Pressured by doctor to buy local

[chipschap]

Please excuse if this topic has been discussed frequently--- a search didn't find it, though.

I live in Honolulu. The doctor who prescribed the CPAP for me pushed very hard to get me to buy local. He "quoted" (not very well) problems patients who bought from the internet have had. In the end, he didn't even give me the prescription, just a list of local suppliers, telling me to choose one and call his office, and they'd fax the prescription to the one I choose.

Opinions? I really don't like the way this is going ... and I am more than willing to insist that his office fax the prescription to the supplier of my choice .. and make a very big deal out of it if necessary.

Of course, to say he's getting a kickback is presumptive; I know nothing of the kind.

But the whole thing is not pleasing.

Any thoughts about this, and about local vs. online purchase?

I'm guessing that buying local, especially in Hawaii, is going to be way, way more expensive.

[cpapernewbie]

If you want to buy from the web merchants, you need some more time to educate yourself.
1. type of machines are available and its manufacturers
2. which one is suitable for you
3. which mask is suitable for you
4. which web merchant to buy from
5. how to setup the CPAP
6. how to monitor your progress from daily reports

I do not have insurance and sleep doctor, it took me months to read through this forum and 3 other forums and learn enough to buy from CPAP web merchants and Craiglist

[spinifex]

I first went online and checked out the prices, including postage.
Since i knew which type of machine i needed, apap in my case, i kept googling till i had 3 prices, including a happy average for masks.
I picked up my S9 Autoset on monday from the sleep clinic $500 cheaper than they quoted, cause i told them i could get it cheaper online.
I also gave them the websites so they could check for themselves. I also said i did not want to go the internet way, but seeing how i was pretty much broke, they left me NO choice.
They dropped the price to just above internet prices, which was fine by me, as i still made a big saving.

So in a nut shell. Google to get some prices, then check your local prices. Be ready for them.
Wish you well in your pursuit of a fair price.

Jon

[Slartybartfast]

The doctor who prescribed the CPAP for me pushed very hard to get me to buy local. [snip]

I'll go you one better. My doctor's office WAS the supplier. The sleep doc wrote the prescription, handed it to the sleep tech who started unwrapping a new S9 CPAP, then the doc headed down the hall to his next patient. I went 'round and 'round with the sleep tech about wanting an automatic machine. But then he totally blew it when he said, "Look I've been doing this for 20 years." In other words, "Shut up and take what we give you." So I firmly said "no" and left the office, and told the front office gal on my way out that I'd be calling later for my prescription. She said no problem-o, or words to that effect.

I placed my order with cpap.com the next afternoon, had them request the prescription, which they did, and I had my new ResMed S9 Autoset within a few days.

You don't have to put up with that stuff.

[allen476]

Well since you are in Honolulu, I would imagine that there is more than one sleep doctor. Call his office and ask that your sleep study and cpap titration report be copied so that you can pick them up. If they ask why, tell them the truth, that you won't be pressured to buy from someone on a list and that you are switching to a new doctor. And don't let them BS you about you not being able to have a copy. Call your insurance company and find out what is covered and if you have to go to a certain DME to maintain coverage. If you don't have insurance, then the decision is all yours.

If there are only a few (3-4) places on this list, then I would highly suspect a kickback situation exists between them and the doctor. If it is all of the places listed in the yellow pages, then maybe not.

I would be leery and skeptical of this person. He doesn't have your best interest in mind if he is doing this. If he did, then he would let you get your machine anywhere and then ask you to bring it in to make sure that the settings are correct.

Allen

[jonquiljo]

If there are only a few (3-4) places on this list, then I would highly suspect a kickback situation exists between them and the doctor. If it is all of the places listed in the yellow pages, then maybe not.

Sorry, but your Dr. sounds like an ass. He is either getting a kickback or one hell of an opinionated SOB. Either way it sounds like he does not have your interests covered. I wouldn't trust any Dr. who does not trust his or her patients to take care of themselves beyond a point. What was his beef with people buying online? If you have insurance that will pay for a local supplier - go ahead - but if you don't then this guy has no regard for your wishes. The fact that he wouldn't give you a prescription directly speaks volumes about this person. And yes, if you paid two or three times to buy locally what you can pay on the Internet - I would say you were lucky.

Well, Honolulu is a big town - so I bet there are many other physicians to choose from. Good luck.

[Slinky]

First and foremost be aware that online suppliers do NOT take insurance, you must purchase out of pocket. And most insurances will NOT reimburse you for that out-of-pocket expense. So if you have insurance your first step is to call them to verify if you have out-of-network coverage for a CPAP and accessories and if and how much they will reimburse you if you buy online. You should also ask your insurance what local DME CPAP providers they are contracted with. They would be your "in network" suppliers.

