Is there a way to get a DME (Lincare) to order non formulary

They BLINKED!
I knew you could stare them down.

Edit---well, sort of.
Maybe they are trying to string you along.
See comment below.

cpap82 wrote:My Lincare rep just told me her manager is saying they can't order the Airsense 10 for her, because it's not on their forumlary list. Since, I'm stuck with Lincare, is there a work around? Is there something I can do or say to get them to order this machine?


Thanks in advance

Ask them for a copy of their formulary list.

If they are denying your claim, they are required to provide it to you.

Cardsfan wrote:Call the corp office- Tell them you need your machine now, if they can not order it, you will take your business elsewhere.
See what happens.

That presumes they care, but the truth is they don't.

For every one of us who takes the time to be educated and involved in our care, there are probably 500 who don't. So the loss of our business is no skin off a DME's nose, and the extra work involved in getting us what we want, combined with the lower profit margin, means they'd rather us go away.

In the 80's most businesses subscribed to various programs meant to boost their bottom line. One of the big things in those days was to "identify your customer". I happened to work in those days in a health care profession and the facility I worked for got bought out by one of these money making corporations. So we had to go to inservices to learn to identify "who is your customer." Most of us involved in patient care were surprised to learn that the patient was not really the important "customer". It was the doctor who made repeat referrals, it was the insurance companies who paid the bill, the it was the vendors who provided equipment, supplies, and "free training". Oh, yeah, and the patient. The patient was the after-thought. That mindset was the beginning of the end of my career in that field. When the patient in front of me wasn't the priority, then something was very, very wrong with the system.

And so it goes with DME's. WE are not their customer, we are at best "end users". Their customers are doctors who make repeat referrals and insurers who pay the bills. We are but a small obstacle to their getting paid. And there's plenty more where we came from, so there's no need to please us. They don't need us.

The question is, do we need them?

In the same situation, I would jump ship!
Lincare does not deserve your business, not now or later.
They have tried to screw you once; no reason they won't keep trying.

I decided to quit Lincare and go with the other DME. I'm returning the used cpap Lincare gave me on 6/30/16 tomorrow first thing in the morning.

so the new DME needs a copy of the cpap Rx, but my doctor's office is saying they sent the Rx down to records to get scanned into my medical file and that process takes about a month. So, the soonest they can get a new script will be when my doctor gets back from vacation on 7/13.

So here's my question, will Lincare give me a copy of the Rx my doctor sent them when they gave me the used machine they tried to pass off as new?

In case I didn't make sense:

6/14/16 sleep doctor sent Lincare my cpap Rx. However, I had to wait a week to get a machine because the Lincare person was on vacation.
6/30/16 I go to Lincare to get demonstration and to pick up my "new machine"
7/1/16 I figure out my "new" cpap is actually a "used" cpap with 1179 hours on it. Lincare saids I can return it and they will order a "For Her" for me and when it comes in they'll swap out the used machine they gave me for the new machine.
7/5/16 Lincare saids they can't get me the "For Her". Drama ensues. Lincare buckles and saids, yeah to ordering the "For Her". However, I've found another DME and have opted to end my unhealthy relationship w/Lincare. So I'm returning the used Lincare machine tomorrow.

Question: Am I entitled to a copy of my cpap Rx Lincare has on file?

cpap82 wrote: Question: Am I entitled to a copy of my cpap Rx Lincare has on file?

YES absolutely you are but i would get my copies before turning in the machine cuz they can by law take up to 30 days IF you submit your request 'in writing' which is what i would do
see that is the law and that is what the doc is using to stall you
it doesnt take 30 days to scan - ask them to write another or get it from your sleep lab
your doc prob owns that too
and from the way the doc is treating you i would find another doc too
fwiw - any doc even your dentist can write you a script
the new dme may be willing to coach the doc to get it written correctly

What are u going to use if you return your used machine? Do NOT go without therapy. Hang on to that used one Lincare gave you until you get a new one.

