DME DID NOT FOLLOW ORDER

[onesight1]

first off, id like to say that I am a sleep technician. After hearing about my dads symptoms from my mother, i finally got him to come and have a PSG at my lab. He was severe, qualified for Split Night Protocol, and had much success with PAP treatment.

However, he lives far from me... states away.
I faxed him everything he needed to go to his local DME company, Apria.
i sent a script for 14cmh2o with cflex 2 + heated humidification for nasal dryness.

i also had his referring physician send a script saying " RESMED S8 ELITE II W/ Heated Humidification"
i personally called and spoke to Apria about the machine, and why it was chosen and needed.

....days go by... DAD calls me.. "hey! i got my machine in! Respironics REMstar M series, good right?"

WTF. why would the DME do this.
I called insurance and asked if there was any problem covering the RESMED machine... they said absolutely not, the only reason they couldve sent another is if maybe they didnt carry it.... ( i called Apria before i even sent the script and they said they did carry it... they were great via phone"


so they mail my father this shit machine, and a few papers on how to turn it on.... why would they not follow specific orders?

what can my father do ? just go back and raise hell and show the papers stating he needs the s8 ELite II? .... what can the DME company do in return?..

also, i know an Apria rep near my house.... maybe i can just go and speak with him and have him issue me the CORRECT order and mail my dad that machine... and have my dad take his current REMstar back to his Local Apria DME.



i finally understand why people always have problems with DME, its like pulling teeth to get what you want.


any input?

i dont even think the REMstar basic has cflex... and the data collectiong isnt anything as good as theeasy to check daily RESMED ( AI/HI/LEAK/USAUGE)

[Muse-Inc]

Welcome to the "DME didn't get it right" club ! Tell your dad to have a fit & demand what the script was written for; can he take the equipment there and dump it on their desk and then have a fit...that'd be even better. Best would be you (go visit dad) take the equipment there, dump it on their desk, and have a fit, get the Elite II, decent mask or 2 for dad, instruct dad on how to use & clean equipment and check the masks for fit and comfort.

[harry33]

I guess he gets a higher commission from remstar, what dont you like about their CPAPs?

[Gerryk]

First off I would find out what the state laws are for changing a written prescription in the state your father lives in. Call the insurance company back and explain things to them again to make sure they will cover the machine the script was written for then have them fax that to you saying the machine will be covered if they will or just get first and last names and get extension numbers.
Then call the DME and tell them who you are and ask why they didn't follow the script? Tell them you want the correct machine shipped immediately. Depending on what the state law is you may have legal recourse, but remember your father who lives a long ways from you will have to deal with them in the future unless you find a different DME for him.

Best of luck....

Do you have any pt's who use the new PR1 system? Just wondering if anyone has the software to read the data. I understand some DME's don't have the capability to get the data from these machine but they are selling them to pt's.


Let us know how things go

Gerry

[onesight1]

as of right now, no we do not have any patients that i know of using the PR1 system, time will tell though

[Wulfman]

first off, id like to say that I am a sleep technician. After hearing about my dads symptoms from my mother, i finally got him to come and have a PSG at my lab. He was severe, qualified for Split Night Protocol, and had much success with PAP treatment.

However, he lives far from me... states away.
I faxed him everything he needed to go to his local DME company, Apria.
i sent a script for 14cmh2o with cflex 2 + heated humidification for nasal dryness.

i also had his referring physician send a script saying " RESMED S8 ELITE II W/ Heated Humidification"
i personally called and spoke to Apria about the machine, and why it was chosen and needed.

....days go by... DAD calls me.. "hey! i got my machine in! Respironics REMstar M series, good right?"

WTF. why would the DME do this.
I called insurance and asked if there was any problem covering the RESMED machine... they said absolutely not, the only reason they couldve sent another is if maybe they didnt carry it.... ( i called Apria before i even sent the script and they said they did carry it... they were great via phone"


so they mail my father this shit machine, and a few papers on how to turn it on.... why would they not follow specific orders?

what can my father do ? just go back and raise hell and show the papers stating he needs the s8 ELite II? .... what can the DME company do in return?..

also, i know an Apria rep near my house.... maybe i can just go and speak with him and have him issue me the CORRECT order and mail my dad that machine... and have my dad take his current REMstar back to his Local Apria DME.



i finally understand why people always have problems with DME, its like pulling teeth to get what you want.


any input?

i dont even think the REMstar basic has cflex... and the data collectiong isnt anything as good as theeasy to check daily RESMED ( AI/HI/LEAK/USAUGE)

There's a contradiction there......in that the ResMed machines don't have C-Flex. That's a Respironics technology.

I was also under the impression that Apria had a (pretty much) exclusive contract with Respironics. (although I've heard of others getting the ResMed machines from them.....but not without some arm twisting).

Whatever it takes......make sure he gets what you think he needs. (at least a data-capable machine)


Den

[jules]

well if you had a script with cflex in it and expected that to be followed to the letter, then they can't issue an elite

get it all straight (you think), run the rx by this forum, then fight apria with it -

[onesight1]

first off, id like to say that I am a sleep technician. After hearing about my dads symptoms from my mother, i finally got him to come and have a PSG at my lab. He was severe, qualified for Split Night Protocol, and had much success with PAP treatment.

However, he lives far from me... states away.
I faxed him everything he needed to go to his local DME company, Apria.
i sent a script for 14cmh2o with cflex 2 + heated humidification for nasal dryness.

i also had his referring physician send a script saying " RESMED S8 ELITE II W/ Heated Humidification"
i personally called and spoke to Apria about the machine, and why it was chosen and needed.

....days go by... DAD calls me.. "hey! i got my machine in! Respironics REMstar M series, good right?"

