A DME Brick Intervention

[VikingGnome]

I went to new DME to order my replacement mask. Had to wait while RT was working with a middle-aged couple for new CPAP. After about 15 minutes, they exited and went to "business desk" to do all paperwork for the stuff under MEDICARE. I went in and spent about 15 minutes with the RT, explaining that my old DME could not get a Hans Rudolph mask for me. Brought all paperwork, they made copies. As I left, the previous couple were just leaving the DME. I asked, "Is that for him or her?" He replied, "This is a man's pickup truck. Can't you tell?" (It was a new, really fancy Ford F-150 Crew Cab with lots of extras). LOL. No, I meant the CPAP machine. Well, the wife said the CPAP was for her to use but was really for him so he can sleep without her loud snoring.

"What machine did you get?" I asked. She was clearly a newbie and didn't even know name brand. It was in a ResMed case so I assumed a ResMed CPAP. "Which model did they give you?" I asked. Husband opened the case and it was an ESCAPE "Brick". They explained to me that it has a data card that stores information about how well she was doing on it. "Exactly what did the RT say was stored on the data card?" Number of hours and days she was using it.

I just couldn't help myself. Time for a Brick Intervention. I explained that she really needed to get the ELITE model. Medicare covered it at the same cost to her and it stored a lot more information than just hours/days used. It will tell you your AHI in the morning by pressing a button if RT sets it up so she can see it. You can also find out about how bad your mask leaks are. I explained that with lots of leaks, she wouldn't be getting appropriate therapy. She said she was a mouth breather but RT gave her a CHIN STRAP for that. Her chin strap may not work but she won't know it. If it's really bad, her husband will know by her snoring. But with the machine model they gave her won't tell her anything about AHI or leaks. The ELITE would provide information to her sleep doctor that could indicate a need for pressure adjustment. But with the brick, the doctor won't know anything about response to CPAP therapy nor will the DME RT. I don't think the couple had a computer at home (just the impression I got).

The husband immediately said, 'Let's go back in while still in the parking lot and exchange for the ELITE." Wife was a bit hesistant (don't rock the boat type), but husband persisted (it's his sleep that is being disturbed). They immediately went back in the DME and I left. I'm sure the RT will know I'm the one that talked to them. Will she be mad enough to NOT order my mask? Don't know. But in July, DME bids will be announced and I will probably have to go to new DME anyway.

[caffeinatedcfo]

Screw the DME. I gave them the benefit of a doubt when I started. They quickly and systematically earned my distrust. As a non-profit professional, I am very sensitive to the scum that take advantage of uneducated customers for personal profit.

[NateS]

That was very considerate and thoughtful of you to have done that, VikingGnome.

I only wish I could be optimistic about the outcome.

I'm afraid that it is highly likely that the DME defended their position, ridiculed everything you told the couple, and double-talked, overpowered and bamboozled the couple to leave with the machine that had already been palmed off on them.

Wish we as consumers could organize "intervention patrols" to hang out around DME offices, do what you did, and offer to accompany the victims when they agree to go back into the store and demand a decent machine. But I know it is impractical. And despite being legitimate patient advocates, we'd probably be charged with trespassing!

Regards, Nate

[SleepingBetty]

Good for you, VikingGnome! I hope they were successful in getting the brick exchanged! Ironically, rather than the DME, it's our insurance that is stopping my husband from getting something other than the brick he has had for years. He is having terrible mouth leaks with the old machine since increasing the pressure. I had my hands full and seriously thought about dropping yesterday as I was taking it in to the DME so he could get compliance data off of it! Wish I had! Previously, there was a gasket that was leaking, but the DME had what was needed to fix that. It was no wonder my husband had been feeling tired for a while now. He was also apparently needing increased pressure, but he is having difficulty exhaling against that increase. He went back to the loner machine from the DME, which is what he used to figure out the pressure increase, to see if that made a difference ... and it did. He got the Rx from the doctor for an APAP and the DME submitted a letter to the insurance company, telling them the doc had prescribed the APAP and that my husband was doing better on it than on the old brick. Didn't work... the DME called me today and had gotten a denial from the insurance, saying that there was no evidence my husband's machine was broken or that it couldn't be repaired. Ugh!

So, our plan is to back the pressure off on the old machine and see how he does since he hadn't used it at the old pressure with the new gasket, then gradually increase it. He has done really well with CPAP for 13 years without having A-Flex or anything like that, so it shouldn't really be that much of a problem, right? Anyway, we are kind of flying blind here, but if he can't adjust to the pressure, then the next step may be a letter of medical necessity from the doctor. Of course, that old machine may just bite the dust in the mean time!

[jdm2857]

It sure would be a shame if it fell off of the night table with a full humidifier tank.

