More DME antics

Slinky · Post by **Slinky** » Wed Jan 03, 2007 12:57 pm

My secondary insurance contracts w/"local", rather than national chain DME suppliers. I have the choice of 3. I've only had experience w/one DME supplier for xPAP, but they aren't particularly small since they cover a 3 state area. I'm NOT impressed w/them. I went w/them only on the suggestion of my sleep lab.

I have had experience w/one of the other 3 local DME's, both cover most or all of this state, for 02 and supplies. The one I elected to go w/is the smallest and closest to my house. The other two are considerably further away in the next town. I can't say I am overly impressed w/them as far as their "supervision", but pretty much any thing I've asked for they have been "johnny-on-the-spot" to provide. They deliver and I can't say I am any too impressed w/their driver nor his "image". He could dress neater and he certainly could improve his skills at explaining new equipment. Plus he is always in a hurry making his explanations and/or demonstrations very perfunctory. The office itself has been very good to work with. I "would" have gone w/them for my xPAP - except they did not give me the xPAP machine that was scripted. They delivered the equipment the very next day after receiving the script from my sleep lab. Had the driver explained better I would have been advised that this machine was a "loaner" until the machine scripted was available as they had to order that particular machine. As it was, I returned the delivered machine and on suggestion of my sleep lab went w/the DME I do have for xPAP.

I wish I had known enough to shop the 3 DMEs before agreeing to the script being sent to any of them. I'm sure I would have been happier w/my 02 supplier supplying my xPAP equipment and I suspect I would have been happiest w/the 3rd DME. They are affiliated with or part of a large hospital in a town an hour away but have an office in the nearest town w/in blocks of my current xPAP DME supplier.

One thing my sleep lab did do that put me one step ahead of most new PAPpers, but not far enough ahead, was to give me the URL for myresmed. If only they had included the URL for cpaptalk instead or in addition!!! Even just one week ahead of taking xPAP delivery spent at cpaptalk would have put me so very far ahead of the game and a lot of mistakes on my part would have been avoided!!! I have since given them the URL for cpaptalk and told them how great this site is for patient information on using and acclimating to xPAP use.

Catnapper · Post by **Catnapper** » Wed Jan 03, 2007 4:40 pm

My first RT told me not to read any of the forums because people on them did not know what they are talking about, and they give very bad advice. She told me to be very careful about doing what anyone suggested on various apnea forums.

Wonder why?

dataq1 · Post by **dataq1** » Wed Jan 03, 2007 5:08 pm

I just don't understand the providers allowance. Both the DMEs and my BCBS (self-insured employers plan) tell me that the Plan Allowance is a fixed allowance established by contract between BCBS and the DME. I'm Ok with that concept.

I'm assuming that the price DMEs pays the manufacturer (or the distributer) for a specific peice of equipment is reasonably the same, say give or take 10-15%.

Why would DME #1 agree to an allowance that is 70% less than their competitor for the same product?

Actual details:
Mask at DME #1 has an plan allowance of 174.00
Exactly the same mask at DME #2 has a plan allowance of 103.00

What would motivate DME #2 to agree to such a write-off (assuming that they are purchasing that mask at approximately the same cost as DME #1)

This makes no sense to me, can someone explain this?

Incidentially, the insurance is the same, the employer's contract is the same, the copay, coinsurance, deductible, year and month, and the user (me) is the same.

Mile High Sleeper · Post by **Mile High Sleeper** » Thu Jan 04, 2007 10:56 pm

Summary of national chain local DME level of service over a 9 month period from my perspective as a patient.

Lost prescriptions: 2 out of 2 times.

Machine prescription errors: 2 out of 2 times with no procedures to detect RT errors in setting up the machine.

Concealing or only reluctantly giving mask information, if pressed, in the best interest of the patient: 3 out of 3 times.

Not providing safety information: 2 out of 2 times.

Providing inadequate or incorrect equipment and therapy information: much of the time.

Poor communication or different and conflicting procedures between regional customer service and the local branch, requiring the patient to run interference: 100% of the time.

Of 3 equipment orders, 1 had no problems, 1 shipped the wrong size requiring a return, and 1 had billing problems.

Guest · Post by **Guest** » Fri Jan 05, 2007 9:12 am

Maybe my experience is unique with my national DME (Lincare). My local rep is very attentive and did not argue about switching me to an apap once my dr prescribed it (even though they wanted to give me a resmed and I wanted a respironics, when my dr prescribed the respironics they got it).

Next, they sent me a mask too soon. I notified my local office and they said if it was billed they would write it off as it was their mistake (they were in the process of switching to an automated re-supply system). When I got the bill from them for the mask I called my local office, informed them and next day was contacted by someone in billing telling me to disregard the bill.

Finally, I dealt with the national office of Lincare on a mask issue this week: told by my local that I could not get Soyala because Somnotech was not Lincare approved; contacted Somnotech, they said they were; contacted Lincare corporate, got someone to call me back and they confirmed Somnotech was approved and actually called the local office to give them the billing codes.

Maybe I am lucky with my experiences and the people I personally deal with on the local level, but as with anything there are "good" and "bad" in every industry and you just need to search out the good ones to conduct business with if you are not satisfied with the service.

