Finding an honest DME provider

An earlier post has been some very interesting reading, for the newbie like me who has not reached the DME stage yet. Now to add fuel to the fire, how does one try and discern a good DME provider, before the fact. Is there any way of rating them, keeping in mind we travel all over the North American continent? Also, is it common for the Pulmonary Dr to own the whole package from diagnoses to sleep study to DME provider and if so, is this a good way to go or should the DME provider be separated out of the equation? With Medicare and TFL, I understand I can utilize most of the DME's out there, but need an honest one that services North America. Thanks
Bob

I think this is a matter of trial and error to a certain extent. We have had poor luck with two of the biggies -- Apria and Lincare. We ran into problems with Apria because your "home" branch has to give you travel authorization in order for other branches to serve you. It took an extra day to get my humidifier replaced when it died because no one at the Tacoma branch bothered to tell us this in advance, even though we discussed using the Tucson branch before we left on our trip. If you have a billing problem with Apria, you are not allowed (by company policy) to actually talk to someone who does the billing. You have to talk to someone in the Patient Pay department who sends an email request to the billing people. It took me three weeks to get an answer and only then after a supervisor gave me the direct number to the billing department against company policy....

We are currently using Walgreens OptionCare. So far, they have been very responsive and I have nothing bad to say about them. They have branches in many cities, but we had developed a relationship with the person closest to our home in Washington. When we need supplies, she sends them to wherever we happen to be at the time. Right now, she's sending them to us in Tucson. There is a Walgreens Option Care in Tucson, but I don't see the need to deal with them as long as we get good service from our Tacoma gal. Both branches would have the supplies sent from a central warehouse, so I'm not sure it matters who places the orders.

Keep in mind that Medicare and TFL will likely rent your xPAP and humidifier for up to 13 months, so you'll have a relationship with the provider of your machine for that time. As long as you don't have problems with your machine, that's really just a billing thing. You can switch providers for your supplies any time you want, though. Apria still owns my machine, but we've stopped using them for supplies, as I said above.

If there's a Walgreens OptionCare in your area, I think they would be worth talking to.

Since you are Medicare primary there are a few things you need to know.

1. Medicare requires documented proof of compliance from the DME after the 31st day on therapy. Most DME's use PAP machines with some sort of downloadable media that you will need to bring in on a regular basis.

2. Medicare requires you to have a followup appointment with you treating physician between the 31st and 91st day on therapy. The physician must document that he has seen and reviewed your previously mentioned compliance data.

3. If you are out of the Medicare region you are inrolled in for longer than 60 days (There are a few exceptions, travel is not one of them), the DME cannot LEGALLY bill Medicare for the equipment and may ask you to return it or you may be responsible for the charges.

These things make it very difficult for patients on Medicare who still lead a very active travel lifestyle. Often people think that because they are on Medicare the rules are the same everywhere, but each Region has there own rules and regulations.

CorgiGirl, is that N at Lakewood? Isn't she a DOLL????? See why I want to buy stuff from her, even when I don't NEED it???

For the rest of your - https://www.cpap.com. Then send in a reimbursement claim to your insurance. It's pretty damned painless for me to do this with Premera, my BC/BS provider. I download their form, input a few things, print it out, sign it, and send it. I save it to my computer, so I don't have to retype it every time with my personal info.

I only get 70% back, but the savings in emotional strain is worth every penny of that 30%!!!

LOL,
Babs

Ditto the Walgreens recommendation.
They've always been honest with us and have been there to support and answer questions.
When it looked like one of our sons was going to lose his medical insurance and have to pay outright for his machine, they came up with a price for us which matched the cpap.com price.

Shari

CorgiGirl,

That's interesting about Apria requiring your home office to give you permission to get supplies elsewhere. Something else to bug them about....

How does the Walgreens OptionCare work?

Kiralynx, call your local OptionCare office and ask them. I wandered into the one near my office, and was just bowled over by the excellent customer service. They ordered my scripts and PSG's, looked into ordering all the masks and supplies I wanted, and were fabulous to let me try and compare a mask that I decided I didn't want.

Seriously, they did it all for me, and then explained how they could do it all for my buddy CorgiGirl.

If you don't find an OptionCare near you, call Walgreen's and ask them where it is. Some of them are inside Walgreen's, some are stand alone. Mine's stand alone.

Or try: http://www.optioncare.com

Cheers,
B.

The information posted below is troubling, especially for the hundreds if not thousands that live in an RV and call North America their home. If this information is true, how do those that are full time RVers get around the limitations imposed by Medicare? When we leave our home location in 6-7 weeks, we will not be back for at least 18 month and more like 3 years. Our last out time was 18 months and included 3 1/2 months in Mexico, so I am very concerned with these supposed restrictions.

