Update on Dad

Anyone have a pair of wading boots I can borrow?

I've called the DME every day (sometimes twice) to try to find out when Dad can expect the FitLife in Large. No answer until yesterday, when I was told by yet another dolt in the Call Center that it'll be a week to ten days before they can get one. (If you remember, the RT I finally spoke with a week ago Saturday told me that any mask by Respironics, Resmed or F&P could be had in 1-2 days if it wasn't already in stock. Now, suddenly, it'll take a week or more? )

Each of the recent calls has resulted in more frustration for me - nobody in the RT Department to talk to (they were all supposedly out on calls), and nobody has called me back. Color me shocked, positively shocked.

During my last call, I told the lucky Call Center employee that I wanted to speak to the person in charge, the owner of this terrible company. He was reluctant to tell me who the owner is and would only tell me his first name until I started to lose it; he then put me on hold and eventually came back on the phone with the full name. Wouldn't give me an email addy or a phone number where I could actually reach him directly, of course, but rest assured this guy will hear from me by snailmail.

I'm supposed to hear from a supervisor (or someone in charge) tomorrow, but I'm having centrals from holding my breath with this POS organization... I'm also calling Humana tomorrow to bitch about the DME and to ask them about the supply replacement schedule. This stupid DME company is insisting that the white filters are only changed every three months, when Respironics' suggested schedule says monthly and Medicare provides two filters per month. I can't imagine that Humana has set the schedule for three months, against manufacturer's suggestions and Medicare's guidelines, but I'll find out exactly what their policy is tomorrow.



In the meantime, when I do hear from this POS DME, I'm going to request the Pilairo Q for Dad, rather than waiting up to ten days for the FitLife. They'd better have a Pilairo in stock and deliverable in a day or two.

Here's Dad's data from last night. I upped the Min from 5 to 8 but left the top end open. I might lower the ceiling tonight. He had the mask on during the afternoon, so it looks like an almost-all-day affair, but the nighttime sleep data started at about the six-hour mark:



His AHI is under 5 for the first time with this data, so I think he's doing better with and getting more used to the machine, overall. I think, if he's still mouthbreathing, it's minor and he goes back to breathing through the P10 pretty quickly, which is why I now think the Pilairo might be a really good choice for him. The PB shown here is pretty typical of the data I've seen so far, but he's showing more centrals than he had during his study (just one all night). And just like me, he has much more Hypopnea than Apnea. Does anyone still think apnea is NOT hereditary?

Any other suggestions from anyone? TIA

With all the time he spends using the machine, he's gonna bankrupt me with all the distilled water he's using.

BleepingBeauty wrote: During my last call, I told the lucky Call Center employee that I wanted to speak to the person in charge, the owner of this terrible company. He was reluctant to tell me who the owner is and would only tell me his first name until I started to lose it; he then put me on hold and eventually came back on the phone with the full name. Wouldn't give me an email addy or a phone number where I could actually reach him directly, of course, but rest assured this guy will hear from me by snailmail.

name the miscreants and let the power of the internet help you dig them out.

if you have anybodies email address, then it's likely that the name of the 'owner' you got follows the same format.

you can also look for business licenses and DBAs at county records. etc.

This is an easy problem to fix...

I have both hip boots and waders. The hip boots would probably be all you need but you may want the waders just in case the crap gets "really" deep...

One solution is to go to https://www.cpap.com and order a mask from them. I see they have free shipping. It's nice to have a spare in case the replacement schedule gets fouled up.

Cost is around $120. Is the frustration and wasted time worth this amount?

This would allow you to move on to assisting your Dad in figuring out how to make the mask and xPAP therapy work. I would also remove you from being desperate to having a position of power with which to deal with those people.

Send the mask they provided back with a note saying that it doesn't fit. When talking to the insurance people be sure to mention that they supplied a machine but not a mask that fits. I would also add that you purchased a mask out of pocket and expect to be reimbursed for the cost. You never know, you may get lucky.

As a matter of federal LAW a Medicare provider (and Humana IS a Medicare provider under Part C in this case) MUST provide at least what Medicare provides. That is two white filters per month. So the DME (and Humana by extension) is violating federal law by refusing to provide the white filters per the Medicare schedule.

If they refuse to provide the white filters according to the Medicare schedule, it's because they don't want to spend the time billing Medicare/Humana--not enough profit for them. You've got yourself a Medicare complaint.

palerider wrote:name the miscreants and let the power of the internet help you dig them out.

if you have anybodies email address, then it's likely that the name of the 'owner' you got follows the same format.

you can also look for business licenses and DBAs at county records. etc.