[SleepingBetty]

It sure would be a shame if it fell off of the night table with a full humidifier tank.

[DavidCarolina]

Youre my HERO. Nice job.

The *** holes had tried to pawn off a useless brick on an unsuspecting suffererer just to
make a buck.

Its sickening. These bricks should be outlawed.

The sleepdocs are often just as corrupt.

No wonder we try to get rid of them on this board.

Remember the douchebag who was trying to start up his practice on here about two months ago?

Hopefully he's gone too.

[Hose_Head]

Good for you, VikingGnome! I hope they were successful in getting the brick exchanged! Ironically, rather than the DME, it's our insurance that is stopping my husband from getting something other than the brick he has had for years. He is having terrible mouth leaks with the old machine since increasing the pressure. I had my hands full and seriously thought about dropping yesterday as I was taking it in to the DME so he could get compliance data off of it! Wish I had! Previously, there was a gasket that was leaking, but the DME had what was needed to fix that. It was no wonder my husband had been feeling tired for a while now. He was also apparently needing increased pressure, but he is having difficulty exhaling against that increase. He went back to the loner machine from the DME, which is what he used to figure out the pressure increase, to see if that made a difference ... and it did. He got the Rx from the doctor for an APAP and the DME submitted a letter to the insurance company, telling them the doc had prescribed the APAP and that my husband was doing better on it than on the old brick. Didn't work... the DME called me today and had gotten a denial from the insurance, saying that there was no evidence my husband's machine was broken or that it couldn't be repaired. Ugh!

So, our plan is to back the pressure off on the old machine and see how he does since he hadn't used it at the old pressure with the new gasket, then gradually increase it. He has done really well with CPAP for 13 years without having A-Flex or anything like that, so it shouldn't really be that much of a problem, right? Anyway, we are kind of flying blind here, but if he can't adjust to the pressure, then the next step may be a letter of medical necessity from the doctor. Of course, that old machine may just bite the dust in the mean time!

I've quoted your entire post, and have highlighted in red the part of it that I'd like to address:

Odds are that your DME never submitted anything to your insurance, or if they did, they are lying about the response that they received. The response you got ("... no evidence my husband's machine was broken or that it couldn't be repaired") is a complete non-sequitur. It looks to me as though the DME simply doesn't want to supply the apap, despite doctor's orders that they do so.

My advice would be to start asking your DME some very pointed questions and demand clear answers to them. A call to your insurance company would be a good first start.

[pootsie]

I'm glad I read this. I did not know you could see AHI from the screen on the Elite. I guess you need to configure it to allow that. Can anyone tell me how?

[squid13]

I guess you need to configure it to allow that. Can anyone tell me how?

Here is a good video on the S9 that will show you how to do it. http://www.cpaplibrary.com/machines.html

[archangle]

Maybe we could be like the pro lifers and hang around with signs outside DME locations with signs.

[Kenwood]

He got the Rx from the doctor for an APAP and the DME submitted a letter to the insurance company, telling them the doc had prescribed the APAP and that my husband was doing better on it than on the old brick. Didn't work... the DME called me today and had gotten a denial from the insurance, saying that there was no evidence my husband's machine was broken or that it couldn't be repaired. Ugh!

I've quoted your entire post, and have highlighted in red the part of it that I'd like to address:

Odds are that your DME never submitted anything to your insurance, or if they did, they are lying about the response that they received. The response you got ("... no evidence my husband's machine was broken or that it couldn't be repaired") is a complete non-sequitur. It looks to me as though the DME simply doesn't want to supply the apap, despite doctor's orders that they do so.

My advice would be to start asking your DME some very pointed questions and demand clear answers to them. A call to your insurance company would be a good first start.

I completely agree here. I had the same problem battling for a month with my old DME in getting my BiPAP switched out for an Auto BiPAP. The DME kept claiming that my Sleep Study did not warrant switching to an Auto. I even called my insurance company and spoke to them about switching...Insurance company said they don't really care what machine I use and they only have one code for a CPAP machine - as long as my doctor writes a RX. Finally my Sleep Doctor got pissed off and personally called the DME and reminded them that SHE was the DOCTOR and THEY were to MEDICAL SUPPLIER and to submit my new RX to my Insurance company. My Auto BiPAP was miraculously approved my machine in an hour and shipped it that same day.

CALL YOUR INSURANCE COMPANY.....do not take your DME word for anything.

[pootsie]

I guess you need to configure it to allow that. Can anyone tell me how?

Here is a good video on the S9 that will show you how to do it. http://www.cpaplibrary.com/machines.html

I have two things to say:

1) Thank you, Squid

2) ARGH! Why the fark don't they tell you this stuff when you get a machine?!?! I can understand not giving out the keys to the clinical menu, but why should I not know how to see a report?!?!

