Finally! DME Appointment Tomorrow

[jb1654]

So this was me --> viewtopic.php?f=1&t=92311&p=851133#p851133

I'm finally upon the day that I go to the DME to pick out/up my machine. I know what I want (S9 AutoSet™ w/Humidifier) now I'll just have to see if they give it to me. (They tried to give me an escape over the phone) When I got my first machine they just brought whatever they wanted me to have to my house and set it up for me, but I figure by coming down to their office, I'll have more say in what I get.

I've armed myself with information directly from my insurance company (Aetna) about deductibles, their whole rent-to-own program, and info about how often supplies can be replaced and what that will cost me each time. I'll have my original Rx in hand and am prepared to make them show me the "Run Hours" on any machine they want me to take home so I can verify it's new and not a refurb. I'm also prepared to make for the door if they can't give me what I want.

I have a question though. What if they say they don't carry that type of machine? Am I just forced to find a new DME or can they order it?

I did a bunch of research about DMEs on this forum after my last post, but I just want to make sure I have all of the information I need before driving 45 mins away to get to their office tomorrow morning.

[StuUnderPressure]

If they don't carry the machine you want, they can always order it.

But some DMEs will NOT do that because they sell very few or none of ResMed & their actual cost would be much greater than some DME who regularly buys ResMed.

I would confirm with them that they do have or can order that machine for you.

And, if they have to order it, I would NOT go in until they call you to verify that it is in.

Even at that point, I would make them confirm to you on the telephone that it is exactly what you want.

[Babette]

Snort! I gave up on brick and mortar DME's in 2007. I get better service and cheaper prices from https://www.cpap.com

However, my insurance will only reimburse me a small percentage of the price I pay there, vs. paying 100% for the over-inflated prices of a brick and mortar DME.

If you can afford that, I highly recommend using https://www.cpap.com

If you cannot, I feel very sorry for you and wish you the best with your brick & mortar DME.
B.

[jb1654]

I would confirm with them that they do have or can order that machine for you.

And, if they have to order it, I would NOT go in until they call you to verify that it is in.

Even at that point, I would make them confirm to you on the telephone that it is exactly what you want.

I just called the DME and they told me that since my Rx lists a CPAP with one pressure (7cm) they will not give me an S9 AutoSet. I called my doctor's office but of course they close at noon on Friday's.

Is this one of their tricks?

[Babette]

Not really. Your scrip has to say APAP or Auto to get that type of machine. It's a drug-regulation thing.

The downside is that unless your scrip says CPAP or Auto, you can't buy a LESSER machine! Wanted to buy a cheap travel cpap last year, but my scrip said APAP, so I had to upgrade to the auto. Oh well, it's working well for me.

Get your doc to upgrade your scrip. Shouldn't be any problem at all. They can probably email or fax it to you, or send it directly to your DME for you.

Cheers,
B.

[StuUnderPressure]

I would confirm with them that they do have or can order that machine for you.

And, if they have to order it, I would NOT go in until they call you to verify that it is in.

Even at that point, I would make them confirm to you on the telephone that it is exactly what you want.

I just called the DME and they told me that since my Rx lists a CPAP with one pressure (7cm) they will not give me an S9 AutoSet. I called my doctor's office but of course they close at noon on Friday's.

Is this one of their tricks?

Yep, with that RX, the best you could do would be the Elite.

Instead, get your RX changed to reflect a range of pressure.
I would even get the RX to specifically read ResMed S9 AutoSet.

Pick up the new RX so that you have it, make copies of it, & only give a copy to the DME.
They will just scan the RX into their system anyway, so they really don't need the original.
But, don't tell them it is a copy, otherwise they will insist on the original.

That way, if they try to give you another machine, you can just leave & not have to beg them for the original RX.

[jb1654]

Thanks for the info everyone!

I cancelled my appointment for tomorrow so I can speak with the Doctor's office on Monday.

[Uncle_Bob]

I would confirm with them that they do have or can order that machine for you.

And, if they have to order it, I would NOT go in until they call you to verify that it is in.

Even at that point, I would make them confirm to you on the telephone that it is exactly what you want.

I just called the DME and they told me that since my Rx lists a CPAP with one pressure (7cm) they will not give me an S9 AutoSet. I called my doctor's office but of course they close at noon on Friday's.

Is this one of their tricks?

Don't give in.

Tell them that the Autoset can be set to CPAP mode and run at a pressure of 7cm.
Tell them that the autoset and cpap are billed using the same insurance code.
Tell them you want whats best for you and you have no interested on them maximizing their profits.

