Why dooes a DME need full copy of sleep study to sell me supplies?

The DME I was using for a number of years went out of business. (The CEO is doing a few years in federal prison for not depositing payroll taxes with the IRS.)

Anyhow, I have contacted multiple local DMEs, and they all want a prescription and a full copy of my sleep study results. The doctor's office only has a summary of my sleep study, and I have been unsuccessful in getting a full copy of the sleep study results. I have been buying my own supplies, but I would prefer to go through insurance as insurance will pay for nearly all of my CPAP costs. I have no idea why they need the full sleep study results just to sell me a mask and other supplies for my CPAP.

So they won't get sued if something goes wrong of course.

That does seem odd. Like a pharmacist wanting to your know your vitals and see an EKG before selling you blood pressure medication. If the doc prescribes it, they should be good to go. I'd push back.

This was two separate locally owned DMEs. They are not related in any way so far as I know. I only gave my prescription and sleep study information to the first DME. I contacted them after not hearing from them for a month, and they said they were trying to get the full sleep study results from the doctor. They refused to do anything without the full sleep study results. I contacted another DME and asked if they required the full sleep study results and they indicated they would require that.

I wonder if it is a United Healthcare requirement? A number of DMEs l contacted won't even take United Healthcare.

Probably for insurance purposes.

Sheriff

Unsurprisingly, the tendency to be anal is related to other undesirable traits.
" . . . Federal prison"
Yep.

The need for copies is so that if the DME ever gets audited by someone then they have the needed "proof" of need.

Your insurance company may have a copy of your old sleep study in its records that you could request be sent to you or the new DME if you can't get hold of a copy yourself.

The new DME could easily get that copy from your existing insurance if they were willing to do a little paperwork.

So IMHO "why does a DME need a copy" and they want you to furnish that copy instead of doing the paperwork to get it....lazy.

I somehow doubt my insurance company has a copy, but maybe. The last time I got a new CPAP machine my insurance company wanted to rent it until it was paid off. My employer switch to a new insurance provider on Jan 1 of the next year. The new insurance company wanted to immediately pay off the remaining balance in full.

reader2580 wrote: ↑

Tue Oct 01, 2024 4:33 pm

I somehow doubt my insurance company has a copy, but maybe. The last time I got a new CPAP machine my insurance company wanted to rent it until it was paid off. My employer switch to a new insurance provider on Jan 1 of the next year. The new insurance company wanted to immediately pay off the remaining balance in full.

Smart people.
Avoiding excessive paperwork.
The cash outlay is the same, except for the documentation.

The insurance company that paid for the first cpap machine has a copy of the diagnostic sleep study.
The first DME would have sent them a copy as part of verification or proof of need.

Sounds like you have an employer and new group insurance.....call up your current insurance company and ask THEM what they require ....like do they require a copy of the old sleep study or do they need a new sleep study.
Group insurance is sort of a special beast.

DMEs will often set their own in house rules and then blame the insurance company....so verify with your insurance yourself.

This is about reimbursement. The DME doesn't want to provide the supplies and then find out that you don't meet the qualifications for insurance coverage of these supplies. They can't resell a used filter, mask, or hose (or machine, really).

You have a right to your medical records, and you should be able to get them from whomever did your sleep study. But state laws vary about how your medical records have to be managed when a practice closes, so it may turn out to not be a fruitful search. Contact your state's medical board to find out how you might be able to get copies from that provider.

There were no rules in place when my physician father-in-law passed away. My mother-in-law and his office manager spent months contacting EVERY former patient to see if they wanted their medical records or if they could destroy them. When they couldn't reach a patient, they had to retain those records. They were kept in a file cabinet in my MIL's garage (before HIPAA mandated how records were to be handled). Every once in a while she would get a call from someone who was 30 or 40 years old asking "did I get a measles shot when I was a baby?"

A typical sleep study can produce about 1,000 pages of data. A DME refusing the summary page(s) and asking for a full copy is nuts.

Janknitz wrote: ↑

Wed Oct 02, 2024 6:03 pm

They were kept in a file cabinet in my MIL's garage

Was she a member of the Trump or Biden families?