My time (for xPAP) has come! (Slinky, Rested Gal? Help!)

Slinky · Post by **Slinky** » Wed May 07, 2008 11:07 am

She's still full of horsepuckies that she can not give you a copy of your script because it has already been FAX'd some place.

It is NOT her place to decide WHERE or WHO you buy your equipment from: local or online nor for that matter whether you utilize insurance to pay for your equipment or out of pocket.

Who cares what her usual practice is regarding medical records? You have provided a written request. Follow it up w/a brief statement that you don't feel it is necessary to make that emergency appointment, please provide the medical records requested by mail in a timely manner. And send this one Certified Mail, Return Receipt Requested so that you have PROOF your request has been received. Keep it diplomatic but remain firm. "Thank you for your time and consideration in this matter" is a diplomatic line of BS on your part if you feel so inclined.

Meanwhile, I assume by now you have called your insurance company and asked what local DME CPAP suppliers they are contracted with? If not, do it TODAY. Hopefully, you will have the option of more than one - just in case. But don't just assume that Brian is gonna be a PITA. Keep an open mind and see what you can work out w/him. Be diplomatic but firm in what equipment you want. And do NOT accept or sign for anything less - assuming your request is reasonable. (For instance, asking for a bi-level when your script is for a CPAP (CPAP includes autoPAPs - same insurance code E0601) is NOT reasonable).

schleima · Post by **schleima** » Wed May 07, 2008 11:40 am

[quote="Slinky"]She's still full of horsepuckies that she can not give you a copy of your script because it has already been FAX'd some place.

It is NOT her place to decide WHERE or WHO you buy your equipment from: local or online nor for that matter whether you utilize insurance to pay for your equipment or out of pocket.

Who cares what her usual practice is regarding medical records? You have provided a written request. Follow it up w/a brief statement that you don't feel it is necessary to make that emergency appointment, please provide the medical records requested by mail in a timely manner. And send this one Certified Mail, Return Receipt Requested so that you have PROOF your request has been received. Keep it diplomatic but remain firm. "Thank you for your time and consideration in this matter" is a diplomatic line of BS on your part if you feel so inclined.

Meanwhile, I assume by now you have called your insurance company and asked what local DME CPAP suppliers they are contracted with? If not, do it TODAY. Hopefully, you will have the option of more than one - just in case. But don't just assume that Brian is gonna be a PITA. Keep an open mind and see what you can work out w/him. Be diplomatic but firm in what equipment you want. And do NOT accept or sign for anything less - assuming your request is reasonable. (For instance, asking for a bi-level when your script is for a CPAP (CPAP includes autoPAPs - same insurance code E0601) is NOT reasonable).

Pineapple · Post by **Pineapple** » Wed May 07, 2008 12:35 pm

Well written.

schleima · Post by **schleima** » Wed May 07, 2008 1:55 pm

schleima wrote:Yes, I agree ,patients have the rights to access to their records,when properly executed and for proper their medical care.

Upon rereading this, I'm even more horrified that she qualifies her statement that patients have a right to their medical records under specific circumstances. How generous!

goose · Post by **goose** » Wed May 07, 2008 4:57 pm

Hey Schleima,
Very well said!!!!!

I think that an additional follow-up with her supervisory chain and medical board is in order, but that's not my call.
She may be very competent in her field, but her "bedside manner" apparently needs a whole lot of work.....

Let us know how things progress.
Take care
cheers
goose

schleima · Post by **schleima** » Wed May 07, 2008 5:13 pm

goose wrote:Hey Schleima,
Very well said!!!!!

I think that an additional follow-up with her supervisory chain and medical board is in order, but that's not my call.
She may be very competent in her field, but her "bedside manner" apparently needs a whole lot of work.....

Let us know how things progress.
Take care
cheers
goose

I just got off the phone with the Administrative Director of the sleep clinic and she was very understanding and helpful. (she was copied on all the correspondence). She told to me that she consulted with the other medical director at the clinic as to whether or not there is any reason why she could not fax me my prescription while it was out at the DME, and he said "no."

I have been assured by the Admin. Director that she will personally collect all the information that I have requested and mail it to me tomorrow.

Dr... "You're Fired!"

That feels pretty good to say.

ozij · Post by **ozij** » Wed May 07, 2008 8:46 pm

Just curious, Schleima, did she call you in response to your letter, of did you call her?

