Problem with medical supply provider

I underwent sleep studies, got referred to a medical supply provider in my local area (Fort Worth). They gave me the most basic machine on the market--a resmed tango. I cannot tolerate the constant pressure from the tango, so I talked them into doing an apap study. I love the resmed auto vantage machine and am having very good luck using it. Here's the problem--they say I already bought the humidifier to the tango so I'm stuck with it and will have to pay the difference between the tango and a resmed machine out of pocket even though I have insurance. In addition to that, I was going to buy the machine I have on loan from them, but after checking the clinician menu I have found it has 1400 hours on it even though they told me it was new. I feel like I was rail roaded into buying the tango humidifier and paying rent on that machine--the med supply tells me I have to keep renting the tango machine or go AMA. The only offer of help from them has been to continue to bill for the tango and let me keep the resmed for an additional fee. How do I extract myself from this provider and find one who is more concerned with their patients? Any suggestions?

i would take pictures of the machine showing the hours, take it back to them, demand what you want. bring up that you will goto one of the news channels that exposes crap like this and helps people out. call your insurance company, tell them they have sold you a used machine at new price. personally i would yell, scream, etc. until i got what was right. call the better bussiness bureau, file a complaint. at the very least, get money back, go somewhere else.

i have to wonder how many people buy 'new' when its really used.

Welcome to the forum!!! Glad you found us!!

Basically the DME's (the providers of machines, masks, and supplies) are out to make the most money. Your situation isn't all that uncommon unfortunately. Basic bare bones machines have the same billing code as the apaps. They get paid the same no matter which machine you get so they naturally will give out the cheapest machine made to increase their profits.

I was prescribed a "smart apap" with a pressure range of 8 to 12. I was given an M series Plus machine with c-flex. There is nothing "plus" about this machine. It doesn't record data, just compliance hours, and is one of the cheaper machines in the M series. When I questioned them about the constant pressure I was told that was "normal" that they always pick the middle number and set the machine to it. The DME that provided the machine kept telling me what a good machine I had, etc. etc. Well I found this forum and discovered what I was given and I was prescribed was not the same. I was prescribed an APAP with a range of pressures. Bless my sleep doctor's heart for prescribing a data capable machine.

With the help of my doctor and my insurance company I was able to take the basic machine back and switch DME. I called my doctor and explained the situation (my primary care doctor and not the sleep doctor since I never really saw him) and made a call to the insurance company explaining the situation. THEY both agreed to help me get the prescribed machine.

Call your doctor and see if they are willing to help you in your endeavor to keep the better machine. You may have to bite the bullet on the humidifier since it was a purchase. You might try listing it on cpapauction to help recover some of the cost on it. Be firm and insist on a machine that will help you be compliant. Explain to your doctor why you want the better machine. You should not have to pay any difference since the insurance pays under one billing code -- the same amount for a bare bones machine or a data capapble one.

libintexas wrote:I underwent sleep studies, got referred to a medical supply provider in my local area (Fort Worth). They gave me the most basic machine on the market--a resmed tango. I cannot tolerate the constant pressure from the tango, so I talked them into doing an apap study. I love the resmed auto vantage machine and am having very good luck using it. Here's the problem--they say I already bought the humidifier to the tango so I'm stuck with it and will have to pay the difference between the tango and a resmed machine out of pocket even though I have insurance. In addition to that, I was going to buy the machine I have on loan from them, but after checking the clinician menu I have found it has 1400 hours on it even though they told me it was new. I feel like I was rail roaded into buying the tango humidifier and paying rent on that machine--the med supply tells me I have to keep renting the tango machine or go AMA. The only offer of help from them has been to continue to bill for the tango and let me keep the resmed for an additional fee. How do I extract myself from this provider and find one who is more concerned with their patients? Any suggestions?

