HMO's don't need RX to supply a machine?

Seen this twice in California, HMO says it does not need a RX to supply a machine. Therefore it does not exist, so I can't get a copy of it. Two different HMOs.

Is this legal?

I was able to talk a primary care doctor into writing one.

I have now heard everything!
There is little doubt there is indeed a prescription--IMHO
They just want to ensure you can't take it somewhere else. (which we often advise)
Contact your state medical board--or Medicare--if they are in any way involved.
I take it your insurance will not cover a machine, hence your plans to pay out of pocket?

jacobsbd wrote:Seen this twice in California, HMO says it does not need a RX to supply a machine. Therefore it does not exist, so I can't get a copy of it. Two different HMOs.

Is this legal?

I was able to talk a primary care doctor into writing one.

Point out that it's illegal to dispense a CPAP machine without a prescription. It says so in the manufacturer's literature. It says "Rx only" on the label of PRS1 and S9 machines.

Write them a letter asking for the prescription or doctor's order they used when they dispensed the CPAP. Then when you get a written statement that there is no prescription, send them a picture of the "Rx only" label on the machine. Mention HIPAA.

They may be playing word games here to some extent. Sometimes, they say it's a "doctor's order," not a "prescription."

(looks for image of male bovine defecating)

chunkyfrog wrote:(looks for image of male bovine defecating)

something like:

Is your HMO Kaiser?

As a self-contained HMO (that is, it is both the insurer and the care provider) I can see that, because Kaiser is also technically the DME (Crapria is merely the "supplier"). As far as I know, Kaiser DOES have prescriptions for CPAP, but they are internal computer orders, so it may be true that they don't need a formal written prescription like most other situations. But if you request a written prescription, they should give it to you--you have a right to go elsewhere to purchase equipment and supplies as long as you understand you have to pay for it yourself. If they are giving you guff about providing a written RX, then file a written complaint. I NEVER do it though Kaiser's internal process, it's rigged. I always do it through the California Department of managed care (not much better, but Kaiser can't ignore it then).

If it's not Kaiser or something similar, then the DOCTOR writes the prescription, not the insurer.

First was Kaiser. They would not even allow me to know who the doctor who looked at the study was. Any phone calls asking for information were transferred to a voice mail box and not returned. I was going to try kaiser one more time and report them to the board of pharmacy when I found out we were changing insurance. They are kind of there own DME but right after someone admitted to having the doctor look at my sleep study, Apria called to ask when would be a good time to deliver my machine. Because I had a working machine and could not afford the copay at the time I told them no.

New insurance is Anthem blue cross HMO and they sent me directly to a DME

Imagine going to the doctor, they run some blood tests. Two days later Walgreens calls you to pick up your meds. LOL

Why does apnea get no respect

Seen this twice in California, HMO says it does not need a RX to supply a machine.

Any xPAP is a medical device and requires an Rx, regardless of your insurance. Does it have to be on a piece of paper? Absolutely not, but it can always be printed if you want a copy.

The DME is a just a supplier without a medical license. I would never take medical advice from them. The sleep center (or wherever you are tested) polysomnographer administers or interprets (if you do a home study) your study and makes a recommendation to you doctor, who generally follows it, but it certainly should be open for discussion if you ask. After all, you are the patient, making you half of the healthcare doctor-patient partnership.

About Kaiser: while they seem like "their own thing", they actually are 1) a health plan (that's the HMO/insurance part), 2) a medical group (that's the doctor part), and 3) in CA, OR and HI also a hospital. The difference I have heard in their sleep studies is that their formulary for xPAP machines is limited. So, while someone qualified decides on your pressure, the actual covered machine options under your plan may be quite narrow.

Kaiser does issue an RX on their electronic system. It may not be a printed piece of paper. But they certainly can and should (by law) provide you with a written RX if you request one to purchase elsewhere. They do medication the same way. It's all computerized. But if you want to buy your own medications at full cost elsewhere with NO help from Kaiser, they must give you a written RX.

This happens rarely. My copay on asthma meds through kaiser is $20, so why would I want to go to CVS and pay nearly $300 instead? So I don't need the written RX in my hand. By the time I walk down the hall from an exam room to the nearest pharmacy in the same building, my RX is already being filled.

If I were to ask for the written RX, they'd have to remember where the RX pads are stashed.

Kaiser provided me with a written RX with no questions asked. They did take a whole month to do so however...