local dme

Help, when i went for the second part of the sleep test( on the machine) they said i had to name a dme. not knowing any i asked the tech for a name. now my question is, am i stuck with that dme because that is where the doctor faxed my info. i haven't gone in to get my machine yet. the RT that called didn't really want to talk on the phone, i ask what machine i would be getting and she sounded unsure when she said it was a Respironics M series. i ask if it was data compatable, she said yes. also i could not down load the info, only she could. now, after she had called my regular gp's office called to say they had my paper work ready. and said i could take it any where to get my machine.am i locked in now or not until i agree and take the machine from the first dme. medicare is all i have so what do i do.

samfreddyc wrote: i ask what machine i would be getting and she sounded unsure when she said it was a Respironics M series. i ask if it was data compatable, she said yes. also i could not down load the info, only she could.

I'm not sure about the specifics on switching DMEs. I have switched a number of times, however, I didn't have a rented machine at the time.

As for a "M series", there are a number of "M series" units. If you are specifically looking for data capability, they all technically record data. But the Plus units only record compliance (which isn't particularly useful to you)

You will want to make sure it is either a:
M Series PRO CPAP - records full data
M series AUTO titrating CPAP (commonly called APAP) - will adjust pressure on the fly and record full data.
(either with a-flex or c-flex)

Usually, you will need to get the Dr to specify a machine on the Rx, otherwise the DME can give you whatever CPAP they want. (Usually a M Series Plus)

As for you not being able to download the data, they are lying to you. (Or they don't know)
You will need a card reader and respironics software.
Respironics Encore Pro software was the only thing around and is no longer sold to patients as it does allow you to change the Rx on the smart card.
Respironics Encore Viewer was then released with the end patient in mind. It basically reads the data off of the card, but won't allow you to change anything.

Hope this helps, if nothing else, it definitely gave you some specific key words to search for.

-craig

Almost all local DME suppliers accept Medicare so you are most likely NOT "stuck" w/"just" this one local DME supplier. On the other hand, understand that Medicare only pays 80% of the agreed upon price for the DME supplies. You will be responsible for the other 20%. SOME FEW local DME suppliers will accept just the Medicare 80% reimbursement and write off your 20%. So the thing to do is to visit the various local DME suppliers, ask if they accept Medicare and then explain Medicare is your ONLY insurance. Your sleep lab "might" have recommended this particular local DME supplier as the one they've had experience w/as providing the best equipment or the best service, most lenient mask exchange policy, etc. Or there may be some other relationship.

IF you find a local DME supplier willing to accept only Medicare reimbursement and write off your 20% copay be prepared to accept whatever CPAP they offer you.

IF you are going to have to pay your 20% then INSIST on a full data capable CPAP. That would be the Resmed S8 Elite w/EPR, Resmed S8 II Elite w/EPR, Respironics RemStar (pre-M Series) Pro II w/C-Flex or Respironics M Series Pro w/C-Flex.

Most local DME suppliers buy most of the CPAPs from one manufacturer and thus they get a lower bulk price than if they have to order a CPAP from one of the other manufacturers.

Provide a WRITTEN request to your sleep lab for a copy of the doctor's dictated results (1-2 pages each) AND the full scored data summary report w/condensed graphs (5+ pages each) for BOTH your sleep evaluation AND your titration studies AS WELL AS your equipment order (script). They are part of your medical records and as such you have a LEGAL RIGHT to copies of them. You will need the script and the titration report to get your equipment. Be sure you KEEP the copies from the sleep lab and only provide COPIES to the local DME supplier.

Also, be aware, that Medicare insists upon a 13 month capped rental of your CPAP after which it becomes your sole property. The mask, hose, etc. are all paid for outright at time of delivery. And again Medicare pays 80%, your copay is 20%. So you will have a fairly hefty upfront cost when you accept your equipment and then 13 months of 20% copay for your CPAP.

thanks guys, guess i should have been calling dme's before now but didn't think i would need therapy. do they try to rush you so you will just go with them or is the doctor telling them to. mine is mild but i have had heart attacks.

When you "named" a DME provider, that probably just gave them the ability to get your results from the tests.

As a point of reference, get the "preferred" pricing from cpap.com for the machine you want (or think you can get from the DME), same for the mask. Respironics works off a "Minimum Advertised Price" structure, but that only says what they can ADVERTISE the price at, not the price they can sell at.

So, when your DME provider tells you that the Respironics M-Series Auto-pap with A-flex and heated humidifier is $1200, you can show them a $700 price tag where you can get it online and explain that Medicare only covers 80% and ask if they'd be willing to discount the 20% you have to pay (as suggested earlier in the thread). If you go with the pricing information in hand, you should have more leverage on pricing. Do understand though that with an online e-tailer, you're getting less "service", no store to walk into, and all that jazz, so the DME provider has expenses an online store doesn't.

You have a choice in which DME provider you wish to use. Make sure they are in -network with your insurance provider! Most DME providers will not and cannot "price match" internet pricing due to the contracts between the DME and your provider.

Medicare has fixed contract prices with the DME's it deals with. For the DME to change that, they would leave themselves open to losing their Medicare contracts and end up with possible big fraud charges.

You can probably change which DME you can use but it you want to use Medicare, make sure they accept it.

In future years, Medicare is getting even tougher for some DME's to keep contracts with. This has been posted about on the forum a few times.

Buying from an online vendor, not only would be money spent up front, Medicare is not likely to reimburse for any of the expense.

well i got a machine, a Remstar M Series cpap Pro with C/Flex. i think it will suit me ok. Thanks to all for your input.