TM

hades161 · Post by **hades161** » Fri Jan 05, 2007 1:32 pm

I have yet to use a DME's and for 1 main reason. Always to expensive. I wonder how many people have DIED for DME's GREED. Many people like me who suffer OSA start this whole process with A. an expensive study that some insurances may cover or may not. B. Then talk to a DME to look into the prices of the equipment and then look at our pocket book and have to come to the conclusion that there is NO WAY to treat OSA and make the cost of living. With this cold hard truth that we can't afford it and make rent and bills, we are forced to tough it out till we die from heart failure or get lucky and find someone who knows what OSA is about and where to get equipment at a NORMAL or close to affordable price. So Greed is GOOD and it's all great to over charge for a piece of plastic that can be injection molded and packaged for the cost of around 33 cents? I am happy for the people that can take the brunt of the GREED. But I am sure there are more people out in the world just like me trying to just get by and live who can't. If it wasn't for that fact my girl friend had a co-worker who pointed me here and the people here weren't so great and helpful, I most likely would have died in the next few years due in large part to severe OSA (116 index) and DME's misinfo and outright GREED.

So DME Dan I have to ask and wonder how many people through your companies GREED have you helped die? Or at the very least destroyed their quality of life due to the fact they can't get proper equipment or info or training on how to use it. And don't even try to tell me about charities and other such non-sense yes they are out there but only because of GREED in the first place. And even they cant help everyone.

Slinky · Post by **Slinky** » Fri Jan 05, 2007 2:02 pm

Whoa! There are bad AND GOOD brick & mortar DME suppliers out there and to target Dan and his company is totally out of line. Dan has been good about answering questions and offering advice and certainly didn't and doesn't deserve that type of comment. There are two sides to every story and Dan has done nothing more than try to share the view from his side of the fence. There is always a middle ground. Always a grey area, nothing is totally black and white.

hades161 · Post by **hades161** » Fri Jan 05, 2007 2:24 pm

Your right, I shot from the hip and vented some frustration. I am sorry for blasting ya Dan. My appologies to you DME dan. The point though is there is no real justification for the costs of these life changing and life saving products. I guess what got my goat was the idea that this site and others like it are responsible for the reputations of DME being bad. When this site has been more helpful then my Doc or anyone in my local area I have talked to as yet.

dataq1 · Post by **dataq1** » Fri Jan 05, 2007 2:26 pm

I agree, comments like that are out of line. All DMEs are not evil. True, some are, maybe even many are....
But sweeping statements characterizing DME as death-mongers is just sooo WRONG.
We all should be looking for solutions, that is much more productive than name calling.

Sleepless_in_LM · Post by **Sleepless_in_LM** » Fri Jan 05, 2007 2:27 pm

hades161 wrote: So DME Dan I have to ask and wonder how many people through your companies GREED have you helped die? Or at the very least destroyed their quality of life due to the fact they can't get proper equipment or info or training on how to use it.

I gotta say that type of comment is way over the line. I have had bad experiences with DME's and some not so bad. Is the problem the DME's? Partly, but there is plenty of other blame to go around (insurance companies, health care system). To single out Dan and his company is not fair. I for one appreciate Dan's comments. He has been helpful in many ways, and even on this topic he has helped me understand how screwed up the system is. I don't think he has ever tried to justify unethical methods, he has just explained why the system has allowed and even encouraged some of these problems.

Dan, I hope you stick around and provide your perspective and expertise, but I could sure understand you never coming back here after comments like these.

Slinky · Post by **Slinky** » Fri Jan 05, 2007 2:27 pm

Thanks, Hades. I have to say I can understand your frustration, obviously shared by many of us here. I'm sure Dan will appreciate your apology and have some understanding of where you are coming from.

jules · Post by **jules** » Thu Jul 12, 2007 9:33 pm

jules wrote:
Back to the overcharging by the B & M DME's. They are a business and have people to pay. They put money into the local economy. They have to consider what little profit (if any) they make on some patients who can't pay their bills. But I agree charging for the hose in the box and the filters in the box is a little too much and I was charged for those too. I saw charges submitted to my insurance on the order of those above but my insurance determined they be paid at 80 % of submitted charges.

The last mask I got from the DME (and it will be the last one I get from them as it is less frustrating to buy online and pay the whole cost out of pocket over deal with the screwed up bills) I was changed for the mask, headgear, and the nasal pillow all separately. It was a Swift and they only gave me one pillow. If I had gotten all 3 I would have been charged an extra $ 40 each for the other 2.

They break open sealed boxes to only give out one piece. I was really surprised they didn't try to bill for the CD that comes with the Swift as well as the case. I didn't need another CD and case but could have used an extra nasal pillow. I complained about the billing and was told I would get another pillow my size (they didn't say free btw just they would send it). That was last April. I have yet to see it and am sure not going to hold my breath waiting for it.

I know this is an old thread but there is an update to my tale.

Today I received a small check from the DME for a refund. I haven't bothered to check to see if it was really the right amount they owed me as it isn't worth it. I had figured it was a lost cause about a year ago when I complained to corporate headquarters. I didn't get a detailed explanation today just a check. I have yet to see a new EOB from the insurance on this either.

This is money I paid in good faith back in Jan or Feb 2006 for my cpap purchase/rental.

I would guess I could go out and buy lunch with this check - it sure isn't enough to pay for a nice dinner. Maybe instead I should frame it and put it on the wall with my other accomplishments in life.

More DME antics

the cpaptalk recommendation

national chain DME track record