"Interviewing" a DME - questions to ask

[Heddyho]

Hello All!

I want to call some different DMEs on the list that my CIGNA health insurance has provided. I finally have my prescription in hand, and it says:

E0601 - CPAP S9 at 11 cm
A7046 Humidification chamber used with CPAP/BIPAP Qty 1 "with climate line tubing"
E0562 Heated CPAP/BIPAP Qty 1
A9279 CPAP/BIPAP Compliance Qty 1
length of need: lifetime 99
327.23 OSA
also includes nasal mask, headgear, tubing, and filters

When trying to choose a DME to use, what basic questions should I be sure to ask? (Model numbers, mask return policy, etc.)

[Pugsy]

Ask what model machine they normal dispense with that RX...unfortunately dispensing a brick satisfies the RX so you need to know your models. Some routinely dispense top of the line full efficacy data but more often they dispense basic entry level machines that only collect hours of use which we not so lovingly refer to as "bricks".
http://maskarrayed.wordpress.com/
http://maskarrayed.wordpress.com/what-y ... me-part-i/
If you haven't read Janknitz's 2 blogs above..read them now.

Also ask specifics on mask trial/swapping policies. While most mask manufacturers allow 30 days per mask...most DMEs will come up with their own in house rules which might be anywhere from any number of trials/swaps to one in 30 days period ...or even none at all. You want a DME with a very liberal mask swapping policy and don't be afraid to use it. The right mask is critical in this therapy and no one should have to use one that doesn't work just because some DME wants to not do the work to get credit for failed masks.

I had to look this one up A9279 it's for monitoring device and all it specifies is compliance..which is hours of use so the insurance company is satisfied you are using the machine. They don't care if it is working or not...just if you are using it...that's what bricks collect...hours of use only. Usually 4 hours or more per day for 70% of the days within a 30 day period. It may or may not be the same with your particular insurance company.

[JDS74]

1) Will I get an auto CPAP.
2) Will the CPAP you provide record efficacy data as well as hours of use to a removeable SD card?
3) What data in particular will be recorded? Apnea events (obstructive, central, hypopnea, etc.), flow data, RERA,
4) What software will be needed to get reports from the SD card? Just the name, they normally won't provide it.
5) What pressure ranges are supported?
6) How is humidity controlled?
7) Is battery power supported and what adapters are needed to run from battery?
What is your exchange policy for masks? How often? How many? Until I find one that works?
9) Do you do in home fittings and adjustments?
There must be others.

[Janknitz]

Take the positive approach, don't ask them what they are going to provide, ask them to provide what YOU want.

"I am looking for a ResMed S9 Autoset or a Philips Respironics System One Auto DS560. Can you provide one of these machines to me?"

The answers are either "yes", "no" or "maybe".

1. If they say no, thank them for their time, and call the next one.

2. If they say maybe, then ask what maybe means? What hoops do they want you to jump through? The usual answer is "only if your insurance authorizes it." Your response is "My insurance will cover any E0601 machine, and my prescription calls for an E0601." At that point, the arguments may start. They may say that because your script calls for a fixed pressure they can't provide it. Thank them for their time and call the next on your list.

3. If they say yes, then you have to run script # 2 anyway, because when you show up there will be the same excuses.

The danger here is that you may find NO DME's willing to provide what you want. Then you have to decide if you are willing to settle for a data capable CPAP instead of an APAP, and go through the list again. Or if it's not worth the hassle, buy your own machine. The third option is to ask the doctor to specify the exact machine you want in the prescription.

I highly advise that you pick up the machine yourself from the DME who agrees to provide what you want and check the model and run hours before you accept anything. We've seen a lot of DME's play bait and switch--i.e. give you an old, used machine, or swap the Autoset for an Escape Auto.

If you have a choice of providers who will provide what you want, the next most important criteria is the mask return policy.

Good luck.