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

yea as time goes on you will learn to just ignore palerider as those other insecure little boys who want people to think they know everything but plague this great forum
you will see the ones who repeatedly come out not to help but to make rude negative comments then go back into hiding
just do a search on their screenames to see how they repeat rude and negative comments
unfortunately there are so many of them here and that is what has driven pugsy and many others away

guesty wrote:

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.*

All BS...just like most posts from "guests"

This was the only Rx is my file.




If you notice this is a form from AHP, which is the first DME I tried but they weren't in my network. So, I called my insurance and found Lincare, called sleep doctor's office and told them I needed the Rx faxed to Lincare, because I'm going to use them. All of this happened mid June.

But there is no other Rx/DWO in my file.

At least that is what they told you is all that is in there, so use that just be sure to make copies.

AHP is no better they gave me a similar run around when getting my machine. And unfortunately for them, after they decided to "special order" the machine they lost my business cuz they took more than 7 weeks with the runaround game. I did order supplies from them since they had all of the paperwork until they out right refused to order a mask I wanted. Lesson learned, they are history.

If you'll notice that form letter serves as both the script with all the info requirements of a DWO including the sleep study report etc..

As mentioned before it looks like it will be a long time before you can get all this sorted out you may want to try the out-of-pocket routes first so there is
craigslist,
this forum,
cpap dot com
and Verus who does Medicare and may take other insurance too.

Is it possible that your insurance might change in the future?
That is all I can think of right now.

That is pretty much what mine looks like. I believe they should have checked the box that says 99 months , meaning it is lifetime use. So it will be good forever.
Just keep on that Dist. Mgr. to expedite your order. Anything more than a 7 -8 working days is unreasonable, and I would call that corporate # for help.

FYI- I've looked into the "FOR HER" and the climate line hose is *optional. When you get your new machine, it may come with the slimline hose. So make it CLEAR you want your original order to include the Climateline hose. I'd ask the local office to get a climate line for you so they can switch it out if your FOR HER arrives with a slimline.

*I would also talk to the local office about getting hypoallergenic filters. They may have to order them for you if the warehouse does not stock them.
The warehouse told me they only stock regular filters. Warehouse phone # to order supplies 888-544-2715. You may not be in their system yet though.

I think all along, your local office didn't want to put in the extra effort it takes to get your order the way you want it. And they were hoping you wouldn't push it. Be firm, with a smile, and get what you want. Remember, to Lincare, your insurance is a lifetime cash cow for them. The corporate office will make sure to keep your business, if you have a complaint with the local office, call corporate.

Insurance companies use a formulary. It is a way to control expenses.
(((Basically a license to cheat. Bought and paid for.)))
If a DME claims to have a "formulary", they are usurping a practice that "belongs" to insurance companies.
And not a moral one by any definition.
Fire their slimy outfit! ASAP!

I have Lincare. The service I get from my local office compared to cpap82's local office is like night and day. The problem is not Lincare or formulary. The problem is the RT in 82's local office.