How can I fire my DME?

[sylphdreamer]

I'm a CPAP newbie with a bad DME experience. I was given a Resmed S8 Escape II and a swift LT for her nasal mask. I got the CPAP on a Friday and called on Monday saying it gave me a terrible earache in one ear. They said they'd have an RT call me back. No one called me back and after three days of pain I went to the doctor. She said, I had some nasal congestion and to stop using CPAP until it subsided. I also said the mask hurt the inside of one of my nostrils.

Restarted use after 1 week. Called the DME and said I was concerned the unit wasn't working that I was feeling worse after using it and could hardly breathe. I felt I couldn't get enough air. Plus the mask hurt my nose. I told her that no one had called me back after my previous complaint and no one had called to check how I was doing as she said they would. She said that I would have to get a prescription from my doc to get a new mask. I questioned that because she said she had signed me up for "mask insurance". I called and had one faxed for a Swift FX (her recommendation). I didn't receive it. I started using the mask I had at the sleep study and still don't feel I'm getting a good nights sleep.

This is a very long story so I'll cut most of it out. After upteen phone calls and conversations with at least 9 different people including a visit to my home, I still don't have a mask. They finally admitted they lost my paperwork. A new rep came to my home bringing all the same masks I had already told him I tried at the sleep study that didn't work. I had explained that I had a petite face and felt I needed a smaller sized mask. The first one he brought out was the swift LT with medium pillows! He didn't have any small sizes with him. I explained how frustrated and mad I was about this. I told him my cardiologist wants me using an effective mask. He said they'd get the new mask to me FED EX the next day. TWO days later he calls my home (while I'm at work--they have my work number) and leaves a message that they ordered the mask and it will be available in 7 days! I called back and left a message for him that I didn't want to buy anything from him ever again!

How do I fire this DME and get a new machine? I called another DME and he said I'm stuck with the machine because it's past one month and the original DME has no doubt already billed my insurance. Argh!

Is there a regulating body or board that I could complain about this company?

[GumbyCT]

Start with your Insurance to find out if any other DME's are contracted with them. Read (search) here there are many post which will guide you.

Licensing is done thru your state prob the state Health Dept. Contact them to find out exactly how your state is structured. I strongly suggest that complaints are filed with Ins. and state. If others had - you wouldn't be having this trouble now.

Good Luck

[sleepycarol]

They may have stalled you on purpose for the very reason stated.

Most of the time it is difficult, sometimes impossible, to do anything after 30 days. I would first off contact my insurance company and explain what is going on. Be nice to the insurance company, as you want them on your side. See if they have some solution ideas. If you have more than one DME in network, see if they would allow you to change even though the "magic" thirty days are up. I know that sometimes billing delays happen, and that could work to your advantage. If possible are you willing to pay out of pocket for a month? If the insurance hasn't sent the invoice through see if you can pay for the month and start fresh with a new DME. If they have made payment, can you still switch and pay an additional month at the end (many times the insurance company will only pay an X amount for X months.

If you can get your insurance on board, half the battle should be over.

I would also contact your doctor and explain what is going on. Are they willing to help you?

In all likely hood the DME, if you do return your equipment that is on rental, will want you to sign a waiver stating you are not going to use a cpap. I was asked to sign one (I returned my stuff to the first DME I had but it was within 30 days) and simply refused. My doctor and insurance were already on my side as I had called them prior to the return. That DME called my doctor and become very agitated that the doctor was already aware of the situation (I had told them already).


Others will probably have suggestions as well. Good luck!!

[sylphdreamer]

Thanks Gumby CT and Sleepy Carol.

I have contacted my insurance company and I think they must have hired folks that the DME fired! They have a central company that handles DMEs and won't give me the name of any in network DMEs. I called the central company and they won't do anything without a prescription from my doctor. I told them I just wanted to talk to different DMEs to see what my options are. They refused to even give me any information. I called every person I knew that had a CPAP and asked them the name of their company. I've called 5 different places and only one would talk to me without a prescription. It's astonishing. You would think I'm asking for top secret information.

I will call my state health dept. and find out about licensing.

When I initially signed the paperwork (if they ever find it) I agreed to pay if my insurance doesn't at the whooping rate of $274 per month for the machine alone! My insurance pays 100% for required DMEs so I'd really rather not pay out of pocket.

I really would like for the DME to take responsibility for its own screw ups. After perusing this board, I'm not sure if that ever happens.

[Slinky]

Your state will have some type of licensing board for both insurances and local DME providers. Explain your situation w/both the local DME provider AND your insurance. If your insurance is thru your or your husband's employer contact your Benefits rep and explain the situation. You are getting the royal shaft job from both the DME provider AND your insurance.

And it is time to put your complaints IN WRITING. There is nothing like a paper trail to inspire action.

If your doctor will write you a new equipment order (script) ask him to include "access to Leak, AHI and AI" and "full face, nasal cushion, nasal pillows or oro-nasal mask of patient's choice". Plus ask that he give you either the original script or a copy of it as well as the sleep study results needed by local DME providers.

[jules]

is your insurance an HMO?

[GumbyCT]

ok so let's start from the beginning.
1. Who is your insurance? HMO??
2. Where on this planet are you located?

Then spend some time here reading and making notes - yes get a notebook. The notebook will be your saviour. You will find the common message is to get a copy of your script and sleep study "IN your hand".

