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

***Let us ladies handle this please, we have it covered. thanks

Susie Kay wrote:

Cardsfan wrote:***Let us ladies handle this please, we have it covered. thanks

Did anyone ever notice the good help on this forum comes primarily from ladies*? I've thought that is because women are the traditional care keepers. Also, there are more women who are stay-at-home moms who have the time and experience dealing with insurance and medical professionals.

*Exception for Palerider who is a big help to many people.

I don't post much, but I read the posts every day.....I've noticed that most of the irrelevant posts come from women.

notice this thread was going along fine until people who never post positive things started posting

Guest wrote:notice this thread was going along fine until people who never post positive things started posting

And you?

I think it is a good thing if the regulars shout down guests like Pap-Daddy. If you want to make a contribution here, register and begin to build some credibility.

I also never had a problem with the shouting matches that sometimes come up among the regulars. In the end, the truth usually prevails. Squash the discussion, and the truth may be hidden.

UPDATE:

I'm so upset right now, I'm shaking. I just got off the phone with my insurance company. I called them for another issue not related to this, but after that was settled I asked if she could help me find another DME provider in my network.

I told her about Lincare and Express Medical and then she said, let me call Express Medical and I told her, 2 agents already called them last night and told them they are in network and Express Medical is saying they need to clear it with a whole bunch of managers. The BCBS agent said, okay well lets just see where they're at in that process. I said, go for it and I'm on hold for a really long time. When the BCBS agent comes back on the line, she saids "upon speaking with Express Medical they said they received an email from you with a list of specific items you want and that actually isn't covered in your plan, it would be considered specialty equipment."


The email that EM got from me yesterday is the email I sent with a copy of the new Rx written by my NP that they didn't accept and a copy of my insurance card. In the email I just wrote them a reminder list of the items I discussed with their RT during the initial call. The items are: Airsense For Her, climateline tubing, the airlift 10 pillow mask for her, and hypoallergenic filters because Im allergic to dust.

When I initially called express medical on 7/5/16 (I have the phone call recorded), I spoke to their RT and she said, we just need a script to order the "For Her". I told her the Rx I have right now is just a general CPAP Rx but I can get one with the specific make and model on it. She said, it's no problem the general Rx will work. She also said there is no price difference between the "For Her" and the regular machine. I said, also I want the climateline tubing and she said, thats standard on all our machines. I also asked about a pillow mask for her and she said that was fine. And during this call she asked me what insurance I use. and i told her, BCBS

I feel like she was making it seem like I'm trying to go on this medical equipment shopping spree. I also feel like she flagged my insurance provider.

What do you guys think?

Use Lincare- there is no question they are in your plan. Didn't the other lincare office say they could order the For Her for you?

cardsfan, Im going to PM you.

cpap82 wrote:She said, it's no problem the general Rx will work. She also said there is no price difference between the "For Her" and the regular machine.

That is certainly true and it should not have to say a specific make or model but some providers seem to get kick backs for selling a certain brands of equipment.

Contact Lincare Executive Support Line; 855-937-2238. Stop talking to all the middle men. You have a legit prescription.

cpap82 wrote:UPDATE:

I'm so upset right now, I'm shaking. I just got off the phone with my insurance company. I called them for another issue not related to this, but after that was settled I asked if she could help me find another DME provider in my network.

I told her about Lincare and Express Medical and then she said, let me call Express Medical and I told her, 2 agents already called them last night and told them they are in network and Express Medical is saying they need to clear it with a whole bunch of managers. The BCBS agent said, okay well lets just see where they're at in that process. I said, go for it and I'm on hold for a really long time. When the BCBS agent comes back on the line, she saids "upon speaking with Express Medical they said they received an email from you with a list of specific items you want and that actually isn't covered in your plan, it would be considered specialty equipment."


The email that EM got from me yesterday is the email I sent with a copy of the new Rx written by my NP that they didn't accept and a copy of my insurance card. In the email I just wrote them a reminder list of the items I discussed with their RT during the initial call. The items are: Airsense For Her, climateline tubing, the airlift 10 pillow mask for her, and hypoallergenic filters because Im allergic to dust.