Or you could just fax your Rx into cpap.com order an S9 Autoset and bill the insurance yourself.

~UB

[chunkyfrog]

Get the doctor to insist on leak data.
This can tell you whether your cushion or pillows are no longer performing.
The Smiley face is not accurate!

[Janknitz]

1. If they carry the Escape they carry ResMed products and can order the Autoset.

2. There is no law that says that they cannot give you the Autoset if your RX is for a fixed pressure. All they have to do is set your machine for a fixed pressure. It IS one of their tactics not to give you the more expensive machine. An RX that specifies an APAP or leak data is helpful, but not required by any law. But it's much easier to have the specific RX than argue with them until the "cows come home".

Good luck!

[hueyville]

While my insurance is very expensive as I chose the best plan BC/BS had at time over 20 years ago. Maximum 1,500 out of pocket per year and only six copays per year. Thus far they have paid for anything my doctor orders. I get a new mask every quarter, filters every month, chin straps, heated hoses, etc. Allowed up to six sleep studies per year. I was worried when doctor said switching me to ASV or similar and since my diagnosis 2 years 7 months ago they have bought me two machines already. First a cpap then the bipap with biflex. Called them today to ask and was assured they would pay 100% if doctor orders this year. After January 1st my 1,500 deductible kicks in again. I get to now pay the Obama luxury tax on our plan as it not fair to rest that we chose good insurance instead of a new car every 5 years. I like my plan. When wrecked my motorcycle my primary requested an orthopod from another state and since I was messed up bad fhey flew him to me rather than discomfort me by moving me. We have not been to a restaurant in over a year, no movies in a decade, drive good used trucks, no premium cable channels and use the savings to pay for best insurance. Now that we are needing it wortb every dime. The weeks I was in hospital following moto crash they even covered a minisuite at hospital with small bedroom for wife and sktting area for guests. I have zero complaints thus far as nothing any doctor has ordered in 23 years denied. Got letter from government in January asking for proof policy was over 7.5 years old. New laws do not allow this policy and unless grandfathered was going to have to change to Obama approved plan. We should be able to buy any policy provider willing to sell.

[archangle]

Not really. Your scrip has to say APAP or Auto to get that type of machine. It's a drug-regulation thing.

The downside is that unless your scrip says CPAP or Auto, you can't buy a LESSER machine! Wanted to buy a cheap travel cpap last year, but my scrip said APAP, so I had to upgrade to the auto. Oh well, it's working well for me.

Get your doc to upgrade your scrip. Shouldn't be any problem at all. They can probably email or fax it to you, or send it directly to your DME for you.

Cheers,
B.

They can sell you an APAP. They just have to set it to be in CPAP mode. It will be easier if you have an APAP prescription.

You can also DME shop if there is more than one DME in your area on your insurance's network.

[OKCSleepDoc]

I find it so interesting that so many people have trouble getting APAPs. I can understand if you don't know any better and your doctor doesn't know any better. However, have many of you run into situations where your doctor hasn't been willing to write for APAP and insisted on fixed CPAP? I would think that if the doctor didn't know any better and you did, that most should be willing to script it more specifically for an AutoPAP.

Of course I could be wrong. I see patients all the time coming in with fixed CPAP, no data machines who were told it was "the top of the line".

[Sheriff Buford]

... and we have folks that will come on this forum and defend DME's.... shame, shame, shame.....

Sheriff

[archangle]

I find it so interesting that so many people have trouble getting APAPs. I can understand if you don't know any better and your doctor doesn't know any better. However, have many of you run into situations where your doctor hasn't been willing to write for APAP and insisted on fixed CPAP? I would think that if the doctor didn't know any better and you did, that most should be willing to script it more specifically for an AutoPAP.

Of course I could be wrong. I see patients all the time coming in with fixed CPAP, no data machines who were told it was "the top of the line".

There seems to be a lot of anti-APAP bias.

The most benign explanation is that too many doctors think you just set an APAP for 4-20 auto and forget about it. That doesn't work that well for a lot of patients. Some don't realize that you can and should set a minimum pressure, and maybe a maximum pressure and observe the results. Or that an APAP can do everything the manual CPAP does, including full manual pressure.

DMEs like to dispense CPAPs or even bricks because it's more profitable. It seems they may have some effort steering doctors in that direction.

The most skeptical reason is that some doctors feel they will lose business from followup visits if the auto machine figures everything out without intervention by the doctor.