You need to do several things. First, I would contact my Doctor and find out what he prescribed and let him know what the DME is doing, and get a copy of your prescription from the doc. Then, contact your insurance company to find out what they will cover, and if there is an alternate supplier you can contact. Go with boston's advice, take pics and document the used condition of your new machine. Before you contact the news stations: If you have an alternative DME you can go through, send the DME a certified letter with a calm presentation of the facts with a request that they will take the equipment back and let you out of your contract, or that you will notify a. the news stations, the BBB and your state's medical licensing agencies with a complaint. If you do not have an alternative DME you can use, request they make it right or you will contact the news stations, the BBB and will lodge a complaint with the state's medical licensing angencies. the key word here is "fraud", since they are trying to fit you with a "new" machine, bill you for a new machine and it is actually pretty well used. After all, at an 8 hour average per night (generous I think), that "new" machine has been used for about 6 months.

You need to be pro-active, document everything and make all contact in writing, certified mail preferred. If you do verbal contacts, follow it up with a certified mail summary of the discussion, complete with names. Copy the doctor who referred you. Using the fraud word is going to get them upset....but keep at it..they are not doing you any favors.

If you have had the Tango less than 30 days take it back. They can't even bill insurance during the first 30 days!

I think the key is finding out first WHAT the doctor ordered. If the doctor ordered a cpap with a straight pressure -- he was given a bare bones machine -- this isn't fraud -- just bad business from our perspective -- but not illegal. Get your original script in hand if you haven't already done so.

Many people use the bare bones machines and have success with them. Many of us here on the forum want the better machines and I am not faulting them for that -- I agree everyone should be given a data capable machine -- but until the manufacturer does away with the bare bones machines DMEs are going to keep handing them out to maximize their profits.

In almost all instances the humidifier is not a rental but is a purchased item from the start. No fraud or illegal activity there. If the DME was nice they would allow an exchange of the humidifier but in reality probably won't.

In my opinion let the doctor and insurance company help you get what you need -- instead of making threats -- there is time for that later if need be.

Explain about your confusion on the machine hours. Ask why they would possibly be passing off an used machine for new? Do it matter of factly. If the machine was "loaned" to you are you taking it for granted that it is the one that you would have kept or would they have exchanged it for a new machine? I can't see a company "loaning" everyone a new machine -- what would they do with all the used loaner machines? It would make more sense to have some for "loaners" and then swap them out when actually purchased.

sleepycarol wrote:I think the key is finding out first WHAT the doctor ordered. If the doctor ordered a cpap with a straight pressure -- he was given a bare bones machine -- this isn't fraud -- just bad business from our perspective -- but not illegal. Get your original script in hand if you haven't already done so.

.

I'm not basing the fraud claim on the barebones machine, but on her comment that the machine she was sold as "new" actually has 1400 hours on it....Maybe I'm picky, but if someone tells me something is "new", there should be NO previous useage on it.

libintexas wrote:I underwent sleep studies, got referred to a medical supply provider in my local area (Fort Worth). They gave me the most basic machine on the market--a resmed tango. I cannot tolerate the constant pressure from the tango, so I talked them into doing an apap study. I love the resmed auto vantage machine and am having very good luck using it. Here's the problem--they say I already bought the humidifier to the tango so I'm stuck with it and will have to pay the difference between the tango and a resmed machine out of pocket even though I have insurance. In addition to that, I was going to buy the machine I have on loan from them, but after checking the clinician menu I have found it has 1400 hours on it even though they told me it was new. I feel like I was rail roaded into buying the tango humidifier and paying rent on that machine--the med supply tells me I have to keep renting the tango machine or go AMA. The only offer of help from them has been to continue to bill for the tango and let me keep the resmed for an additional fee. How do I extract myself from this provider and find one who is more concerned with their patients? Any suggestions?

I am basing it on the key word LOAN. It doesn't state that this particular machine was actually purchased. Just states they were GOING to buy it. Before the purchase -- if they actually carry through with it is the time to ASK any questions about the hours it is showing.

I was given an Auto "on loan" for 30 days .. it was a used machine. After reviewing my reports, it was swapped out for a brand new Auto.

AuntieNae wrote:I was given an Auto "on loan" for 30 days .. it was a used machine. After reviewing my reports, it was swapped out for a brand new Auto.