I have an appointment with my general practice family Nurse practioner tomorrow. Would she be able to write me a cpap Rx?

cpap82 wrote:I have an appointment with my general practice family Nurse practioner tomorrow. Would she be able to write me a cpap Rx?

A NP wrote mine out as per my request...

ger365 wrote:

cpap82 wrote:I have an appointment with my general practice family Nurse practioner tomorrow. Would she be able to write me a cpap Rx?

A NP wrote mine out as per my request...

Thank you.

you should research what is needed on the script well its actually not a script but an order and needs to have specific info on it.
like if you want a specific make and model and the pressures esp for auto not to worry you can change those later but the dme may not issue it if not correct.
you can google or go to cpap dot com i believe has what are the min. reqs for them
there should also be that info on this forum but use google to find it
use search terms like "cpap order example"
be sure write down what is needed and be sure to include pressures as some dmes get pretty anal about it

as for lincare you can and should file a complaint with the state licensing board then to lincare corporate but state licensing will get their attention
make notes about the dates & details but get your therapy going first.

I googled cpap script and looked at my current machine to get the settings. I wrote it out for my NP:


Dx OSA
- Resmed Airsense 10 AutoSet For Her CPAP Machine with HumidAir Heated Humidifier
- Pressure Setting 5 to 20 cmH2O
- Mask to fit
- All Necessary Supplies
- Dispense as written

cpap82 wrote:
Question: Am I entitled to a copy of my cpap Rx Lincare has on file?

The answer is no you are not entitled to the copy of your script that Lincare has on file in most states because it has already been actioned (they gave you a prescription only device, even if you return it!). The prescription you need is from your doctor's office. Get on the phone with your doctor's office and INSIST that they get that script back to fax to your new DME. There is just no excuse for such sloppiness. Note: In my state, the DME could be asked to fax the prescription to the new DME, and that would be legal and valid, but I'll bet they won't be willing to do so.

SewTired wrote:

cpap82 wrote:
Question: Am I entitled to a copy of my cpap Rx Lincare has on file?

The answer is no you are not entitled to the copy of your script that Lincare has on file in most states because it has already been actioned (they gave you a prescription only device, even if you return it!). The prescription you need is from your doctor's office. Get on the phone with your doctor's office and INSIST that they get that script back to fax to your new DME. There is just no excuse for such sloppiness. Note: In my state, the DME could be asked to fax the prescription to the new DME, and that would be legal and valid, but I'll bet they won't be willing to do so.

That is wrong on sooo many levels.
Time to Google "hipaa records release". Give credence to the HHS dot gov sites.

First, you are entitled to copies of your medical records under most conditions providing you are not insane, etc.
And you (as the doc) don't request the "script back" to issue a new one, that is NOT how it works. In many cases you will need an original from the doc anyway, even if you bring your "copy" the dme will request an original from whoever signed off on the copy. That all takes time and prob won't happen in a day or two unless the wheels are greased before hand.

The sticker here is no matter who the records are requested from it should be done in writing and that starts a 30 day clock in which they should comply with the request or provide a reason to deny. That can or will be a problem here as the doc is aware of this and appears to be using that as a delay to get his way.

cpap82 wrote:I googled cpap script and looked at my current machine to get the settings. I wrote it out for my NP:


Dx OSA
- Resmed Airsense 10 AutoSet For Her CPAP Machine with HumidAir Heated Humidifier
- Pressure Setting 5 to 20 cmH2O
- Mask to fit
- All Necessary Supplies
- Dispense as written

That looks good to me. It is known as a DWO - Detailed Written Order not a script as we call them.
I do wish you luck with this.

The new DME wouldn't accept the Rx written from my NP and now they are saying they aren't in my network, but they are. I don't even think I can go back to Lincare, if I wanted to. When I dropped off their CPAP machine this morning they were so rude to me and confrontational. And my sleep doctor's office still doesn't know it's head from it's ass in regards to my original Rx.

You can't make this stuff up, people.