O.

schleima · Post by **schleima** » Wed May 07, 2008 11:47 pm

ozij wrote:Just curious, Schleima, did she call you in response to your letter, of did you call her?

O.

First the doctor replied via email. Then I replied back to her, and then the clinical admin director called me.

NightHawkeye · Post by **NightHawkeye** » Thu May 08, 2008 7:01 am

Wow! Looks like this chapter is coming to a close. Hopefully, the next will go better for you, Schleima.

It sure sounds like the physician you've been dealing has gotten some remedial training in dealing with patients. Hopefully, this will benefit future patients.

Sometimes you just gotta get their attention. Ya done good, Schleima. Maybe better for future patients than a direct benefit to yourself now, but I suspect that this messy episode sets a useful precedent which will benefit you in all your future health care, as well as currently. Let us know how you get along with the replacement physician.

Regards,
Bill

ozij · Post by **ozij** » Thu May 08, 2008 10:01 am

schleima wrote:First the doctor replied via email. Then I replied back to her, and then the clinical admin director called me.

NightHawkeye wrote:It sure sounds like the physician you've been dealing has gotten some remedial training in dealing with patients. Hopefully, this will benefit future patients.

Well, if she hasn't gotten it yet, someoned is certainly concerned by her beahvior.

Good for you, schleima!

O.

Slinky · Post by **Slinky** » Thu May 08, 2008 10:42 am

Good job, well done, Schleima.

pjwalman · Post by **pjwalman** » Thu May 08, 2008 2:44 pm

I think I need to take you with me to my next appointment. Wow!!

Peggy

schleima · Post by **schleima** » Thu May 08, 2008 3:15 pm

OK, well here's the update.

Brian from the DME (Aircare) didn't call me-- another sales rep did. She told me that my doc (the one I fired) wrote me a cpap, not an apap prescription. She told me that if I wanted an APAP machine that they consider it a "luxury item" and as such I would need to pay the $400 difference between what the insurance pays and what the actual cost is!

I said, "so you need me to get a doctor's prescription which specifies APAP, then?" and she said "No, it won't make a difference. Our company policy is still to charge you the $400 difference"

As a Blue Cross network provider, it seems to me that this DME is violating their contract. Aren't they contractually obligated to accept what the insurance pays? I'm currently on hold with the provider services department of Blue Cross to find out exactly what they are obligated to pay.

Of course, I probably should just go to the next DME on the list But this makes me so angry, I've gotta see this all the way through (and of course report back here!)

EDIT: OK, just got off the phone with Blue Cross Network Relations, the guys who deal with the contracts. According to the rep I spoke with, because of insurance coding limitations there are in fact certain "upgrades" that network DME providers are allowed to upcharge on. So it appears that I may in fact be obligated to get a standard CPAP, regardless of the doc's prescription.

Oh, and in news regarding my medical records, I just got a call from the nice lady who promised to get me my medical records and prescription. and the doctor would not release the prescription to her without my calling her first.

What a nightmare!

NightHawkeye · Post by **NightHawkeye** » Thu May 08, 2008 3:23 pm

schleima wrote:As a Blue Cross network provider, it seems to me that this DME is a total scam. Aren't they contractually obligated to accept what the insurance pays?

Under these conditions, no. If the physician had prescribed APAP, then the answer is a "qualified" yes. Your physician was very well aware of this. That is why she refused to prescribed anything other than "generic" CPAP. Your DME is not obligated at this point to provide anything better than a very basic model, the kind you can get online for $150 or so.

Regards,
Bill

schleima · Post by **schleima** » Thu May 08, 2008 4:22 pm

OK, just got off the phone with Aircare.

With this new information regarding I've gathered from my insurance that it is actually legit for DMEs to charge more for "upgrades", I decided that I could live with a high-end cpap, as long as its covered at 100%

I went ahead with the Resmed Elite II with the Humidaire 3i. I confirmed that their compant has a 7-30 day trial policy for masks.

There's still time to cancel if something terrible happens-- she's getting a preauthorization now.

I feel a little defeated, but I don't want to fight for the APAP anymore, in light of what my insurance told me.

What do you think?

My time (for xPAP) has come! (Slinky, Rested Gal? Help!)

Re: Response from my doc