More DME antics

Hey, SuxBeingU, if you are in the USA you have a LEGAL RIGHT to a copy of your xPAP script. Ask your sleep doctor and/or your DME for a copy of it. If necessary, put your request IN WRITING and if they still drag their feet, put your request in writing and SEND IT CERTIFIED MAIL, RETURN RECEIPT REQUESTED. Don't send it Addressee Only tho. That can be ignored and left sitting at the PO until its return date.

Once you have a copy of your script you can purchase online from any online DME supplier. And you "should" also be able to use that script w/any local DME supplier as well.

Frankly, I would suspect that an "exclusive contract" between sleep lab and DME supplier would be illegal. Now, it may well be that your insurance company only contracts w/that one local DME. That isn't too uncommon and would be much more likely. In our town there are two hospital sleep labs and at least two "independent" sleep labs. There are at least 5 DME suppliers of PAP equipment. My insurance only contracts w/3 of the local DME suppliers, none of which are national, but at least I have a choice of those 3.

As you've already figured out, it can be cheaper to self-pay for PAP equipment online than to pay your insurance's copay to a local DME supplier. My understanding is that a script is only needed for the PAP machine itself w/online DMEs and no script needed for mask, etc. I'm not sure about the humidifiers. Others in the forum would know better than I do about that.

If, as I suspect, it is your INSURANCE, and NOT your sleep lab, that is restricting you to just the one local DME, you shouldn't have any problem getting a copy of the script from the sleep lab w/just an in-person visit or phone call.

And, if there is a specific PAP machine you want that will do what your sleep doc wants it to do, you can purchase that machine online w/a "generic" type script whereas from the local DMEs you would NEED a script SPECIFICALLY for that particular machine if it is more than a bare-bones machine.

SuxBeingU wrote:the clinic my HMO is at has an exclusive contract with this DME so I can't buy a machine on my own w/o switching Drs.

If "buy a machine on my own" means you're willing to buy it using your own money, not going through your insurance at all, then you can buy ANY cpap or autopap machine you want, using just a copy of the prescription you have now for "cpap" -- if you shop with cpap.com

That one word -- cpap -- on an Rx signed by a doctor, will let you buy any CPAP machine OR autopap machine from cpap.com

If you want an autopap, the Rx doesn't even have to say "autopap" or state a pressure range. The autopap will come preset 4 - 20 cm, and will have the setup instructions with it so you can change the range if you wish.

So, if you're willing to pay out of pocket and order what you want, you don't have to even talk to the doctor or the DME. Just get a copy of your present Rx and do your shopping online.

rested gal wrote:

SuxBeingU wrote:the clinic my HMO is at has an exclusive contract with this DME so I can't buy a machine on my own w/o switching Drs.

If "buy a machine on my own" means you're willing to buy it using your own money, not going through your insurance at all, then you can buy ANY cpap or autopap machine you want, using just a copy of the prescription you have now for "cpap" -- if you shop with cpap.com

That one word -- cpap -- on an Rx signed by a doctor, will let you buy any CPAP machine OR autopap machine from cpap.com

If you want an autopap, the Rx doesn't even have to say "autopap" or state a pressure range. The autopap will come preset 4 - 20 cm, and will have the setup instructions with it so you can change the range if you wish.

So, if you're willing to pay out of pocket and order what you want, you don't have to even talk to the doctor or the DME. Just get a copy of your present Rx and do your shopping online.

This was my entire argument with, Health care Partners, the middleman for the hospital/clininic. They refused to give me a script and said I HAD to use their DME that I had no choice. IF I wanted to buy a cpap on my own I would have go to another Dr at a different facility. In the end it was converted to a purchase but they are still trying to get me to pay the 681.00.

thanc for the info, I am wiser yet again for reading these boards.

sleepyWI wrote:[

The numbers I quoted are what the DME submitted as charges to the insurance company. The insurance company willingly paid those excessive charges. Then they have the gall to tell me to cut my pills in half to save money.

Good news is (maybe) I have a new insurance provider starting January 1. I'm calling them today to find out what my DME options are.

I have run into similar situation where I am being told to go out and buy a razor blade and cut pills while they overpay other contracted DME services an extra $ 100 a month over what their contracts allows.

I raised h**l and got the pills that I don't have to cut them now as well as they are allegedly asking the DME for the money back. I haven't seen all of it but some progress was made.


