HCPCS codes - do YOU know what your rights are?

dllfo · Post by **dllfo** » Thu May 01, 2008 4:55 am

I got a couple of emails recently that is leading me to believe the DME field lacks continuity in allocation of assets to customers.

Short version: we are getting screwed.

A7032 Cushion for use on nasal mask interface, replacement only. 2 a month
A7038 Filter, disposable. 2 a month.

FIND your codes and know them. Respironics put out a PDF file that nicely summarizes most of my codes.

My current gripe is A7032. An Apria lady told me "2 a month" meant one for the left nostril and one for the right nostril. I am about to request adult supervision for her, then I will request a senior customer service person to work with. I email Apria with my request, HCPCS codes included.

Slinky · Post by **Slinky** » Thu May 01, 2008 5:32 am

I think that you will find your local DME supplier is correct, one pillow for each nostril. Check the nasal cushion cushion replacement, I'm pretty sure that is just one a month. Why would they allow 2 "sets" of nasal pillows but only one nasal cushion per month?

KansasRT · Post by **KansasRT** » Thu May 01, 2008 8:23 am

The rule that I follow is two per month. Two nasal seals or two pairs of nasal pillows. I have never had an insurance company that allows that to deny 2 sets of seals.

Slinky · Post by **Slinky** » Thu May 01, 2008 9:25 am

Thanks for the clarification, KansasRT. My first local DME, a real sheister, didn't carry ANY mask parts, including the cushions. You had to get snarky to get them to "order them" and, of course, that took a good 2 weeks or better. The cat got my simple nasal cushion from my CL2 and I NEEDED it! I was SO GLAD to complete that capped rental and change local DME suppliers!!!

Guest · Post by **Guest** » Thu May 01, 2008 9:36 am

No offense KansasRT, BrianRT and all the other fine DME's & RT's in this forum.

SNARKY HUMOUR TO FOLLOW - TONGUE IN CHEEK WARNING!!!

Something JUST occurred to me.

Want to make money fast? Want a job where you don't have to work any more than you WANT to? Guaranteed high volume, fast client turnover, with little to NO repeat business! Most clients DO NOT RETURN, so you do not have to "service" them in any way! More than half quit the system completely - since they are lazy and fat and stupid anyway - after having spent thousands purchasing equipment FROM YOU!

Open your own DME!

I wonder if I could get folks to pay me money to come to my weekend seminar where I show them just how easy it is to open your own DME, get referrals from doctors and labls, and then trick customers into signing lease and buy agreements for exorbitantly over-priced, low-end, non-data capable equipment? WITH NO MONEY DOWN!

LOL,
Babs

dllfo · Post by **dllfo** » Thu May 01, 2008 10:18 am

Sorry, I forgot to tell you, I called Medicare and was told it is two nasal pillows per month, not one per nostril.

The other oddity is that some high ranking Apria people thought Tricare For Life would only cover what Medicare covered. I literally had to send them the link where it plainly says TFL pays for things Medicare does not cover. File with Medicare, get a rejection, send it to Tricare For Life and they pay. I would think that sort of thing would get priority since it effects what they can sell.

xyz · Post by **xyz** » Thu May 01, 2008 11:50 am

> My current gripe is A7032. An Apria lady told me "2 a month" meant one for the left nostril and one for the right nostril.

That's so typical of Apria California. These people need to be reported to the state Dept of Managed Care. They deny that you are eligible for an item and they also badger you so that you won't even place the order in the first place.

> I am about to request adult supervision for her, then I will request a senior customer service person to work with.

That would be the one who has been there _two_ months, I guess. At the local AWAKE meeting the Kaiser patients, who have to use Apria, complain about them also.

jomac30 · Post by **jomac30** » Fri May 02, 2008 9:32 am

what is Tricare for Life. Can anyone get it?

Wulfman · Post by **Wulfman** » Fri May 02, 2008 10:32 am

jomac30 wrote:what is Tricare for Life. Can anyone get it?

