No Medical Necessity to replace a Brick

Dave,

I am so sorry about the difficulties you are having.

Since a dentist is allowed to write a prescription, would yours be willing to since so many of the are aware of the dangers of sleep apnea? Hopefully, if you used reasoning based on that girl's post, you could get his/her cooperation.

Any other medical professionals from this list who are allowed to write who would be willing to such as another doctor you go see?

Medical Doctor
Doctor of Osteopathy
Psychiatrist (MD Only)
Physicians Assistant
Nurse Practitioners
Dentist
Naturopathic Physicians

Best of luck in sorting things out.

49er

Strange thing, my PCP did not want to write an Rx for a machine. He said that it could come back to haunt him, because my insurance company could inquire of him what made the new more expensive device suddenly necessary and he wouldn't have a suitable answer.

Your insurance company DOES NOT CARE. Why? Because it will not cost them one penny more. They pay X for an E0601 machine whether it's a brick or a Rolls Royce. They aren't going to pay extra for a data capable machine.

The DME on the other hand, loses that whole $35 profit margin when they supply a better machine. Now they lose more because they have to take back a used machine AND give you a new machine with a lower profit margin. I'm sorry you took my remark the wrong way, but you have to be (here's a polite way to say a "prick") very forceful to succeed with convincing a DME to do this. I didn't get from your posts that you are going to be successful, because each time someone has told you something you accepted it ("data capable machines aren't accurate", "data machines cost thousands more", "insurers don't want to pay extra for data machines"). You have to do your homework first so, armed with the facts, you can't be manipulated by professionals who don't really get the whole picture. Your DME is going to be 1000 times WORSE.

Trying to get a DME to agree to swap out your machine at this point is going to be VERY DIFFICULT. The aggravation may simply not be worth it.

Seriously, this makes me think of the Discount Tire commercial where the little old lady throws the tire through the plate glass window of the tire store. The ad says "any time you're dissatisfied with your tires just bring them back ".

I would very likely show up at the DME with the brick and make reference to that commercial and rioters throwing bricks through store windows, and picketing in front of their store.

I might also show up with a pillow and suggest I wouldn't leave until I had the APAP I wanted. I would also ask in a loud voice in front of every customer why they provided such lousy service and when they planned to take care of me.

As Jan suggested you may need to be a bit more assertive.

davep700 wrote:Strange thing, my PCP did not want to write an Rx for a machine. He said that it could come back to haunt him, because my insurance company could inquire of him what made the new more expensive device suddenly necessary and he wouldn't have a suitable answer.

I am sorry I didn't post this thought before your appointment but maybe you can follow-up with your PCP.
I would ask the PCP, "How am I doing? Is the therapy working? How can you (the PCP) tell?
The PCP's answer should not be "well how do you feel?" While there are cases where efficacy is understood by the patient's observation, I believe there are many that require lab work or the equivalent. If the PCP does not have an answer to give you on your progress, then you might ask how will the PCP measure progress? If progress is simply your reporting back how you feel, then what is the PCP role? I would want to know what are the measurable goals and milestones anticipated by the PCP. Does the PCP expect to monitor your health through your "feelings" or will "routine" sleep studies be the plan?
Such a dialogue might help you decide if this PCP should be managing your sleep apnea and might help explain to the insurance company what the PCP's long range plan entails and what the cost to the insurance company will be. They may not agree.
Good luck.

bwexler wrote:Seriously, this makes me think of the Discount Tire commercial where the little old lady throws the tire through the plate glass window of the tire store. The ad says "any time you're dissatisfied with your tires just bring them back ".

As Jan suggested you may need to be a bit more assertive.

I got a new humidifier tank at no cost when mine leaked (no insurance) when I said loudly "What do mean, only 3 months on this piece? I have to wear this every night for the rest of my life and yet this is only good for 3 months!?!" in front of half a dozen people waiting for their appointments. Service was amazingly fast after that. Mind you this was the same person that sat across the large desk from me and said my mask didn't leak after she had me hold it up to my face.

They make used car salesmen look like saints. At least used car salesmen know what they are selling!

At least people buying used cars expect to be treated like shills. When you go to a DME for medical equipment, most people are unaware there is an inherent conflict of interest between the Dme's profit margin and your health. We expect them to "take care of us" but they really are taking care of themselves. If you know that going in, you have a much better chance of advocating for yourself.

All you have to say is that you are paying HUNDREDS OF DOLLARS for a machine that you have to deal with for 5 years. Unless they can provide a medical reason why a brick is necessary, you should get what YOU want, which is UP TO DATE technology that actually HELPS patients. EPR, more options for humidity adjustments, heated hoses, better algorithms, ability to SEE THE DATA from your sleep in order to improve it. The insurance company doesn't care because they pay the same for a brick as they do top-of-the-line. It's all the same code. Remind them that YOU are the customer, not your insurance company. Otherwise, they can take their machine back. Either you are dealing with really stupid people or they are simply shystering to get a buck out of you. Bring the machine back and tell them you want what you want and if they can't provide, leave the machine with them and buy online. Your doctor's office is REQUIRED to give you a script for a machine and since no insurance is required, demand the one you want.

I feel fortunate. Even though Lincare has a bad rep nationally (not as bad as Crapria), my local office has been great. Even the supply and billing people have been great so far (6 months). My only complaint about the local office is that their new location is nearly completely inaccessible for someone in a wheelchair (way too steep). Fortunately, I can make an appointment for them to come try masks out on my brother.

And yes, sometimes you have to be obnoxious.

SewTired wrote:All you have to say is that you are paying HUNDREDS OF DOLLARS for a machine that you have to deal with for 5 years. Unless they can provide a medical reason why a brick is necessary, you should get what YOU want, which is UP TO DATE technology that actually HELPS patients. EPR, more options for humidity adjustments, heated hoses, better algorithms. .

Saying that loudly in front of other customers helps a lot too. All of them suddenly perked up and looked at me when I started talking like that!

Even the supply and billing people have been great so far (6 months). My only complaint about the local office is that their new location is nearly completely inaccessible for someone in a wheelchair (way too steep).

How's that for sending a message that they don't care about the people they are in business to serve?? That's an ADA violation will eventually get them sued.

Greg Riddle wrote:

Julie wrote:Her ignorance showed up the minute she told you to just lose weight.

My wife just lost 115 pounds abd I've had to raise her issue to keep get ahi below 5. She is going to sleep dr tomorrow

I've lost 90 lbs in the last year, and my average AHI has gone from around 0.2-0.3 to around 0.8-0.9