My DME wants to fire me
Posted: Tue Apr 24, 2007 6:12 pm
About 2 weeks ago I got a call from my insurance company advising me
that I won my appeal to have insurance coverage for my Bi-PAP
supplies under my DME benefits. They were supposed to issue me
and both the DME and the ordering pulmy letters stating such.
I never got the letter, so yesterday I called the DME to advise them I
won my appeal and I need replacement tubing, filters, and mask parts,
if not a complete new mask. I spoke with the gal who fills the orders
for supplies. She advised me that she would have to speak with the
director of the facility to find out what they are going to do.
I asked if she meant to imply that they may not want to be my DME
provider anymore, and she said that is a possibility. Guess fighting
for my medical benefits rights got a few toes in the process.
So, I call my insurance company to ask for names of DME providers who
handle CPAP supplies, as my provider listing does not break that type
of thing down and I shouldn't have to call all the DME providers on
their panel to ask, chewing up my cell phone minutes. To make a long
story short, both the first insurance rep I spoke with and the rep I
was transferred to (tho I only got her voicemail), were leaning
towards me filing a complaint against the Sleep Lab/DME provider, a
one stop sleep disorders facility. I got a voicemail back from the
insurance a bit ago advising they will begin working on finding me a
new DME provider if this current one is dropping me.
I am shocked, as this battle has been all about getting proper
treatment. When I requested copies of my entire sleep studies with
graphs and tables, I was advised by the sleep lab that performed the
studies that I don't need them, that I couldn't possibly
understand them. Well, they changed their tune when I advised them I
have 2 college degrees under my belt and that understanding the
reports is the least of the problem. In fact, it is in direct
violation of Federal law to deny patients their medical records. I
don't figure I was in the wrong when I insisted on copies; they were
the ones who should have apologized. Then, when my fully-data-capable
bipap indicates that the sleep study results were entirely wrong, and
their sleep doc prescribed pressures that did not work, I was told in effect that I was nutso, that I could not speak with the sleep physician who
read the sleep study results. I repeatedly requested to speak with
her, and indicated that I was sure she would want my treatment to
work for me and would certainly want to know if there were incorrect
titration studies being done at their facility, with her signing off on her sleep tech's work. But still, these same people denied me the opportunity to
discuss my breathing issues with the sleep lab's physician, and instead
transferred my call to their facility manager. I told him I needed to
speak with a medically trained sleep doc, and he refused to allow me
to discuss the treatment problems with the doc.
After yesterday's little insult (I should be firing them, not the other
way around), I'm more than a bit perturbed. I still do not have any
replacement supplies, despite this issue being unresolved since last
November of 2006, when I was undergoing the initial sleep studies and
trying to get correct benefits out of my health insurer. I finally
began e-mailing the president of my health insurance company, and
kept cc-ing the state insurance board. I think they got the hint and
approved my bipap supplies as medically necessary. Now I have a nasty
DME throwing a temper tantrum and not being fair with me. It stinks,
as if I have to change DMEs, I have to start over with another 10
month bipap rental which would mean I'm going to fall under next
year's deductible and it's going to cost me an arm and a leg to get
the machine, much more than it should have had this DME not had his
head up his b*tt. I've paid my copay in full for the entire machine
rental up front to this sleep clinic, and got to find out how the
insurance company is going to handle this one. Like we will ever see
that money?! They ought to know by this time that I'll cc the state insurance board if this situation goes any farther south.
If y'all are still with me, thanks for listening and supporting me.
Lord knows, there's no support here in the medical community. I'm
looking for yet another pulmy at this time, as the first 2 I've been
to here in south FL haven't been interested at all in my medical
care, only in the payment. The first pulmy couldn't even pull my
chart before talking with me on the phone and couldn't discuss my
treatment problems intelligently as he couldn't even remember who I
was and had me mixed up with someone else. The second one told me to
stop my stomach and breathing meds at night, without having a single
xray or blood test in front of him to know a thing about my body.
That's pulmonary medicine for ya??? Excuse me, but I tried going
without the nighttime doses of those two meds, and my bipap machine
gave horrible stats. As soon as I went back on my prilosec and advair
the stats came right back down. Interesting that the pressures that
are working for me, 15 and 9, are nowhere near what the sleep lab
prescribed, 9 and 5. Pretty scarey that they got it so far off. When
I used their prescribed pressures I got no effect on my apnea stats
at all. Seems I should be the one firing docs, not the other way
around. So, with the help of the sleep apnea patients online, I've
got my apneas and hypopneas down to an acceptable level, so that I
should at least not die of a stroke in the middle of the night. Ugh,
I am so disgusted. One has to have a physician to monitor the lung
disease, and that's a pulmy, as GPs don't have a clue there, most
usually. So, I'm still searching for yet another board-certified
sleep physician.
I'm seriously considering pursuing their (insurance company)
complaint procedure down the road after the records are all
transferred and I am at a lull in symptoms of all these dang medical
conditions. Oh, and I was supposed to receive a return call from the DME today to advise me how they intend to 'handle' me. Yeah right. No call ever received. Guess that means a nastygram from the DME is in the works. If they dare try to pull that stunt, I'll be all over my insurance company with complaints, as well as to the state; and I don't intend to begin a new rental period and another deductible whilst these DME people try to put it to me.
girlsaylor
that I won my appeal to have insurance coverage for my Bi-PAP
supplies under my DME benefits. They were supposed to issue me
and both the DME and the ordering pulmy letters stating such.
