xxyzx wrote:
the problem is that we have to pick a DME first
if i coudl get approval then i coudl shop DMEs and ensure it was a new machine with the features i want etc
all they have to do is provide the cpt code device as insurance does not require new afaik
It's quite possible to shop DMEs if you are really wanting to shop around. Insurance complicates things a bit: If you want to spend your insurance company's $$$ on your machine, you are limited to the DMEs your insurance company considers as "in-network", and if they only have a limited number of in-network DMEs, that's something to bring up with your insurance company.
And to shop around DMEs, you also have to be willing to tell the lab and the sleep doctor, "No, I won't sign that piece of paper authorizing you to send a prescription to a DME that I've never heard of."
Here's the story of how I did shop around to find a DME that would sell me the S9 AutoSet that I decided that I wanted for my first machine.
1) On my diagnostic test I politely refused to sign the paperwork that authorized them to send a script to the DME of their choice as soon as the doc read the test if my apnea turned out to be bad enough for a split test. (It didn't turn out to be that severe). I refused to sign that paperwork because I knew I didn't know anything at all about CPAP, DMEs, or even my insurance coverage for CPAPs. And I wanted to check that stuff out before committing to CPAP therapy.
2) My titration test was scheduled about 3 weeks after my diagnostic test due to a family trip. I spent the time between the two tests educating myself (here and on another forum) about OSA, CPAPs, and DMEs. By the time of my titration test, I knew that I wanted an APAP, or at least a CPAP that recorded full efficacy data. And I also knew most DMEs set most new patients up with bricks. (Since my diagnosis was for plain old moderate OSA, there was no reason to expect the doc would prescribe anything other than CPAP at
n-cm.)
3) On my titration test I was again asked to sign a paper authorizing them to send a script to the DME of their choice as soon as the doc read the test. I again politely refused to sign the paperwork. At that point I knew that I still did not know enough about my insurance coverage or which DMEs in my area might be willing to sell me an APAP, but I did knew that I did NOT want to be railroaded into a long term business relationship with a company that I did not choose.
4) After my titration test, I also had to be very firm with the sleep doc's office and repeatedly tell them that I was NOT going to allow them to just fax my script to the DME of their choice. I was also very firm with them that I was in the process of contacting multiple DMEs and that once I found a DME that I liked, I would let the sleep doc's office know where to send the script.
5) I contacted my insurance and found out that they had a very long list of in-network DMEs---so long they were unwilling to send me a copy of the full list; they did send me an abbreviated list. After calling every DME on that list and finding out that they were going to set me up with a brick (yes, I'd already done my homework and knew about brick CPAPs), I started going through the yellow pages and found a small DME that specialized in CPAP equipment (and only CPAP equipment). Much to my pleasure, this DME sets all their new patients up with the patient's choice of the newest model Resmed AutoSet or the newest model PR Auto CPAP, even when the script just calls for CPAP. AND they were in-network. They earned my business and I have continued to recommend this place to anybody in the Buffalo, NY or Rochester, NY areas. The name of the place is CPAPXpress for anybody who is interested.
Once it became clear I was going to be moved to bi-level, I worked with CPAPXpress for about a month in an attempt to find out whether the S9 Vauto was going to be released anytime "soon" or whether I could get an S8 Vauto or whether I should get the PR System One 750 machine that I used for several years. It took a month of digging on my part and theirs to decide that in late 2010, the S9 Vauto was still vaporware with an unknown release date, the S8 Vauto was not what I wanted (it has a proprietary data card and card readers were already getting scarce) and the PR 750 was worth trying.