DME Problem

I'd like to know what my options are in this situation. We're due for a new mask this month, our first since we started except for the first month of exchanges until we settled on the UltraMirageFF. They received Dr's RX for a mask of "patient's choice" yesterday so I called today to set up an appt with the RT for a new UM but they told me they don't stock them anymore, just the Quattro. The gal sounded very firm about it. Can we insist that they order the UM for us? They should be able to do that, right? This DME is the only one around here, they're a very big company. I'm ready for a fight if I know I can win!

Do you have a copy of your doctor's script for a mask 'of patient's choice'?? Try calling your supplier again only this time ask to speak to the manager and put your request to him/her. If you've been successful w/the UM that is they one they should supply.

It seems to me I read that others have had a similar problem and I "thought" at least one said their DME supplier told them the UM had been discontinued but others had no problem. If you are given the "discontinued" story I'd be inclined to contact Resmed and ask them directly if the UM has been discontinued. Local DME suppliers have been know to be "less than truthful" or ignorant. Resmed has been very good about responding quickly to any inquiries I have made. AND if you do have to contact Resmed I'd be sure to let Resmed KNOW who this local DME supplier is, which branch office as well as company name.

If you know the UMFF works for you, why don't you just order from Cpap.com and submit the bill to your insce? Though I guess I would check with them beforehand to be sure they'll honor it (though considering that it'll be half the price they normally have to shell out for - from DME's - I can't see why they wouldn't.

I'm not going to say you shouldn't buy from cpap.com, but for me if I get mask from local DME I pay nothing.
If I buy from cpap.com I pay $118 (I am pricing Swift LT.) My insurance would paid me back 80%. My cost about
$24. My insurance pays local DME $129 for Swift LT. However if my DME didn't sell a mask that I knew worked
for me, I would buy online. I am just saying what the DME charges for mask and what my insurance pays are two
different things.
About DME selling someone a different mask because they don't have one in stock, then I would be calling people to
let them know I wasn't happy. The mask is the major part in xPAP therapy. Once you find one that works, you need to
be provided with that mask.
Good luck

I agree with everything that's been said. Julie's idea is a great one, but some insurance companies (like mine) won't allow patients to go "out of network" without at least a severe penalty, if in fact they'd even reimburse the patient for any of it. Mine won't; not a penny. It really depends on the individual policy/company. Check with your insurance company to be sure. You said that DME is the only game in town, but if you ask your insurance company for a list of "in-network" DMEs, you could always handle things by phone and mail with another one if you got no satisfaction from your DME.

Before even doing that, though, I think I'd go with Slinky's suggestion and speak with the store manager. If you calmly and nicely explain that you really don't want to go to another DME if you can avoid it, but you will if you can't get the mask that works for you, I'd hope the manager would realize that you'd not only be taking your mask business elsewhere, but also any future big-ticket business, as well (such as a cpap machine), and order the mask that you need. Good luck! Let us know what happens.

Marsha

DoriC wrote:I'd like to know what my options are in this situation. We're due for a new mask this month, our first since we started except for the first month of exchanges until we settled on the UltraMirageFF. They received Dr's RX for a mask of "patient's choice" yesterday so I called today to set up an appt with the RT for a new UM but they told me they don't stock them anymore, just the Quattro. The gal sounded very firm about it. Can we insist that they order the UM for us? They should be able to do that, right? This DME is the only one around here, they're a very big company. I'm ready for a fight if I know I can win!

In addition to what the others suggested.......

Hi Dori.

What size does he need?
There may be some folks reading this thread that have a UMFF that didn't work for them and they'd be interested in getting rid of it or trading.

And, if the size he's using is correct, the seals can be purchased without having to buy a whole new mask.

https://www.cpap.com/productpage/resmed ... irage.html

Hmmmm......the prices have dropped (a lot) since I bought the extras I have.


Den

Thanks guys for all the suggestions. You always come through. I did some checking this morning, called Medicare to ask if I could buy online and they will not reimburse if supplier is not enrolled in Medicare program. Called cpap.com and they said they were not enrolled and don't think Medicare will reimburse us, called our secondary union insurance and they said although they follow medicare guidelines and don't pay if medicare declines it, if we get documentation from our Dr and write our own protest, fill out some forms,etc,etc, "maybe" they would reimburse. I also called 2 little local medical supply stores who are enrolled in Medicare but they checked with their suppliers who only handle Respironics? We haven't gone the "get me the manager" route yet, we will go in person if he's there today. But again Den saved the day with a simple solution. If all else fails we'll just order the insert from cpap.com for $49 and call it a day. I think M's leaks would improve with a new cushion,the one he has now is a little cloudy and "mushy". Dori

Mine's been cloudy and mushy for years (my mask)......and it keeps sealing better with age.

Den (whose brain is still "cloudy and mushy")

Wulfman wrote:Den (whose brain is still "cloudy and mushy")

Nope. Gotta protest. I know you are by nature the unpretentious sort, Den, and that certainly wins points over those who are compelled to beat their own drums, but from what I've witnessed here, your brain is anything but cloudy and mushy. Many of us have benefitted greatly from the workings of your very able brain.

Marsha

Yeah, what Songbird said.

So what's the consensus here. Den, are you in the minority as far as cloudy and mushy vs new? (Cushion, that is). I'm seriously asking because hubby had one of his best nights so far with his original UM. Hmm? I'd love an RX for a new brain but I don't think Medicare will pay for that either!

I am sure any DME can order any mask they do NOT carry if they want the business. I tend to think they have other products which bring them a higher return and try to 'force' people to use those products.

Mine gave me this story about Corp policy - so I called Corp.

GumbyCT - who could not even imagine any pharmacy saying they couldn't get the medicine your doc prescribed.

DoriC wrote:So what's the consensus here. Den, are you in the minority as far as cloudy and mushy vs new? (Cushion, that is). I'm seriously asking because hubby had one of his best nights so far with his original UM. Hmm? I'd love an RX for a new brain but I don't think Medicare will pay for that either!

Dori,

All I know is my original (seals and headgear) UMFF mask has been sealing better with time. I've got over 3 1/2 years on it (approaching 4 yrs.) and I can still get flat leak lines with it. In my first year with it, I had leak lines that looked like a metropolitan skyline......with skyscrapers.

Den