DME and Insurance Dilemma

frostman · Post by **frostman** » Sat Jul 02, 2005 7:29 pm

I am with BCBS and my DME is Lincare. If I had researched everything before getting into this I would be better off. My doctor calls me and says you are ready for a CPAP machine, we usually use Lincare, although there are others in town. Not knowing one thing about machines, etc they set me up with a remstar plus with CFLEX. Well I have only been on it about a month, and now know that I want the Auto w/CFLEX. DME says the doctor will have to approve it since I already had a titration study and my pressure is supposed to be 9. I say this is a long term commitment and I want to be able to manage myself, be able to use the computer read outs, and that a one night study can't possible be that accurate to say i always need a pressure of 9.

Other DME's in town have the item in stock, can I just give it back and say thanks and go on to another DME, with the insurance company balk?? I told lincare I would like to stay with them, but they need to work with me

Maskedmechanic · Post by **Maskedmechanic** » Sun Jul 03, 2005 7:59 am

It is most likely that your insurance company will pay Lincare the same amount whether it is an Auto or a Plus. Lincare, understandably does not want to provide you with a more expensive machine and take what is now a used, less valuable Plus back. They make much less money in this case.

Lincare is not "your DME". They are owned by their shareholders. You are free to buy from anyone you like if you get a copy or the doctors prescription. If you go to a second DME now, expect trouble with your insurance. Since Lincare will have a valid claim as will the second company they will short the second company and you will be billed for any difference.

Under the circumstances, you might suggest to Lincare that they provide you with an auto cflex in exchange for the Plus and something like $200. That would be fair to them and you would have great equipment.

Legally, the auto provides cpap pressure that was prescribed by your doctor, so Lincare can switch machines. Whether they will is another story.

Let your doc and sleep lab know about your concerns. Tell them about cpaptalk. It is time these professionals did more to point new patients to educational resources.

SheilaB · Post by **SheilaB** » Sun Jul 03, 2005 9:27 pm

I was also "prescribed" the REMStar Plus. I had read here and knew I wanted an auto or at least the new REMStar Pro 2 so I could monitor the data. My DME did confirm that the insurance company would only pay one rate for any machine. I ended up with a compromise--not the auto but the Pro2. They were really nice and would take no extra money--I think that would violate the "assignment" regulations. I did have to have one face to face "get-down to business" session with the manager--after that all was well. BTW, I am very satisfied with my Pro2.

frostman · Post by **frostman** » Tue Jul 05, 2005 7:45 am

What did you say to the manager??? I am pretty upset with my DME right now. I am the customer, I should have the right to have the machine I feel i need since it is probably a lifetime commitment. If I would have researched it I would have gone with a different DME, the nurse is great, but the manager i don't care for

SheilaB · Post by **SheilaB** » Tue Jul 05, 2005 9:12 am

My post below is how I handled it. Sorry I don't know how to link to a post. Maybe someone will tell me--I looked in the FAQ's and did not see it.

Here is the old post:

Thanks for the advice folks. I was able to reach a compromise with the DME dealer in my area. They simply refused to sell me an auto--I was willing to negotiate on that anyway. They did not want to sell me a REMstar Pro 2 with the software/recording capacity, I explained to the person in charge the importance of viewing my progress or lack thereof myself and keeping track of it. I almost lost it when the DME person asked me who would download all of that and help me with it!!! It took all my patience to calmly tell him I built my own computer so I think I can handle downloads. He agreed I could talk to his Respironics representative. The Rep did call me and I went through the whole thing with him again. He agreed to send a Pro-2 to the local DME dealer and to order me the Comfort Curve mask I wanted. He said if I thought I could work with the software and the smart card then I could buy one--of course my insurance company would not pay for that part.
Will keep you all informed on the continuing saga......thanks again for the advice from everyone.
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sarkel · Post by **sarkel** » Tue Jul 05, 2005 12:11 pm

I have BC/BS also I have had my machine for about aweek now. A remstar Plus w/cflex.. What I wanted was at least a Pro2. THe DME told me that I could get a Pro IF I wanted to wait for a new prescription. (NOt a Pro2, they didnt have them in stock hahaha) They couldnt even answer when i told them it was a discontinued model. .

So I settled for a Plus. Now this is on rental, so my thinking is if the doctor changed the prescription, can I get the Pro2 like i originally wanted??

This process has been so complicated and i am so frustrated.

DME and Insurance Dilemma

DME and Insurance Dilemma

Met with manager????

hey.....Me too