The neverending DME story...........

After over a year on CPAP, I was pretty sure the DME had used up all their tricks but, by gosh and by golly, they came up with a new one. And it is a GEM! I received a flyer in the mail that my DME would be having a CPAP/BIPAP Clinic on the third Wednesday of every month. Call ahead for your reservation and place your order for any new supplies that you need. They will also check your insurance to see if it is time for a new mask. Bring in your machine and they will check the hoses for leaks and check the calibration of the machine. They will have all your supplies ready for you. So, being the doubting Thomas that I am, I called and asked lots of questions. Of course, I had already guessed the answers. They will bill your insurance for a "clinic visit", they will bill your insurance for "repair service" on your machine, hoses, etc. They will bill your insurance for each and every filter, hose etc. They will bill the insurance for RT time to do your "personalized" fitting. Of course, you have to tell them which mask you want ahead of time so that they will have it for you!!!!!! This is the same DME who sent my new mask and supplies in a plastic bag with Travis, the delivery boy. This also means that they will NO LONGER be calling you or making in home visits to check on your machines. Also, if you want your card read ( by doctor request only), you must bring it in and pick it up. Don't worry I have my own - wouldn't want them to exert themselves. Let's see! Is this: A. A SCAM; B. A SCAM; or C. A SCAM? HMMMMMMMMM! This is the same DME who has yet to pick up the oxygen concentrator that the Pulmonologist removed me from a week ago. And yes, I called my insurance and told them the notification date so when they get a bill for an extra month or two, they will not pay it.

Well, aside from them no longer providing in-home visits (bummer!), this sounds like a reasonable alternative and an attempt by them to cut costs. I mean, they would be billing your insurance company for all of those things if they did / brought them to your home, wouyldn't they?

- JB

Better yet, buy it at cpap.com and have it delivered to your door. Just don't participate in the EVIL DME SCAM !

:twi sted:

This is very strange to me...would it be out of line for me to ask who your DME is? I was a little nervous when I started reading your thread because I just sent out flyers for my CPAP clinic. Here's how mine works. The only thing the patient/insurance gets billed for is supplies that you carry out of the store. And if you're just needing filters or tubing, I don't charge for those at all (not worth the time and money to bill it). Nothing else costs anything. I don't understand how they can charge you for the others; I have never billed for a "clinic visit." Heck, I didn't even think I could. Our company is trying to move away from doing in-home visits for patients who are CPAP only, which is good to me (from this side of the fence anyway) for several reasons: first of all, most of my patients who are CPAP only are working full time jobs. It's easier for them to schedule to come to my store on their lunch hour or before/after work than it is for me to catch them at home. It is easier for me to lay out all of my mask samples and information (besides, I have my entire stock in the back in case I need a different size) at my store than to haul it to every patient. Last, at least with my first clinic a few months ago, it actually spawned a few friendly conversations among my patients (who were scheduled at close times) about masks they liked/didn't like, doctors, other conditions, etc. Which was nice to see. So that's why it's a good thing. But the rest of the billing issues and stuff sounds like a load to me.

Christine -

Sounds like yours is a great idea! My DME cane to my job to set me up the first time 3 months ago. They have been great. Good luck with your clinic - I wish we had something like that - would be great to see others face to face and chat - This forum is wonderful - but I would like to get together face to face. Jen

Why in the world would a DME stop in home visits. What about the workds CUSTOMER SERVICE. This lack of attention or concern about a customer, is typical.......and we should wonder why everyone (nearly everyone) has a growl and a story about the lack of attention.

I have nicknamed my DME, the ghost. I got better luck seeing "casper" than her.My DME got me the 420E that I wanted with some grousing, phoning etc. Her big lesson on ''how'''to'' my 420E, was 1 conversation with her sales rep. So truth be told (and I found out after the fact re: cpap.com) she knew dit squat..I knew more, and I didn't know much.

Sad but true, we accept mediocrity......and when we do find a good DME story, or rep,like Christine, we're always so surprised and pleased.

