Call Me: "Rockin Mama - Take II" (Update: RESOLVED!)

jules wrote:I believe Thomas is dealing with Medicare.

I believe you are right.

Here is the answer.

IF the provider has NOT agreed to the "Medicare allowable rate", they are allowed to charge me up to 15% above the 80% Medicare pays.

If they HAVE agreed to the "Medicare allowable rate" (which they HAVE), then they are NOT allowed to charge me extra, which is EXACTLY what they are trying to do!

ARGH!!!!!

As for getting a machine online. No dice. I want it local. I want to be able to service the machine.

ThomasMcKean wrote: As for getting a machine online. No dice. I want it local. I want to be able to service the machine.

I would seriously rethink this line of thinking. What service are you hoping will take place by your local DME? Repairs?

The locals don't do repairs. They can't do repairs. They have to send it back to Resmed. (Or Respironics in the case of a Respironics device, etc.).

Thomas, you need to get an Rx specifying the exact machine. If it just says CPAP at 7 then can give you any old leaf blower.

Go back and talk to the doctor about getting a machine specific Rx.

ThomasMcKean wrote:

jules wrote:I believe Thomas is dealing with Medicare.

I believe you are right.

Here is the answer.

IF the provider has NOT agreed to the "Medicare allowable rate", they are allowed to charge me up to 15% above the 80% Medicare pays.

If they HAVE agreed to the "Medicare allowable rate" (which they HAVE), then they are NOT allowed to charge me extra, which is EXACTLY what they are trying to do!

ARGH!!!!!

As for getting a machine online. No dice. I want it local. I want to be able to service the machine.

It does not matter if it is an Escape, Elite II or APAP...the insurance pays the exact same amount since they bill under the exact same billing code. Print this list and take it to your DME, then explain that yes, your insurance WILL pay for the data capable machine. Better yet, find a new DME....

CPAP or AutoCPAP E0601 (Any make, any model)
BiPAP E0452 (Any make or Model)
Any Mask K0183 (FF, nasal, gold seal, mirage...)
Any Nasal Pillows K0184
Any Headgear K0185
Any Chin Strap K0186
Humidifier K0268 (Heated or passover...same code)
Air Tubing K0187
Filters (any) K0188

Hey guys I got a GREAT happy ending! This is an awesome story... Well worth the read.

So some of yew may remember I had the DME from hell. The good looking one who made Nurse Rachet look like Pollyanna? The place I went today that gave me the bull crap was a different provider. I am amazed there are two in this town, small as it is.

So after I realize they tried to con me, I went back to Nurse Rachet. I walked in to talk to her, there she was, out of her usual dressy, dressy outfits, wearing jeans, a belt and a T shirt and she smiled (yes, she actually SMILED!) at me and said, "Hello Thomas!"

And I stared at her for a minute and decided to just come clean. I said (direct quote), "Where in the hell has this person been?"

And without missing a beat she said, "This person's boss was here and she was hiding behind him."

I told her that her lack of personality drove me to the other provider and what they had tried to do. She told me that wasn't allowed and brought me out a Remstar Plus.

I said NO. I want an Elite.

She said the Pro will do the same thing.

I said not quite as well, but yes it will.

Let me see if I have one, she says...

She goes back to look and there is none there. She comes back out singing the praises of the pro.

I told her I wanted an Elite.

She told me I wanted a Pro.

And I said (again, direct quote), "Underneath this child-like autistic demeanor is an internationally respected disabilities advocate with a genius IQ and a medical background."

She stopped pushing the Pro immediately. She asked me if I wanted the Elite.

I told her NO.

She got mad at me (and rightly so, looking back at it) because she thought I was giving her the runaround.

I told her I *did* want the Elite, but I also wanted some actual personality from her. She smiled and said she thought maybe she could give me both.

I told her maybe she had my business.

End of story.

Your behavior toward her seems really disrespectful. Not to mention how dumb it seems to go to another provider because you think the nurse, rt, clerk or whatever her title is "lacks personality". Who cares as long as you get the machine you want.

ThomasMcKean wrote:

SharkBait wrote:I guess they reserve the right to refuse to sell certain equipment. Hopefully you have a choice in DME's.

That makes sense.... But only in the small term. I mean wouldn't they want my future business? If this CPAP thing is for life, then I will be coming back to them again and again and again (and again, even) for supplies and such. Or so I am led to believe. Wouldn't that give them business and profit?

Yep, Thomas... one would certainly think so. Hope you can find a DME that does think long term and wants your business for life.

It really amazes me when a DME stubs up and refuses to cooperate with a new customer who asks for a particular model of "cpap" machine -- a machine that fills the prescription just fine and is only slightly more expensive than the basic. Heaven knows, the DME has hundreds of newly diagnosed people walking through the door who are perfectly willing to accept whatever the DME gives them... hundreds of basic machines. No questions. Plenty of profit.

So when one person out of a hundred asks for a specific cpap machine that can provide AHI and leak information instead of the basic machine -- both machines being exactly the same except for the amount of data one can record, how could that possibly be a problem to the DME?

The vast majority of people accept the basic machine and don't know the difference. The few, like you Thomas, who have researched this and found out the difference in machines, are a drop in the bucket. I shake my head in wonder every time I hear of a DME balking, the few times they are asked for a more informative machine.

I don't think that kind of DME realizes (unfortunately, maybe just doesn't care) that THAT person, simply because a specific machine request is showing a lot more interest in treatment than the average person, is very likely to be a "cpap success." Sticking with it for life. That's a customer coming back for supplies for a long, long time. Just as you said, Thomas.

P.S. I was typing this while you were typing your happy ending, Thomas! Loved the way you tell your story! WTG!

Visited your website, btw. That's a truly remarkable story of your life and your ongoing work. Great site.

nobody wrote:Your behavior toward her seems really disrespectful. Not to mention how dumb it seems to go to another provider because you think the nurse, rt, clerk or whatever her title is "lacks personality". Who cares as long as you get the machine you want.

It could be seen that way, I suppose, but in trying to impress her boss, she got frightened and was disrespecful to ME. TWICE! So naturally I did want to go back there. What she thought was proper business protocol was instead disrespectful to the client.

I have no idea if the boss called her on it or not. And it really ain't any of my business.

By the way, I did go back to the other place and I told them I called the insurance company and that what they did was not allowed.

They really didn't care. At least one of them is disrespectful only when the boss is around.

Do you really want to be seen as disrespectful even if someone is disrespectful toward you? I hope your story means you got the machine you wanted finally.

nobody wrote:Do you really want to be seen as disrespectful even if someone is disrespectful toward you? I hope your story means you got the machine you wanted finally.

Not only did I get the machine I wanted, but she and I are all buddy buddy! I really couldn't have had a happier ending. This is more than I expected.

That's good I'm glad you got the one you wanted.

nobody wrote:That's good I'm glad you got the one you wanted.

I am very good at what I do, nobody. It is just that I have always done it for others and up until now I have been a bit afraid to do it for myself. Looking back, I now see how silly that was. Self-Advocacy. It is a good thing. I do hope Rockin Mama finds that to be true this afternoon.

So McKean, now that you got the machine you need how is it going? Are you getting good results? Sorry you had to deal with the "spammer" accusations, and you got past that.

Georgio

CONGRATULATIONS, Thomas!!! Another success story! Hallelujah! Now you just keep hanging w/us and we'll get you thru any other minor problems you may encounter!!! We are SO PROUD of you!!!