DME Problem

possum · Post by **possum** » Sat Oct 20, 2012 7:04 pm

I recently changed my DME to a company My doctor owns. I was told by my doctor that it would be better because the DME is in house and could help me with new masks and supplies when I had my regular Dr visits. Well I was 2 days away from insurance co covering a new mask and the DME said he would hold the billing a few days so insurance would cover it and gave me a new mask. Well his billing department did not wait and submitted bill to Blue Cross. A few weeks later I got a letter from Blue Cross saying they would not cover the 460.00 bill for the Mirage Quatro fx I guess because I was a couple of days shy of the 3 month replacement. I felt that was expensive but I know how the DME jacks the price up to the insurance co. I called the DME and he said he would take care of it. Well he didn't and I got a bill the other day from his office for the 460.00 now I can't get a hold of him to correct the problem. I think I will go back to original DME because they at least got the billing correct. Any advice how I can get Blue Cross to cover it?

chunkyfrog · Post by **chunkyfrog** » Sat Oct 20, 2012 7:12 pm

I quit buying in network. They want $460 for this mask?
https://www.cpap.com/productpage/resmed ... dgear.html

possum · Post by **possum** » Sat Oct 20, 2012 7:15 pm

Yep, The DME guy thought it was high also. I think once it goes to there billing office he is out of the loop.

LSAT · Post by **LSAT** » Sat Oct 20, 2012 7:55 pm

possum wrote:Yep, The DME guy thought it was high also. I think once it goes to there billing office he is out of the loop.

Since he did not keep his part of the bargain...return it. DON'T pay it. I would NEVER use a DME that was associated with my doctor. First of all, After my initial consult with a 'sleep doctor'...I have never seen him again. I was not necessary.

Janknitz · Post by **Janknitz** » Sat Oct 20, 2012 11:45 pm

Your doctor owns this company?
Can you spell "conflict of interest"???

I would write a formal complaint to your physician and demand immediate correction of your bill (polite, but firm). And find another doctor--as long as your doctor sees dollar signs your treatment is compromised.

ughwhatname · Post by **ughwhatname** » Sat Oct 20, 2012 11:56 pm

My doctor co-owns a CPAP equipment company with his wife. He never told me that, nor steered me in that direction. I happened to find out by doing a DME search in my area. I just put two and two together.

I'll see if he tries to refer me there, I'd see that as a conflict, much like the orthopedic surgeon who sent me to continual physical therapy... at his PT office nearby. One of the PTs revealed that during my treatment.

Janknitz wrote:Your doctor owns this company?
Can you spell "conflict of interest"???

I would write a formal complaint to your physician and demand immediate correction of your bill (polite, but firm). And find another doctor--as long as your doctor sees dollar signs your treatment is compromised.

DiverCTHunter · Post by **DiverCTHunter** » Mon Oct 22, 2012 8:45 am

ughwhatname wrote:My doctor co-owns a CPAP equipment company with his wife. He never told me that, nor steered me in that direction. I happened to find out by doing a DME search in my area. I just put two and two together.

I'll see if he tries to refer me there, I'd see that as a conflict, much like the orthopedic surgeon who sent me to continual physical therapy... at his PT office nearby. One of the PTs revealed that during my treatment.

Janknitz wrote:Your doctor owns this company?
Can you spell "conflict of interest"???

I would write a formal complaint to your physician and demand immediate correction of your bill (polite, but firm). And find another doctor--as long as your doctor sees dollar signs your treatment is compromised.

Amen to both points. Even if you get a well-meaning doc, the DME billing side of the business has to be handled separately to avoid conflict of interest. As for in-network vs out-of-network, it's a complete crock. I did a cost-benefit analysis and by the time you get done with deductibles & co-pays it's cheaper to buy online.

archangle · Post by **archangle** » Mon Oct 22, 2012 9:09 am

Even if you have the best of motives, we tend to see the things that make us profit. For instance, if you're the one whose pocketbook gets hit if you dispense a fully data capable auto CPAP, you tend to rationalize that the manual brick CPAP will give good therapy to the patient.

Conflict of interest doesn't have to involve deliberate actions. We tend to see the good in things that are profitable to us and see the evil in things that cost us money.

Your doctor will make better decisions if his financial best interest doesn't conflict with the patient's.

possum · Post by **possum** » Tue Oct 23, 2012 11:48 am

Good news. After calling the DME 5 times a day he finally called back and apologized for the error and said to disregard the bill. Even though he said that I think I will go back to my previous DME and I am thinking about looking into a new Doctor, I don't need the aggravation. Thank you all for your help and support.

chunkyfrog · Post by **chunkyfrog** » Tue Oct 23, 2012 1:24 pm

I agree, lip service is cheap.
To quote Ben Franklin," He had little to offer, but gave expectations."

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