I am trying to get CPAP switched out for APAP. Did you switch from CPAP or did they start you with APAP. What in your reports qualified you for the switch?
My nightly pressures change. In the last two weeks they have ranged from 6.4 to 11.6. They are mostly below the 9.0 my CPAP machine was set at. The DME says my insurance company made the last payment for my CPAP in Oct. 08, so that machine is mine. The DME also said that if the insurance company will pay for another machine, then I get to keep the old machine and use it as a backup machine. Well that's great, but it wasn't helping me sleep, and I don't really want to use machine that is not the right one for my condition. Thanks,
M

I started with the M Series Plus .. which only records compliance. I went back to my Doctor two weeks later and explained the differences in the machines and asked for either the Pro or Auto. He wrote the script for the Auto. The DME gave me an Auto for 30 days "on loan" so I dropped off my reports to my Doctor and asked if he would support me keeping an Auto. I went back to the DME and they swapped out the loaner Auto for a brand new one, no further questions.

Unfortunately this situation seems to be the rule rather than the exception ......DME's for the most part are greedy. Not all DME's, but it seems there are a lot more that are than not......

You're really stuck with the humidifier unless you can get the DME to trade it for one that fits the "Loaner". Humidifiers aren't really that expensive in the overall scheme of things, so as has been suggested, you can sell it on cpapauction.com or craigslist, or......
I would not accept the loaner as my "Permanent issue" since it was obviously used prior to your receiving and using (take pictures and document).
I would also do as suggested and work with the doctor and the insurance company to rectify the situation. Ask your doctor to re-write your prescription for a specific make/model at a specific range of pressures. The DME saying that they set a machine in the middle of a range that has been prescribed is not only unethical, it is illegal. They MUST set the machine as the doctor orders. Period!!!!
If the doc will re-write your script for the make/model that you have (or want), then work with the insurance company and the DME to return the machine they issued (you can also try to make them take back the humidifier, but that may not be successful -- especially since you are "forcing" the DME to provide you with a better machine which will provide them with less profit).
In the insurance world, a CPAP machine and an AUTO CPAP machine are coded the same on the invoice the insurance company sees. The insurance company, for the most part, has no idea of what make/model machine you were provided -- be it the vacuum pump that Billy-bob rigged up in the back room, or the top of the line Auto CPAP from Respironics or ResMed. The billing code is the same!!!! The difference is that Billy-bob's machine will give the DME, maybe 60% higher profits than the Auto machine......so being a typical American business, seeking the almighty dollar above all else, they really don't care about you or your problem, only their profits. The bottom line is all that matters.
Unfortunately that's just the way it is.....

If the doc will write you a script for what you want -- ask him/her to be very specific, then hold the DME to the fire and make sure they provide you exactly what has been prescribed!!!! Their profits be damned; it's your treatment -- make them know and understand that you are in control of it, not them!!!!!!!

Good luck
Take care
cheers
goose

hose head wrote: I am trying to get CPAP switched out for APAP. Did you switch from CPAP or did they start you with APAP. What in your reports qualified you for the switch?
My nightly pressures change. In the last two weeks they have ranged from 6.4 to 11.6. They are mostly below the 9.0 my CPAP machine was set at. The DME says my insurance company made the last payment for my CPAP in Oct. 08, so that machine is mine. The DME also said that if the insurance company will pay for another machine, then I get to keep the old machine and use it as a backup machine. Well that's great, but it wasn't helping me sleep, and I don't really want to use machine that is not the right one for my condition. Thanks,
M

How long have you had your cpap? You state the last payment was in Oct. of 08, what was the length of the rental period? If you have had the cpap for any length of time you may be stuck. Most insurance companies will only replace your machine after a period of time ranging from 3 years to 5 years (5 years seems to be the norm depending up on your coverage). While on cpap did you have any documentation that the machine was not working for you?

Is your doctor willing to rewrite the script for an apap saying you failed cpap therapy? If so you maybe able to justify the cost of a new machine and then keep the old machine for a back-up.

Good luck.