Let's clear up some misinformation

[squid13]

BlackSpinner said "Oh stop comparing apples to squid." Hey I'm a lot better than apples.

[Elle]

I don't think bullying works very well as a business model so no doubt this person is a little worried about staying afloat. This kind of personality usually doesn't do well when having to deal with actual people. I can see why it might be afraid and lashing out.

I also think there might be a bit of mental illness happening here because a 'stable' person has a bit better radar for reading reactions to their behaviour and make changes. I think we should leave it alone.

[Guest]

Billing practices have nothing to do with whether AHI is useful or APAPs are useful. Why would a crutch-salesman's opinion on that matter more than a patient's? The lie occurs when DMEs reply that "insurance won't allow you to have that" instead of replying "we feel we won't make enough money if we give you what you are asking for."

It is the patient's job (hopefully with doc's help) to attempt to get a machine that will be most useful in therapy. It is worth fighting for. APAP and AHI play a vital role in that. And the OP is being dishonest, IMO, in implying that any patient that gets a machine with basic features like APAP and AHI-data has been given an undeserved gift by the DME. Most of the good DMEs I know of ONLY give out AHI-data machines and will give APAP (set to CPAP mode) unless the doc says no. I have heard owners of DMEs say that out loud to rooms full of patients and doctors at AWAKE meetings, so I KNOW there are DME owners who think that way. I assume they were not advised by the OP of this thread.

Our position as patients is naturally different from the priorities of DMEs. They know what they want to give us and we know what we want to get. It is a shame that we have to even ask for something as basic as AHI-data. Good DMEs don't make you ask for it. It comes automatically. I agree that sometimes patients have to get their doctors to put "auto" and "AHI data" on the actual Rx in order to keep people like the OP from claiming that the patient is asking for something outlandish when they insist on basic features such as AHI data and autotitration.

DMEs are not qualified to give medical opinions to patients on which features are needed on their machines, so if the DME is uncooperative with a patient's wishes, that patient should by all means get a doctor involved. DMEs tend to listen to medical opinions expressed by doctors more than opinions of patients. In much the same way, patients should ignore any statements about PAP machines made by non-medical people, like DME crutch-salesmen.

I have found CPAPcom to be MUCH more helpful than the brain-damaged people at my local DME. What CPAPcom says is true. What the local DME said was not true.

My thoughts for fellow patients on this subject are found at the link next to my PM button. The following is from that location:

GET A FULL-DATA MACHINE: Your having a machine that can give you leak and apnea-hypopnea index (or, AHI) data will allow you and your medical team to make sure your therapy is as effective and comfortable as possible. Your local DME may not understand that concept (or may pretend not to, for financial reasons), so be sure to get a list of in-network DMEs from your insurance before you speak to any DME. That may allow you to push for a full-data machine, or perhaps allow you to shop around in the interests of fostering healthy competition among businesses. Some users have found it cheaper for them in the long run, and less frustrating, simply to buy their own equipment online instead of paying their insurance co-payments at local-DME prices. Some users have even found ways to get reimbursed from their insurance for online purchases.

GET THE RIGHT KIND OF MACHINE FOR YOU: Straight pressure as delivered by a regular continuous positive airway pressure machine (or, CPAP) does fine for most people with obstructive sleep apnea (or, OSA). But many have found great benefit in the use of an APAP (auto-adjusting machine), and many with high-pressure prescriptions (over 15 cm H2O, for example) have benefited from the use of a bilevel machine (also called Bi-PAP or VPAP). Machine users with a high number of significant central apneas may do better on specialized machines designed to deal with that problem.

If the OP has any suggestions for me for making the above more accurate, I would appreciate that critique.

Let's try this again. This is not about "billing practices" - this is about insurance coverage critiera. I realize that for most of you your only exposure to DME is PAP devices. But this is hardly the only item in the DME world where a variety of features are available and where features are available that are not covered by insurance. I'm probably wasting my time, but I will give you some examples of other features on other products that insurance payers consider upgrades and do not cover. Hopefully that will help you understand this concept.

Power wheelchairs and scooters - more powerful batteries that last longer and/or charge faster, scooters that are more lightweight and fold down so they are easier to put in a car, fancy seats, upgraded power controls, a device that allows the the patient to be raised vertically so they can cook meals, access cupboards. All desirable features, but none of which are covered by insurance payers under the rules they make.