WTF. why would the DME do this.
I called insurance and asked if there was any problem covering the RESMED machine... they said absolutely not, the only reason they couldve sent another is if maybe they didnt carry it.... ( i called Apria before i even sent the script and they said they did carry it... they were great via phone"


so they mail my father this shit machine, and a few papers on how to turn it on.... why would they not follow specific orders?

what can my father do ? just go back and raise hell and show the papers stating he needs the s8 ELite II? .... what can the DME company do in return?..

also, i know an Apria rep near my house.... maybe i can just go and speak with him and have him issue me the CORRECT order and mail my dad that machine... and have my dad take his current REMstar back to his Local Apria DME.



i finally understand why people always have problems with DME, its like pulling teeth to get what you want.


any input?

i dont even think the REMstar basic has cflex... and the data collectiong isnt anything as good as theeasy to check daily RESMED ( AI/HI/LEAK/USAUGE)

There's a contradiction there......in that the ResMed machines don't have C-Flex. That's a Respironics technology.

I was also under the impression that Apria had a (pretty much) exclusive contract with Respironics. (although I've heard of others getting the ResMed machines from them.

Whatever it takes......make sure he gets what you think he needs. (at least a data-capable machine)


Den

youre right, however, C-flex = EPR.... resmed uses the EPR. Apria sells both resmed/respironics, and are readily available.

the whats so funny though, is the basic M series DOESNT EVEN HAVE CFLEX.... the basically tossed my father some outdated crap machine to put more $ in their pocket.

[Wulfman]

youre right, however, C-flex = EPR.... resmed uses the EPR. Apria sells both resmed/respironics, and are readily available.

the whats so funny though, is the basic M series DOESNT EVEN HAVE CFLEX.... the basically tossed my father some outdated crap machine to put more $ in their pocket.

Not quite. The C-Flex technology drops the pressure slightly at the beginning of exhale cycle and it's dependent on the exhale effort of the user. With EPR, it drops the exhale pressure by a given centimeter pressure, through the entire exhale cycle, as determined by the EPR number setting.
Therefore, with a pressure of 14 cm. and an EPR setting of "2", your father would only be getting an "effective" pressure of 12 cm. on exhale......it works like a mini Bi-Level machine......where you set the EPAP pressure to where it eliminates most apneas. If the user is subject to experiencing apneas on exhale (at a lower pressure - EPAP), then that would have to be taken into consideration when setting pressures and EPR settings (to compensate for that drop in pressure).


Den

[GumbyCT]

First off I would find out what the state laws are for changing a written prescription in the state your father lives in. Call the insurance company back and explain things to them again to make sure they will cover the machine the script was written for then have them fax that to you saying the machine will be covered if they will or just get first and last names and get extension numbers.
Then call the DME and tell them who you are and ask why they didn't follow the script? Tell them you want the correct machine shipped immediately. Depending on what the state law is you may have legal recourse, but remember your father who lives a long ways from you will have to deal with them in the future unless you find a different DME for him.

In CT most docs don't and won't talk to you about family members unless you have written permission to discuss their "healthcare". I feel certain that Apria will be that way.

If you want more than head bobbing you need to have dad give you the authority. Explain why and that it doesn't revoke his rights in any way.

I used a form I found online at the state's Atty. Generals website and modified it slightly - then only had a problem with one doc.

Health Care Representative
http://www.livingwills-freelegal.org/Co ... ative.html

http://www.ct.gov/ag/lib/ag/health/adva ... arerep.pdf

http://www.google.com/search?hl=en&clie ... f&oq=&aqi=

Edit: Den makes a valid point about why they may NOT have followed the order. Still they should have contacted the doc to get it right.

[onesight1]

Edit: Den makes a valid point about why they may NOT have followed the order. Still they should have contacted the doc to get it right.[/quote]

The referring Doc= very good family friend i work for , and i am the rpsgt who ran study.

but sure, having papers wont hurt.

you right, i can see why they may have mixed it up... HOWEVER.... the machine they sent him DOESNT EVEN HAVE CFLEX as an option... its the remstar BASIC....

[jules]

well what is the insurance?

that determines a lot and they might over ride the doc's script saying these "frills" are not medically necessary

we see people with cases like this all the time on this forum

[onesight1]

youre right, however, C-flex = EPR.... resmed uses the EPR. Apria sells both resmed/respironics, and are readily available.

the whats so funny though, is the basic M series DOESNT EVEN HAVE CFLEX.... the basically tossed my father some outdated crap machine to put more $ in their pocket.

Not quite. The C-Flex technology drops the pressure slightly at the beginning of exhale cycle and it's dependent on the exhale effort of the user. With EPR, it drops the exhale pressure by a given centimeter pressure, through the entire exhale cycle, as determined by the EPR number setting.
Therefore, with a pressure of 14 cm. and an EPR setting of "2", your father would only be getting an "effective" pressure of 12 cm. on exhale......it works like a mini Bi-Level machine......where you set the EPAP pressure to where it eliminates most apneas. If the user is subject to experiencing apneas on exhale (at a lower pressure - EPAP), then that would have to be taken into consideration when setting pressures and EPR settings (to compensate for that drop in pressure).


Den

honestly, the MAIN reason why i even want the Elite II is becuase its a kick ass machine, quiet, visually appealing, small...

and most of all FULLY DATA CAPABLE.

the remstar basic....none of these. i guess it could look nice since its a small black square.

[onesight1]

well what is the insurance?

that determines a lot and they might over ride the doc's script saying these "frills" are not medically necessary

we see people with cases like this all the time on this forum

well as of right now, the insurance said there should not have been a problem.... $50 one-time copay..., insurance pays the monthly... then its his to keep.

[jules]

what plan? medicare? medicaid? BC/BS? CIGNA? etc. and what group