When I initially called express medical on 7/5/16 (I have the phone call recorded), I spoke to their RT and she said, we just need a script to order the "For Her". I told her the Rx I have right now is just a general CPAP Rx but I can get one with the specific make and model on it. She said, it's no problem the general Rx will work. She also said there is no price difference between the "For Her" and the regular machine. I said, also I want the climateline tubing and she said, thats standard on all our machines. I also asked about a pillow mask for her and she said that was fine. And during this call she asked me what insurance I use. and i told her, BCBS

I feel like she was making it seem like I'm trying to go on this medical equipment shopping spree. I also feel like she flagged my insurance provider.

What do you guys think?

You are not asking for "specialty equipment". All your insurance company cares is that they are paying for the equipment you requested by billing code. The "For Her" machine is an E0601 just like the dumbest CPAP. Your insurer covers it, your DME is supposed to provide it AS PRESCRIBED for the contracted price. End of story.

All my order says is " EO601 Cont. airway pressure device."
And my Lincare office said I can get the "For Her" machine with that prescription.

Janknitz wrote:

cpap82 wrote:UPDATE:

I'm so upset right now, I'm shaking. I just got off the phone with my insurance company. I called them for another issue not related to this, but after that was settled I asked if she could help me find another DME provider in my network.

I told her about Lincare and Express Medical and then she said, let me call Express Medical and I told her, 2 agents already called them last night and told them they are in network and Express Medical is saying they need to clear it with a whole bunch of managers. The BCBS agent said, okay well lets just see where they're at in that process. I said, go for it and I'm on hold for a really long time. When the BCBS agent comes back on the line, she saids "upon speaking with Express Medical they said they received an email from you with a list of specific items you want and that actually isn't covered in your plan, it would be considered specialty equipment."


The email that EM got from me yesterday is the email I sent with a copy of the new Rx written by my NP that they didn't accept and a copy of my insurance card. In the email I just wrote them a reminder list of the items I discussed with their RT during the initial call. The items are: Airsense For Her, climateline tubing, the airlift 10 pillow mask for her, and hypoallergenic filters because Im allergic to dust.

When I initially called express medical on 7/5/16 (I have the phone call recorded), I spoke to their RT and she said, we just need a script to order the "For Her". I told her the Rx I have right now is just a general CPAP Rx but I can get one with the specific make and model on it. She said, it's no problem the general Rx will work. She also said there is no price difference between the "For Her" and the regular machine. I said, also I want the climateline tubing and she said, thats standard on all our machines. I also asked about a pillow mask for her and she said that was fine. And during this call she asked me what insurance I use. and i told her, BCBS

I feel like she was making it seem like I'm trying to go on this medical equipment shopping spree. I also feel like she flagged my insurance provider.

What do you guys think?

You are not asking for "specialty equipment". All your insurance company cares is that they are paying for the equipment you requested by billing code. The "For Her" machine is an E0601 just like the dumbest CPAP. Your insurer covers it, your DME is supposed to provide it AS PRESCRIBED for the contracted price. End of story.

Aerocare/Express Medical told my insurance that they dent keep that machine in stock and have to special order it. That's when insurance Rep said that my insurance won't cover it.

I get what you're saying, but that's what my insurance rep told me. Is she wrong?

When looking for a provider under Medicare, I expanded the search radius to include Omaha.
What's a short road trip, if it saves money and frustration?

Insurance pays by Code. EO601 is the code for a cpap machine. The "For Her" is covered as an EO601 item. Just because the DME has to order it, because they don't stock it, does not mean it is "special order" it is still considered EO601. Does your order say EO601 ?

Cardsfan wrote: Does your order say EO601 ?

By order, do you mean Rx? If so, I don't know because I never saw the original script my sleep doctor's office faxed it to the DME. But If I had to guess, I'd say yes, because Lincare ran my insurance and they gave me a CPAP w/supplies and they said i didn't have to pay anything out of pocket.


Speaking of Lincare, I called the district manager and ask them to take me back and they said they would. I also called the state licensing board on Aerocare/Express Medical Supplies but they dont take customer service complaints. So, I called their corp. office, I'm also going to write a yelp review and report them BBB. That's all I can think to do.