Hospital beds -- attachments that make it easier for permanently disabled persons to get in and out of bed without a caregiver's assistance. Standers that attach, solid rails, etc. All desirable features, but none of which are covered by insurance payers under the rules they make.

Oxygen -- homefill systems that allow patients to fill tanks on the fly and not wait for deliveries; portable concentrators that allow patients to travel without having to find a provider that can deliver tanks when they get to their destination, and that last longer than tanks. All desirable features, but none of which are covered by insurance payers under the rules they make.

Oddly enough I have never heard of a patient demanding that a they receive these extra non-covered features on the above items and expect the DME provider to provide them for free. They cost money. A pretty simple concept that the average patient can grasp. And DME providers don't try to upsell them either. They simply quote the patient's that ask for these items the price and let the patient decide.

I think it's wonderful for any patient that wants an Autoset features to get a free upgrade to a system with that non-covered feature set. And it's perfectly legitimate if a DME providers wants to make that their default product. And contrary to your accusation, I have never told a DME provider that they should not do that (and never posted that I had either, so your accusation is uncalled for). I have, however, encouraged them to get a handle on their costs in general and consider how much they can provide for free. They typically tend to do a lot of free care for patients without insurance or those trying to get on public assistance. Most of them have hearts of gold - at least the non-corporate ones.

A successful DME provider that plans to be around to take care of patients needs to balance two priorities -- good patient care, and maintaining their financial stability.

I don't understand the rationale for them to provide free products, at a detriment to themselves, for people that can perfectly afford to pay for the upgrade. The free care they provide, in my opinion, should be reserved for those that cannot pay. Can I ask, if this feature is soooooo important to so many of you, why is it not worth paying for? It's important enough to expect the DME provider to give it you for free, but not important enough for you to open your own wallet?

As for your "thoughts" for fellow patients, it is mostly good information, with the exception that this "Your local DME may not understand that concept (or may pretend not to, for financial reasons)...."

Let me clear something up for you. They understand the coverage rules and the features of various devices very well - and much, much better than people that are posting on this forum. In my opinion, it is extremely offensive and arrogant for you to suggest that people that make their living doing this don't know what they are doing. And if a patient truly thinks that they should not be using that DME in the first place.

As for the "pretend not to" - gosh, after posting and reading here I certainly can't blame them if that occurs. My experience here shows me that at least the posters here believe what they want to believe, with absolutely no evidence to support their assertions. They are simply impervious to reason and facts. I can hardly blame a DME provider that doesn't want to go through the experience of trying to explain these issues to every patient that comes in demanding a free upgrade. However, I doubt any "pretend" not to understand.

[idamtnboy]

Finally, I can't imagine why all of you seem so convinced that it's the DME providers job to make the insurance you freely engaged with do something they are unwilling to do.

Freely engaged????? Get real. Very, very, few of us freely engaged our insurance company. That choice was made for us by our employer or other association we are in. Or do you consider the option of either paying for the preselected provider, or paying entirely out of pocket, a free engagement choice?

[jedimark]

I've been doing a little reading and research on DME "Consultants" as ltts states he/she is.

It's an interesting read. I invite anyone interested to simply google "DME consultants" and see what pops up.

It seems that one of the main things these firms do is help DMEs to maximize their profits. (No surprise, really, otherwise why would anyone hire a consultant to help their business?)

So... ltts is here trying very hard here to get patients to stop insisting on machines that actually help improve therapy, which is completely consistent with his vested business interest in the matter.

He has, I see, bulldozed into several threads here for that purpose.

All the while, ltts's google hits are going up because every post gets him a new one.

Folks - we're being used.

Those google hits are certainly showing him/her up to be quite the douche.

And if this person really is a consulting force that has an effect on DMEs buying decisions, they are 10 times as guilty as the dodgy DME's they represent.
Honest DME's who give half a crap, will give patients decent options up front, even if it means the patient gets charged a bigger gap.

What we have here is nothing but a manipulative corporate weasel in damage control mode, trying to offload their stash of C-RAP machines that they have suddenly realized no-one wants..

[RocketGirl]

I don't think bullying works very well as a business model... I think we should leave it alone.

You've hit the nail on the head here. This could have been a decent opportunity to exchange views and have both sides learn something, but the OP came out with a public attack on a highly valued member of the community, and has been combative and didactic all the way. Very quick to accuse and call names, and quick to take offense when people call him on it: bullying is the word.