Thanks, PR. I looked the guy up already, but there's no info about contacting him directly. I haven't gotten anyone's email addy, so I'm still in the dark on that, too. I did, however, find some horrible reviews (and recent ones) about this place. I gladly took the opportunity to add my own 1-star review (would give them none if I could).

This lovely ditty is on their website: "Our medical equipment experts are trained to accommodate physicians ‘orders, refill requests, and offer in home set-up and comprehensive training to patients and their caregivers." What a fucking joke...

HoseCrusher wrote:This is an easy problem to fix...

I have both hip boots and waders. The hip boots would probably be all you need but you may want the waders just in case the crap gets "really" deep...

I'll take the waders, please.

I may very well buy his mask outright, but I'm hoping for an even sweeter solution to this current mess. Read on.

Janknitz wrote:As a matter of federal LAW a Medicare provider (and Humana IS a Medicare provider under Part C in this case) MUST provide at least what Medicare provides. That is two white filters per month. So the DME (and Humana by extension) is violating federal law by refusing to provide the white filters per the Medicare schedule.

Thanks for that info, Jan. It doesn't surprise me in the least that the DME is willingly ignoring federal regulations. I think a call to the AG's office is now in order for tomorrow.

~~~~~~~~~~~~~~~~~~~

Here's a hell of an update for you all: Someone from Humana just returned one of my (many) calls to them, so that's one less call I have to make tomorrow. I told them what's going on with this awful DME, and she tells me I can choose any DME in the Provider book. Really? Why did someone from Humana tell me the opposite two weeks ago, that I could ONLY use this terrible excuse for a company for CPAP equipment? She doesn't know who told me that or why, and she apologizes for that (like an apology makes anything about this situation any better), but yes, any DME in the book is available to my dad. So I ask her how and why it is that the pulmonologist in the book (that Humana confirmed was "in network") told me that she doesn't take this insurance? This woman on the phone today said the same, that the doctor is in network. So who's zoomin' who here, and what do I believe?

I took the opportunity to ask about their resupply schedule (what's covered and when), and she told me the regulations only say that they cover supplies (no timeline, no specifics). How can this be? A company as big as Humana has to have everything nailed down and specified, I would think.

The end result (if Humana is to be believed) is that, if this awful DME will let me, I can return the machine to them and go with another DME. You know and I know that's not likely to happen, but in my dreams, it will, and I'll be totally relieved to wave goodbye to them (and give 'em the finger as I do). The whole process (between the dopes at Humana and the incompetent assholes at this DME) has been incredibly frustrating. Just unbelievable...

BleepingBeauty wrote: I'll take the waders, please.

might I suggest a full dive suit? it sounds like it may be really deep.

palerider wrote:

BleepingBeauty wrote: I'll take the waders, please.

might I suggest a full dive suit? it sounds like it may be really deep.

You may.

~~~~~~~~~~~~~~~~~`

I just thought of something, and it has me wondering if I might have the upper hand with these jerks. Their Patient Service Agreement was not signed by Dad; I signed it (with my name), as it's difficult for him to write these days. Might that give me room to claim that Dad's not under any agreement with them at all and, therefore, they *have* to let us out of this arrangement with them?

Somebody please tell me this is a valid "out" re: having to continue dealing with them. I'll take the brutal truth if that's not the case, but I really want that to be the case.

BleepingBeauty wrote:
I just thought of something, and it has me wondering if I might have the upper hand with these jerks. Their Patient Service Agreement was not signed by Dad; I signed it (with my name), as it's difficult for him to write these days. Might that give me room to claim that Dad's not under any agreement with them at all and, therefore, they *have* to let us out of this arrangement with them?

Somebody please tell me this is a valid "out" re: having to continue dealing with them. I'll take the brutal truth if that's not the case, but I really want that to be the case.

That depends on whether you have "power of attorney" for him - And I really wouldn't play this way because they could come back and charge you with fraud instead.

ETA: You may want to get a POA because of the signing problem - he can say what he wants you to sign for and limit it to things like this for now. We did this for mom when her hands got to bad with arthritis.

ETA: You can only fight this by staying totally clean and shiny and incorruptible. Don't give them a lever.