[MagsterMile]

ARGH! Why the fark don't they tell you this stuff when you get a machine?!?! I can understand not giving out the keys to the clinical menu, but why should I not know how to see a report?!?!

They don't want you to know since they are very protective of their jobs. I know this since I asked my DME about it and was told that 'it was her job to do it' so I shouldn't worry myself about it. Knowledge is power and few who have it don't want to share it.

[SleepingBetty]

Good for you, VikingGnome! I hope they were successful in getting the brick exchanged! Ironically, rather than the DME, it's our insurance that is stopping my husband from getting something other than the brick he has had for years. He is having terrible mouth leaks with the old machine since increasing the pressure. I had my hands full and seriously thought about dropping yesterday as I was taking it in to the DME so he could get compliance data off of it! Wish I had! Previously, there was a gasket that was leaking, but the DME had what was needed to fix that. It was no wonder my husband had been feeling tired for a while now. He was also apparently needing increased pressure, but he is having difficulty exhaling against that increase. He went back to the loner machine from the DME, which is what he used to figure out the pressure increase, to see if that made a difference ... and it did. He got the Rx from the doctor for an APAP and the DME submitted a letter to the insurance company, telling them the doc had prescribed the APAP and that my husband was doing better on it than on the old brick. Didn't work... the DME called me today and had gotten a denial from the insurance, saying that there was no evidence my husband's machine was broken or that it couldn't be repaired. Ugh!

So, our plan is to back the pressure off on the old machine and see how he does since he hadn't used it at the old pressure with the new gasket, then gradually increase it. He has done really well with CPAP for 13 years without having A-Flex or anything like that, so it shouldn't really be that much of a problem, right? Anyway, we are kind of flying blind here, but if he can't adjust to the pressure, then the next step may be a letter of medical necessity from the doctor. Of course, that old machine may just bite the dust in the mean time!

I've quoted your entire post, and have highlighted in red the part of it that I'd like to address:

Odds are that your DME never submitted anything to your insurance, or if they did, they are lying about the response that they received. The response you got ("... no evidence my husband's machine was broken or that it couldn't be repaired") is a complete non-sequitur. It looks to me as though the DME simply doesn't want to supply the apap, despite doctor's orders that they do so.

My advice would be to start asking your DME some very pointed questions and demand clear answers to them. A call to your insurance company would be a good first start.

Hi, Hose_Head! Thanks for your comments. I'm not really following you, though. Why wouldn't the DME want to sell a new machine, APAP or otherwise? I don't think he even sells any machines that aren't fully data capable! He recommended an APAP for me and I got exactly what he said he was going to give me, a PR S1 560. He could have given me some line about not needing an APAP or data capable machine once I had been through the sleep study, but he didn't. He also could have not told me about this forum, but he did! And I'm grateful!

Perhaps you need to reread the part of my post before the part you put in red! My husband has been on CPAP for nearly 13 years. He's always had a brick and actually adapted quite well in the beginning. He's on his second machine which is now about 7-8 years old. He got it shortly after changing jobs where he was going to be traveling quite a bit and he wanted something more portable than the one he had previously, which at that point, was around 5 years old. We ran into the same problem with the insurance then. The DME (different DME, same insurance) suddenly discovered a problem with the old machine which was not fixable. Voila! My husband had a new machine, albeit another brick! But, we didn't know any better back then. However, it has served him well until fairly recently when I began to notice more and more snoring. He also was complaining of being tired in the afternoons. Something was obviously wrong.

I talked to the DME about it and he suggested an auto CPAP trial for my husband to see if his pressure needed to be adjusted. He never charged for the use of the machine, but he could have! He did charge for me when I did it, but then he let me use the machine for a couple of months until I got through the necessary sleep studies so that insurance would pay for the machine. The fee for the auto trial will go against what I owe him for my equipment, though, so it's all good. So, my husband'a auto trial indicated that his pressure needed to be adjusted. We did that, but also got a Rx from the doc for a new machine, mask, etc. which the DME has on file. My husband thought his machine was leaking, so I took it in and the DME checked it. Sure enough, there was a gasket that was totally worn out. Unfortunately, he had the necessary parts to replace it! The pressure is off just a bit, but that is something that could be worked around.

The problem is our insurance is just the opposite of Medicare! While Medicare apparently hands out stuff when you don't even need it, our insurance says they'll only replace the machine if it's broken. That's the same problem I mentioned above that we ran into when he got his current machine. The DME even suggested we switch insurance companies, but even if we did, that's not possible until sometime in the fall and won't go into effect until January 1. So, I have no reason to believe that our DME didn't submit the letter. He read me what he had written up to the point that I took my husband's machine in so he could get the data off of it to include with the letter. He actually loses by not submitting it and getting to sell a new machine. How is that a non-sequitur?