DME Difficulty

I'm near the end of my first year on CPAP very well, happily using a Respironics ComfortLite mask. My DME (Praxair) called to say it was "time to order new supplies" so I said I wanted the new Comfortlite 2. They sent me the old one. I returned it and repeated that I want the newest model. First they said it might take a few weeks until they get them in, then they said "it might take up to five months" because their company "has to test them" to make sure they're safe. What the heck??? Should I tell them that I'm going to go to a different DME or just buy one on the internet and get my insurance to re-imburse me? If I buy one on the internet, is it very tricky to get re-imbursed?

I was going to ask the very same question, I would prefer to order my own mask and get reimbursed the insurance companies 60% share of the cost.

The answer to your question will vary considerably from one insurance company to the next. I would recommend contacting your insurance company (there should be a patient rep contact number on your card) and asking, preferably in writing, what your benefits would be for reimbursement.

Some people have experienced that they are treated as "in network" when they purchase and request reimbursment, others have been relegated to "out of network" rates, and yet others have no reimbursement for purchases anywhere but a specific DME.

Several people have also reported being told one thing before hand and getting completely different benefits in actual practice. This is why I suggested preferably in writing. That way you go back to the written statment of benefits if there is a discrpency.

Good luck!

that's a question for your insurance company. while you're talking to the insurance rep, inquire about switching DMEs altogether. tell them your present one is jerking you around and is unable to meet basic service requirements. DMEs are not in the business of certifying equpment that has already been certified by the FDA. your DME is just making up wild stories to clean out his present inventory of old stuff (at your expense) and enhance his profit margin. but don't feel singled out, it's been done efore. nothing personal. i would be SHOCKED to learn that your DME truly cannot pick up the phone and have a CL2 delivered within a few days. i'm not a DME, but i bet i could go online and order a CL2 and have it delivered anywhere AT A LOWER PRICE than what your insurance is willing to pay for an older model of the same.

good luck! and keep us posted!

One of the DME's that I deal with is part of Praxair. They didn't know about the CCL2 until I told them. It took about 2 weeks but I did get the mask with no problem, so you should be able to as well. Testing them is a bunch of bull dinky!

I called United Health care today and asked about buying the mask on my own and getting reimbursed and was told that I cant because it would be illegal and I could never get a better price than what they can get, I just left it alone and hung up.

Simply amazing.

They are so full of it on the illegal and price.

Can't shovel it much deeper.

I own at least 3 masks all legally purchased from Cpap.com

Does the word "professional" mean anything to some DME's?? Frankly, the one I use lacks the very basic requirements to deal with patients. He lacks patience and if he continues his know-it-all attitude and rudeness he will see the day come when he has no patients.

Respironics will switch out the ComfortLite for the ComfortLite2 for the DME at no charge. They must not be aware of that.

I returned the Comfortlite mask to Praxair and reminded them that I wanted a Comfortlite 2. When I had not heard from them in two weeks, I called again. At your advice, I said "I know that these masks are tested and approved by the FDA so Praxair doesn't need to test them further. I know people who are using them now. Praxair is a large company and shouldn't have any difficulty obtaining them, so can you please explain why it's taking so long?" He asked what size simple cushions I used, called me back within 10 minutes, and my mask was delivered today - TWO DAYS after I called them! Wow! I can't wait 'til bedtime to try it out! Thanks, guys, for your help! Rigby

Rigby4 on June 18th wrote:My DME (Praxair) called to say it was "time to order new supplies" so I said I wanted the new Comfortlite 2. They sent me the old one. I returned it and repeated that I want the newest model. First they said it might take a few weeks until they get them in, then they said "it might take up to five months" because their company "has to test them" to make sure they're safe. What the heck???

Rigby4 on June 28th wrote:At your advice, I said "I know that these masks are tested and approved by the FDA so Praxair doesn't need to test them further. I know people who are using them now. Praxair is a large company and shouldn't have any difficulty obtaining them, so can you please explain why it's taking so long?" He asked what size simple cushions I used, called me back within 10 minutes, and my mask was delivered today - TWO DAYS after I called them! Wow! I can't wait 'til bedtime to try it out! Thanks, guys, for your help! Rigby

On June 18th the DME lied to the patient. If Rigby4 were not an informed consumer and if he were not persistent, he still wouldn't have the mask he ordered.

Why do DMEs lie? Why? I mean this as a sincere question. What do they gain from this kind of lie? I don't understand it.

--------------------------------------------------------------------------------

I returned the Comfortlite mask to Praxair and reminded them that I wanted a Comfortlite 2. When I had not heard from them in two weeks, I called again. At your advice, I said "I know that these masks are tested and approved by the FDA so Praxair doesn't need to test them further. I know people who are using them now. Praxair is a large company and shouldn't have any difficulty obtaining them, so can you please explain why it's taking so long?" He asked what size simple cushions I used, called me back within 10 minutes, and my mask was delivered today - TWO DAYS after I called them!

Good for you Rigby! Way to go!!!

Anonymous wrote:

Rigby4 on June 18th wrote:My DME (Praxair) called to say it was "time to order new supplies" so I said I wanted the new Comfortlite 2. They sent me the old one. I returned it and repeated that I want the newest model. First they said it might take a few weeks until they get them in, then they said "it might take up to five months" because their company "has to test them" to make sure they're safe. What the heck???

Rigby4 on June 28th wrote:At your advice, I said "I know that these masks are tested and approved by the FDA so Praxair doesn't need to test them further. I know people who are using them now. Praxair is a large company and shouldn't have any difficulty obtaining them, so can you please explain why it's taking so long?" He asked what size simple cushions I used, called me back within 10 minutes, and my mask was delivered today - TWO DAYS after I called them! Wow! I can't wait 'til bedtime to try it out! Thanks, guys, for your help! Rigby

On June 18th the DME lied to the patient. If Rigby4 were not an informed consumer and if he were not persistent, he still wouldn't have the mask he ordered.

Why do DMEs lie? Why? I mean this as a sincere question. What do they gain from this kind of lie? I don't understand it.

My guess is it was someone who didn't know what they were talking about and was trying to make something up on the fly. And failing, horribly.

Isn't that still "lying"???


Den

I agree that it is still lying.

If someone doesn't know the answer they should have the common decency to say so and get someone who does.

I was in the bank this week and overheard some customer asking a teller what the difference between an US Savings I bond and an E bond was.

The answer he was given was that the I bond earns more interest. WRONG.

Maybe at this exact point in time that might be true but there is a world of difference in the rules and rate calculations for each and only when one understands all those factors can one decide which bond "THEY THINK" will earn more during the timeframe that they intend to keep it.

I was appalled that a teller would tell someone that "THE I BOND EARNS MORE INTEREST" and leave it at that. How about saying that it is complicated and giving them a handout on how interest is calculated for each, or the 800 phone number for the government office that issues the bonds (one of the Fed banks I think) or even the Bond web site where it is all clearly explained for all to read.

Not just a problem with some DME's!!