DME visit: My worst fear might soon be realized...(long)

[RosemaryB]

If I don't notice any change, I'll call anyway and asked to be upgraded to the Elite at the very least and get back with the sleep doc in the meantime if need be.

With these DME's there's a definite difference between asking and telling! As in "telling them what you plan to get" rather than "asking them what they plan to give you." Now the telling must be KIND but FIRM, just as with a kid in school (since you're a teacher, you KWIM). If is your therapy and your insurance money, not theirs!!!!!!!!!!!!!

They will try and try to put you in the asking mode, but IMHO, you being in the telling mode is the way to go. This is especially true if you have other DMEs you have contacted that will do better by you, including "BillMyInsurance.com." In that case, if they don't give you what you tell them you want, it's clear you can go elsewhere. If you have a script in your head of what you are going to tell them, you might be better off. Then don't let them take over, just keep at the script, like a broken record, insisting. (Polite, cheerful even, but extremely FIRM).

I know how hard it is to deal with them when you are sleep deprived. They are supposed to be the experts and helping you with your therapy, the best possible therapy. That is what we all expect at first. But it's not what happens for the vast majority of us.

I wouldn't wait for the doctor's visit, I'd do the research now by talking with your insurance company, getting a list of DME's checking BillMyInsurance.com and get ready for them.

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[jjposey]

Don't believe what the DME's tell you that your insurance will pay for either.
For that matter, don't believe what the insurance tells you it will pay for. I've gotten three different stories out of my insurance about what they pay for. All wildly different.

[geoDoug]

Don't believe what the DME's tell you that your insurance will pay for either. For that matter, don't believe what the insurance tells you it will pay for. I've gotten three different stories out of my insurance about what they pay for. All wildly different.

It seems that here there is more griping about DMEs than about insurance companies. IMO, the real fix is taking a profit motive out of the equation altogether and going to a single-payer system. I called Aetna three times asking about how often they'd replace products. (Don't ask me why I tried that many times. I have no idea!)

Unfortunately, I didn't have the specific codes for the products on hand. I suspect each of the rep was trained that when they heard the phrase "durable medical equipment" they should spew the script: "we replace on wear and tear." Bull. I doubt seriously that they'd approve replacing a CPAP machine in a year if, for example, it got fried by a power outage. It took a lot of independent research on my part to finally figure it out.

As far as DME's are concerned, my RT at Apria told me a blanket "6 months for all accessories." I'm reasonably sure that the reason for this was to make his job easier. It simply isn't true. When I figured that out, I sent a letter to my RT with a printed copy of medicare's reimbursement schedule, detailing all cpap information and proof of the fact that Aetna follows that schedule--carefully highlighting the relevant paragraphs. After I sent it, I thought, "He probably was insulted by that, but I don't care. He has to know who he's dealing with."

Doug.

[drummergirl410]

Amen to that! I think it was just a matter of doing the same thing in this instance.. if you haven't seen it, I posted an update as a new thread!

[socknitster]

I haven't seen the new thread yet, but wanted to say this:

You DO have leverage with the DME. Tell them if they won't give you data compatilble machine, you will fire them and buy online and then bill the insurance yourself. You are still in rental phase, you don' t own this machine. This is ridiculous the way they jerk people around. I hadn't heard a story like this yet and I'm apalled. I would make a big stink right there where other patients can hear and threaten to pull the plug on the MONEY. They would rather risk losing a little by giving you an upgraded machine (or make you pay the difference depending on how your insurance works--maybe you could point that out as well since the difference in price prob isn't much, but I am not famililar with resmed machines) than LOSE ALL THE MONEY if you fire them and buy it yourself on a credit card until your insurance pays you back

You better believe I'd be on the horn exploring these possiblities. They won't won't to lose you as a long term patient because there are all those supplies and masks they want your insurance to pay for too!
I think if presented in this way, you may be able to get what you want.
Jen