Arrogant DME , Long because I am just venting.

[illinigal]

Hi everyone,
I just need to vent so this may be long. I was diagnosed with OSA in January of this year, chose a DME close to my job for the convenience. As is usuall it seems from all our members and their posts, I got more support from you folks than I did from the DME. My family doctor gave me the name of the sleep doc he worked with and told me any concerns I might have would be better anserwed by him, but he would like to have a copy and regular update from the sleep doc. Ok..he was honest and I know him to be a sincere and caring family doctor. The DME is another story..I was trained and given 3 choices of FFM..was told I would be contacted in 6 weeks to have info downloaded and sent to my family doctor. At 6 weeks I managed to tear my silicone cover on the padding of my mask and went back to the DME for a new one..asked 2 questions..should you read my machine at this time and should I pay something on my account ? I do have insurance but have not met my out of pocket yet. My answer was no..and no...you have only been on cpap for 6 wks..and we understand insurance pending balances,there will be no problems. Jan-April my insurance denied the claim because they needed a copy of the original rx. I am sure many of you know the story...DME says they have requested it from the doctor..doc says they included it when they sent the sleep study to the DME to order my machine..and logicaly they should not have given me the equipment without the rx! May the claim was denied..I went to my family doc and got a copy of the rx for cpap and took it directly to the DME..and bought some filters..should I pay? and should we download ? same answer as before on paying and she told me if I was feeling better that was a good indication the cpap therapy was working and the doctor had not requested a download yet!!!

So June comes long ..claim is denied and by this time I am beginning to have problems sleeping, waking up gasping, heading towards zombie world again..so I called the sleep specialist as I was told..I called my insurance to be sure he is in my network ..he is..and to find out their version of why my claims are being denied. It is the same story..the insurance is asking only for a copy of the original rx to have on file..the insurance phone person actually called my DME while I was on the phone with her..told her to fax it over NOW, that I had told her I had brought them a copy and would get another copy for them if necessary. My Dme stuttered a little and said they would take care of immediately. Later in the day insurance actually called me to tell me they had received and magically 2 days later the claim of 90% of the balance had been paid .

So why am I upset and ranting and raving and rambling? Today I got a bill from my DME with my monthly rent to own fee for 7 months, the supplies I had bought and the insurance payment reflected and attached to the bottom was a cute little sticker full of lady bugs that said...We hate to bug you..but can we get paid..your account has gone more than 90 days without a payment ! AAAAGGHHHH!!!!

The other thing I received in the mail today was a copy of my sleep study I had requested from the specialist..with an rx attached for..Nasal PIllows of pts choice and a list of his recommendations...recorded nocturnal 02 saturations should be checked in one week..and a heated humidifier ( I got that because I read about them on this forum and went back and ask for one ) . Nasal pillows?..were never offered me...nocturnal 02 saturations? subject never came up...hmmm...payment...they can wait until I get my new supply of checks in about 5-7 days. It was also noted that this record had been sent to my family doctor and a carbon TO MY DME!!!...AAAAGGHHHH!!!!!!

The good thing in all this is I like the sleep specialist, Blackneto has re-assured me in a pm that he has an excellant reputation and an excellant well trained and experienced staff. ..(I ask him because he lives in the same town as the sleep center and the doc) . I am going to the a different sleep lab than my original, to have a titrated study..they are larger and can offer me a variety of masks ..among other things

If anyone has read this far....thank you for listening ! I shal now go and have some JD on the rocks..

Happy pressures and sleeping to you all..

Illinigal/Marsha

[Slinky]

Ahhh, it DOES feel good to get the frustration off your chest, doesn't it? Especially when you know others have experienced similar and have vented here too and so understand your feelings and what you've gone thru. I think the local DME suppliers delight in doing some of this so that it drags on past that first 30 days when it becomes more difficult for you to switch to a different local DME supplier. Thank goodness, though, that you do have both a good family doctor AND a good sleep doctor.

I think that I would be inclined to watch my credit report and IF I saw that this local DME supplier had me down as a "slow pay" with them I would be sure to provide the credit reporting company(ies) w/the REASON along w/a copy to the local DME supplier as well just to let them know.

[WhiteBeard]

Hi illinigal why does your venting not suprise me! That is why I use the DME in Champaign as well as the Doctors, although your fair city would be closer. Your ranting has brought a bit of a smile to my face as I am more than familiar with the medical system in Gibson City, and I appreciate your frustrations. I do wish you luck, a neighbor with SA White Beard

[illinigal]

Whitebeard.

In defense of my fair city I do not use a DME there( I love the little town but I understand the other things you are referring too ) ..not sure if I have one there..I am always joking that I live 35 miles from everywhere. Champaign..Bloomington..all those surrounding real towns ! .I actually drive 42 miles to work 5 sometimes 6 days a week to have insurance to go the rotten DME ! I am slowly changing DME but I still have the same respnse when I see the statement on my desk..AAAAAGGGHHHH!

illinigal

[WhiteBeard]

illinigal

You are a bit closer to Bloomington than I am, but about the same distance to Champaign, however I like both of those cities very much, and Gibson City is actually a very clean and neat small town and it has a great drive in theater besides! That is really rare these days and it is lots of fun, brings back memories of my younger days! It won't be long though and it will soon be surrounded by windmills, or at least it might seem that way! Anyway Good Luck with Your CPAP and the billing process! WhiteBeard

[m1aman]

why do you guys use dme's? i take my prescription and buy my gear through the internet for much less. gives me complete control, no phone calls, no "permission" etc.

[Blackneto]

Wow, Illinigal, this really sucks.
when you go for you titration make sure you let the tech that helps you know about the problems you've been having with the DME.

m1aman is right though, don't use those jokers.
get your script and buy online if you can.
bypass the shysters.

[danw61]

why do you guys use dme's?

My insurance pays 100% if I go through the in-network DME. They will NOT reimburse if I buy online or elsewhere even though it would cost them less. I tried to talk them into it... no go.

That's why I use a DME.

[illinigal]

That was going to be my answer too Dan, I have met my out of pocket for the year and now they will pay 100% . I got my check supply today so I am going to pay my old DME the balance of the nasty remark statement I got and start going to another DME . After I have my titration I have already made arrangements to get my new mask..whatever it may be..at a DME recomended by my sleep doc. I have only been to see him 3 times but I am very impressed and he says this store meets his standards and works with him all the time. Interestingly enough, despite some of the things said by the DME I am currently using and the annoyance to me of their billing dept...I have an excellant cpap unit! As said by Blackneto and others it was more than if I had bought online..but not not as much as you think..only about $300 more. I say only because I have helped my elderly in-laws with their medicare and DME for equipment and saw the EOB where the DME had billed medicare for a walker exactly like the one I had bought for my sister when she had a broken hip and was in rehab. Medicare was billed over $500 more than what I had paid at our local drugstore !

And another reason ..cuz I was a newbie and didn't know no better !

Illinigal