My DME Horror Story

[JointPain]

You should at least report them to the BBB for fraud.

You really don't want to be stuck with a brick for five years. Five years is a long time. My first CPAP was a brick and it was horrible not having a clue what was going on while I slept. It's only with the efficacy data that I've finally been able to conquer my leak and mouth breathing issues. (And why is leak data of all things hidden from the user? Surely there's no way getting your leaks under control can be harmful.) Being able to see how you respond to CPAP over time is immensely helpful, and there's no way an occasional sleep study in a different environment can give you the same perspective.

It sounds likes this DME is far more interested in their profits than your health, so I would definitely be looking for an alternative. Are there good DMEs in the Austin area? (Sounds like they can't be any worse, not even close.) I would talk with your insurance and the (good) DMEs in the Austin area and see if it's possible to change providers and whether you could return your brick to the current DME and get a new one. The sooner you do this the more likely you are to get what you need.

[nanwilson]

Lurch
Call your insurance company NOW and find out where else you can buy your gear. Then TAKE that brick back and give it to them....GET A RECEIPT for the return. Then walk out and go to another DME, ask them if they handle the machine you want and get it Insurance pays the same amount for a brick or data capable machine, they have the same codes when submitted to insurance...................they are taking you to the cleaners. If it were me I would publish the DMEs name and address here, so no other new person gets pushed into the same corner. I actually had the same kind of squabble with a carpet supplier a few years ago. After fighting with this guy for a couple of weeks, I went into the store on a Saturday (first making sure there were lots of people in the facility) then went up to the store manager and stated my case in a nice polite manner, when he again refused to change his story, I kinda got louder and repeated my reguest.......end of story all the customers walked out and I got the carpet that we had agreed upon in the first place, not the cheap crap he was trying to foist upon me. We have all been where you are right now at one time or another, just take a big breath and DO IT!

[sleepycarol]

Your story is very similar to mine. I had Blue Cross Blue Shield as well (I am in Missouri though). I started with them and my doctor's office.

When I picked up my machine I was told that it was a very good machine and was the "Plus" model. Indicating to me that is was superior to other machines. The RT told me that it provided "all" kinds of data that would be useful, etc. That evening, I found this forum and learned the REAL truth. My script was written for a "smart cpap / 8 - 12 cmh2o / with humidifer / F & P 431 full face mask". After reading the forum and asking upteen questions, I determined that my script was not filled as written. I called the DME and was assured that the script was indeed filled correctly and they always set the cpap to the mid range of the pressure written. The list goes on and on about the deceptions they were trying to pull.

I called my doctor (pcp) and described what was going on. I called the insurance company and explained what was going on. I had both of their blessings to go ahead and change DME's. I took the machine back (signed a receipt for return of machine/humidifier) and refused to sign the receipt that I was "giving up" or whatever that form is where you aren't going to use the machine. They called the doctor and after they argued with her, she hung up on them.

I went to another DME and had the script filled as written.

DO IT NOW. You will be glad you did.

[Lurch]

If it were me I would publish the DMEs name and address here, so no other new person gets pushed into the same corner.

No problem.

<Name and address removed by Admin due to liability. Forum members are welcome personally contact the author>

From the way they appear to treat their customers, this SHOULD be their new logo...

[Pugsy]

You can fire them. I did it to my first DME. They said "are you refusing treatment?" I said "No, not at all but I am refusing to do business with you". You aren't married to them. The machine can be returned. The insurance has not bought it yet. You haven't bought it. You were flat lied to.

Do you have a copy of your RX in your hands? If not, get one. Make sure it says model name, not just
cpap at so and so pressure and mask of so and so. Then find DME who wants your business and will work with your insurance.

[kempo]

If you have had it less than 30 days you can carry it back and let them have it. All you would owe for one months rent max. Stop with the emails Lurch, they are laughing at how they have pulled one over on you. Your DME is scum. They love to screw sick people.

[zeeclass]

Can you get your doctor to "prescribe" the machine you wanted? Would your doctor be willing to get involved and go to bat for you?

This kind of crap is the reason so many doctors don't take insurance anymore. They are tired of dealing with the insurance companies.

Also, do you have written proof that you asked for an Elite model? Or any proof at all to make your case to a higher power about this?

[chunkyfrog]

Unfortunately, Lurch, it is hard to determine if the behavior you describe is an exception or the rule--doggone it!
Congress should investigate; but the big DME companies probably make HUGE 'contributions' to prevent that from happening.
No, I'm not a paranoid obsessed on conspiracy--just observant.
Suffice it to say; we need to fight for our right to what we paid for.

