Bill my insurance

Offerocker · Post by **Offerocker** » Sat Sep 16, 2006 1:38 pm

Melissa,
After my b&m DME rented a Remstar Pro (NOT the Pro2) w/cflex to me, I obtained a new Rx which stated I must have an Auto w/cflex. Gave a COPY of this to same DME, who ultimately told me: "You have what you need" - this was from the manager. Case closed - or door closed - by them. I was tired of it all, wanted no more hassles, and was too late into the rental to switch DME's and still go through insurance. Another DME wouldn't take the Rx because they wouldn't be reimbursed by insurance enough to cover their costs.

I took the new Rx, FAX'd it to cpap.com and got my AUTO with C-Flex.
Yes, too bad we aren't aware of this site BEFORE any action is taken, either by us, or being hustled by docs to a brick & mortar dme.

However, I no longer have hassles with anyone, may be a little lighter in the pocker, but is nothing compared to my peace of mind and health.
I do believe there is something in the works to provide needed info to potential apnea sufferers regarding their options, list of things they need to consider, etc. It will be helpful to the 'next generation', as it is a tricky thing to bypass the politics of it all, and get that info to the sleep labs, where it all starts.

Keep up your attempts, but do not drive yourself nuts if you continually hit a wall. Bite the bullet and purchase outright, if you can, from somewhere else. I suggest supporting the company that's made this site possible: cpap.com. If you're here, you know the intent and quality of service.

Here's to your success!
Kathleen

whatrdreamsmadeof · Post by **whatrdreamsmadeof** » Sat Sep 16, 2006 7:24 pm

Hi Melissa,
My situation was quite simiar to yours........i had a 3 month rental and then the machine was mine...paid for by my insurance...at the 3 month point, i wanted an apap so i could be more proactive......the dme gave me a fit.......but as snoregirl suggested i got a script for the maching i wanted.....had it faxed to the crazy dme and they did give me the apap..........the dme tried to tell me the new apap was now mine purchased in full...however she was overheard by a fellow dme and corrected her right in front of me........since then they have billed my ins co. for a hybrid mask i didn't keep and gave me a used swift for free.........so they said.......who wants a used mask from the dme.........i did get the clinical info. to sterilize it and maybe someday i'll feel comfortable or desperate enough to use it.............keep an eye on your insurance charges as i don't recieve eobs like regular charges would produce.........get what you need or want from the dme by way of your doctor or nurse...... good luck ellen

NyNurse33 · Post by **NyNurse33** » Sat Sep 16, 2006 7:38 pm

Ellen
Hopefully I am in a better position, b/c by the time of my MD appt (9/29) I will only have been renting the machine for not quite 2 months yet and I think I have to rent for 3 months. I see that you are not using an apap now, may I ask why?

I am becoming more and more convinced that apap w/c-flex is the way to go, as the weeks go on, I believe I am experiencing aerophagia. Is that normal, to only start having it after a month and a half of therapy?

So why I am decided on what type of machine, apap w/cflex, I'm still unsure of what model of Remstar. I would like to get info without having to buy extra software at first, so I think that leaves me the M series.

seenas · Post by **seenas** » Sun Sep 17, 2006 7:36 am

Hi,
I started out on a Cpap (Remstar Pro 2) 5 weeks ago. After 3 weeks learning more about my therapy and having problems with my first DME. I asked my Doctor for another prescription with the exact machine I wanted and my Doctor's office referred me to another DME. The second DME was very receptive to my needs. The billing department informed me of the cost for my APAP and mask (approx. $500). My insurance charges a $200 deductible and pays 80%. I do think this is high but at this point, after trying 4 masks I guess Im paying for the service. Do get what you need to succeed. Although costs are not cheap it is important to get what we need.
Good luck,
Seena

arthuranxious · Post by **arthuranxious** » Sun Sep 17, 2006 8:06 am

My DME was super accommodating when I talked to them before titration, I shopped around for the most willing to be helpful. Then after I was titrated I got a prescription sent to them, they said they submitted it to insurance immediately for approval, and the next day didn't get a call back eventually told they had me down for REMstar M with c-flex but not auto. I told them they had originally said it would be auto, they said even if you get an auto-PAP it would only be for one month to see how the results compare to what you did in the titration study, after one month you will then be put on a regular machine.
the nurse in my sleep doctor's office said she will send a revised script if the doctor thinks it is necessary manadating an auto-PAP.
But by then it was friday afternoon, and so no call back to tell... the DME says they will deliver whatever the final decision is at 1:00 p.m. Monday... I hate being in this situation.. the doctors and sleep labs and DMEs all talk as if "Whats the difference, take what you get and stop being a cry-baby" and yet we know from those who have been there that reality is it alld epends on getting the exactly right solution for you.

snoregirl · Post by **snoregirl** » Sun Sep 17, 2006 12:54 pm

Arthur.....Is this all happening this weekend? This DME essentially lied to you to get you to come to them?

You don't say what your copay is or your total personal out of pocket cost by dealing with a local DME, but I would figure it out in a hurry. If it is close to the cost of buying cash from CPAP.com I would tell them to keep their non-auto and buy online.

In any event I would stop now and approach another DME about auto. I do think if the doc doesn't prescribe auto, most DME's will not give it, but, you don't know unless you ask. At the very least I think I would hesitate to continue to deal with that particular DME that you have now since they seem to have assured you that you could have auto then went back on their word once they thought they had you hooked. If you haven't signed anything you can go anywhere. Also since you don't have anyone's machine yet you can check Bill-my-insurance to see if they can get you the auto with your current prescription if your insurance company will work with them.

You can get your auto with a regular CPAP prescription at CPAP.com but may end up paying out of pocket.

Your choice, but I detest anyone lying to me to get my business.

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