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

Call Lincare Dist Manager, ask HER to order the "For Her" for you. And do they have a loaner you can pick up today till your "For Her" arrives. There should be no problem because it is the same ins. code as the machine they originally gave you.

Your prescription is also called an "order" for medical supplies. You should get a copy for yourself.

Cardsfan wrote:Call Lincare Dist Manager, ask HER to order the "For Her" for you. And do they have a loaner you can pick up today till your "For Her" arrives. There should be no problem because it is the same ins. code as the machine they originally gave you.

Your prescription is also called an "order" for medical supplies. You should get a copy for yourself.

I just spoke to the RT, who honestly, didn't seemed thrilled to be talking to me, but whatever. She said, she had already ordered the "For Her" yesterday, but she doesn't know when she'll get it in, could be weeks. She said the district manger is callng around to find one in stock. I asked about the mask and she said, it's whatever comes with the machine or whatever we have in the warehouse. I pushed the subject and she begrudgingly asked, what kind I wantd and I told her I wanted the air fit 10 for her pillows headgear and she said she'd look into it.

I asked if she ordered the climateline air tubing and she said, she ordered the machine and whatever tubing that comes with the "For Her". I asked about the hypoallergenic filters, she said it's not something they usually order, but she'd ask.

I also made an appt. with my sleep doctor the day after she gets back from vacation. I guess I'll ask her to prescribe every item I mentioned above.

In regards to picking up a used machine, I don't even know if it's worth it because, the mask she gave me with the first machine was a pillow but was huge for my nostrils, it became quite painful after about 15- 20 mins. The way she sounded, I think the mask and supplies are going to be whole new issues.

I have a question, my insurance said they'll only pay for cpap claims on equipment that were prescribed from the doctor who ordered the sleepstudy, or my sleep study doctor. Is that correct?

You really need to get a copy of your prescription/order. Most have a complete list of all the supplies that go with your machine. So they are probably already approved and covered by your ins. if your order is complete and correct. You would understand what is going on much better after you see your order.

Masks do NOT "come with the machine". They are a separate item and individual to what you want order.
The "warehouse" is in Tampa FL. who will eventually supply your replacement parts.
The "warehouse" in Tampa does not supply hypoallergenic filters. They just stock and send regular filters. (works fine for me)

Yes, your ins. only pays for items on your order/prescription that your Dr. has written. That's why I said you need to get a copy. So you know what is on it. Your order does not have to be specific to each item. It will say it covers a mask, you get to pick what fits you. It does not have to say exactly what mask. As long as it says "Mask" most masks should be covered.

Masks come with different pillow sizes. Usually small, med, large, it is called a "fit pack" so you get to try whatever size pillows you want. You get the headgear plus several different size pillows. **Tell the RT you want the "fit Pack" with all the pillow sizes.

Ask your DME to make an appt. for you to go in and fit you for the masks you are wanting to try. (My Lincare guy did all of this for me, and he came to my house to do it) I think your RT
needs an attitude adjustment.

The climate line tubing comes from the warehouse with no problem. I don't know what will be packed in with the machine when it arrives. Tell them you specifically want the climate line, even if they have to special order it. YOU are the customer, only accept items that are what you are spending your money on.
The good news is, this is a one time thing. After you are set up with your initial supplies, you deal mainly with the warehouse. And they are pretty helpful to me.

And FYI- Lincare has a 30 day policy to exchange your mask for something else if you are not happy with it during your initial set up.

Cardsfan wrote:You really need to get a copy of your prescription/order. Most have a complete list of all the supplies that go with your machine. So they are probably already approved and covered by your ins. if your order is complete and correct. You would understand what is going on much better after you see your order.

I'm trying to get a copy of the order (I guess that's the correct term and not Rx). I'm going to the medical records department tomorrow.

Cardsfan wrote:Masks no NOT "come with the machine". They are a separate item and individual to what you want order.
The "warehouse" is in Tampa FL. who will eventually supply your replacement parts.

Yeah, but she made it sound like it's whatever we give you type of tone. But after I stayed firm, she said she would look into it.

Cardsfan wrote:The "warehouse" in Tampa does not supply hypoallergenic filters. They just stock and send regular filters. (works fine for me)

I'm highly allergic to dust, that's why I was requesting it.

Cardsfan wrote:Yes, your ins. only pays for items on your order/prescription that your Dr. has written.

What I'm asking is, will insurance pay for a CPAP order written by your PCP and not your sleep doctor? Because, remember, now that I'm back with Lincare I still have that issue with them wanting an order with the detailed make and model on it because they had to order the "For Her" for me. And they said, yeah we placed the order, but more than likely it's going to be held up until we get the specified order/Rx.

And I still have that new order/Rx from my NP that she wrote for me yesterday that Aerocare/Express Medical didn't want to use. This Rx has the make and model on it. It reads, "Resmed Airsense 10 Autoset FOR HER CPAP & Humidifier - Heated. Pressure Setting 5- 20 cm h2o, Mask to fit, all necessary supplies. dispense as written". It's written on a Rx pad. I'm going to try to use it with Lincare so they can get the machine without any road blocks.

Cardsfan wrote:That's why I said you need to get a copy. So you know what is on it. Your order does not have to be specific to each item. It will say it covers a mask, you get to pick what fits you. It does not have to say exactly what mask. As long as it says "Mask" most masks should be covered.

Masks come with different pillow sizes. Usually small, med, large, it is called a "fit pack" so you get to try whatever size pillows you want. You get the headgear plus several different size pillows.

Ask your DME to make an appt. for you to go in and fit you for the masks you are wanting to try. (My Lincare guy did all of this for me, and he came to my house to do it) I think your RT needs an attitude adjustment.