I never got the letter, so yesterday I called the DME to advise them I
won my appeal and I need replacement tubing, filters, and mask parts,
if not a complete new mask. I spoke with the gal who fills the orders
for supplies. She advised me that she would have to speak with the
director of the facility to find out what they are going to do.
I asked if she meant to imply that they may not want to be my DME
provider anymore, and she said that is a possibility. Guess fighting
for my medical benefits rights got a few toes in the process.
So, I call my insurance company to ask for names of DME providers who
handle CPAP supplies, as my provider listing does not break that type
of thing down and I shouldn't have to call all the DME providers on
their panel to ask, chewing up my cell phone minutes. To make a long
story short, both the first insurance rep I spoke with and the rep I
was transferred to (tho I only got her voicemail), were leaning
towards me filing a complaint against the Sleep Lab/DME provider, a
one stop sleep disorders facility. I got a voicemail back from the
insurance a bit ago advising they will begin working on finding me a
new DME provider if this current one is dropping me.
I am shocked, as this battle has been all about getting proper
treatment. When I requested copies of my entire sleep studies with
graphs and tables, I was advised by the sleep lab that performed the
studies that I don't need them, that I couldn't possibly
understand them. Well, they changed their tune when I advised them I
have 2 college degrees under my belt and that understanding the
reports is the least of the problem. In fact, it is in direct
violation of Federal law to deny patients their medical records. I
don't figure I was in the wrong when I insisted on copies; they were
the ones who should have apologized. Then, when my fully-data-capable
bipap indicates that the sleep study results were entirely wrong, and
their sleep doc prescribed pressures that did not work, I was told in effect that I was nutso, that I could not speak with the sleep physician who
read the sleep study results. I repeatedly requested to speak with
her, and indicated that I was sure she would want my treatment to
work for me and would certainly want to know if there were incorrect
titration studies being done at their facility, with her signing off on her sleep tech's work. But still, these same people denied me the opportunity to
discuss my breathing issues with the sleep lab's physician, and instead
transferred my call to their facility manager. I told him I needed to
speak with a medically trained sleep doc, and he refused to allow me
to discuss the treatment problems with the doc.
After yesterday's little insult (I should be firing them, not the other
way around), I'm more than a bit perturbed. I still do not have any
replacement supplies, despite this issue being unresolved since last
November of 2006, when I was undergoing the initial sleep studies and
trying to get correct benefits out of my health insurer. I finally
began e-mailing the president of my health insurance company, and
kept cc-ing the state insurance board. I think they got the hint and
approved my bipap supplies as medically necessary. Now I have a nasty
DME throwing a temper tantrum and not being fair with me. It stinks,
as if I have to change DMEs, I have to start over with another 10
month bipap rental which would mean I'm going to fall under next
year's deductible and it's going to cost me an arm and a leg to get
the machine, much more than it should have had this DME not had his
head up his b*tt. I've paid my copay in full for the entire machine
rental up front to this sleep clinic, and got to find out how the
insurance company is going to handle this one. Like we will ever see
that money?! They ought to know by this time that I'll cc the state insurance board if this situation goes any farther south.
If y'all are still with me, thanks for listening and supporting me.
Lord knows, there's no support here in the medical community. I'm
looking for yet another pulmy at this time, as the first 2 I've been
to here in south FL haven't been interested at all in my medical
care, only in the payment. The first pulmy couldn't even pull my
chart before talking with me on the phone and couldn't discuss my
treatment problems intelligently as he couldn't even remember who I
was and had me mixed up with someone else. The second one told me to
stop my stomach and breathing meds at night, without having a single
xray or blood test in front of him to know a thing about my body.
That's pulmonary medicine for ya??? Excuse me, but I tried going
without the nighttime doses of those two meds, and my bipap machine
gave horrible stats. As soon as I went back on my prilosec and advair
the stats came right back down. Interesting that the pressures that
are working for me, 15 and 9, are nowhere near what the sleep lab
prescribed, 9 and 5. Pretty scarey that they got it so far off. When
I used their prescribed pressures I got no effect on my apnea stats
at all. Seems I should be the one firing docs, not the other way
around. So, with the help of the sleep apnea patients online, I've
got my apneas and hypopneas down to an acceptable level, so that I
should at least not die of a stroke in the middle of the night. Ugh,
I am so disgusted. One has to have a physician to monitor the lung
disease, and that's a pulmy, as GPs don't have a clue there, most
usually. So, I'm still searching for yet another board-certified
sleep physician.
I'm seriously considering pursuing their (insurance company)
complaint procedure down the road after the records are all
transferred and I am at a lull in symptoms of all these dang medical
conditions. Oh, and I was supposed to receive a return call from the DME today to advise me how they intend to 'handle' me. Yeah right. No call ever received. Guess that means a nastygram from the DME is in the works. If they dare try to pull that stunt, I'll be all over my insurance company with complaints, as well as to the state; and I don't intend to begin a new rental period and another deductible whilst these DME people try to put it to me.
girlsaylor