The person's mind is completely closed, and he will just keep saying the same things over and over. There's nothing to be gained by continuing to try to engage under those circumstances.

[Madalot]

I think it's time all of us accepted that this is a person trying to make a point but with no more ability than a young child. No matter what points we make to support our position or counter his, he keeps saying the same thing over and over again. As you would with a defiant child, put this poster (and this now tedious thread) in a much deserved time out.

[RocketGirl]

Amen! Except before we do, I want to blow a kiss to Jedimark for the pithiest opening line and thus the best laugh out loud I've had all day

[ems]

Wait a sec... my doctor wrote a script saying exactly what machine I should have. That was the beginning and the end of it. I then went to the DME to try on two masks, and came home with the exact machine the doctor had ordered and a mask. The DME followed her orders to the letter. They had to. Didn't they??

[Kilgore Trout]

What your DME told you in each instance is absolutely true. Those are rules set by the insurance payer. What you would have liked them to tell you is not reality. By all means complain to your insurance company. The DME did not make those rules. Complaining to them is pointless.

OK, I don't think you read my post correctly. What I would have liked them to say is 100% true, and that's based on what they eventually told me after confronting them with changing their story several times. The new DME also confirmed that my "what I wanted them to say" version was all true.

That's two real DMEs vs. someone who won't even register to the board.

I didn't mention this before, but I'm sorry, I don't believe you're a DME. There's nothing you've presented that would lead us to believe you are. You've regurgitated information we all know, and have easy access to.

[idamtnboy]

He has, I see, bulldozed into several threads here for that purpose.

Minor correction. According to this quote from her first post, "he" is really a she.

I'm an RCP that got her degree in 1984.

Of course, she should have said "who" rather than "that", but we'll let that one go!

[Kilgore Trout]

Oh stop comparing apples to squid.

QOTT!

[Madalot]

What your DME told you in each instance is absolutely true. Those are rules set by the insurance payer. What you would have liked them to tell you is not reality. By all means complain to your insurance company. The DME did not make those rules. Complaining to them is pointless.

OK, I don't think you read my post correctly.

Your post was as clear and easy to understand as night and day. The response to it was intentionally dense to muddy the waters. Same type of thing my children try to pull when they want something they can't have. Intentionally ignoring logical statements requires a response that you would give a child or teenager.

TIMEOUT!!!!!

[idamtnboy]

Okay, let's use a little analogy. Let's say you're sick and you need to be admitted to the hospital. Your insurance only covers a semi-private room, but somone on the internet told you (while providing no proof whatsoever) that you were entitled to a private room, and the hospital can't charge you any extra for that. The nurse tells you that your insurance doesn't cover a private room, but you can pay extra and they can find you one. You loudly declare that the nurse is a LIAR! YOU ARE LYING TO ME!, you say to the nurse. Do you think that's going to get you a free private room?

So you don't get the private room because you were a jerk about it, AND you're not entitled to it. Now do you think they are going to look in on you and respond to your requests as fast as they can while you continue your stay in the hospital, or are they maybe going to avoid you except when they actually have to in order to provide the care you need?

Let's think of a different approach. You fully understand what your insurance covers, and you know you will have to pay extra to get a private room. Perhaps you don't want to get charged for the private room, but you'd really like one. You think you will recover much sooner and it will be much better for you health wise if you can get a private room. Might you say to the nurse, hey, is there any chance you have a room that is vacant right now that you wouldn't mind putting me in?

Which scenario do you think will give you a better chance of the free private room and service over and above what you are entitled to?

So yes, I am trying to provide good advice. And honestly, I think there isn't a DME in the world that would mind one bit if some of the posters that post here walked right on by and found someone else to take care of them. If you called any health care professional a liar they would more than pleased to have you take your business to some other unsuspecting caregiver. Believe me, they won't mind "losing" your business.

In each of those cases above, what does the PCHPC specifically cover? I'll bet the code for a private room is not the same as for a semi-private room. If you're going to use those kinds of examples then for hell's sake make sure you use examples where the upgrades are covered by the same code as the lesser option.

You want us to ignore the fact an S9 Autoset is covered by the same code as an S9 Escape. We WILL NOT do that!

[idamtnboy]

I'm not going to create a log in and as a result I cannot post links.

You would enhance your credibility a hell of a lot if you would.