New Rx in hand...new DME search. Help?

[SnoozyQ]

My neurologist is sending a new script for me to have in hand and give to a DME of my choice (pending Wellpath insurance approval,of course).

How do I find a good DME? Do online companies work with insurance? I hear nothing nice about local DMEs, including mine, which I know from experience, SUCKS.

I really want a DME with easy access to supplies, someone to answer questions, etc so I don't have the run around like I do now. Is there such a thing? LOL

[Madalot]

Hi Snoozy!

I think when it comes to selecting a DME, unless you know someone that uses a particular one, it's so hard to know which one to select.

For me, I had worked with my DME on my powerchair in 2007, so I already had an idea of what to expect from them as a company. It's still been a wild ride, but I've stuck with them because despite the problems I've had, I do believe the owner of the company has my best interests in mind.

Maybe if some other posters here are in your area, they can help you if they have any experience with the DMEs close to you.

[SnoozyQ]

How funny...Neuro just told me that my current DME has been calling them, wondering why they don't get business from them. I was happy to provide them allllll the reasons I am not happy with them.

They never could get it together to enable me to send a mask back....how they will ever retrieve the entire set up is beyond me.

[Janknitz]

Snoozy, BEFORE you call any DME's, call your insurance company and understand exactly what they will cover, how they reimburse, AND what DME providers you can use.

If you go to my blog at http://maskarrayed.wordpress.com/what-y ... me-part-i/ you will see the questions you should ask and what you need to understand before contacting the DME. Armed with that information, you can "interview" the DME's, and that will give you a good idea of whether or not they are going to be truthful and work with you. This puts YOU in the driver's seat, not them.

You already list equipment. Are you going to be able to get new equipment, or are you just looking for a supplier for your supplies (masks, hose, filters, etc)? Be sure to compare your out of pocket costs based on what your insurance covers, including co-pays and deductibles to what it would cost you to buy online without all the hassle. If you are getting a new machine, you should know if your insurance covers a rental or a purchase, and what their method of reimbursement is (i.e. HCPCs codes). Make sure you understand whether or not a DME can charge you more if you ask for "upgraded" equipment (almost never!).

Then go shopping for your new DME. BTW, it would be a courtesy to other new CPAP users to write a list of your objections to your current DME, send it to them with a CC to your sleep lab and doctor. Maybe the DME will get the hint!

[SnoozyQ]

Thanks Janknitz! Very informative....I don't feel quite so unprepapred!

I should be getting new equipment....what I have was a loaner until they verified compliance--which they never bothered to do. I've sent an inquiry to my insurance folks about how to proceed and asked Neuro if they recommend anyone that I can look into.

This should be another interesting rollercoaster in my CPAP adventure--breaking from old DME,talking with ins co and trusting a new DME....I hope my insurance co plays nice...It's a shame that I fear I have created a mess, all in an effort to take care of myself!

[msradar65]

I would start by finding out what DME companies are accept assignment by your insurance company. The insurance company should give you a list of all the approved DMEs in your area.

Then start calling. I called and this is what I did. I let them know I was a patient of Dr. X and I had my sleep study done at X sleep study center. I had BCBS-LA insurance and I was given this information that they were a participating provider. I confirmed that they were. I left them know I was a new CPAP patient and I asked them what machine set up the issued to CPAP patients.

The first few places I called didn't do sleep therapy at all. One place I called I spoke with the billing specialist for the sleep therapy department. When I started asking questions she got very snippy with me. I wanted Resmed s9 autoset with climateline and I was not settling for anything less. This place wanted to give me s8 very basic unit. When I question why they were not offering S9...she would not answer me. When as I asked specifically what they charged for the equipment..she got rather nasty with me. So I thanked her for my time and let her know at the end of the conversation that I would be going with the DME that was the most honest, helpful and customer service friendly and offered the equipment I WANTED.

The next DME which is my current provider was wonderful. After she answered all my questions, offered to run my insurance, then sent me a print out with all the filing codes, the cost, what my insurance paid and what was my portion. I decided to go with this company. I let her know to please fax for my prescription.

They even worked with me on the cost. I was allowed to pay my part in installments. So I think you really have to shop to find what you want. I was very grateful I had found this group after my first night in the sleep lab. I did all my homework and knew what I wanted and went also with the recommendations of the sleep lab techs as well.

[robysue]

Snoozy, BEFORE you call any DME's, call your insurance company and understand exactly what they will cover, how they reimburse, AND what DME providers you can use.
<much deleted>
Then go shopping for your new DME. BTW, it would be a courtesy to other new CPAP users to write a list of your objections to your current DME, send it to them with a CC to your sleep lab and doctor. Maybe the DME will get the hint!

I'd add to this suggestion that you also CC that list of objections to your insurance company as well. If your insurance company ever decided to drop the DME from their list of providers, that really would shake the DME up I bet.

And also CC the list to the local BBB.

As for how to find a good DME, call around and set up interviews with the DMEs and talk to them in person if they are local: Make them earn your business.

[sleeplessinaz]

Hi SnoozyQ--well believe it or not I have had EXCELLENT experiences with them EVERY Single time!! I use Apria Healthcare.

Good Luck on your quest --the RS9 Auto is an awesome machine!!!
Carrie

[SnoozyQ]

Well the ball is rolling....I took the wonderful advice here and contacted my ins company with a load of questions

I found a DME that I'm interested in using (ins approved) but I want to see what ins. has to say before I pick.
I have notified my neuro/sleep doc and ins. co which DME I am dumping and why....and the DME knows too. They don't seem to care--there was no "please let us know how we could serve you better" or "sorry for the trouble" or anything....just "so you will be sending the machine and unused supplies back now?"

My authroization for the rental expired Nov 14....who knew? No one.

Buh bye crappy DME.

[sleeplessinaz]

Hi SnoozyQ--congrats!! Good luck with the new DME--who ever it is!! Which machine are you trying to get from them?

Carrie

[Bokes]

My experience with DME's is mixed. Some of the technicians are knowledgable, caring and truly understand CPAP and will explain pros and cons of varying masks and systems. Others have no idea and are just moving product to get you out the door. I would be firm with them and if you do not like who you are dealing with ask for someone else or change DME.

[LackingSleep]

For filters and masks: these are not a class 2 medical device and are much cheaper on ecommerce sites rahter than atempting to buy them at DME's. Mainly due to not needed an RX for these. Google cpap filters and you will see a list of companies.