Back to the overcharging by the B & M DME's. They are a business and have people to pay. They put money into the local economy. They have to consider what little profit (if any) they make on some patients who can't pay their bills. But I agree charging for the hose in the box and the filters in the box is a little too much and I was charged for those too. I saw charges submitted to my insurance on the order of those above but my insurance determined they be paid at 80 % of submitted charges.

The last mask I got from the DME (and it will be the last one I get from them as it is less frustrating to buy online and pay the whole cost out of pocket over deal with the screwed up bills) I was changed for the mask, headgear, and the nasal pillow all separately. It was a Swift and they only gave me one pillow. If I had gotten all 3 I would have been charged an extra $ 40 each for the other 2.

They break open sealed boxes to only give out one piece. I was really surprised they didn't try to bill for the CD that comes with the Swift as well as the case. I didn't need another CD and case but could have used an extra nasal pillow. I complained about the billing and was told I would get another pillow my size (they didn't say free btw just they would send it). That was last April. I have yet to see it and am sure not going to hold my breath waiting for it.

And I will reiterate: IF you are in the USA you have a LEGAL right to your script. Put your request in writing to the sleep lab/doctor. Send it Certified Mail, Return Receipt Requested. Give them 14 days from the date they received your written request. (The date will be on the green Return Receipt card you get back from USPS). If you haven't received your script by then send a copy of your request for the script, a copy of your Return Receipt and a letter describing your difficulties in getting a copy of your script to your state's licensing board. Send a copy of your complaint to the sleep lab/doctor as well.

That script is a part of your medical records and in the USA you have a LEGAL right to a COPY of your medical records.

At this point I would be so fed up w/these jokers that I would also request a copy of my entire sleep study and titration study results, not just the report. Of course, these sheisters then have a legal right to charge you a "reasonable fee" per page for the copies. But, at least then you have all the info. Events in which position, desaturations, etc, etc, etc.

"They refused to give me a script"

If they are refusing to ask the doctor to write a new prescription to hand to you, I can understand that.

But if you ask for a copy of your current cpap prescription, I cannot imagine ANY health care outfit not being willing to give you a copy of that...even if they drag their feet delaying all they can. They might try to refuse, but I don't believe they can legally withhold that from you. The most they could do would be delay, delay, hoping you'd get tired of the runaround and stop asking for it.

If they don't give you a COPY of your existing prescription, then I'd do what the Guest suggested:

"If necessary, put your request IN WRITING and if they still drag their feet, put your request in writing and SEND IT CERTIFIED MAIL, RETURN RECEIPT REQUESTED. Don't send it Addressee Only tho. That can be ignored and left sitting at the PO until its return date. "

RestedGal, that "Guest" was me, Slinky. I didn't realize that the forum hadn't let me sign in until it was too late and the post was made.

Slinky wrote:RestedGal, that "Guest" was me, Slinky. I didn't realize that the forum hadn't let me sign in until it was too late and the post was made.

You gave good advice, Slinky.

I am also having fits with my DME over their provider’s charge for a Hybrid mask.
The first item on my EOB is for HYB500 (manufacturer’s product code for the complete Hybrid system, this product code includes the headgear, three sizes of nasal pillow sets, three cushions, the facepiece, and a carry case). The providers charge for this was 217.00
I was provided the complete system.
The second item on the EOB was for HYB513(manufacturer’s product code for a medium size cushion). The Providers charge for this was 69.00
The third item on the EOB was HYB523 (manufacturer’s code for a set of medium size nasal pillow)
The providers charge for this was 56.00
The fourth item was HYB530 (manufacturer’s code for the headgear)
The providers charge for this was 45.00

When I told the DME that I did not receive the 2nd,3rd,and 4th items, as separate items but were already in the complete set, their response to me was that they are permitted to bill my insurance Co BC/BS for these items separately as well as in the complete set.
They went on to explain that (while they forgot to do it in my case) they would normally take the headgear out of the complete set and then sell that as a separate item, but would not reduce the price of the complete set. Their justification for doing this is the my insurance will permit me a new mask more often than new headgear, consequently they separate them.

My BC/BS representative has been “looking” into this for three weeks now without an resolution.

I hope that this is just my DME that’s doing this, but it sure seems unethical, if not illegal.

Bottom line: My employers self insured program is being charged twice for the same items. I’m paying a co-pay twice for the same item.

Snoredog wrote:

The reason they jack up the price is when you have any kind of a deductible, that deductible comes off the price charged by the DME, the $1800 figure for the machine not the $783 the DME would like you to believe.