BlackSpinner wrote:

BleepingBeauty wrote:
I just thought of something, and it has me wondering if I might have the upper hand with these jerks. Their Patient Service Agreement was not signed by Dad; I signed it (with my name), as it's difficult for him to write these days. Might that give me room to claim that Dad's not under any agreement with them at all and, therefore, they *have* to let us out of this arrangement with them?

Somebody please tell me this is a valid "out" re: having to continue dealing with them. I'll take the brutal truth if that's not the case, but I really want that to be the case.

That depends on whether you have "power of attorney" for him - And I really wouldn't play this way because they could come back and charge you with fraud instead.

ETA: You may want to get a POA because of the signing problem - he can say what he wants you to sign for and limit it to things like this for now. We did this for mom when her hands got to bad with arthritis.

ETA: You can only fight this by staying totally clean and shiny and incorruptible. Don't give them a lever.

I don't have a POA for him. I signed the paperwork with my own name, but I have no legal status re: Dad. I'm just hoping that that technicality might get him off the hook with these dolts. If they claim that my signing the paper is fraud, then the agreement should be void, period. Dad was sitting right there.

I suppose they could claim that he (the RT) wasn't aware of the law re: me signing in place of Dad without having a POA, but he never questioned me about it; just handed me the paperwork. (I doubt he has even a smidgen of a clue about anything...)

Hi,

My experience is different but has similarities.

I went to the DME my doctor referred me to, attended the orientation, used the equipment in the demonstration, and took everything home.
During the orientation I questioned why I was receiving only one filter and was told a second filter was not billable for 3 months.

When I got home I researched Medicare reimbursement policy and learned I was correct. I called the DME and they refused a second filter.
I elected not to start treatment until the equipment issues were resolved. This likely is not an option for your Dad.

A few days later the DME supplier called me to introduce himself. I discussed filters, he said I was not eligible for more, but offered to send me more for a fee. I argued and during the argument the supplier looked on the computer and informed me the RT sent me home with 6. I said this was not true. Then I asked about hypoallergenic filters and he told me they did not exist. I referred him to medicare and to Cpap catalogues and he would not budge, telling me in all the years he had worked in this field that I was the most difficult patient he ever had.

I decided to purchase hypoallergenic filter online and processed the order. Then I realized this was ridiculous. I pay for both for Medicare and a supplement policy and am 100% covered. It did not seem right to be purchasing equipment before treatment had even started.

I called my doctor and said I could not work with their DME. My doctor's office informed me I could return the equipment and if the DME would not allow this for me to call them back and they would talk to the DME.

I called Medicare, discussed the issues, and they told me that as long as they had not received a bill that they would reimburse a second machine. They checked their computer and they had not received a bill for me.

I called the DME, told them not to issue a bill to Medicare, and that I was returning everything.

The above scenario took about a week.

At the DME office they handed me a form to sign. They crossed out the box where I checked returned with doctor's approval and checked the box that said returned against medical advice. I took the form back and underneath I wrote this was not correct that the doctor was aware of and approved the return. I initialed and dated my added comment. The DME was not happy. I asked them if they had a doctor in their office and they said no. I informed them that changing my documentation after I signed the formed was illegal.

I believe insurance does not have to pay if something is done against medical advice so it is important these forms are filled out correctly. Also get a copy for yourself in the office during the return.

It took me a few more weeks to get set up with a new DME and this may not work for your Dad.

Even so you can still call Medicare and call your doctor and tell them this is a relationship that will never work and find out legally how you can switch to a new DME without your Dad incurring a lapse in treatment. If Medicare has no idea then ask to speak to the Medicare supervisor.

Medicare should be able to help this transition. I filed a Medicare complaint online and Medicare responded within a day.

I was able to find a DME that would give me everything I wanted including the Airsense 10.

Good luck.
This process takes work.

BleepingBeauty wrote: So I ask her how and why it is that the pulmonologist in the book (that Humana confirmed was "in network") told me that she doesn't take this insurance? This woman on the phone today said the same, that the doctor is in network. So who's zoomin' who here, and what do I believe?

In this instance, believe the doc. Insurance companies have been known to pad their specialist listings to make them look good.

Just because a person gets a machine from one DME doesn't mean that they can't switch DMEs and get the masks and other supplies from another DME.

Now if a person just wants to be a butt and PITA to the first DME and return the machine...hey, that's always an option but if it were me I might just see what I could do about finding a different DME for masks and other supplies.
Guess it would depend on how much of a butt I wanted to be

Sonnyboy wrote:Hi,

My experience is different but has similarities.

