Interesting dilemma afoot with my DME

[old dude]

After being prescribed a PRS1 760P BiPAP initially last year and passing compliance with no problem, I decided to buy a second identical machine as a back up. At the time I had a really good relationship with my DME, but it was largely based on one very helpful individual who is now gone. She sold me a "gently used" 760P that looked brand new at a price that I thought was very favorable at the time. But I was looking at CPAP.com's "sticker" prices for comparison, and I wound up paying within $300. of what I could have bought a brand new one for from CPAP.com. I have since discovered that the "gently used" machine had around 600 hours on it when I purchased it.

So now, fast forward and the machine has developed a problem with a very noisy blower. It's still under warranty until December, but I'm getting a bit of a runaround from my DME because "I purchased the machine with my own money". Had it been the machine they initially provided through my insurer they would just swap it out for a new one. But since I bought it, they're having to call Respironics for a ruling on what to do.

This is my biggest complaint about Respironics: there is absolutely no way for a patient to get through to them for any reason whatsoever, they simply tell you to call your DME. And of course having done exactly that I'm now caught in the middle. Where would this leave a person who buys a used machine from another private individual that subsequently needs service? It appears to me that Respironic's policy here is to protect the DMEs who are clearly gaming the system to milk the insurance companies and Medicare for every possible penny.

I'm not normally a conspiracy theorist, but in this case I have to wonder how much less this very expensive equipment would sell for if it was left up to an open and fair free market.

[robysue]

I have since discovered that the "gently used" machine had around 600 hours on it when I purchased it.

Under ordinary circumstances, 600 hours of blower time would be gently used---that's only 100 days of use at 6 hours a night, which is less than 4 months.

But:

So now, fast forward and the machine has developed a problem with a very noisy blower.

That's a issue that does need to be addressed.

and

It's still under warranty until December, but I'm getting a bit of a runaround from my DME because "I purchased the machine with my own money". Had it been the machine they initially provided through my insurer they would just swap it out for a new one. But since I bought it, they're having to call Respironics for a ruling on what to do.

This is my biggest complaint about Respironics: there is absolutely no way for a patient to get through to them for any reason whatsoever, they simply tell you to call your DME. And of course having done exactly that I'm now caught in the middle.

That's the real bummer. The DME and Respironics both want the other one to deal with you.

In your case I'd suggest the following if it's possible. Go to the DME with your cell phone. Make the call to Respironics in the presence of the manager of the DME. As soon as the Respironics rep tells you to contact the DME tell him/her that you're at the DME and you'd like to put the DME's store manager on the phone and hand your cell to the DME manager.

Seriously---that's the only way you are going to get both the DME and Respironics to (a) realize that you HAVE talked to the other party and (b) talk to each other to resolve your issue.

Where would this leave a person who buys a used machine from another private individual that subsequently needs service?

Pardon my language, but it leaves the person shit out of luck.

It appears to me that Respironic's policy here is to protect the DMEs who are clearly gaming the system to milk the insurance companies and Medicare for every possible penny.

Perhaps. Or just as likely, both PR and the DME are working under "cover your ass" policies----neither wants to eat the cost of replacing the machine and neither wants to be legally responsible for any possible damages by admitting the machine might have a problem.

I'm not normally a conspiracy theorist, but in this case I have to wonder how much less this very expensive equipment would sell for if it was left up to an open and fair free market.

Thing is: Medical equipment is never going to be a totally "open" market. The necessary government regulations for proving each model of machine and mask does what it is intended to do and is safe under normal usage is NOT insignificant. And the US requirement that you have a prescription for the machine and mask makes it a closed market. The real problems (as I see it) are wide ranging and are caused by multiple entities.

Sure DMEs and the manufacturers create a lot of the problem. But so do the insurance companies. Many of the insurance companies have extremely complex paperwork trails that must be completed just so the DME does get their money. Sure, some insurance companies are willing to pay plenty of $$$ for the patient's machine, but others are not. Some insurance companies make their payments on time; others foot drag the whole process out.

[old dude]

A very helpful response, robysue, and I think your suggestion about taking my cell phone to the DME meeting (as soon as they will allow it, they're giving me the runaround on that one too!) is a capital idea and I'll do exactly that. I'll win this one sooner or later because I'm just not the kind of person who will be put off. But I'm trying to preserve a decent relationship with my DME inasmuch as it's possible, given that warranties on both my machines have to be brokered through them.