[quote="IllinoisRRT"]This is very strange to me...would it be out of line for me to ask who your DME is? I was a little nervous when I started reading your thread because I just sent out flyers for my CPAP clinic. Here's how mine works. The only thing the patient/insurance gets billed for is supplies that you carry out of the store. And if you're just needing filters or tubing, I don't charge for those at all (not worth the time and money to bill it). Nothing else costs anything. I don't understand how they can charge you for the others; I have never billed for a "clinic visit." Heck, I didn't even think I could. Our company is trying to move away from doing in-home visits for patients who are CPAP only, which is good to me (from this side of the fence anyway) for several reasons: first of all, most of my patients who are CPAP only are working full time jobs. It's easier for them to schedule to come to my store on their lunch hour or before/after work than it is for me to catch them at home. It is easier for me to lay out all of my mask samples and information (besides, I have my entire stock in the back in case I need a different size) at my store than to haul it to every patient. Last, at least with my first clinic a few months ago, it actually spawned a few friendly conversations among my patients (who were scheduled at close times) about masks they liked/didn't like, doctors, other conditions, etc. Which was nice to see. So that's why it's a good thing. But the rest of the billing issues and stuff sounds like a load to me.

Forgot to log in - it is I, 2Listless

I think you misunderstand. This is not a support group, a chat, a group meeting. This is an individual appointment in which you call the DME first, tell them the supplies that you need, then drive over there and get them and for that pleasure, your insurance gets billed a clinic visit! Do not forget, they are not showing you or fitting you with any masks. When you make your appointment, you have to TELL them which one you want and what size you want! The person seeing you is not a RT. She is like a Home Health Care Aide. When she told me that she did not know that the Activa came in sizes, I knew that it was over. Actually, I have my prescription and have ordered many items online. I have an appointment with a new Sleep Doctor on the 21st. After I see him and am assured that the equipment I am using is actually appropriate, I intend to do an online purchase - I already have written approval for it from the insurance. I think that I will actually feel better about this treatment if I am not dealing with incompetency. At least the decisions, right or wrong, will be mine!

The only way a DME could possibly justify the rediculous prices they charge our insurances company and us is because they home deliver and service. If I have to go to them, then there prices should be greatly reduced.

You know I have to wonder if Cpap is the only insurance ripoff that goes on? And if so, why are we douped. How does a racket like this get started in the first place? Dang it makes me mad

I love my DME person! She is a Respiratory Therapist who is also an RN. I have her office phone number, etc., and her cell phone number.

The first time she came she brought the Respironics BiPAP S/T and the Swift nasal pillows and spent the better part of an hour showing me how everything worked and calibrating the machine to my comfort. She also helped me get the BiPAP and the humidifier plugged in (behind furniture and a water dispenser crock) and set up in a modular bookcase next to my bed.
Two days later she brought another machine (VPAP) and spent about another hour trying to calibrate it so I could use it. (She left the Respironics machine as a back-up) I tried it for about ten to fifteen minutes and went back to the respironics.
The next day she brought out the Puritan-Bennett GoodKnight 425 and the Fischer-Paykel FlexiFit HC405 nasal mask. It was love at first breath! <LOL>

She has been back twice to check on my progress and she follows the results of the various sleep studies I am having as well.

As far as I'm concerned, this is the way this is supposed to work.

Nothing has been billed yet and this all began about 1½ months ago..

(she has also brought out two different styles of chin straps, neither of which worked or was really needed.)
- JB

I'm a little worried that I'm about to get the BAD side of a scam. I was out of the country when my order went in, so my gf set up the appt with the RT. My Appt is the VERY next day after I get back, so I'm not out of island time or anything, and I get my machine.. everything seems great... until today.

I was calling my insurance company on an unrelated issue, and just happened to ask just to "double check" about my DME and find out they are out of network. I call them and they assure me that they are only going to charge me what i would be charged for in network....

I have a different deductable.. there's a good chance that my insurance isn't going to pay for this, because it's going to go to my out of network deductible.. well, at least a good portion. and Insurance is going to say that I owe 40% of the remainder, as well as the DME CAN, balance bill me.. and they are charging the insurance company like 1200 for the PB 425G that I've got.. No telling what they are charging for the Comfort Select....

Needless to say, I'm very nervous that the DME is lying to me, but am not sure what recourse I have at this point. The DME rep on the phone said that she did inform my GF that they were out of network, but that I would be charged as if I was in network...

All I know is something besides my avatar smells fishy.

Just so everyone knows. Christine RRT is one of the GOOD DMEs out there. Rare I know but she is for real a GOOD DME !

Keep up the good work Christine.


Irving