More DME Games

[Sal_In_Ga]

I was able to secure a new ResMed S9 Auto set because I've been studying with you all.
Late June - Called Ins. co to find out when I would be eligible for a new machine (I had been prowling around in Ins booklet for other benefits and it looked like 3 yrs. to me). The rep. told me that my policy would allow for a new machine every 3yrs., that I could have Cpap or Apap, and that it was the best time to buy one since I had met my out of pocket due to a surgery I had earlier this year. I called the Dr. to see about getting the S9 AutoSet. What do you need to see him about? (Don't you just love it when the receptionist want's your diagnosis(from you) before you can make an appointment to find out what's wrong with you so she can tell the Dr? OOPS! I digress.).
Can't see him for a month. I then called the DME Dept of the Pulmonary Clinic and told them I wanted to order a ResMed S9 Auto set and that my Ins. Co had told me that I was eligible 100%. The girl in the Dept that handles supplies has been a big help in my adjusting of my mask, etc. With much stammering, she began with the questions:
Me: "I want a new machine and I want an S9 autoset. It's the best out there (The pulmonary clinic only sells ResMed), my S8 Elite will then become my backup machine. I've already talked to my Ins. Co and they told me I was eligible for a new machine. Plus, I have reached my out of pocket and this is the only opportunity I may have to get a new the machine.
Me: " I tried to get an appointment with Dr.__ , but He's not available for another month. So I called you. I want to order a ResMed S9 AutoSet"
C: "Why do you want an autoset?"
Me: "I want a new machine and I want an S9 AutoSet. The S9 AutoSet is the best out there (The pulmonary clinic only sells ResMed), my S8 Elite will then become my backup machine. I've already talked to my Ins. Co and they told me I was eligible for a new machine. Plus, I have reached my out of pocket and this is the only opportunity I may have to get a new the machine.
C: "Just because your Ins. co told you you were eligible for a new machine doesn't mean you can just get it. You would have to have a new prescription for it.
Me: "An autoset can also be run as a straight Cpap, right? Then it doesn't require a new prescription.
C: "Uh...yes, it is a Cpap" (Hello!)
Me: "Then an Rx is not required."
C: "You'll need a letter of medical necessity."
Me: "What for?"
C: "Well, I'll talk to R _____(DME Director) and I'll call you.

Within a week I received chipper call from C: "Well, your S9 is ready for you to pick up. Your Ins. approved it 100%, When would you like to come?" she sang.

This was fun.

[Sal_In_Ga]

Well, I forgot to ask for a written Rx after the earlier go-round, - I like to have my Rx with my machine and since we are to vacation out of state I figured I could get without a lot of trouble. So I call my pal C and tell her what I need. She can't handle that for me - she would transfer me to Dr__'s nurse.
Yep. Here we go again.
N: " Now, what is it you want?"
Me: "A prescription for my S9 AutoSet"
N: "Why do you want the RX? Your insurance isn't going to pay for another machine."
Me: I don't want another machine. Did Dr.___have to write an Rx for my machine?"
N: "He had to write a letter of medical necessity." (No one has yet told me to whom he had to write the letter. Ins. co I guess?)
Me: "I see. Well I want an Rx for my new machine, please."
N: "You have an appointment with R____on the 12th.
By this time I had lost track that It's my right to the Rx.
Me:"I want to have to keep in my bag. I'll be traveling out of state next week. If something happens to my machine I can't just bob over to your place
and say "OK,Guys. I need a machine mine is toast." I can't just go into a DME and even rent a machine with an RX."
N: "Ok, you want an Rx for an S9"
Me: "S9 AutoSet with all supplies and mask of patient's choice."
(Before I could actually finish my sentence):
N: "I've written this down and will give it to Dr____. Do you want to pick it up or me mail it to you?"
Me: "Just mail it will be fine."

[firedog66]

Congrats on choosing the S9. I have had mine for three months and absolutly love it. I am always amazed when the "experts" have no idea what they are doing!

[Janknitz]

Whoo Hoo! Sounds like it's Sal 2, DME 0. I like it when our side wins

[DoriC]

Power to the People!! Good job!

[Sal_In_Ga]

Somewhere early on in the scenario with the nurse, I failed to include the part about the sleep study:
Me: ".....an Rx for my S9 AutoSet.
N: "You will have to have a sleep study.
M: "Why? I've already had a sleep study. I use a Cpap.
N: "Then why do you need an Rx?"
Etc., etc, etc.................

Where do these people come from?

Would like to have been a fly on the wall to see those two 'professionals' frustrated by a little old lady. I didn't mean to be mean to anybody, really. My day finally came around, though.

Thanks to all on the board for you knowledge and willingness to share it with all of us.

[Sillyme]

Where do these people come from?

I hope these discussions will help people new to CPAP to get proper equipment. Unfortunately, you don't look for help until you have a problem and once you sign for equipment it can be a real mess and involve interruption of therapy while waiting for a new machine (and charges for non-returnables). Most people just accept what they are given without question and do little or no research. I'll bet this has a lot to do with the low compliance figures. I think we're a bunch of troublemakers.

[Sal_In_Ga]

Where do these people come from?

I hope these discussions will help people new to CPAP to get proper equipment...... Most people just accept what they are given without question and do little or no research. I'll bet this has a lot to do with the low compliance figures. I think we're a bunch of troublemakers.

