Why can't DMEs special order machine of choice?

[MaryLand]

I was officially diagnosed with severe sleep apnea 2 weeks ago, but have been using a second-hand machine (Airsense 10 Autoset for Her) for 6 weeks because I was tired of waiting. I really like the machine, though haven't found my perfect mask yet. I have been calling around to the DMEs in my insurance plan in order to get a new machine, and nobody carries the "For Her" model. A couple of places said maybe they could special order it but then it turned out they couldn't. I am trying to understand this. Why can't they special order it? Is there so little profit in it for them? Are they just lazy? You go to just about any store for anything and they're happy to special order stuff for you, but not a DME? I'll go the online provider route if needed, but meanwhile I'm just trying to figure out how this business of DMEs and CPAP works.

[chunkyfrog]

They most certainly CAN, but they are, IMO, effing LAZY!
If you can get your DOCTOR to specify the "for her" model, they have no excuse.
They HAVE to fill a prescription as written.

[MaryLand]

The prescription is in fact written for that exact model. They don't seem to care. I'll do what I have to do to get one, but I am just super curious as to why they wouldn't just special order the darned thing.

[TASmart]

I don' think it's as much about being lazy, but more likely it costs them more to special order a one off purchase. The was the system is structured (following the Medicare model) with a single payment amount for any machine if the same code, there is a disincentive to actually work with the customer. Also make no mistake, they treat us like customers not clients. There is not much in the way of a team effort. Being aware of this helps me get along with them better. I know where they come form, I know where I come form. It's the poor sod who thinks the DME is looking out for them or their condition that gets shafted.

[chunkyfrog]

Go in and demand to speak with the MANAGER.
THERE IS NO EXCUSE FOR THIS CRAP.
Call around to the other in-network DME's, and ask who WANTS YOUR BUSINESS.
You can also complain to your doctor.
I doubt he wants to refer any other patients to this kind of delaying tactic.
Your SEVERE apnea needs to be treated--ASAP,.
(But the DME need not know you have a loaner--tighten the screws on them, as it were.)

[Goofproof]

It's time to call your INS company............ Actually, past time! Jim

[ChicagoGranny]

A couple of places said maybe they could special order it but then it turned out they couldn't.

It's not really a special order. I was able to find out that ResMed stocks them in their regional distribution centers around the country. All the DME has to do is send them an order through their regular channels.

[MaryLand]

I don' think it's as much about being lazy, but more likely it costs them more to special order a one off purchase. The was the system is structured (following the Medicare model) with a single payment amount for any machine if the same code, there is a disincentive to actually work with the customer. Also make no mistake, they treat us like customers not clients. There is not much in the way of a team effort. Being aware of this helps me get along with them better. I know where they come form, I know where I come form. It's the poor sod who thinks the DME is looking out for them or their condition that gets shafted.

Thanks, TASmart, I figured it was something like this. And, like you, if I understand their point of view (even if I don't agree with it) it helps me to work with them better.

Fortunately I live in a highly populated area with dozens of DMEs within a 50-mile radius. I've been working the phones all morning. (And can I just say, how many DMEs have appallingly bad and uninformative websites, if they have them at all.) On my 14th phone call, I located a DME about 30 miles away who can get me the machine if they don't have it in stock. They'll bring it to me and get me all set up and bring masks for me to try as well. At least, that's what they tell me. I'll fax them over my Rx and info, and we shall see.

I thank everyone on these discussion forums. Since I first began to suspect OSA, it has been an invaluable source of help, information, and inspiration. With my second-hand machine, I've gone from an AHI in the 60s to an average of about 1 per night, and that's without finding the perfect mask fit (still working on that). Night sweats and heart palpitations are down 95%. Nocturia is greatly improved. Still have ongoing fatigue and brain fog, but I think that will take awhile -- pretty sure I've had this 15+ years.

[chunkyfrog]

Welcome to the community!
(shoulda said that first)

[Janknitz]

Also make no mistake, they treat us like customers not clients.

They don't even see us as their customers, because (for the most part) WE don't pay. Our little co-pay is not important to them. In the 80's the big buzz in business coaching was "who is your customer". I worked in the health care industry, and at a training we health professionals all answered "our patients, of course". Nope, wrong, according to the bean-counting suits. Our "customers" were the doctors (who gave us referrals in exchange for good service to THEIR customers), other health care professionals we traded referrals with, and the insurers (who paid the bill). Patients--according to them--were an inconvenience.

