DME being difficult, as usual

fredpb · Post by **fredpb** » Sun Oct 07, 2007 10:51 pm

Over a month ago the DME said he would get me another machine, the Pro.
Excuses are for not providing it: forgot, it's backordered. Flat out lies.

I am having problems anyway with just the M Series plus. The 16 pressure is very uncomfortable, and there are major problems for me getting mask seals, the mask always "blows out" during the night. My therapy stinks so far.

I am thinking of asking the doctor for a prescription for the Remstar auto with cflex.

Would that force the DME to get me another machine????

I have also asked the DME for supplies, like tubing, which I am entitled to under Medicare. He again, is not providing them.

I am now completely fed up with this DME.

Should I ask the doc for the specific machine prescription? Would the DME provide the new machine that way???

Guest · Post by **Guest** » Sun Oct 07, 2007 10:59 pm

Ask the Doctor for a new prescription for the Remstar Auto with cflex, then order it online at cpap.com, I wouldn't do any more dealings with that (DME). If you have a prescription, you don't have to ever go back to him.. Also, if your order is over $ 100.00 at cpap.com, you get free shipping.. I have the remstar auto with cflex and I love it. Goodluck and keep us posted

fredpb · Post by **fredpb** » Sun Oct 07, 2007 11:02 pm

But I thought cpap.com did not take Medicare??? Right now, my plus is not costing me anything.

Can you buy with medicare or do you have to rent?

Guest · Post by **Guest** » Sun Oct 07, 2007 11:21 pm

Oh, I don't know if they take it or not but I did see one internet site that takes it and I will try to find it and then I will get back to this post and let you know, in the meantime maybe you ought to call your doc for that remstar auto with cflex rx ! Tomorrow, i'm sure this great forum of people will respond and know more than I do and there are alot of knowledgable medicare patients on here as well.. I wish you all the luck with this ...

Guest · Post by **Guest** » Sun Oct 07, 2007 11:33 pm

yes they take medicare. go to cpap.com and click on the link.

Guest · Post by **Guest** » Sun Oct 07, 2007 11:36 pm

Hello Fred the web address is cpapforseniors.com and it's cpap.com's sister website so go there and read up on it maybe it will help you out... Please keep us posted.. That is only one web address, I think there is one more but I can't seem to remember how I found it SleepyNoMore

snoregirl · Post by **snoregirl** » Mon Oct 08, 2007 12:00 am

The problem is Cpapforseniors will most likely not be able to work with you since you are already started with another DME.

On the issue of the DME having to provide what the doc orders. That is also not the case. The insurance (in your case medicare) can if they want, say that it is not medically necessary and overrule your doc.

I would try it anyway as 16 is quite a high pressure and in my non-medical opinion, an APAP would help since you most likely can run at a lower pressure much of the night reducing all kinds of issues (exhale, mask blowing off face...)

As I see it you have two options. Get the prescription and get in the DME's face, or move to a new local DME that would be willing to help you.

I doubt you will get anywhere with CPAPforseniors as I stated above, but you certainly an call and try.

Snoredog · Post by **Snoredog** » Mon Oct 08, 2007 1:18 am

If my pressure requirement was 16 cm, I would be wanting the Bipap Auto not the CPAP auto. You might as well have some comfort with this therapy.

At a minimum, I would want the new AFlex version instead of the CFlex version, you can always switch it to CFlex, but AFlex is a whole lot more comfortable than CFlex is.

By your DME NOT providing you the machine, you can take the current machine back and set it on their counter and that shows up as a failed CPAP trial, then based upon your pressure they should get you the Bipap machine (again, I would tell the DME if you they don't get the machine you ask for you'll leave that one on the counter also).

Slinky · Post by **Slinky** » Mon Oct 08, 2007 7:23 am

Two and a half months into CPAP therapy thru a local sheister DME supplier I called cpapforseniors too but once you have started w/another supplier whilst on Medicare cpapforseniors can NOT work w/you.

The situation is that Medicare pays for a 13 month capped rental. They pay NO MORE than 13 months, so any DME you would want to switch to would HAVE to be satisfied receiving ONLY the monthly payments left of the 13.

Your current DME supplier knows this and knows they have you by the short hairs. Unfortunately, I don't see that you have many options other than hoping your doctor will work with you on getting you a more compatible for you machine or returning the equipment (and being willing to go w/o CPAP therapy is they opt to call your "bluff"). Medicare does NOT care which CPAP you get, they pay ONE price for a CPAP whether straight CPAP or an autoPAP.