<snipped for brevity>

Good luck.
This process takes work.

Thanks for relaying your experiences, Sonnyboy. (And boy, is that work comment true!) Today was another (long) exercise in serious frustration - between Dad's doctor's office, Humana, and this awful DME.

There are about 30 different DME companies listed in Dad's 2015 Provider Booklet. I called about a dozen of them today, inquiring about their ability to provide Dad with equipment and supplies. About half the numbers I called were no longer in service, and of the other half, only one supplies xPAP, and they don't take the insurance. Argh! They suggested I use the one DME that I've had so much trouble with, and I kindly asked them not to ever refer anyone to them again, that they're horrible to deal with.

In between calling all these DMEs and getting nowhere, I was also calling Humana (to ask someone in charge to PLEASE tell me which other DME in the book I can use), telling them what I've been dealing with re: this Provider Book being so inaccurate). The people I spoke with honestly tried to help, and one guy finally gave me the name of another outfit in Miami (and the woman he spoke to there) who said that they DO dispense xPAP equipment, would come here to set Dad up, and they DO take the insurance. (I subsequently called and spoke to the woman, myself, and she confirmed all of that but then said that the ONLY equipment they deal with is by DeVilbiss. Apparently, they don't make enough $ on the other manufacturers' products. ) She was very familiar with the horrible DME I'm already involved with and said she's heard about similar experiences from many other people.

The other joyous news from the current DME is that, if I want to return the equipment to them, they insist on instructions from Dad's doc that they're to take the equipment back because he no longer needs it. I objected and said he DOES need it and that we'll get the equipment elsewhere. They insist on this paperwork from his doc (which I absolutely will not make happen). I did call the Assistant at Dad's doc's office at about noon today (to ask that the doc send instructions to the DME to remove the equipment because Dad wants to deal with another DME), but he hasn't called me back yet. I can't simply walk into this DME with the equipment and return it; they only have a corporate office filled with (apparent) dummies who just answer the phones and take messages that either never get delivered or are delivered directly to the round file...

And in-between all this crap, a supervisor from the DME (I got her name) was supposed to return my call; of course, she hasn't. I'll be calling her again tomorrow. I'll be bald before this is all said and done...

howkim wrote:

BleepingBeauty wrote: So I ask her how and why it is that the pulmonologist in the book (that Humana confirmed was "in network") told me that she doesn't take this insurance? This woman on the phone today said the same, that the doctor is in network. So who's zoomin' who here, and what do I believe?

In this instance, believe the doc. Insurance companies have been known to pad their specialist listings to make them look good.

Hey, stranger! I'm not around the forum that often anymore, but I haven't seen your name here in ages. Nice to "see" you again, and I hope you're doing well. Thanks for chiming in.

I do believe the doc, and it's not surprising that the insurer would pad the book. It's just frustrating as hell to make all these phone calls and get nowhere fast.

Pugsy wrote:Just because a person gets a machine from one DME doesn't mean that they can't switch DMEs and get the masks and other supplies from another DME.

Now if a person just wants to be a butt and PITA to the first DME and return the machine...hey, that's always an option but if it were me I might just see what I could do about finding a different DME for masks and other supplies.
Guess it would depend on how much of a butt I wanted to be

I wouldn't care if Dad kept the machine, itself, from this terrible company, because we'd never have to deal with them again unless the machine had a problem (gawd forbid; I'd be kicking my own ass really hard if I ever had to rely on them for anything). But I absolutely won't deal with them in the future for any other reason. So that may be the way it goes, that we keep the machine and nothing else, getting supplies from another dealer (or just buying outright, at this point, to put an end to all the aggravation I'm experiencing). When Dad's being taken care of to my satisfaction, I *will* out this awful DME so anyone reading this saga who's in south FL will know to stay far away from them. (If I knew then what I know now... But I was only going by what Humana told me when this adventure began, so I won't be mad at myself for too long.) Thanks, Brenda.

Hi

I feel really bad for you. You have enough on your plate without the added insurance drama.
When things come down for you think about filing a written complaint to Humana and Medicare.

When I had my problem with the DME I had not yet discovered this forum and had no resources other than my sleep doctor who told me to schedule my next appointment after I achieved compliance. The DME respiratory therapist was part of the problem and I did not feel I could work with her. I still needed to learn how to operate the equipment and achieve compliance. I came very close to throwing in the towel before I even started. I sometimes wonder if the lack of DME support is why so many people fail at Cpap.

This forum does a really great job.