Guest wrote:Since you are Medicare primary there are a few things you need to know.

1. Medicare requires documented proof of compliance from the DME after the 31st day on therapy. Most DME's use PAP machines with some sort of downloadable media that you will need to bring in on a regular basis.

2. Medicare requires you to have a followup appointment with you treating physician between the 31st and 91st day on therapy. The physician must document that he has seen and reviewed your previously mentioned compliance data.

3. If you are out of the Medicare region you are inrolled in for longer than 60 days (There are a few exceptions, travel is not one of them), the DME cannot LEGALLY bill Medicare for the equipment and may ask you to return it or you may be responsible for the charges.

These things make it very difficult for patients on Medicare who still lead a very active travel lifestyle. Often people think that because they are on Medicare the rules are the same everywhere, but each Region has there own rules and regulations.

That particular guest (akcpapguy) works at a DME in Alaska, and he has provided the latest information many times.

I would believe him, but of course, check it out for yourself.

That is troubling, indeed, Texan.

It might be that you'll need to get your prescription, buy a machine out of your own pocket from an online store like cpap.com, or from cpapauction.com, or from a Craig's list, and skip Medicare altogether.

Or, go the Medicare route, being sure to come back "to town" sometime during the 31st and 91st day on therapy so that the doctor can document compliance and see you face to face, to document that you are receiving benefit from cpap therapy.

From that point on, if YOU don't inform the DME you'll be out of the region for longer than 60 days at a time, I'd think the DME could, legally and in good faith, assume you're in the region and continue billing Medicare. I don't know how that would fly, though. akcpapguy would know if "don't ask/don't tell" could work in your unusual situation.

Babette wrote:Kiralynx, call your local OptionCare office and ask them.

Alas, and alack! They don't serve Louisiana!

CorgiGirl wrote:We ran into problems with Apria because your "home" branch has to give you travel authorization in order for other branches to serve you. It took an extra day to get my humidifier replaced when it died because no one at the Tacoma branch bothered to tell us this in advance, even though we discussed using the Tucson branch before we left on our trip. If you have a billing problem with Apria, you are not allowed (by company policy) to actually talk to someone who does the billing. You have to talk to someone in the Patient Pay department who sends an email request to the billing people. It took me three weeks to get an answer and only then after a supervisor gave me the direct number to the billing department against company policy....

I am willing to bet the Apria "home branch" thing is an accounting thing where the "guest servicing location" won't get paid unless the the "home branch" releases their claim to the client. Not good customer service but DME's are ALL about the money. So you could be in distress but they won't care.

As for finding an "Honest DME" - research my friend is the ONLY way. Get a list of who is "In Netowrk" for your Insurance plan. Hopefully there will be more than one. Then you can also park outside their location and ask people coming out. Anything at all that makes you nervous, try another.

If you are out-of-state - how will the DME get the equipment back? Oh, you're not worried

GumbyCT - who is just thankful the DME's do NOT do medical emergencies; that would be ddme's, ha

Guest wrote:Since you are Medicare primary there are a few things you need to know.

1. Medicare requires documented proof of compliance from the DME after the 31st day on therapy. Most DME's use PAP machines with some sort of downloadable media that you will need to bring in on a regular basis.

2. Medicare requires you to have a followup appointment with you treating physician between the 31st and 91st day on therapy. The physician must document that he has seen and reviewed your previously mentioned compliance data.

3. If you are out of the Medicare region you are inrolled in for longer than 60 days (There are a few exceptions, travel is not one of them), the DME cannot LEGALLY bill Medicare for the equipment and may ask you to return it or you may be responsible for the charges.

These things make it very difficult for patients on Medicare who still lead a very active travel lifestyle. Often people think that because they are on Medicare the rules are the same everywhere, but each Region has there own rules and regulations.

I don't doubt that you are telling the truth but the Medicare rules must be VERY DIFFERENT in different sections of the country. I have been on VPAP for 9 months now and I have never had to show my DME or my doctor any compliance data. I have never even gone back to my original DME because I found one that accepts my primary, (medicare) and secondary. I don't have to fill out any forms and there is never any cost for replacement parts such as filters, hose, mask, etc. (my original DME also accepted medicare and my secondary but I had to pay my secondary up front and wait to be reimbursed.)

Strange, isn't it?

Ed

Medicare rules changed Nov 1 I think it was on this tightening of compliance.

You got your machine before this.

I think DME's are honest but not everyone has the same knowledge level or concern that you have to deal with. Where it be for mask or mattress I have found mine to be more than helpful if I ask questions of them. They have to make a profit to stay in business (USA) so they are motivated to service you well.

We have more than a few auto repair centers in our town but I only do business with a few. The others I assume are honest but some have staff that should not even be checking the oil level in a car.