Depends on whether "anyone" was in the military and for how long.

http://www.military.com/benefits/tricar ... ligibility

Den

Guest · Post by **Guest** » Fri May 02, 2008 11:10 am

Babette: You're right- ALL DMEs are totally useless. The manufacturers should just sell direct to patients since DMEs obviously do nothing.

THanks.

Pineapple · Post by **Pineapple** » Fri May 02, 2008 11:32 am

The flyer I was given by the DME states " nasal pillows - 1 per month", but when I called in for my monthly supplies, the young man that handled my order told me "no ma'am, you're covered for 2 cushions for your mask per month" I told him if it was covered, send it to me. I haven't called for this months supplies yet to see if they're going to change thier minds. The insurance claim was denied, it seems the insurance company has no record of me having a CPAP

Slinky · Post by **Slinky** » Fri May 02, 2008 2:41 pm

Actually, I wouldn't say ALL local DME suppliers are useless, or liars, or less than smart ..... BUT ..... it would be a great idea if the manufacturers would sell direct to the patients!!!!!

Look, I realize it has to be darn frustrating if you are in "the profession" to see the local DME's beat up so bad - but the best thing you could do would be to clean up your own profession. You're obviously too closed-minded and thin-skinned to contribute anything worthwhile to this forum as so many RTs, RPSGTs, etc. do. Thank heaven for them.

We are here in this forum BECAUSE of local DME suppliers who fall flat on their face in providing good equipment w/o hassle and the education, support and service they swear to the insurances and the rest of the profession they provide.

dllfo · Post by **dllfo** » Fri May 02, 2008 10:24 pm

I am tired of getting a different answer from each Apria Customer Service person.

I am having more medical problems right now and I do NOT need Apria's crap.

Next week won't be fun for Apria. I am going to take the time to get my benefits defined and I want it in writing. If Apria can't do that, I will take the time for file a complaint with Medicare.

Some people might get by with one set of Swift Nasal Pillows, but my AVERAGE IPAP is 17+

I hit 30 cmH2O last night, a lot. My nasal pillows don't last long under high pressures. I think our DMEs on this forum mean well and are demonstrating that fact by being here. I have shared emails with most of them and found their knowledge and abilities to meet industry standards and then some.

The AMA is responsible for building an empire and stranglehold over us. Complain to your representatives in congress.

xyz · Post by **xyz** » Sat May 03, 2008 1:28 pm

> Next week won't be fun for Apria. I am going to take the time to get my benefits defined and I want it in writing. If Apria can't do that, I will take the time for file a complaint with Medicare.

If your insurance is Medicare, the answers to your questions about replacement periods is very well defined. On the other hand, you are unlikely to get any satisfaction at the branch level with Apria. There are too many incompetent people.

Be sure to meet in person, not over the phone. Insist that the branch manager and an RT be there. Bring a friend if you can. Tell them before the meeting that you will want in writing a replacement period list for OSA items so that they can't say that they are not prepared. After the meeting, send them an email summarizing everything.

dllfo · Post by **dllfo** » Sat May 03, 2008 7:24 pm

I have dealt with Corporate a few times and have had 100% success.

I don't go down there because they are in a high traffic area. When we started dealing with each other they demanded I come down there. I said fine, I am on morphine for pain, will you please email me or fax me a directive that says in order to procure my health needs, I HAVE to come to you.

They deliver or mail things to me.

I KNOW what Medicare told me, but I want to establish with local mgt exactly what I am supposed to get, THEN they can order it and please put it in writing. If your clerk tells me I am not authorized an item on the list, I file complaints with Corporate the first time, then Medicare. If enough people complain to Medicare they will lose the account and probably Tricare's business. Chapter Eleven might save them.

Jim H., their manager knows me on a first name basis. I have called him and received replies within a short period of time. He gets their side of it, then calls me. After I explain their screw ups he corrects it and that is usually that.

In the past I was sending the HCPCS codes in with the order on email. I got lazy because they were doing so well.

There should be a way to list these things in advance. Apria says they are not allowed to automatically order things for us. Hmmmmmmmmmmm.

I will read the Medicare info to them, if they don't agree, I will tell corporate to please call Medicare and Ask. Make sure they write down the name of who they talk to. Because I will.