I recently changed docs within the same practice (more on this later) and my new doc asked about how I liked my DME. He then told me that their practice, which is part of a major medical group in my large city, had it's own DME department and would be glad to help me with and of my needs. When I told him that I was in the market for a third machine (one at each house 400 miles apart plus one backup/travel machine) he demurred, saying that a recent edict from the head of their medical group mandated that they could no longer sell machines and supplies direct to customers who were paying themselves at anything other than sticker price. He suggested I call CPAP. com.

I can't quite grasp why the group would adopt such a policy when they previously were competitive on direct sales, but again I suspect that it has something to do with mutual back scratching among the manufacturers, DMEs and the practice.

[Jay Aitchsee]

I can't quite grasp why the group would adopt such a policy when they previously were competitive on direct sales, but again I suspect that it has something to do with mutual back scratching among the manufacturers, DMEs and the practice.

Yes, I think reading the quarterly earnings call of companies like ResMed ( http://www.morningstar.com/earnings/529 ... x?pindex=1 ) provides a lot of insight to their thinking. They refer to HME (DME) as Customers, insurance companies as Payers, and finally to the end user (us) as Patients.

[robysue]

A very helpful response, robysue, and I think your suggestion about taking my cell phone to the DME meeting (as soon as they will allow it, they're giving me the runaround on that one too!) is a capital idea and I'll do exactly that.

This is too much. The DME won't make an appointment to see you?

I'd say just show up and walk in the door and tell them that you need to speak to the manager or who ever is in charge.

[Pugsy]

It's still under warranty until December, but I'm getting a bit of a runaround from my DME because "I purchased the machine with my own money". Had it been the machine they initially provided through my insurer they would just swap it out for a new one. But since I bought it, they're having to call Respironics for a ruling on what to do.

This is BS. It shouldn't matter who paid for the machine. What would they do if you hadn't had any insurance?
They can still be the go between to Respironics.
It's no different than if you had moved clear across the country and had a new DME and your machine had a problem...the new DME would still be required to be the go between if they sold Respironics equipment. They wouldn't have to provide a loaner though and you would have to pay for shipping though.
Loaner service is a courtesy and not a requirement.

[JDS74]

The reason that their "captive" DME won't sell equipment outside of the insurance company relationship is the problem of insurance fraud.

If they sell to you at a different and lower price than they are submitting to the insurance company, this would be considered fraud since they would otherwise be obligated to bill the insurance the same price.

[chunkyfrog]

You might want to solicit another DME to serve as go-between in return for your good will and possible future business.
Another DME may even be more than happy to help report the misdeeds of their competitor to the manufacturer.

[Drowsy Dancer]

You've seen this thread, right?

viewtopic.php?f=1&t=88603&hilit=+CPAP+Basics+re%3A

Also, whether the machine was purchased via insurance coverage versus private pay has nothing to do with whether it is covered under a warranty AFAIK.

[Thewino]

Tell them you are are going to call ACHA on them to report their unfair practices regarding selling a machine as newer than it really is and now they will not honor the warranty you have in writing.

ACHA can help in these situations. Believe me, they do not want an ACHA visit.

Thanks,
TheWino

[houndlover]

This is very interesting. Medical billing is a complicated sport...it is why people go to college and earn a degree for it.

I can think of a few possibilities of what is going on here.

1. The DME sold you a machine at an unauthorized discount. There are rules for how you can bill for services and you can't get one person a discount that isn't available to all. Since you had a friendly person...maybe they are gone for a reason (ie:breaking rules). Break these rules and you can lose contracts with every insurance company out there. If they find a pattern of this, there are even more dire consequences.

2. The DME sold you equipment that had already been sold (so Respronics thinks some dude in Kansas is using it and it was purchased by BCBS). So really, there is nothing on record that your machine actually exists. This is basically like buying it from a private individual. They can't get it serviced, because it was never supposed to be there for you to buy to begin with.

3. You DME is a bunch of lazy asses.

[Stevoreno_55]

After being prescribed a PRS1 760P BiPAP initially last year and passing compliance with no problem, I decided to buy a second identical machine as a back up. At the time I had a really good relationship with my DME, but it was largely based on one very helpful individual who is now gone. She sold me a "gently used" 760P that looked brand new at a price that I thought was very favorable at the time. But I was looking at CPAP.com's "sticker" prices for comparison, and I wound up paying within $300. of what I could have bought a brand new one for from CPAP.com. I have since discovered that the "gently used" machine had around 600 hours on it when I purchased it.

So now, fast forward and the machine has developed a problem with a very noisy blower. It's still under warranty until December, but I'm getting a bit of a runaround from my DME because "I purchased the machine with my own money". Had it been the machine they initially provided through my insurer they would just swap it out for a new one. But since I bought it, they're having to call Respironics for a ruling on what to do.

