned my equipment and have gotten started with the new DME. She has literally lied to me more than a few times, she thought I was ignorant on this subject and I wasn't. I have done my research well ahead of time. She just doesn't know that, YET !!!!!!

BelmontAl · Post by **BelmontAl** » Tue Mar 04, 2008 1:32 pm

Hi Bap,

I second Slinky's advice - be firm.

Among the many great tips that I picked-up on this forum, I learned two important facts that helped me work with my DME provider:
1) How DME providers make money. DME providers receive a fixed reimbursement from the insurance company for a given type of xPap (One rate for a CPAP, another for a BiPap; the insurance company does not differntiate for machines that do or do not have auto-adjusting and/or data recording capabilities). Therefore, a DME provider is incented to provide patients with the least expensive alternative (lower cost for the same revenue = more profit), rather than the best solution for the patient.
2) The patient has the option to choose (within certain boundaries) which company to use as their DME provider.

My DME provider initially resisted my request for a specific machine (an Auto Cpap w/ Aflex). However, she quickly capitulated when I told her, simply but firmly, that if they wouldn't provide me with the equipment that I wanted, then I would find another DME provider who would. In my region (SF Bay Area), Blue Cross lists pages of eligible DME providers.

She seemed to have been trained to react more agreeably upon learning that I was aware of my right to shop around for a DME provider. This makes good business sense...less profit is better than no profit, and they retain me as a customer for future supplies.

Good luck,
Al

Mask