Is the process always the same?

[clitherow]

I just went through a miserable experience, driving all around south Jersey in the rain trying to find a DME to get machines for my husband and I. We both had our studies, and then went back to the doc this week and I got our scripts -- which is written just like the examples given here -- specifies machine, setting, mask type and size.

The first two DMEs I tried were closed, as in, shut down, and one obviously for quite some time. The third (and last in my area) really gave me a hard time -- I had to have my doctor fax them the sleep studies, then they would have to contact my insurance company for approval, and then they would have an RT contact me for an appointment. When I insisted that all the necessary info was on the script (which she hadn't even looked at) she gave me a look like I had two heads. I then asked for my scripts back, and she didn't want to hand them back over. Someone else came over and told her to give them back, while saying, "if she wants to call her doctor...".

I got back in my car, called the insurance company to find out if this was the process. The girl said no authorization was needed to get my machine.

So I've got two more options -- Apria (their headquarters are about 20 minutes away), or a place in Delaware (near hubby's work -- we have BCBSDE).

But, out of experience, are these they same hoops you all have had to jump through, unless you want to pay for it yourself?

[ScrappinMom]

are these they same hoops you all have had to jump through, if you want to pay for it yourself?

No hoops if you're paying for it yourself! Online you only need your rx. If you're paying yourself, definitely check online...MUCH cheaper! In fact, mine was cheaper to pay totally out of pocket online, than the co-insurance to get it from DME.

Sorry you've had such a bad experience. Sadly, it is not unusual.

[clitherow]

Paying for it ourselves is tempting, but we already over 15k/year for my son's therapies that aren't covered by insurance. Adding another $1100-$1200 to that would really hurt, when the machines should be fully covered....

Trying to get Apria on the phone now....

[BleepingBeauty]

I just went through a miserable experience, driving all around south Jersey in the rain trying to find a DME to get machines for my husband and I. We both had our studies, and then went back to the doc this week and I got our scripts -- which is written just like the examples given here -- specifies machine, setting, mask type and size.

<snip>

But, out of experience, are these they same hoops you all have had to jump through, if you want to pay for it yourself?

I didn't experience a lot of hassle in getting my equipment, since my insurance only contracts with one DME; so no choice in the matter unless I want to pay out-of-pocket (in which case I would buy online). The most troublesome aspect of getting my equipment from the DME was the time involved and the lies the DME spewed about the machine I was given and what my insurance would and would not cover.

Perhaps I'm misunderstanding something, but your post is confusing. You talk about insurance, and then talk about paying for the equipment yourself. If you're paying out-of-pocket, why bother with a DME at all? Just buy your equipment online and save yourself a wad of cash and a lot of aggravation.

[LinkC]

I assumed she left a "don't" out of the "pay for it yourself" phrase, since she'd already mentioned insurance.

[jweeks]

Paying for it ourselves is tempting, but we already over 15k/year for my son's therapies that aren't covered by insurance. Adding another $1100-$1200 to that would really hurt, when the machines should be fully covered....

Hi,

Check into getting used machines. There are places that sell used machines over the Internet. They clean them up and test them first, so there shouldn't be an icky factor. Look for something with less than 500 blower hours on it. In my case, my DME had a used machine with 400 hours. It was 1/5 of the normal cost. Even if you get the machine via insurance, you may want to get the hose, mask, and extra filters on-line. Those will almost certainly be less than your co-pay. For example, my DME wanted $80 for a hose. The co-pay was $28. I paid $10 on-line.

-john-

[cflame1]

Also check cpapauction... some of the machines on there are new.

[jules]

The whole thing is -

you pay you get to determine what the DME gets - of course they will want their money up front and need an rx

your insurance pays on it - well - the DME can ask you to fly to the moon and pick up some green cheese along the way - a DME will want to make sure the insurance will be paying for the machine before they let it out the door - a copy of the diagnostic PSG is pretty standard - some will want more - some DME's want to get insurance to preauthorize

it sounds like you didn't do all your homework before contacting a DME to find out what machines they carried and what hoops you would have to jump through to get them to allow you to use their services

Like BB, I didn't have a lot of choice - only one DME in the area that did CPAP when I started. The DME had to locate my PSG from several years before in another state; even the sleep doc here wasn't able to obtain it on a release. I talked to the RT extensively about what machines they had, what could be obtained with my Rx, and took that information home to find out which one I wanted. The Rx I took in wasn't the one used as once I had that Rx in place the sleep doc decided to write one himself - oh it was a mess too, but that RT did a lot of leg work to make that sale. She knew if I ran into hassles I was going to buy online and dump them. Of course I did dump them in time.

[clitherow]

After adding up all our out-of-network medical expenses for the year, I decided to order our machines from cpap.com instead of going through the DME. There were a number of factors in the decision, but in the end it was a gut feeling that I wasn't going to be happy with the DME process and waits, etc. Had a long talk with my hubby about the stresses on the family (I've been very short-fused lately, because I haven't had a chance to nap in weeks), and we decided the quicker route was worth the expense, and overall the total purchases end up meeting our out-of-network deductible for the year.

So hopefully the two of us will be hooked this weekend and sleeping better....

[ScrappinMom]

So happy you are going to be sleeping restful sleep soon! Sometimes things just need a face to face talk through for us to be able to figure them out! I know you'll be happy with your decision. And you're right, sometimes reduced stress and aggravation with worth a lot more than $$.

Good luck!