A Miracle has Occurred in my Life

echo · Post by **echo** » Sun Oct 21, 2007 6:04 pm

hey babs,
I had totally missed this thread. sorry to hear things were giong so horribly, but GREAT that you've managed to resolve it all finally!
Sweet dreams.....

sharon1965 · Post by **sharon1965** » Sun Oct 21, 2007 6:35 pm

yay babs
(that betty boop picture should be your avatar...you are the personification of her!)

sharon

DreamDiver · Post by **DreamDiver** » Sun Oct 21, 2007 7:15 pm

Hi Babs,

I'm glad you went armed. Often, things just fall into place when you do. Congrats!

Your adventure made me think to look closer at my insurance EOB's. I found a number of charges from my DME that look similar to what you were talking about. The explanations only go as far as saying "medical equipment". Some are as much as $550. Others are piddling. The charges are considerably more than the paperwork I got from the DME. I'm looking at new masks sometime this coming week. I think I'll bring my EOB's and ask for matching paperwork from the DME. It should prove very interesting.

Babette · Post by **Babette** » Sun Oct 21, 2007 9:31 pm

Organplayer wrote:Way to go Babette. Story with a happy ending. Would not want to meet you in a dark alley... on the other hand, may be I would.

See you in Lower Alabama in Nov.

From Upper Alabama,
Kevin

Seriously??? You coming to Frontier Days at Fort Toulouse? Yee-Haw!!! Though I don't think Wetumpka really qualifies as LOWER Alabama. Maybe Central. Dad always calls himself my "LA" Dad - He lives in Mobile, which is TRULY Lower Alabama!

I'm getting pretty psyched for Frontier Days! You just ask for Babette - they know me as the same wild woman you know and laugh at here.

LOL,
Babette La Mauvaise

gasp · Post by **gasp** » Wed Oct 24, 2007 10:32 am

Yeah! You rock. Good job!

Guest · Post by **Guest** » Wed Oct 24, 2007 10:49 am

Babette: without all the editorial fill-ins...can you help me understand why you think it was wrong for them to bill in advance or whatever for your equipment? Did you have a co-pay or something that you're mad about?

Also I wish someone on this forum actually knew someone that owned a DME and had to actually MAKE A PROFIT from the sale of CPAP equipment.

Not every industry is run like Wal-mart.

ozij · Post by **ozij** » Wed Oct 24, 2007 12:10 pm

Be careful what you wish for, sometimes your wishes are granted.

Becoming VERY disillusioned with my DME (i.e. my employer)

Well I had thought I worked for a pretty decent 'mom and pop' DME that did things a little different and went a little further for the patient than most of the others.

However, an order came from a doc's office to set a patient up on an auto w/ a-flex. Knowing this doc, the auto is 'to keep' instead of a loaner for a month or two to ascertain data and avg pressures like most cases in the past (with the patient ending up with a standard CPAP with the pressure set from the auto report or retitrating their old CPAP with the new info from the auto)

This doc is an awesome sleep doc who reads his own patients' cards so that's why I think it's to keep.

The owner has just implemented a new policy, brought about by this order that any patient who is ordered an APAP 'for keeps' will be charged a $200 upcharge fee. Of course, this is out of pocket. This is implemented to help protect the DME's bottom line from the reduced reimbursement that an AUTO costs them versus the base model (in our case a DS100H)

Oh, and that's not all, the owners just got back from Medtrade in FL. They ordered about 30 Fischer/Paykel HC230 CPAPs for patients who have insurance that doesn't reimburse very well (like United Healthcare)
Evidently the HC230 costs us less than the base model DS100H from Respironics.

All of this is very nauseating. One more DME finally succumbing to the Dark Side ($$ vs. patient care and satisfaction)

Kind of makes going back to critical care at the hospital look a little more appealing

Appeared on this forum on oct. 8 of this year - two and half weeks ago.

O.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, CPAP, DME, auto, APAP

DreamStalker · Post by **DreamStalker** » Wed Oct 24, 2007 12:16 pm

Anonymous wrote:Babette: without all the editorial fill-ins...can you help me understand why you think it was wrong for them to bill in advance or whatever for your equipment? Did you have a co-pay or something that you're mad about?

Also I wish someone on this forum actually knew someone that owned a DME and had to actually MAKE A PROFIT from the sale of CPAP equipment.

Not every industry is run like Wal-mart.

