DME says "no" to prescription for Hybrid

When I went to see my doctor three weeks ago, I asked him to prescribe a hybrid mask for me to use in addition to/in lieu of the Swift nasal that I'm currently using. There have been a few nights when I can't use the Swift because of nasal congestion due to cold or allergies.

The doctor dutifully (and cheerfully) wrote the prescription, I faxed it to my DME and then heard nothing more. I called on Tuesday and was told that the DME couldn't fill the prescription because the mask was "so expensive". When I asked them point blank if it was because my insurance wouldn't cover it, they hemmed and hawed and never gave me a straight answer. Instead, they offered to send out a technician to fit me for any other mask I wanted. In the end I said "Well, why don't we let the doctor decide what's best since he's the one who wrote the prescription?"

I'm going back to the doctor next week and would like to be armed with suggested next steps in the process. Any help you guys can provide would be greatly appreciated.

Thanks!

Kurtchan

I would call your insurance company and your company HR insurance person. The DME will do whatever the plan approves. My guess is that there is some limit on what they will pay for and that is why the DME is balking. There is probably also a service agreement that says the DME will not discuss it. The DME will gladly provide whatever they will get paid for. That's how they make thier money.

incredible! I would dump that DME in a heart beat, cheap bastards.

It may well be that the amount they get paid by the insurance company won't be enough to cover the costs of them getting it.
They certainly have the right to decline to fill a prescription. Now as to if it's a good business decision or not could be debated but it would be hard to make that call without more information.
If they have never bought one before for example they would have to go through the mess of getting accounts setup. That company may require minimum purchase amounts and if they have no one else wanting to buy one they end up sitting on extras they can't use. They may be required to pay COD as a new account. All the crappy things that come along with purchasing. Can you tell I used to be a warhouse manager?

The bottom line is their too cheap and want to put you in something cheaper because MANAGED CARE INSURANSE PAYS THE SAME FOR ALL FULL FACE MASKS.
Be firm and demand the script be filled just as written. Hybrid might cost more but for me it's the best thing on the market, crappy headgear and all.

They can't mark it up 300% and charge your insurance that much. There's no profit in it for them. It's all about money.....not your health!

Den