DME practices

Rafe · Post by **Rafe** » Sat Nov 04, 2006 1:55 pm

I'm wondering if it is common practice for DME's to keep parts that they think you don't need, and then re-sell them. For example, my Respironics REMstar Pro M series with C-Flex did not come with a Smartcard, even though it looks like the reader is installed. I walked out of the office not knowing it was supposed to come with the Smartcard. They also gave me a Swift only with the small size pillow, even though I now know that it usually comes with all 3 sizes. I also didn't get the right angle swivel until I called them after reading in the owners manual it should have come with the machine. I'm rapidly losing the little confidence I had in this DME.

So, since I am still only in the 3 month trial phase with the machine, can I switch DMEs? I have BCBS PPO insurance, and my primary care physician initally referred me to Corum for the machine. It was my sleep doctor that sent me to this little DME called Integrated Health that operates out of a one room nearly empty office above a restaurant.

dllfo · Post by **dllfo** » Sat Nov 04, 2006 2:27 pm

Apria kept my smart card, which they sell for $10. I griped and they sent it to me. When my wife got hers, I told them ahead of time to include it, they did.

Our Masks had all three pillows. That is odd that they would keep the pillows.
I asked if our insurance didn't pay for the smart cards and I never really got an answer....I think I got something like..."Well, most people don't use them, so it is Apria's policy to just remove the Smart Cards."

I contacted my insurance and tried to find out what the contract with Apria called for. Tricare would not tell me...or could not tell me. One of my complaints about Tricare Insurance is that you can call the 800 number and get bad info from about half to two thirds of the people answering the phone.

I wish ALL insurance companies would put their info on the internet for us to read. Tricare has refused so far. I also have a PPO.

To say insurance is confusing is an understatement. If your insurance contracted for you to get all three pillows, they owe you two more. And I bet you are due two more pillows. Call your insurance to see what they say.

Good Luck....

Wulfman · Post by **Wulfman** » Sat Nov 04, 2006 2:29 pm

From the many postings and comments I've read about DMEs (and brief personal exposure), I'm under the impression that it IS "common practice". That's why so many of us advocate purchasing from places like CPAP.COM....you get so much more (all the parts and documentation) for less money.

It's my impression that most of the DMEs know that they're dealing with a very "uninformed" (and sleep-deprived) clientele and take every advantage that they can.

Den

pharmwoman · Post by **pharmwoman** » Sat Nov 04, 2006 2:31 pm

I was just going to post how i disovered my comfortlite 2 came with this nasal atachment that i never got, and how when i went and demanded it, of course Im being chraged extra for it(it is not thier "policy" to give patients all the stuff) but I love this new nasal thing--its awesome!!!

Vader · Post by **Vader** » Sat Nov 04, 2006 3:23 pm

These are the kinds of things that give DME's a bad name.
When I tried out the F & P 431, and the Hybrid, the DME would only allow me to take the size configuration that I was fitted with in their office.
IOW, without any of the different sized nasal pillows, etc. that are supposed to come with the mask.
Like Wulfman said, this is why so many of us advocate buying from the internet, such as CPAP.com.

mattman · Post by **mattman** » Sat Nov 04, 2006 7:12 pm

Speaking from the perspective of a DME provider:

In my years and with the various business I've either worked for or with it's never been from a standpoint of trying to "rip people off". I'm certain that there are, sadly, some companies out there that do rip people off. Just like I'm certain there are internet companies that rip people off and there are fast food restaurants that rip people off and on and on.

However, here is my reasoning. I'm betting something on the order of 95% of patients don't worry about extra sizes of nasal pillows (for instance). They don't even care much less want to organize swaps of unused sizes for extras of the sizes the use. However, I can absolutely use those sizes. Then when I get that Saturday afternoon call from someone whose cat has just decided that thier Swift looks exactly like that fuzzy caterpillar that it's been wanting to kill and now their pillows are confetti - I now have a spare. I don't have to worry about trying to figure out if insurance will cover a whole new mask yet (And try doing that on a weekend anyways.) I can just give them a new set of pillows at no charge and everyone is happy.

Or for someone who doesn't want, have or give two twigs about a smart card I now have a spare for the guy whose parrot pulled his smart card out and pecked it until it no longer worked (True story). Though to be honest those are still usually left in the machines anyways.