[archangle]

Insurance company policy is irrelevant. They told you it was an ELITE when you asked them. It isn't. You're entitled to return it without paying for anything. Yes, you should have turned it down when you saw it wasn't an Elite, but they DID tell you it's an Elite, didn't they?

One of your options is to try to get a complete refund and buy elsewhere.

The local small town newspaper or media might be interested.

By the way, did you pay by check, or credit card?

[Snooze_Blues]

The DME's behavior is reprehensible, but not uncommon. Mine tried similar, but less blatantly deceptive tactics. It was tiring and frustrating to get what I wanted, but I gutted it out, but only after finding a second office of the same company with more helpful, less aggressive, and more honest people.

Get what you want. Five years is a REALLY long time and probably how long it will be for a second machine.

Few of us are very good negotiators. Most businesses know this and it gives them a big advantage in business transactions with us. What they don't want you to know is that they get paid a fixed amount for a certain Medicare code, but there are many different machines with different prices. The object of their interaction with you is to give you the cheapest one so they net the biggest profit. In your transaction with them, you are what is known in the automobile sales business as "A Lay Down". A clever double meaning phrase referring to (1) simply laying down as much money as they ask for (or in this case, accepting what has been offered with no counter offer); and (2) ...well, I don't think I need to explain two, do I?

I am in the neurotic avoidance of conflict camp most of the time. I have to really buck-up to negotiate with someone. I understand where you are probably coming from. The fact that these are medical people (or so they want you to think, many are simple sales people or telephone answerers) makes us tend to trust them like we trust doctors and hospitals. DME's leverage that implied medical trust to mislead us in negotiations.

It's a supreme hassle in some cases, probably in your case, but it may be worth the trouble to come out swinging hard for round two and get what you want and what you deserve. Go for it!

[Ladelnutts]

Go to a doctor, any doctor - not necessarily your sleep doc - and have the Rx rewritten EXACTLY for what you want. In my case I went to my PCP and he rewrote the script for me. Have the Rx state that it is for the Resmed S9 Elite and also on the script have it read "acesss to AHI, AI, leak, & pressure data." Fax that to your DME and then start calling to arrange a swap out. If they won't swap it out, then take the escape back to them and return it. The machine is a rental on a month to month basis. The hose, humidifier, mask, etc is a purchase.

And Lurch, not to be a dick but you knew better when you accepted the machine. Don't let these people push you around. Be respectful but firm. Become a nuisance. I called the DME every day, several times a day, until they agreed to swap it out. If they won't swap it then return it. Make sure you get a receipt that says you returned it and go to another DME. Whether you get a $50 cpap or the $1000 cpap it is the same E0601 insurance billing/procedure code. If they keep ducking you via phone then be waiting in the parking lot one morning before they open. They are used to people tucking tail and running away so if you hulk up and start annoying them they'll give you what you want. The elite costs roughly $50 more than the escape model. Having you off their backs will be worth the additional $50 they'll be losing.

[Firekeeper66]

I realize this thread is long done but thought I'd post for any newbies (like myself) that come to this site looking for info.

I had the same thing happen to me when I purchased my cpap machine. The staff member told me all the features of an S9 Elite but then gave me an Escape. When it came time to get the data for my doctor, I was told that my machine wouldn't offer such results. I was POSITIVE I was told that I'd be able to get the data from the machine (I researched everything beforehand!) and discovered what had happened (Elite vs. Escape). I pointed it out to the supplier and she apologied, totally owned the error and arranged for the machine to be exchanged with an S9 Elite. Of course, there was some time in between where I stewed about what could be done and feeling like I got duped but it all worked out.

I should also add that 1. I'm in Canada and 2. this wasn't discovered until I had had the machine for 3 months already - they ended up exchanging it under the pretense that it was a doctor request.

I'm interested in hearing what ended up happening with Lurch!

[rested gal]

Welcome to the forum, Firekeeper.

I think many times the DME employees are not that "up" on the names of the machines or what each machine actually does. As long as a machine can record "compliance" (hours used), that's all the DME cares about -- in order to have insurance or Medicare keep paying that good old monthly rental fee.

They pull the usual box off the shelf (usually an Escape or a Plus), hand it to the customer. And that's it. Doesn't matter to the recipient because most people don't want to learn a thing about "cpap" other than how to turn it on and off. Most probably keep it "off" anyway.

Good thing that you had done your homework, knew the differences, knew what you wanted, and knew exactly why you wanted a specific model.

It was nice of your DME to admit to having made a mistake when she gave you an Escape despite all the beforehand discussion and agreement you had had with her. That does sound like it was an honest mistake on her part. They did right to exchange it for you -- for an Elite.

Thanks for posting your story. You're right -- what you wrote can be of benefit to other newcomers to this forum.