Update: The DME worked me over

linuxgrl · Post by **linuxgrl** » Thu Nov 08, 2007 10:40 am

So I've been struggling with my DME to get a data capable machine. First they flatly refused, then they wanted to charge me $550 out of pocket, plus my insurance.

With one call from my doctor, they bent over backwards for me and I've got a RemStar Pro M-Series with C Flex and smartcard on order.

So if you're having the same struggles as I am, don't give up hope! Go to your doctor, he or she holds the cards!

Couldn't be happier!

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Wulfman · Post by **Wulfman** » Thu Nov 08, 2007 10:41 am

Congratulations and best wishes for good therapy.

Den

mindy · Post by **mindy** » Thu Nov 08, 2007 10:58 am

Hi,

Good for you for persisting! Happy cpap'ing

Mindy

Slinky · Post by **Slinky** » Thu Nov 08, 2007 11:54 am

Congratulations, LinuxGirl. And good luck w/your CPAP! Its an interesting adventure. And you meet some great people along the way in this forum!

papdaddy · Post by **papdaddy** » Thu Nov 08, 2007 12:19 pm

Congrats on the victory.

Guest · Post by **Guest** » Thu Nov 08, 2007 1:14 pm

Isn't this whole thing really simple?
Step 1: Call your insurance company and ask what $$ they reimburse for EO601 Cont Airway pressure device
Step 2: With that information in hand, go to your DME and request the lowest quality device they offer (probably F&P lol)
Step 3: Next, demand the REMstar Auto with A-Flex.
Step 4: When the DME wants to charge you more, ask "WHY? All of this is reimbursed under code EO601. My insurance company reimburses $______

I just don't get all the confusion? Can someone help?

linuxgrl · Post by **linuxgrl** » Mon Nov 19, 2007 3:27 pm

Ugh. I don't even know what to say I'm so angry.

The lady just dropped by to drop off the REMstar Pro that she promised me over the phone the other day. She pulls it out of the box and says, "This isn't exactly the one I said it would be, but it's got the data card, see?"

It was a REMstar PLUS and I recognized immediately that it wasn't what I wanted.

I was like - you said it would be a Pro - this machine isn't fully data capable.

So then we went back and forth for awhile and she sang me her sad story of how the insurance company pays them the same no matter what machine they give me. And that she would be stuck with this machine now and would have to order another one and her boss would kill her. And that she thought all I needed was the data card and she wasn't aware that the data was any different. Lied to me, right to my face.

I'm so spineless. I caved. I took the stupid leaf blower and sent her on her way.

So at this point, she's going to look around for a used Pro for me at all the regional offices. That was the best I could get out of her.

I hate this. I'm so angry I could scream. Mostly at myself for letting her do it to me. Why the heck didn't I just say, look, you promised over the phone that I could have a Pro - so give me a Pro.

[/b]

DreamStalker · Post by **DreamStalker** » Mon Nov 19, 2007 3:42 pm

You should call them up right now and tell them you will not accept it and that you will find another DME to business with.

What are you waiting for?

Go! Do it now!!

linuxgrl · Post by **linuxgrl** » Mon Nov 19, 2007 3:51 pm

I have 2 problems with doing that.... Believe me I would love to.

1. She was going to take both machines and leave me with no CPAP over Thanksgiving. Even if I were to order a machine from CPAP.com today, it wouldn't be here for a few days.

2. How do I deal with the insurance company? Won't terminating my contract with this DME leave me with no options as far as insurance goes? As far as I know, insurance only pays a certain amount every 2 years and I've already used up 2 months of rental money.

DreamStalker · Post by **DreamStalker** » Mon Nov 19, 2007 4:00 pm

linuxgrl wrote:I have 2 problems with doing that.... Believe me I would love to.

1. She was going to take both machines and leave me with no CPAP over Thanksgiving. Even if I were to order a machine from CPAP.com today, it wouldn't be here for a few days.

I believe the legal term for that is called "duress". CPAP.com can deliver overnight if you ask.

linuxgrl wrote:2. How do I deal with the insurance company? Won't terminating my contract with this DME leave me with no options as far as insurance goes? As far as I know, insurance only pays a certain amount every 2 years and I've already used up 2 months of rental money.

Someone else like Snoregirl can help you how to deal with insurance. If your doc specified PRO and they did not follow specifications, then your doc and your insurance needs to know. For most, insurance only covers new machine every 6 years ... more reason to fight now or be stuck with the leaf blower for 6 years. You got lots of trees in your yard?

Best of wishes.

Slinky · Post by **Slinky** » Mon Nov 19, 2007 4:03 pm

The longer you keep this Plus the less chance you have of getting a Pro. Have you checked w/your insurance company what other local DME suppliers they are contracted with?

Have you enlisted the assistance of your sleep doctor w/getting a fully data capable CPAP?
Generally, the insurance company is NOT billed the first month whilst your compliance in use of the CPAP is established. Then it is usually late into the second month at the earliest that they get around to billing your insurance.

I'll reiterate what Guest suggested: Step 1: Call your insurance company and ask what $$ they reimburse for EO601 Cont Airway pressure device. Ask them explicitly what they PAY per month for the rental of an E0601.

Gerald · Post by **Gerald** » Mon Nov 19, 2007 4:13 pm

Linux.......

One of the personal rules that I live by....is when I sense that someone is trying to "con" me, I bail out immediately.

It sounds to me like these people are "working you"...."playing you" like they would if they had a fish on a line.

I suggest that you apply what I call "The Kenny Rogers Solution"....."Know when to hold 'em...know when to fold 'em....know when to walk away....know when to run." I suggest that you "run".

Painful as it may be in the short term, dealing with "snakes" is a lot worse in the long term. It's sort of like "stress on the installment-plan".

If you can possibly swing it, purchase your equipment outright from cpap.com.....and then send a written request for your insurance company to reimburse you directly. This technique has been successful for a number of people on this forum....and some have posted details on how they did it.

Gerald

linuxgrl · Post by **linuxgrl** » Mon Nov 19, 2007 5:13 pm

Gerald wrote: One of the personal rules that I live by....is when I sense that someone is trying to "con" me, I bail out immediately.

It sounds to me like these people are "working you"...."playing you" like they would if they had a fish on a line.

You're right Gerald. I can't waste time and effort trying to work with these snakes. I've placed the order with cpap.com and will file the insurance and hope for the best. I will return their leaf blower to them tomorrow.

Thank you, thank you, thank you. I truly feel this was the right choice.

Slinky · Post by **Slinky** » Mon Nov 19, 2007 5:45 pm

Dang! None of us thought to suggest you contact cpap.com's sister site, billmyinsurance.com to see if the worked w/your insurance??? Duh. I'm sorry I didn't think to suggest it. GOOD LUCK!!

Wulfman · Post by **Wulfman** » Mon Nov 19, 2007 6:16 pm

Well, depending on your deductibles, co-pays, monthly payments (if your insurance provider requires you to rent for a period of time), and a bunch of other possibilities.......you may end up within a few dollars of what you would have had to spend......by purchasing out-of-pocket. If you want to check out the method I used to get reimbursed by my provider, do a search on "reimburse" and my username......I've posted it many times in the past.

Many insurance providers actually WANT to save money, so it might work for you, too.

In any case, it'll be to your advantage to get a machine that you'll be able to get information out of.
Your (former?) DME is another money-grubber who puts their profits above your therapy. These are the ones you want to run from.

Den

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