We keep these extra things that the vast overwhelming majority of people never use so that we have extras for the wierd things that can and do happen on a daily basis. So yeah, I like to keep a little bin full of extra sizes of pillows and most other people I know do as well.

mattman

CollegeGirl · Post by **CollegeGirl** » Sat Nov 04, 2006 7:31 pm

Matt,
I'm curious. Do you ASK patients if it's okay if you keep their extra pillows, or Smart cards, etc? Otherwise, even if it's for a good cause, that seems remarkably like stealing to me. The patient paid for the SET of nasal pillows - and they're only getting one size. That's just not right - UNLESS you ask if you can keep the ones they don't need.

Apria didn't ask. In FACT, when I had first started therapy and didn't know better, I decided I needed a full face mask. They TOOK MY OLD NASAL MASK BACK and then charged me for the new full face mask. Basically, they stole a mask I had paid for. I didn't know at the time that that was not the way things should be done. When I did get that full face mask, they only gave me one size cushion for it, though I later found out it comes with three.

Needless to say, I'm not a big Apria fan. One thing they DID manage to do right: They left the SmartCard in the auto they sold me. Otherwise, we might have had words.

--CollegeGirl

Vader · Post by **Vader** » Sat Nov 04, 2006 8:51 pm

CollegeGirl wrote:Matt,
I'm curious. Do you ASK patients if it's okay if you keep their extra pillows, or Smart cards, etc? Otherwise, even if it's for a good cause, that seems remarkably like stealing to me. The patient paid for the SET of nasal pillows - and they're only getting one size. That's just not right - UNLESS you ask if you can keep the ones they don't need.

Apria didn't ask. In FACT, when I had first started therapy and didn't know better, I decided I needed a full face mask. They TOOK MY OLD NASAL MASK BACK and then charged me for the new full face mask. Basically, they stole a mask I had paid for. I didn't know at the time that that was not the way things should be done. When I did get that full face mask, they only gave me one size cushion for it, though I later found out it comes with three.

What College Girl said!

Out of my own experience with the Hybrid mask, it didn't work out out for me at all, however the Hybrid comes with a variety of options to help you tailor the fit for the individual. Seeing that I wasn't allowed to try out all the options, In hindsight- I feel that my chance of success was greatly reduced because the DME was apparently on some kind of "good will" mission (for himself?) and decided to keep the "spare parts".

Wulfman · Post by **Wulfman** » Sat Nov 04, 2006 8:56 pm

Kind of like all of the car dealers keeping the "spare tires" out of the new cars with the pretext of "We'll have them available if you really NEED them.....but we'll charge you extra for them then.....even though you already paid for them to begin with."

Den

snoregirl · Post by **snoregirl** » Sat Nov 04, 2006 9:02 pm

I guess Matman has given the answer to the orignial question.

Yes, they do take parts out that should go to the customer.

I wouldn't have such a problem with the swift pillow thing if they took the two I don't "normally" use and gave me two more I could use, but I won't wait for that day at $30 per pillow.

Go back to that DME and get what you should have and call your insurance company and tell them you are getting defrauded

Don't forget the filters that should have come in the box and spare silicone connector for humidifier if you have Remstar Pro2 or Auto

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): swift, DME

randyyo · Post by **randyyo** » Sat Nov 04, 2006 11:16 pm

For my 2 cents worth:

I have been working with Lincare in Grants Pass, OR as my DME provider. When I first got my equipment (the ResMed S8 Elite) we went over the whole package and looked at what I would need and want to keep. My sleep doctor had asked for a compliance readout after one week so it wasn't an issue to get the smart card. I tried the three pillows that came with the Swift nasal pillow system and found that the med and small were the likely ones that I would use. I didn't mind not having the large since I knew I would not use it. The RT that I work with there is very helpful and has been around when I needed her to answer questions and get help. In addition she has offered other masks for me to try when I am ready to look at others. She has offered great guidance about how and when to buy if I wish to purchase something. She made sure I knew up front what insurance would cover and when. I don't get the feeling from this particular company that they are out to do anything other than to help me (at least at this particular location). It sounds like I am fortunate in that I am very satisfied with this whole process of CPAP from the initial sleep study to the equipment.

As I said, that's my two cents worth.

Randy

Krelvin · Post by **Krelvin** » Sun Nov 05, 2006 2:50 am

I've seen the DME (Apria) a total of 2-1/2 times. The 1/2 is when they delivered a replacement machine to replace the defective one. There was really no interaction other than giving the bad machine and getting the replacement.

In the two times that I've gone to their offices, I have gone very well prepared.