You will want to request both them both your doc AND DME "in writing" since denying you access to your medical records is a HIPAA violation which could give you some leverage along the way.

http://www.hhs.gov/ocr/privacy

ps. keep posting when you have Q? - this is THE Best forum on the internet

[sylphdreamer]

I have Cigna insurance and am in North Carolina. It's not an HMO, so I'm quite grateful that they pay 100% for DME.

I'm amazed at how much good advice I've received already! Thank you all for posting. I've already found a wealth of information in this forum from searching and reading past posts on machines, masks, clinical information and how to be successful.

Gumby CT you are right to recommend a notebook! I've read so much that's been helpful but have been following threads here and there and have had to try and duplicate searches to find the information. Perhaps if I could get a CPAP and mask that work my memory would get better.

Slinky, your advice is excellent too. I will ask my doc for that prescription and start the written trail...

[GumbyCT]

With Cigna so you are stuck with Apria? Isn't that supposed to change in the coming months?

[jules]

there can be other DME's cigna will contract with but their big contract is with apria - check the provider directory at cigna.com for your area - look for DME in "other facility type" in your area for your type of cigna plan

[Kevin G.]

First you need to determine how important it is that the DME pays the cost and how much of a pain in the A-- you are willing to be.

One option is to notify the insurance company that you are going to go out of network because the only DME they provided was incompetent and it had a negative impact on your treatment. If the machine is OK but the problem is with the mask keep the machine you have and go to another DME for assistance with the mask issues. Changes to the setting on the machine can either be done by the new DME or you can likely find out how to make the changes your self, consistent with your doctors recommendations.

Get a copy of your prescription. Your physician should be willing to give you a copy. You can then take this to another DME who will accept it and provide you with the masks or other supplies you need. The internet based suppliers appear to be accommodating as long as you have a prescription. You may need to make it clear that you have the machine and you just need supplies and assistance. Unless they are stupid they should be willing to take your money.

If you believe that the machine part of the problem, consult with your physician, consider the fact that you can likely buy, not rent, the machine for under $900 and a heated humidifier for under $300. These costs are for a ResMed S9 and humidifier brought over the internet. Most insurance companies will pay out of network suppliers at a lower reimbursement rate but it may be worth it.

Take charge of your treatment. Empower yourself. In my esperience what you are dealing with is often the norm. I have had lousy experiences from brick and mortar DMEs. When I purchased a machine over the internet with my own money I had no hassel.

You then need to decide how much energy you are willing to expend to sort this out. Consider the impact this issue has on your relationship with your family. Are you being consumed by this problem. There is an old saying that goes “may you be cursed by a law suit where you are in the right”. Sometimes it costs more to prove that you are right than it is worth. Paying for the machine out of pocket may be cheaper than a divorce.

Even if you will pay out of pocket it might do you good to file a complaint with your insurance company and/or file a complaint with the body that licenses DMEs and RT’s. State that the incompetency has had a negative impact on your treatment.

If the insurance company will not reimburse you for out of network expenses consider filing a complaint with the state agency that regulates insurance companies. Make the point that you had to go out of network because of the incompetence of their supplier.

If you are a little vengeful and want to have fun stand on public property outside the offices of the DME with a sign stating that they provide poor service. To be most effective you do not want to be seen as being out of control. I would only do this after I had sorted out my treatment.

Do not let your emotions consume yourself. If you do then they win.

[cpapqueen1]

Apria lost the Cigna contract. I believe Lincare picked up the contract. You need to check with your insurance company to ss if they purchased or rented the cpap. You can always go somewhere else for supplies if the cpap was purchased.

[GumbyCT]

Apria lost the Cigna contract. I believe Lincare picked up the contract.

That would be out of the pan into the fire.

Your long term plans should include changing Ins. Co.'s.

[sylphdreamer]

I believe it is Lincare. They won't give me any information without a prescription. I think it's a great idea to get the prescription from my doc, then I'd feel more in control.

I did check my provider network. The only one they list is CCS Medical Inc which has a toll free number listed and no address. I also checked my benefits and the DME has either not yet filed a claim or Cigna hasn't listed it yet.

Considering the impact following through with getting them to take responsibility is important. I really do want them to take responsibility but a higher priority is that I get a decent machine and mask. I'd also like to make sure that the RTs are trained and respectful. Since they lost my paperwork, they may not be able to do anything. When the RT came out to my house he actually had the nerve after screwing up again to ask me to sign the paperwork. I told him I wasn't signing anything!

Changing my insurance is not an option. I have just been diagnosed with CVD and will be getting a cardiac catheter and possibly an angioplasty and stents tomorrow. Then I'll be on cardiac rehab for 12 weeks. It's not a good time not to have proper equipment or to be fighting anyone.

I do think folks have given me a lot of good ideas though and I feel empowered to follow through on several of them.

I again want to thank everyone for the incredible wealth of information in your answers to my post and in the forum in general. If only I had found this forum first! Too bad the docs don't recommend it. I will definitely tell my doctor about it.

[jules]

in my dealing with Lincare in two states -

timely billing of insurance wasn't one of their strong suits -

sending you collection threats when they hadn't sent you a bill they excelled at

billing people venting insults at you over the phone they also excelled at

the local people - ones you get equipment from - office manager - RT - they weren't my problem by any means - my problems were higher up

and yeah they do screw up paperwork at the local level - saw that but if you got a real person to see what was going it, it would get fixed eventually (but the bills - nah)