Why so many threads about doctors not prescribing apap?

[neillebo]

I was just prescribed a cpap machine at 9 and it was called into the dme. I really wanted an apap and the dme was not interested in talking.. Nor, can i really get my doctor to call me back.. so, i called my insurance company and they will pay for a purchase that I do online for Apap. All they need is a cpap rx from my doctor and they all allow that to work for apap. I am told that is different online then if you use your dme. However, I hope I am not missing anything since so many threads are upset that their doctors wont rx apap. cant you just do what i did? the only downside is that the dme is in network and online is out of network, so a higher deductible and higher copay. The insurance company knows that i have the other machine and they said to just send it back. is the risk that my doctor will refuse to issue a return/discharge order for the original machine? do i even need to tell her abou it? cant we buy 4 or 5 if we want to? Just making sure i havent set alot of bad things in motion. I still have my original cpap but the apap is in the mail and the insurance company has prequalified the purchase..... thoughts?

[Slinky]

That is just plain BS the local DME is handing you that you can't return the CPAP to them! I had a local DME try to hand me the same bunch of horsepuckies. THAT was a big mistake! The minute they told me I could NOT return it w/o my doctor's order I saw RED and was in my car w/in 10 minutes w/all the equipment! I marched in, told them I was NOT keeping or using their equipment, sat it on their counter, insisted on a receipt for its return and walked out.

Look, think about it. A doctor hands you a script or call it in to your pharmacy. No one can make you go get the script, and even if you did, no one can make you take it. CPAP is no different. Take it back and while you are at it tell them that their lack of truthfulness cost them not only a customer BUT also someone who will tell any and all who will listen just how untruthful they are!!

Enjoy your auto from cpap.com!!!!

[neillebo]

"horsepuckies".. I LOVE IT! yep, I saw red and dont buy it either. It's why i ordered mine on line and spoke with my insurance company without getting the dme approval or my doctors.. I did then call them to see their price for the same unit (almost double) and inquired then about the return policy "should i opt to return it" (of cousre, i did buy the other one already so will return it).. that's when they told me they cant without rx etc.... as an aside, i did just speak w/ my doctor right now. she'll order a discharge request and seemed aggravated that i bought one on my own, but i explained that it was only due to my insurance spend this year and that it's cheaper to buy now then rent this year and next year.. Docs are funny people. she also woudnt answer any of my quetsions and insists on an office visit next week (chaching)..

[lifeartist59]

I did a little reading between my studies and getting my machine. When I saw my doctor I asked about apap, since the tech at the study said I would have to get a new test every time I lost or gained 10-15 pounds. I have lost about 30 so far, and did not see the point in getting tested so much. I also could not sleep much ( only about an hour) and felt it was just a hassle I would rather not deal with. My insurance paid for the first one and the titration one, but I did not see them paying for one every three or four months since it ran 4,000.00. My doctor said she did not think the insurance would pay for apap but would write the script explaining about my weight loss attempts etc. The insurance paid for it, no problem. Insurance companies could save a lot if they compared the cost of apap to the testing and how often it is needed with cpap vs apap.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, CPAP, APAP

[Wulfman]

neillebo,

Ya done good! It sounds like your doctor is tied in with that DME.

I've written about this many times, but what I did was to use the invoice I got when I bought my stuff from CPAP.COM (2 1/2 yrs. ago) to make out an invoice (with me as the billing party) to my insurance provider (as the party being billed) and then they reimbursed me at the in-network rate.
I also had this pre-authorized with my insurance provider. I didn't purchase an APAP at that time as I was mainly interested in getting a machine that had data recording and software capabilities.
In any case, I saved myself and my insurance provider quite a bit of money.

Den

[Perchancetodream]

neillebo,

Ya done good! It sounds like your doctor is tied in with that DME.

I've written about this many times, but what I did was to use the invoice I got when I bought my stuff from CPAP.COM (2 1/2 yrs. ago) to make out an invoice (with me as the billing party) to my insurance provider (as the party being billed) and then they reimbursed me at the in-network rate.
I also had this pre-authorized with my insurance provider. I didn't purchase an APAP at that time as I was mainly interested in getting a machine that had data recording and software capabilities.
In any case, I saved myself and my insurance provider quite a bit of money.

Den

Do you mean that you did not file a claim as a beneficiary, but as a provider? Sorry I haven't read your earlier posts on this, but it is interesting and I might like to try it sometime. Did you agree in advance with your insurance company to send them an invoice?

Susan

[rested gal]

neillebo, your subject title asked:

"Why so many threads about doctors not prescribing apap?"

You may have already seen this thread, but if not...it's kind'a interesting reading.

Feb 19, 2005 subject: "Sleep Doctor" doesn't like autopaps
viewtopic.php?t=1461

[Wulfman]

neillebo,

Ya done good! It sounds like your doctor is tied in with that DME.

I've written about this many times, but what I did was to use the invoice I got when I bought my stuff from CPAP.COM (2 1/2 yrs. ago) to make out an invoice (with me as the billing party) to my insurance provider (as the party being billed) and then they reimbursed me at the in-network rate.
I also had this pre-authorized with my insurance provider. I didn't purchase an APAP at that time as I was mainly interested in getting a machine that had data recording and software capabilities.
In any case, I saved myself and my insurance provider quite a bit of money.

Den

Do you mean that you did not file a claim as a beneficiary, but as a provider? Sorry I haven't read your earlier posts on this, but it is interesting and I might like to try it sometime. Did you agree in advance with your insurance company to send them an invoice?

Susan

Well, as a member of our group plan, I'm considered "in-network"......but, yes, I sent them an invoice (just like a provider would). Yes, it was agreed to in advance. I was in contact with them all the way through the process. I actually had to get after my sleep doctor's office because they hadn't sent a copy of the sleep study to my insurance provider (for review).....and their delays cost me about 10 days in getting my equipment to get started (I wanted to make sure all the I's were dotted and the T's were crossed).

Den

[Perchancetodream]

Congratulations, Den. Wish I could have done something like that. Would have saved the insurance company big bucks!

Susan