With Wal-Mart, you get what you pay for ... with the DMEs it seems most are getting less

socknitster · Post by **socknitster** » Wed Oct 24, 2007 4:59 pm

I don't get it. Guest thinks Walmart doesn't make a profit? Ummmm. Wrong. They may sell things cheap, but they buy them even cheaper. Markup for "lost leaders" may be only 50%, but for many other things, it is more like 100% to 400%. I know retail. Walmart isn't going broke anytime soon.

Most DME's actually ARE operated like Walmart. THe lowest denominator is what matters. If the patient isn't self educated and therefore doesn't push for what is best for themselves, they get stuck with the cheapest machines on the market--no data, no knowledge of whether or not their treatment is working.

That is how a friend of mine ended up going 20 months on treatment before finding out that the reason he felt like shit was because he was using his prescribed 10 cm of water pressure when he needed 20. His sleep study let him down, and then the DME let him down again. Only after pushing for a better machine did he finally discover that for nearly two years he wasn't getting proper therapy. That is like telling a diabetic that taking his sugar every morning just isn't that important. Had he had nothing more than the shitty readout on the m-series pro, he would have known that an AHI in the 30's isn't good and would have been able to have something to talk to his doctor about.

Oh, and I don't know about you, but I don't want to pay for something unless I actually am receiving the goods. Not fair to bill someone 3 months rental AND full purchase price when they have only had the machine what, a week, or something? Amazon doesn't charge my credit card until my item ships. If they did, they wouldn't be who they are today. Why the hell should DME's get to charge rental and purchase price at the same time. THe idea of the RENTAL is to see if the machine will work for you. You MAY want to try another, gasp!

There are a few DME's out there who care about the PATIENT and not how much money they can make on every poor sucker that walks in the door. Even Walmart tries to give us the ILLUSION that they give a crap about us!

Sorry for the rant, but I just went to my "sleep doc" today and waited for an hour only to have him spend 2 minutes with me, tell me I need another sleep study (so he can make more money off of me) and then watch him breeze back out the door while I sit there holding my list of questions in the air, saying, "Buuuuuut. . . . " Silence. I never got to say more than 3 words and he was gone. This is the worst treatment I have ever received as a patient. Sleep medicine, for the most part, seems to be more about money and less about patient care and health and it makes me absolutely sick.

By the way, I don't need another sleep study. I'm doing great, feeling fine and my machine says my ahi is very low, often under 1. His reason? Even though I use a very tight range on my auto, he says I need to "pick a pressure." He actually said, it was because that is what the textbooks say. No kidding. ARGHH!

Jen

DreamDiver · Post by **DreamDiver** » Thu Oct 25, 2007 2:07 am

socknitster wrote:Had he had nothing more than the shitty readout on the m-series pro, he would have known that an AHI in the 30's isn't good and would have been able to have something to talk to his doctor about.

Jen,

What things about your bipap make it better than the pro? or the auto with a-flex? Your machine costs considerably more, and data seems to be part of the key. So I'm asking more about data output capabilities and not the machines' obvious pressure specs.

Guest · Post by **Guest** » Thu Oct 25, 2007 6:50 am

Thanks, but I was asking Babette.

ozij · Post by **ozij** » Thu Oct 25, 2007 7:00 am

DreamDiver wrote:
socknitster wrote:Had he had nothing more than the shitty readout on the m-series pro, he would have known that an AHI in the 30's isn't good and would have been able to have something to talk to his doctor about.
Jen,

What things about your bipap make it better than the pro? or the auto with a-flex? Your machine costs considerably more, and data seems to be part of the key. So I'm asking more about data output capabilities and not the machines' obvious pressure specs.

DreamStalker · Post by **DreamStalker** » Thu Oct 25, 2007 7:39 am

Anonymous wrote:Thanks, but I was asking Babette.

Oops! Well excuse us .. I'm sure she will tell you exactly what you need to hear.

deglorious · Post by **deglorious** » Thu Oct 25, 2007 8:50 am

I just got a bottom of the barrel resmed tango and have been reading with interest about moving up to a data capable machine. I know I am having mouth leaks at night but the Dr. will have no way to know. I have bc/bs too. I'd love to know how I can go about getting a better machine, too, Babs.

Thanks for your help!

Mask	Humidifier

Additional Comments: Pursleep, Padacheek, Regenesis™ Pillow, Neti Pot, Travel Buddy hose hanger

A Miracle has Occurred in my Life

Insurance vs DME discrepancies