I was such a zombie when was diagnosed that I had no clue. I was very fortunate in that the Dr./Clinic sold me an excellent machine to start with. I was told that Resmed was the best and that they didn't sell anything else. After three years using the S8, and much research via this forum and the internet, I am much more confident and feel that I have more control of my health. Add to that a PCP who loves what he does and does his job very well. He ordered the sleep study because of my complaints and vain attempts to correct my sleepiness. He knows that I research on the internet and even listens to my diagnoses and remedies. humidifier a bit.

Get this- when I picked up my S9, it was set to Apap with the range wide open.?? Mmmmmm. The Cpap was set to 9, which the PA had ordered to be raised from 8 (RT got to do the setting.). I asked if I could change it back if it didn't seem to help. Answer: "Yes". When I went back for a follow up, I saw the Dr. and told him that I could see no difference and that I had changed it back. Guess the RT didn't get the word.

I've been looking for the charge for the S9 on my Ins. since July. I asked my pal C (who also takes care of such ins. filings for DME) about it. She checked and discovered that she had entered a 2011 date for the filing. Oh My! I would have had to exercise my Power once again to get that straightened out.

[DHC]

Where do these people come from?

I hope these discussions will help people new to CPAP to get proper equipment. Unfortunately, you don't look for help until you have a problem and once you sign for equipment it can be a real mess and involve interruption of therapy while waiting for a new machine (and charges for non-returnables). Most people just accept what they are given without question and do little or no research. I'll bet this has a lot to do with the low compliance figures. I think we're a bunch of troublemakers.

I was reading through these very posts today when talking with the sleep center who originally gave me the REMstar Plus M series less than a year ago. Apparently I am eligible for a new device, and they already contacted my insurance company to get approval - which was given. They told me they again wanted to give me a lower model with straight CPAP - and I explained how disappointed I am that they gave me an "inferior machine" the first time - provided no discussion of alternatives - and left me with a device that was obsolete the day I walked out of their offices with it. They finally relented, but only after telling me at various points in the conversation that I needed a new prescription or a new study. I finally told them I already had my local PCP write up a current prescription (all true - using the template prescription form our hosts provide), and read the scrip to them - including the identical insurance code for EITHER CPAP or APAP. I then left them with the choice that they can fulfill my needs with the approval already provided by my insurance company, or I will find someone that will.

They called back a while later to tell me they would supply me the S9 Autoset I requested - though they would need to program it in CPAP mode at my original settings. I even told her I would access the clinician's menu and change it back, so I do not mind them configuring it that way so long as they send the machine I want - and they agreed.

It is largely due to this forum I've been able to educate myself enough to know the games they play, and how to counteract them.

And to the point about low compliance being at least somewhat due to the DME's dispensing low-end equipment, that is exactly what happened in my case - and it wasn't till nearly a year later that I learned about it. I won't make that mistake again - and won't let the DME off with giving me half-baked equipment.

Thanks!

[Sillyme]

[/quote]It is largely due to this forum I've been able to educate myself enough to know the games they play, and how to counteract them.[/quote]

Very glad to hear that our rantings did some good. I know these companies need to make money and they have to accept what the insurance companies will pay them. But I think most of us would pay extra to get what we want or need. If they'd just be up front about it . . . It's the lies and deceit that get to me.

[rested gal]

Good going, DHC!

And you, too, Sal.

I imagine that for most DMEs, to hear a "patient" (I hate that word...I think of myself as a "CPAP user") express a preference for a type of machine or certain brand/model is much like hearing a cow open its mouth and start talking.

Most of their "patients" probably file through like cattle, accepting whatever is given to them unquestioningly. It's a shock, I'm sure, to hear a CPAP user (or better yet, a potential user) calmly say, "No, thank you. I don't want an Escape. Do you have an Elite II?" Or, "No, I don't want a Plus. Do you have a Pro?"

Or, really throwing them for a loop... "No, I don't want that CPAP. I want the autotitrating model which is the same E0601 billing code. You can set it for CPAP mode at my prescribed pressure."

[DoriC]

"And also has data capability so I can monitor my own therapy"!! OMG

[Breathe Jimbo]

"And I already have the Clinician's Manual that came with the device, so you can keep that one."

[Junebug999]

thank you for this thread. I'm going to see the sleep doc in the a.m. about the results of my study on 9/6. I'm still exhausted and so sleep I caught myself tryint to doze on the freeway on Tues. morning. You have given me more info I hope will help in dealing with sleep doc, sleep doc's staff (who seemed a whole lot more agreeable and helpful when I was picking between their clinic and another cilnic than they do now), the DME, and the insurance company. hopefully all this info will help me figure this out too....thanks for posting!

[rested gal]

Good luck with your doctor's visit, June.

Here's a link that might be helpful to you when the time comes to accept (or reject) whatever machine the DME tries to give you. You'll want a machine that can record leak and AHI info. The ones in blue do that:


My list of machines that record "full data" (AHI and leak info) and those that don't -- updated through March 2010:
viewtopic.php?p=307168#p307168

And in case the DME tries to convince you that a machine provides "data" simply because it happens to have a card stuck in it:
viewtopic.php?p=344265#p344265

For some entertaining reading about that:
check out LinkC's post on page 2 of this thread:
viewtopic.php?p=342111#p342111
And roster (rooster)'s post on page 3 of that same thread.