requirement for a new rx yearly?

2flamingos · Post by **2flamingos** » Wed Nov 30, 2011 2:44 pm

Is anyone aware of a new requirement that to obtain even supplies requires a current (read NEW) rx every year? I get that an rx is required - but since OSA does not go away and my rx was written for 99 months (and I am only 36 months into it) - wth!

I have gotten this same message from 4 local DME's - 3 of the 4 saying insurance requires it and the 4th saying they didn't know where the requirement came from, but it was required.

I have emailed insurance company (BCBSAL) who says it is not their requirement. I am so frustrated - I am about to spit.

LSAT · Post by **LSAT** » Wed Nov 30, 2011 2:47 pm

PROBABLY A STATE REQUIREMENT.

lktnky · Post by **lktnky** » Wed Nov 30, 2011 2:51 pm

That's a new one on me.
I was told when I got my original scrip, that the '99' months was their (medical) way of saying 'forever.'

Mary Z · Post by **Mary Z** » Wed Nov 30, 2011 2:55 pm

Sounds like much ado about nothing. Just get the prescription. Prescriptions for medicines are only good for one year. I hope it's not too much trouble.

xenablue · Post by **xenablue** » Wed Nov 30, 2011 2:58 pm

My DME supplier (which exclusively handles XPAP supplies and service) recently posted a sign in their shopfront saying they are required to have a prescription for all patients that is no older than 12 months. Fortunately they know most of the doctors in the region who deal with OSA, so they obtained the script for me.

I didn't ask where the directive came from but I will when I visit again.

Cheers,
xena

2flamingos · Post by **2flamingos** » Wed Nov 30, 2011 2:59 pm

Mary Z wrote:Sounds like much ado about nothing. Just get the prescription. Prescriptions for medicines are only good for one year. I hope it's not too much trouble.

If I can get the rx without having to go to the dr, maybe not such a big deal - even though unnecessary. But, if I have to go to the dr - time off and co-pay, which is twice as much if I have to go to a specialist.

So, it is both the principle and the added expense and time.

archangle · Post by **archangle** » Wed Nov 30, 2011 3:20 pm

That's getting very common. Almost everyone in the medical business is part of the medical mafia. They like to throw around rules that help each other collect their protection money on a regular basis. Unfortunately, a lot of the medical mafiosos pay bribes to elected officials and regulators so they help out by instituting regulations as well.

I would be interested to see whether it's a government or industry regulation, or if it's just a "scratch my back and I'll scratch yours" arrangement.

Of course, if it's midnight and the DME tells you it's dark outside, go and check for yourself.

2flamingos · Post by **2flamingos** » Wed Nov 30, 2011 3:33 pm

archangle wrote:I would be interested to see whether it's a government or industry regulation, or if it's just a "scratch my back and I'll scratch yours" arrangement.

I am curious as well. That is why I have asked the DME that I have been using for three years to provide me with something in writing to document where the requirement came from; I have an email from my insurance company saying it is not their requirement; and I have emailed Executive Director of the State Board of Home Medical Equipment to see if it is a state regulation.

I know this probably seems like over kill, but I am tired of getteing fed a line of BS.

We all know that insurance companies are not going to pay for something that is not covered..... So, if they say my rx is still valid, why should anyone else give a flip?

Lizistired · Post by **Lizistired** » Wed Nov 30, 2011 3:51 pm

2flamingos wrote:
archangle wrote:I would be interested to see whether it's a government or industry regulation, or if it's just a "scratch my back and I'll scratch yours" arrangement.
I am curious as well. That is why I have asked the DME that I have been using for three years to provide me with something in writing to document where the requirement came from; I have an email from my insurance company saying it is not their requirement; and I have emailed Executive Director of the State Board of Home Medical Equipment to see if it is a state regulation.

I know this probably seems like over kill, but I am tired of getteing fed a line of BS.

We all know that insurance companies are not going to pay for something that is not covered..... So, if they say my rx is still valid, why should anyone else give a flip?

I'll be interested to hear what your responses are. If this is a new regulation it will hit us all soon. I have to renew my 1 year script next month anyway, but I was hoping to get a forever script.
It sounds like the DME's and docs feeding off each other, but you just don't know. Keep us posted.

jamiswolf · Post by **jamiswolf** » Wed Nov 30, 2011 3:56 pm

Buy off Craigslist,,,good deals can be had. No RX needed.
J

6PtStar · Post by **6PtStar** » Wed Nov 30, 2011 7:43 pm

Cpap.com does not require a new script every year (unless they have changed in the last 6 months) and they are in Texas but the local DME's (also in Texas) also tell me I need one every year so I'll bet it is not a state requirement. I did have one DME tell me I had to have a new script every time I got a new mask..........no longer use that DME!! Be interesting to see if you get an answer.

Jerry

chunkyfrog · Post by **chunkyfrog** » Wed Nov 30, 2011 7:51 pm

At the very least, it could be a simple way to weed out the bad DME's
Just don't do business with people who LIE.

jamiswolf · Post by **jamiswolf** » Thu Dec 01, 2011 8:59 am

Here's one for all you DME haters (myself included)

My DME required a specific Rx if I wanted to get a mask other then Respironics...and when I actually followed through on it, they "forgot" to order the mask. That's when I returned my rental machine and fired them. (I had already purchased a good used machine)
Jamis

2flamingos · Post by **2flamingos** » Thu Dec 01, 2011 1:12 pm

Starting to like it is an insurance requirement. The DME Certification Form (which is what the DME provider is calling a prescription) supposedly now has a caveat at the line where the dr fills out duration saying it cannot exceed 12 months. How ridiculous is that? Like my OSA is going to go away, change signifcantly. or not need supplies for treatment after 12 months. Really?

I have contacted my PCP office about getting a new certification, but not sure he will be willing to do it since he was not the one that dx me (he has a copy of the original script and certification though - and uses cpap). My next step will be my ENT since he is the one that ordered the sleep study, and another dr in his practice is on the team that reviewed my results and wrote the rx and certification. Down side to that is - I haven't been back since (3 years ago).

Komodo · Post by **Komodo** » Fri Dec 02, 2011 7:16 am

I just went through that myself. My DME wouldn't re-supply me until I got a NEW script.
Had to go to my doc for the NEW script.
Doc faxes the script to the DME, I call them to verify and re-submit my order for supplies. DME says all is good, EXCEPT, the script doesn't include filters. They actually called my doc, and had him fax over another script just for the filters!

This new "rule" that we need a new script every year is a giant PITA!

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