I should get an award for being DUMB

[jlmoorekcmo]

I'm in a rural part of Central Pa. There is only one other supply co that I could use with my ins and they are very small and everything is done out of a small bldg.

Is Respira out of Mechanicsburg, PA on your insurance they seem to be really good. Their RT goes really far north. PM me if you want.

[JamesAllen828]

In my experience working at a DME. They will not provide another mask regardless of what prescription you have. DME's go by insurance guidelines and if the insurance will not pay for the mask because you have not waited the 3 months (per your insurance) you won't be able to get one. But that is here in TN. Not sure how other states regulate DME's.[/quote]

That is true. The DME isn't in it to lose money. They only give you what your insurance pays for and allows.
In my case what ever the DR writes a script for, be it a new machine or mask, my insurance will cover it.

*I* should have known. It occurred to me but the DR and my RT said I should still be able to get the 3 month mask. I should have known that wasn't gonna happen.

That said, this DME isn't at all concerned about patient compliance. They supply what the Dr orders IF they carry it, if not they bring you what they carry that they feel will work. There is no other DME in the area so there is no choice.

Since you work for a DME, are they paid X amt of money each month from INS even if the patient gets nothing or do they just get money for what the patient gets from them? I'm curious because they really don't seem to care if I get replacement cushions, hoses, filters, or even new hoses, etc for my husband's oxygen.[/quote]


It depends on the contract that your DME has with your insurance company. If they have a pay for service contract the DME gets paid for each product supplied monthly. If it's a Cap contract the DME gets paid regardless if you have equipment with them or not. I used to work with a nation wide DME and they always pushed Oxygen because thats where they make the most money. They didn't want people to call in and get supplies because they didn't have a big enough profit margin. They wanted us out in patients homes trying to get them on O2. When you get your 3 month mask be SURE to clarify that you want a totally new type of mask or they may ship/order the mask that you are using right now.

[DJD52]

Is Respira out of Mechanicsburg, PA on your insurance they seem to be really good. Their RT goes really far north. PM me if you want.[/quote]

No. There are only two that our ins deals with. I keep asking the INS people to add another DME. There is another fairly large one in the area. It would be nice if the one we have to use had some competition.

[DJD52]

It depends on the contract that your DME has with your insurance company. If they have a pay for service contract the DME gets paid for each product supplied monthly. If it's a Cap contract the DME gets paid regardless if you have equipment with them or not. I used to work with a nation wide DME and they always pushed Oxygen because thats where they make the most money. They didn't want people to call in and get supplies because they didn't have a big enough profit margin. They wanted us out in patients homes trying to get them on O2. When you get your 3 month mask be SURE to clarify that you want a totally new type of mask or they may ship/order the mask that you are using right now.[/quote]

Sounds like a cap deal then.