1) Take a copy of your sleep study
2) Know what type of machine you are supposed to get, pressures etc.
3) If you can, find out ahead of time what they say they are going to give you.
4) Research the machine they say they are giving you so you know what it comes with etc.
5) Take a voice recording device (Tape, digital). Its hard for them to unsay something the told you.

I've seen what happens when a person goes in without a clue. I watched a guy who was handled before me, given bogus info about the costs, refused a full face mask because his RX didn't specify one (It said Patient's Choice) and that his sleep study was done with a FF mask. He didn't have a copy of his sleep study and even though they should have had a copy of it, they said they didn't.

I also keep all the paperwork they give me in a single folder and bring it with me when I see them, my Dr. and when I saw the ENT.

Other than that... they have always been polite and pleasant to talk to.

snoregirl · Post by **snoregirl** » Sun Nov 05, 2006 6:54 am

Randyyo

At least you were asked if you wanted to "donate" your stuff. I have no problem with that.

I was just not told about stuff. I had to know and ask for it. Not right.

Guest · Post by **Guest** » Sun Nov 05, 2006 7:13 am

I guess I should have clarified a bit better. I'm not talking about any of this happening all the time or even on a regular basis. I'm talking about snagging parts to keep a small handfull of extras around. A few here and there is all anyone I know does. And you are correct - we should ask.

There's a bit of a difference in perspective though and I want to try to help you see more of mine just as you have helped me see more of yours.

First I really want you to try and step out of your own views on everything involving not even just your cpap use but your treatment in general.

I would expect something on the order of 95%+ of the people I see on a daily basis are so completely far removed from the types of patients here that you can hardly even compare the two. It's not just that they don't care about this stuff - it goes even farther. They can't even be bothered with anything having to do with it.
A great example of what I'm trying to get at: filters.
As part of our new patient training and instruction we of course go over everything. We touch on filters no less than 6 times during the course of our instruction. Cleaning/changing etc. We go over things multiple times because there is so much going on inside someones head when we first see them that we don't expect them to remember everything. So the important stuff we hit again and again and again. However we also give them a card with cheat-sheat style bullet points on it. Of course we give them the instructions too but no one reads that stuff. Then we also have it mentioned on a 'Care & Cleaning' form they have to sign. We tell them what they are signing. "This is a form that states we have intrsucted you on the care and cleaning of your machine, mask, tubing and filters."
Now all that being said we get calls daily from people having problems with machines. That's par for the course. But at least once a day on these calls - when we ask someone when is the last time you cleaned your filters we hear and I quote: "Nobody told me anything about any stupid filters."
Seriously. Every single day of my life I hear that.
That's just one example. I could go on and on.
Honestly - most of the people we deal with could not care less about thier treatment.

Now I still absolutely agree with College Girl. On the occasion when we snag an extra part we should ask and I'm going to start doing so.

Just try and understand a little bit of our side. Please forgive us if occasionally we assume things. While it's not correct to assume it comes from having seen it all day every day and just sort of giving up sometimes. For all the people I ask, I can with 100% certainty tell you that if it comes up - most of the people I asked will say "Nobody asked me about any stupid extra parts." We tend to get a little jaded about these things.

mattman

CollegeGirl · Post by **CollegeGirl** » Sun Nov 05, 2006 7:25 am

Mattman wrote:
Now I still absolutely agree with College Girl. On the occasion when we snag an extra part we should ask and I'm going to start doing so.

Wow, I can't tell you how excited I am that I have actually helped change the way a DME does things.

And I'd like to point out to you - those who care about their treatment and want to be informed patients are also those who WILL pay attention when you ask if they want their extra nasal pillows. Just a thought.

I'm sorry that DMEs that actually care are getting jaded by patients that don't. Just keep in mind that most of those that don't are probably that way because they just don't know how to cope with being told they have an illness that could kill them, and that to stay alive they have to wear a ridiculous looking mask and stay hooked up to a machine every night for the rest of their lives. Personally, to me, it seems like a pretty good tradeoff. But I know that for some, it's hard to cope with - and many (like my own stepfather) are in denial. If it's a wound on the exterior of the body and is visible, well, that they'll have taken care of. But if they can't see it or cure it with pills, it doesn't exist.

If only there was some way to pair DMEs that care with patients that want to be informed and involved.

Any ideas, anyone?

Rafe, thanks for starting a thread that turned out to be so incredibly helpful. To your original question, which was can you switch DMEs, the answer to that is almost definitely yes. Contact your insurance company, they can probably tell you how to do it.

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