And that's where we still are today. We are not worth the extra effort to the DME's. They make the bulk of their money from our insurers (and have to jump through a lot of hoops to do so) and they live and die by the referrals they get from doctors and sleep study centers. One customer more or less is nothing to them. So if you ask for extra services it's no skin off their nose to send you away.

So we just have to decide if we want to put up with being someone's inconvenience, or do it on our own. I enjoyed the financial help when I had DME coverage, but not the PITA dealing with Crapria every time I needed something. I find it very freeing (if financially a little harder) to never have to deal with them again now that I no longer have DME coverage. I get to choose exactly what I want, I GET exactly what I want with no hassle, no arguing and no billing snafus, no stupid customer lies from the DME.

[Guest]

I was officially diagnosed with severe sleep apnea 2 weeks ago, but have been using a second-hand machine (Airsense 10 Autoset for Her) for 6 weeks because I was tired of waiting. I really like the machine, though haven't found my perfect mask yet. I have been calling around to the DMEs in my insurance plan in order to get a new machine, and nobody carries the "For Her" model. A couple of places said maybe they could special order it but then it turned out they couldn't. I am trying to understand this. Why can't they special order it? Is there so little profit in it for them? Are they just lazy? You go to just about any store for anything and they're happy to special order stuff for you, but not a DME? I'll go the online provider route if needed, but meanwhile I'm just trying to figure out how this business of DMEs and CPAP works.

They can order a cpap OR mask OR whatever they don't have in stock - Don't call it special cuz its not. Problem is just like docs get certain meds to push the DME's get deals from the manufacturers and want to max their profits - your health means nothing to them.

You already have a cpap = very good, they don't need to know that. I choose not to give my business to anyone who treats me that way. But the other reason they treat you that way is apparently no one else filed a complaint. Find out who the licensing authority is in your state and file a complaint with them and include a copy of your doctors order for the equipment.

If they won't give you the cpap you want just imagine how they will treat you while to try to find a mask that will work for you.

It may help if you mention where you are located and which places you are having troubles with. Many times someone will know who in your area can help. Meanwhile, keep your eye on Craigslist under Health and Fitness for what you need. You should always have a spare for a backup anyway - just imagine how you will be treated should your cpap suddenly fail. Once you get adapted to cpap and can't sleep without it, if it fails and they take up to two weeks or more to even look at your broke cpap cuz they still won't care about you.

[CowFish]

they live and die by the referrals they get from doctors and sleep study centers. One customer more or less is nothing to them.

You are ignoring the fact that patients tell their doctors whether the DME treats them well or poorly. The tech at my sleep doctor's office always asks me if I am getting good service from the DME she recommended.

[LSAT]

I was officially diagnosed with severe sleep apnea 2 weeks ago, but have been using a second-hand machine (Airsense 10 Autoset for Her) for 6 weeks because I was tired of waiting. I really like the machine, though haven't found my perfect mask yet. I have been calling around to the DMEs in my insurance plan in order to get a new machine, and nobody carries the "For Her" model. A couple of places said maybe they could special order it but then it turned out they couldn't. I am trying to understand this. Why can't they special order it? Is there so little profit in it for them? Are they just lazy? You go to just about any store for anything and they're happy to special order stuff for you, but not a DME? I'll go the online provider route if needed, but meanwhile I'm just trying to figure out how this business of DMEs and CPAP works.

If your doctor writes a prescription specifying that particular machine,the DME must fill it as written without substitutions. Just like a medicine at a pharmacy.

[Pap-Daddy]

they live and die by the referrals they get from doctors and sleep study centers. One customer more or less is nothing to them.

You are ignoring the fact that patients tell their doctors whether the DME treats them well or poorly. The tech at my sleep doctor's office always asks me if I am getting good service from the DME she recommended.

Not that docs or their staff don't care -some actually may but they also realize that you don't have much of a choice because where you go is directed by your insurance. Insurance may or may not care - IMO most don't as they already have your money and realize that it is not you who will choose their next contract but hey give it a try. And if you are on Medicare those choices are fewer.

So IMO it comes down to money and in no case should you give your money to any business where your doctor profits for his/her referral to that business.

So again it comes down to money and any DME must be licensed to operate in your state. So the licensing authority and/or consumer protection tend to get their attention right away.

[CowFish]

in no case should you give your money to any business where your doctor profits for his/her referral to that business.

This is a common warning that crops up here about doctors and DMEs. I bet there is not a person on this forum who came across such a case. Both the federal Anti-Kickback Law and the federal Stark Law prohibit this. Additionally, Medicare/Medicaid have their own detailed regulations that prohibit it and an enforcement team.