I don't know that returning your current equipment would "qualify" as failing CPAP as I believe in addition to failing CPAP one must have also established "compliance" in order to qualify for a bi-level. Be sure you know what you are doing before you try going that route. Returning this equipment might make it HARDER for you to qualify for a bi-level. I sure do wish you good luck and that your sleep doctor works w/you on this!!!

papdaddy · Post by **papdaddy** » Mon Oct 08, 2007 10:38 am

This is what I did to be able to get a Bipap auto just recently. Recently I had a retitration study and my pressure was adjusted to 18 . I had an old cpap machine of about 6 years and had no c-flex at all. I was give a script for a Respironics auto pap with a-flex and had it for about a week and a half, when the insurance company decided it was not going to pay for it due to "patient comfort" reasons. 18 was just too uncomfortable to use. So my DME suggested that I call the Sleep doctor and ask him for a new script for a Bipap Auto and put on script "FAILED CPAP" I contacted my DR and she did just that. One day later I had my Bipap auto and 2 days later the insurance agreed to cover it. If you have a good DR , just tell them it is too hard to exhale with the pressure and would they change the script for a bipap auto. With the auto you will not have to go for another titration because the machine will set itself with in the parameters. Some insurance companies require that you try cpap first.

It is worth a try by calling your doctor and requesting this. All they can do is say no, but if they do I would seriously look at choosing another doctor (if available) As for the DME I would take my business elsewhere. Check to see if there are others available.
Best of luck to you.

Rich

Kharris · Post by **Kharris** » Mon Oct 08, 2007 12:15 pm

Wow Papdaddy,
I thought my 16 was tough sometimes, I do have c-flex and ramp or I'm
not sure I could take it.
I learn something new everyday here, I had no idea it was possible to
change what your dr ordered.

fredpb · Post by **fredpb** » Mon Oct 08, 2007 9:21 pm

cpapforseniors will not help.

I contacted the doc, via a nurse practishionor appointment. He just gave me a script for a setting of 14, which is useless (i have already tried 14).

He wants me to come in and talk about it.

I am getting very fed up with this whole situation. DMEs are vultures, and docs depend on ignorance of patient to keep this quiet and peaceful for them. Everyone is making money, and I am not having good results.

I do think I just may purchase an auto cpap with cflex. I think I could tolerate that. I cannot afford a bilevel machine.

I can get used the to high pressure ok with ramp. When I wake up, it feels like normal breathing. But the problem is mask leaking and blowout.

That is why I think an auto might help.

Plus, if I bought my own, I could take the current machine back and stick the dme with no more payments, and a used machine.

The nurse did say, politely, that all DMEs will take your money, give you machine of their choice, and don't want to hear from you again.

And she also said the Docs son works for another local DME.

What a racket.

I am still getting over a bad cold or pneumonia. When I am back to breathing normal and can get back into a routine, I will look into an auto.
I may look for an auction one.

Of course I could keep the DME machine, and use the heated humidfier off of it??? LOL.

Any more comments would be appreciated, and I do appreciate all the support.

Fred

snoregirl · Post by **snoregirl** » Mon Oct 08, 2007 10:02 pm

Yes I have more comments.

Get copies of your sleep studies in your hands, and the prescription.

Consider finding another doc. You have the information, maybe another will prescribe the bipap if you want it.

Or, still get the sleep studies and prescriptions (if you have trouble with the doc, get a new doc and have the new office request the records). Then get the apap online and dump the other thing on the dme.

Keep the humidifier as you paid for it up front, same with the mask, that way the machine is not as much.

fredpb · Post by **fredpb** » Mon Oct 08, 2007 10:46 pm

I am going to open a new topic about machine options.

dllfo · Post by **dllfo** » Tue Oct 09, 2007 11:47 am

It can be simple. You tell the provider you have a prescription for DME & they are not providing it. You will hang up and call Medicare to complain that he is not in compliance with Medicare's directives, ask that he be taken off their approved list. Simple. EXCEPT in the case you are not talking to the boss. Ask for a supervisor or the manager of the entire facility.

It is about the only leverage you have unless you want to pay cash.

No rudeness, just matter-of-fact approach. And keep notes of each time and date you talk to them. I have won virtually every "battle" with Apria and others in the last 2 years by doing that. And I would be surprised if anyone else on this forum has as many medical issues as I have. That is a sad fact.

If you put up with bad service, you will continue to get bad service. Simple truths in life. If you don't want to be confrontational with the DME, call Medicare and ask them to call the DME. I have done all of the above at one time or another. Good luck.

_________________

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

DME being difficult, as usual

DME being difficult, as usual

FRED :)

Fred, it's cpapforseniors.com !

Machine	Mask	Humidifier