This is my biggest complaint about Respironics: there is absolutely no way for a patient to get through to them for any reason whatsoever, they simply tell you to call your DME. And of course having done exactly that I'm now caught in the middle. Where would this leave a person who buys a used machine from another private individual that subsequently needs service? It appears to me that Respironic's policy here is to protect the DMEs who are clearly gaming the system to milk the insurance companies and Medicare for every possible penny.

I'm not normally a conspiracy theorist, but in this case I have to wonder how much less this very expensive equipment would sell for if it was left up to an open and fair free market.

I feel your pain because I just went through a similar experience attempting to speak to someone; anyone at Philips Respironics back in February 2014. All I wanted to know was if I could send my 6 year old machine; a DS400S to them for a fee and have it checked out because I had reason to believe it was starting to play out. A CSR at Philips Respironics told me flat out they did not deal directly with patients; only with DME's and that I needed to contact the DME who issued me my machine and have that DME ship my machine back to them.

Apria Healthcare was the DME who issued me the machine but they are no longer my DME when my insurance plan dropped them last year so I'm dealing with a new DME who just last month agreed to ship my machine to Philips Respironics since I couldn't do it and I agreed to pay my new DME a fee of $27.00 to ship my machine off to Philips Respironics. I wrote them a check; I did not have to use a major credit card. Just last week my DME mailed me a copy of the repair estimate they received from Philips Respironics. Philips Respironics wanted more than $300.00 to repair my 6 year old machine; I contacted my DME and told them not to have it repaired which they knew I wouldn't want to do because I've since been scheduled to have a new sleep study soon and I hope to get a new machine after having completed my new study.

I too give Philips Respironics a negative rating for patients inability to communicate with them. They're such a large; worldwide company they don't have the time nor do they want to offer time to take calls from patients who have their products and might have questions about their products. After my recent experience with Philips Respironics I'm now taking a closer look at ResMed machines. My new DME is letting me use a one year old ResMed S9 Elite CPAP with a heated humidifier.

I was told just the other day I could keep their machine and continue to use it until I've had my sleep study and received an order for a new machine. Depending on the outcome of my new sleep study and what my newly diagnosed pressure will be my DME has recommended a ResMed S9 Elite "AutoSet" machine with the heated humidifier and heated hose verses a straight CPAP ResMed S9 Elite machine. If my new pressure is higher than my current pressure which is 18cm I might be looking at a BIPAP machine instead of another CPAP if the sleep doctor who interprets the test results for the lab where I'll be tested recommends a BIPAP instead of a CPAP.


Stevoreno_55
MS Gulf Coast
05/02/14

[old dude]

Well, I'm going to give it one more try this morning before I escalate my complaint to the highest management person I can find in the DME's organization. I really hate to go into my Defcon 1 mode, because I can be relentless in seeking what I deem to be right and proper. But if there's anything I hate, it's people not returning phone calls when they say they will. Plus, even though I will persevere there's no doubt I will have destroyed any relationship I had with this provider.

I'll report in when I have more.

[Pugsy]

3. Your DME is a bunch of lazy asses.

I vote for moving this one to the top of the list but you may be right about the other things.
I have always thought the warranty followed the machine though...no matter who has it. I could be wrong..as with pretty much all this cpap stuff they don't make anything very clear as to the patient end user rights since the machine makers look to the DMEs and retail sellers as their "customers" and not us lowly peons who just happen to use this stuff.
It's not right but it is what it is and not much we can do about it.

[old dude]

3. Your DME is a bunch of lazy asses.

I vote for moving this one to the top of the list but you may be right about the other things.
I have always thought the warranty followed the machine though...no matter who has it. I could be wrong..as with pretty much all this cpap stuff they don't make anything very clear as to the patient end user rights since the machine makers look to the DMEs and retail sellers as their "customers" and not us lowly peons who just happen to use this stuff.
It's not right but it is what it is and not much we can do about it.

Pugsy, I do think you're correct that the warranty follows the machine. But unfortunately, in the case of Respironics (and I would presume other manufacturers as well) a "patient" cannot send in the machine for repair. It must be sent in by the DME that "supplied" you the machine, which precipitated my earlier comment about buying a used machine from an individual.

I find this policy immensely frustrating in that it basically holds us "lowly peons" as you put it hostage by our DMEs. If you happen to have a DME who supplied your machine go unresponsive on you it's a problem. I realize it's just the way the system works and it's not going to change, but I can't help but think that like all things related to medicine that are unnecessarily complicated money is somehow at the root of it. Both ends of the system, i.e., the docs and the equipment manufacturers alike seem to trust the DMEs to do the right thing for the patient , which doesn't always happen.