DME Games

[Breathe Jimbo]

Oh, well. If the humidifier has already been purchased, then I may donate it to someone or an organization that helps people who cannot afford this stuff - like me, soon, if I don't find a job.

[Sal_In_Ga]

I was able to secure a new ResMed S9 Auto set because I've been studying with you all.
Late June - Called Ins. co to find out when I would be eligible for a new machine (I had been prowling around in Ins booklet for other benefits and it looked like 3 yrs. to me). The rep. told me that my policy would allow for a new machine every 3yrs., that I could have Cpap or Apap, and that it was the best time to buy one since I had met my out of pocket due to a surgery I had earlier this year. I called the Dr. to see about getting the S9 AutoSet. What do you need to see him about? (Don't you just love it when the receptionist want's your diagnosis(from you) before you can make an appointment to find out what's wrong with you so she can tell the Dr? OOPS! I digress.).
Can't see him for a month. I then called the DME Dept of the Pulmonary Clinic and told them I wanted to order a ResMed S9 Auto set and that my Ins. Co had told me that I was eligible 100%. The girl in the Dept that handles supplies has been a big help in my adjusting of my mask, etc. With much stammering, she began with the questions:
Me: "I want a new machine and I want an S9 autoset. It's the best out there (The pulmonary clinic only sells ResMed), my S8 Elite will then become my backup machine. I've already talked to my Ins. Co and they told me I was eligible for a new machine. Plus, I have reached my out of pocket and this is the only opportunity I may have to get a new the machine.
Me: " I tried to get an appointment with Dr.__ , but He's not available for another month. So I called you. I want to order a ResMed S9 AutoSet"
C: "Why do you want an autoset?"
Me: "I want a new machine and I want an S9 AutoSet. The S9 AutoSet is the best out there (The pulmonary clinic only sells ResMed), my S8 Elite will then become my backup machine. I've already talked to my Ins. Co and they told me I was eligible for a new machine. Plus, I have reached my out of pocket and this is the only opportunity I may have to get a new the machine.
C: "Just because your Ins. co told you you were eligible for a new machine doesn't mean you can just get it. You would have to have a new prescription for it.
Me: "An autoset can also be run as a straight Cpap, right? Then it doesn't require a new prescription.
C: "Uh...yes, it is a Cpap" (Hello!)
Me: "Then an Rx is not required."
C: "You'll need a letter of medical necessity."
Me: "What for?"
C: "Well, I'll talk to R _____(DME Director) and I'll call you.

Within a week I received chipper call from C: "Well, your S9 is ready for you to pick up. Your Ins. approved it 100%, When would you like to come?" she sang.

This was fun.

[Sal_In_Ga]

Well, I forgot to ask for a written Rx after the earlier go-round, - I like to have my Rx with my machine and since we are to vacation out of state I figured I could get without a lot of trouble. So I call my pal C and tell her what I need. She can't handle that for me - she would transfer me to Dr__'s nurse.
Yep. Here we go again.
N: " Now, what is it you want?"
Me: "A prescription for my S9 AutoSet"
N: "Why do you want the RX? Your insurance isn't going to pay for another machine."
Me: I don't want another machine. Did Dr.___have to write an Rx for my machine?"
N: "He had to write a letter of medical necessity." (No one has yet told me to whom he had to write the letter. Ins. co I guess?)
Me: "I see. Well I want an Rx for my new machine, please."
N: "You have an appointment with R____on the 12th.
By this time I had lost track that It's my right to the Rx.
Me:"I want to have to keep in my bag. I'll be traveling out of state next week. If something happens to my machine I can't just bob over to your place
and say "OK,Guys. I need a machine mine is toast." I can't just go into a DME and even rent a machine with an RX."
N: "Ok, you want an Rx for an S9"
Me: "S9 AutoSet with all supplies and mask of patient's choice."
(Before I could actually finish my sentence):
N: "I've written this down and will give it to Dr____. Do you want to pick it up or me mail it to you?"
Me: "Just mail it will be fine."

[Slinky]

Ach, "just mail it" wasn't the best choice. It does leave an opening for the receptionist/office/doctor/whoever to drag their feet and not get it into the mail early enough for you to receive it before leaving next week.

[Sillyme]

C: "Just because your Ins. co told you you were eligible for a new machine doesn't mean you can just get it.

I think you have the same sleep clinic that I have - only your RN was actually nicer. I'm not accustomed to being treated with such condescention. I blamed all the trouble on the DME. Seems some sleep labs are in cahoots with DME's. I think now that the best idea is to have your GP order the study and then get the Rx directly from the GP as he has no financial interest and go to a large DME that has a reputation to uphold. I told the sleep center RN that I didn't need her to talk to the DME, I just need an Rx for mask and supplies stating "patients choice" but she said she needed to make sure I got what I needed THIS time. I think they like to write the prescription for the mask and machine that is most profitable for the DME. Even Aetna told me that each DME has different agreements with them. My first DME said that they were going by codes (which she couldn't show me) from the sleep center - and these were NOT on my Rx.

And thanks, Slinky - I'm starting the paper trail. I'll never deal with this lab again but I want to rattle their chains a little.

[Breathe Jimbo]

I have confirmed with my DME that they have my new S9 Elite and humidifier, but my RT will not be in until tomorrow, so I will pick it up tomorrow. I was told that the humidifier for the S8 which I am returning was purchased supplies, so I am stuck with that. I hope I don't need a new machine for a long time. This process has been irritating, but I do like my RT notwithstanding. I am excited about being able to collect detailed data starting tomorrow night!

[Sal_In_Ga]

Ach, "just mail it" wasn't the best choice. It does leave an opening for the receptionist/office/doctor/whoever to drag their feet and not get it into the mail early enough for you to receive it before leaving next week.

Actually, I am only 15 min. away from the Pulmonary Clinic and if I don't receive the RX by the first of next week, I will make a visit without an appointment. The RT and PA both told me the first day that this was a clinic and I could come without an appointment if I needed to. Hey, I've got the Power, right?