For example, if you have a 50% deductible for DME equipment, for that $1800 machine, that means you pay $900 copay, the insurance pays the $783 to the DME which is what they have negotiated behind your back (the part where they screw you).

So who do you pay the deductible to? Yep, you guessed it, the DME, you pay them $900 and they collect $783 from your insurance, so they get $1683 for that $295 machine.

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CPAPopedia Keywords Contained In This Post (Click For Definition): hose, DME

Snoredog,
My insurance company does not allow this. In your example my co pay would go towards the $783 and not the $1800. The insurance statement shows that they will pay the DME the $783 less the 50%. It shows what they will pay the DME and what I will pay the DME and it totals what the insurance allows ($783). So I would be required to pay the DME $391.50. If one has a deductable, that would also come off the $783 as well not what the DME is asking for. This is what I experience with my insurance company, I can't speak for the others. If what you said was true, I would be in the poor house just after the sleep study!

So far the Dr bills have not charged one penny more that what the insurance company is allowing (and I follow them very closely). If they did, I would be on the phone.

dataq1 wrote:I am also having fits with my DME over their provider’s charge for a Hybrid mask.
The first item on my EOB is for HYB500 (manufacturer’s product code for the complete Hybrid system, this product code includes the headgear, three sizes of nasal pillow sets, three cushions, the facepiece, and a carry case). The providers charge for this was 217.00
I was provided the complete system.
The second item on the EOB was for HYB513(manufacturer’s product code for a medium size cushion). The Providers charge for this was 69.00
The third item on the EOB was HYB523 (manufacturer’s code for a set of medium size nasal pillow)
The providers charge for this was 56.00
The fourth item was HYB530 (manufacturer’s code for the headgear)
The providers charge for this was 45.00

When I told the DME that I did not receive the 2nd,3rd,and 4th items, as separate items but were already in the complete set, their response to me was that they are permitted to bill my insurance Co BC/BS for these items separately as well as in the complete set.
They went on to explain that (while they forgot to do it in my case) they would normally take the headgear out of the complete set and then sell that as a separate item, but would not reduce the price of the complete set. Their justification for doing this is the my insurance will permit me a new mask more often than new headgear, consequently they separate them.

My BC/BS representative has been “looking” into this for three weeks now without an resolution.

I hope that this is just my DME that’s doing this, but it sure seems unethical, if not illegal.

Bottom line: My employers self insured program is being charged twice for the same items. I’m paying a co-pay twice for the same item.

Sounds like my swift except you were lucky you didn't get billed for 3 sets of cushions and 3 sets of nasal pillows. This is exactly why I chose to buy out of pocket online.

It isn't just your DME I expect but many and I got the line from both the DME and insurance that this kind of billing piecewise was allowed.

It is threads like this that give this site a bad name in the DME world. Confusing patients is dangerous and should be avoided whenever possible. Why upset people needlessly with all this detail? Sure, DMEs make a few bucks on occasion. We know our stuff and earn it. Can you imagine trying to explain all this stuff to patients every day? Gives me a headache just thinking about it.

DME Dan wrote:It is threads like this that give this site a bad name in the DME world. Confusing patients is dangerous and should be avoided whenever possible. Why upset people needlessly with all this detail? Sure, DMEs make a few bucks on occasion. We know our stuff and earn it. Can you imagine trying to explain all this stuff to patients every day? Gives me a headache just thinking about it.

Dan,

It seems to me that the DMEs are giving themselves a bad name in the DME world.
I've never had monetary dealings with a B&M DME establishment (I ordered all of my equipment through CPAP.COM), so I have had nothing bad to say about them. However, the CPAP user forums (and not just this one) have many, many unhappy and confused customers.
From the many, many posts that I've read, I would say that it is YOUR people who are "confusing" their customers.....because they come to these forums to get the "straight scoop" about this therapy.

You may know YOUR stuff, but there are apparently alot of your fellow DMEs that are not doing THEIR jobs.......I think you should take steps to straighten out your portion of this market niche.

Yes, I CAN imagine trying to explain this stuff to people every day......and so can the many, many other members of this forum......we do it every day......because YOU folks didn't.
If it gives you a headache, I suggest another line of work.....or taking a couple of aspirin and check YOUR AHI numbers......maybe you need to tweak your therapy.

Best wishes,

Den

When I bought my APAP from cpap.com, Paul told me the script had to say APAP or auto on it somewhere to get an APAP machine. I asked the Doc to say APAP or auto and in a few days had my machine.