Next, you should be aware that that prescription is part of your medical records and that you have a LEGAL RIGHT to a copy of that prescription under HIPAA. You NEED a copy of the prescription to buy online or from a local DME provider.

Therefore, whether you buy locally or online you would be wise to send a WRITTEN request to this sleep doctor for a copy of
1] his dictated results from any and all in-lab sleep tests you had
2] the full scored data summary report w/condensed graphs from any and all sleep tests you had
3] the equpiment order (prescription) for a CPAP

There's nothing like a paper trail to inspire the medical profession to be more responsive to your requests! If they don't comply YOU have PROOF of their non-compliance and basis for HIPAA complaint action.

[carbonman]

If I can get that in an apap,
will you buy today?

[Janknitz]

You can buy wherever you choose, but you must understand that you may not get insurance to cover your online purchases.

The other thing to watch out for is postage. We lived on the Big Island years ago and mail order was often not cost effective because even places that offered "free shipping" limited it to the continental US. Sometimes the shipping was more than the product unless you can persuade the sender to use US mail.

Good luck!

[chipschap]

Thanks to everyone for the great advice. I'll be verifying everything with my insurance and studying the market for a while before jumping in. I'll also definitely be requiring the doctor to give me a copy of the prescription and study results.

As to shipping to Hawaii, that can be a problem for sure in terms of cost. cpap.com offers free shipping to all 50 states by UPS ground. That's what they say on the website! I'll of course check with them too, as the bridge from San Diego to the island of Oahu isn't quite finished yet

[chunkyfrog]

Shipping--the cost of living in Paradise!

[Roman Hokie]

You can buy wherever you choose, but you must understand that you may not get insurance to cover your online purchases.

The other thing to watch out for is postage. We lived on the Big Island years ago and mail order was often not cost effective because even places that offered "free shipping" limited it to the continental US. Sometimes the shipping was more than the product unless you can persuade the sender to use US mail.

Good luck!

Having done the shipping research several years ago, competing UPS and USPS for my Christmas gift-shipping business, I came to the conclusion that, on average (and based on zip codes), shipping something Parcel Post was less expensive than UPS Ground provided the package was 3lbs or less. CPAP hardware would be better shipped (if you could ground it on that San Diego to Oahu bridge!) UPS Ground, but supplies, probably would be less expensive USPS. USPS offers Priority Shipping for flat fee (and supplies should fit in those boxes) for probably cheaper than UPS Blue (2-day service) because UPS air freight includes a "dimension calculation" that results in the greater of the actual weight and L*W*H/194 as your "shipping weight". So, if a package weighs 2lbs but the L*W*H/194 is 5lbs, you pay to ship 3lbs of "air" with your 2lb package.

http://www.shippingsidekick.com/getrates.wml is a decent site to get you more information on pricing between UPS, FedEx, and USPS. I tried an origin of 76502 (TX) to Honolulu (HI - can't remember the ZIP code) and 3# with scheduled pickup, residential delivery and using the carrier's packaging. USPS was SLOW for Parcel Post but could make it Small Flat Rate box for $4.95 priority. If shipped today, it would get there Monday. UPS, on the other hand, would charge $35 to get there Monday and $25 by Ground on Wednesday.

My guessing is that UPS Ground to Hawaii is more intermodal transportation. Using a combination of planes and automobiles. Probably driven to SD and flown to Honolulu.

USPS Priority Flat Rate boxes are the best deal. You'll have to pay extra for tracking and delivery confirmation. Still MUCH cheaper than FedEx and UPS.

Blessings.

[chipschap]

USPS Priority Flat Rate boxes are the best deal. You'll have to pay extra for tracking and delivery confirmation. Still MUCH cheaper than FedEx and UPS.

And it turns out that for this very reason, Hawaii is the largest user of the flat-rate priority USPS service in the nation. But some vendors just *won't* vary their shipping routine and insist on 2nd day air because they only deal with UPS or FedEx.

To get back on topic here, (1) the doctor's office gave me a list of 3 vendors on-island and said, "These are your only choices on the island." Ha. Two minutes of internet research turned up three more possible CPAP vendors, including a pure rental place, and I didn't even finish the search.

The other thing he told me is that the vendor I choose will order the equipment and let me know when to pick it up. In other words, they don't stock. Want to guess who pays the shipping when ordering?

Seems like a sweet deal all around for everyone except the patient.

[Roman Hokie]

Dude, that's complete crap. Remind your doctor of HIPAA and the patients' bill of rights. Accuse him of limiting free trade in America if you need to.

He's full of shit.

[Janknitz]

Don't forget the insurance factor. When I lived there, insurance offerings were very limited--HMSA (are they still around?) and a few other private policies. Maybe your doctor meant for your insurance these were the only DME's that were covered???