The climate line tubing comes from the warehouse with no problem. I don't know what will be packed in with the machine when it arrives. Tell them you specifically want the climate line, even if they have to special order it. YOU are the customer, only accept items that are what you are spending your money on.

The good news is, this is a one time thing. After you are set up with your initial supplies, you deal mainly with the warehouse. And they are pretty helpful to me.

I know the order doesn't have to have specificities ( is this even a word?) on it other than "mask" and "supplies", but Lincare is requiring it for the "For Her" machine because it wasn't in their warehouse and had to be ordered and I'm thinking by the way the conversation went, they're going to pull the same thing for any other supplies I want that isn't in their warehouse. The RT also said, her manager is looking for a "For Her" if she finds one it's whatever comes with it. In other words, it might not have climate hosing. and if it doesn't come with climate hosing, that means it's not a new machine, because climatehosing comes in the box with the "For Her"

I guess the thing that I'm figuring out is that I have to be super firm.

Your original order ALWAYS covered the "For her" model. They already ordered the FOR HER for you. They would not have done that unless your insurance covered it and they had all the proper paperwork. So just keep on them to expedite delivery to you. Don't bring up the subject of order/prescriptions with them again.

Your PCP is legally able to order you medical equipment.

Like I said, Your RT needs an attitude adjustment.

Pap-Daddy wrote: It is known as a DWO - Detailed Written Order not a script as we call them.

No, it's a prescription. The FDA sets the requirement, and they call it a prescription.

Do I need a prescription for a medical device?

Not all medical devices require a prescription; however, many medical devices do require a prescription (for example, contact lenses).

http://www.fda.gov/AboutFDA/Transparenc ... 194424.htm

I have 2 different papers. One looks exactly like a prescription pad, like for drugs, and says CPAP MACHINE 5CM H20. RX SLEEP APNEA.

The other paper is much more detailed and says "Physicians certification for positive airway pressure devices". It lists all the supplies, insurance codes, how many replacements are allowed, and says it is good for "Life or 99 months". It looks like a shopping list of cpap supplies.

So one is a prescription for my pressure setting, and the other is an order for the equipment.

Lincare has copies of both.

ChicagoGranny wrote:

Pap-Daddy wrote: It is known as a DWO - Detailed Written Order not a script as we call them.

No, it's a prescription. The FDA sets the requirement, and they call it a prescription.

Do I need a prescription for a medical device?

Not all medical devices require a prescription; however, many medical devices do require a prescription (for example, contact lenses).

fda dot gov/AboutFDA/Transparency/Basics/ucm194424 dot htm

We call it a script and if you ask for a copy of the script the doc will give it YOU on a script pad since it is soo much easier. Basically it is to make us feel good - well and to confuse you.

What you don't see is what the provider gets and is indeed the only thing they will act on is an original copy of the DWO sent directly to the provider.

Pap-Daddy wrote:What you don't see is what the provider gets and is indeed the only thing they will act on is an original copy of the DWO sent directly to the provider.

manure.

palerider wrote:

Pap-Daddy wrote:What you don't see is what the provider gets and is indeed the only thing they will act on is an original copy of the DWO sent directly to the provider.

manure.

you never got one new from a dme so how would you know
the dwo is for billing the dme will not deliver if they cant get paid now will they
in fact that may be why the op had a prescription refused
most dmes will take the script then contact the doc to get what they need to get paid period
that is why it all takes so long
but how would you know

My doctors have no idea who my DME is. My family doctor writes my prescription and I hand carry it to my DME. I haven't had a sleep doctor since I started CPAP 8 years ago.

LSAT wrote:My doctors have no idea who my DME is. My family doctor writes my prescription and I hand carry it to my DME. I haven't had a sleep doctor since I started CPAP 8 years ago.

as already mentioned there is a lot you dont see
if the provider wants the business they will take the script
it has the contact info for the doc right?
and get what they need to get paid without you even knowing what is going on
by any chance was you dme lincare? didnt think so

*May a supplier submit a claim for reimbursement of a DMEPOS item prior to obtaining a detailed written order from the treating physician?

No. If a supplier does not have a faxed, photocopied, electronic or pen and ink signed detailed written order in its records before submitting a claim, the claim will be denied.

A detailed written order must be sufficiently detailed, including all options or additional features that will be separately billed or that will require an upgrade code. If the order is for supplies that will be used on a periodic basis, the detailed written order should include information on the quantity used, frequency of change, and duration of need. The detailed description of the item can either be a narrative description or a brand and model number. Someone other than the physician may complete the detailed description of the item. However, the treating physician must review the detailed description and personally sign and date the order.*

Guest wrote:

palerider wrote:

Pap-Daddy wrote:What you don't see is what the provider gets and is indeed the only thing they will act on is an original copy of the DWO sent directly to the provider.

manure.

you never got one new from a dme so how would you know
the dwo is for billing the dme will not deliver if they cant get paid now will they
in fact that may be why the op had a prescription refused
most dmes will take the script then contact the doc to get what they need to get paid period
that is why it all takes so long
but how would you know

because there are DMEs that don't need all your alleged bs.

I didn't know anything about a DWO. I thought a DWO was the same thing as the Rx (the kind written by hand on a Rx pad). I googled DWO and I've seen DWOs before. My NP gives them to me when they're having computer problems and I need to take it to the pharmacy in person to get the medicine. So it's making more sense to me.

So, this shit storm started when my sleep doctor's office didn't give me a copy of the DWO and Rx. I'm heading to the medical records dept in a few mins.

So DWO is the Rx with billing codes.