dme fired me

The dme I used for a whole two months told me they were still taking my insurance but only for two selections of mask and would not ship out every month but only every three months because of cost.No nasel pillow or any other monthly supplies will be send.They sold me a swift lt.They sold me a machine, mask two months back and supplied pillows , machine filters and chin strap last month.Called on 11-30 to put in my order and was told its a business and we made a decision over the thanksgiving weekend to not accept U.H.C, insurance the way its written but only the way we like to make money.Yes the lady really told me this and then said you understand its a business.I had to try and find a dme at 2 pm the day before the end of the month so as I could get this months and next months order in before the deductable starts up again at the first of the year.My question is if I inform my insurance company that the dme is not taking and treating patients the way the insurance contract is written will they care at all? any thoughts would be great. PS : this dme seemed good even gave me a copy of napster 3.7 resscan cd-r to use for my data.

That certainly sounds illegal. I hope someone with more experience with insurance will respond ASAP. Damn DME bastards... I got lucky with mine. If you're in the Los Angeles area, and your insurance will cover this DME, call Western Drug in Glendale and ask for Arthur. Tell him Kenny referred you. He's a great guy.

thanks tattoo,I'm on the east coast(florida) so using your dme may be geographically challenging thanks, did find a new one the afternoon of the 30th of november so all is not lost. The part that angered me most was that my schedule was the 23rd of the month and this same lady messed it up last month and claimed is was her computer so that was why it was on the 30th.They wouldn't give me a one month grace period or anything to find a new dme and basically told me to take a hike with no warning.

Pothole guy...Courious...What supplies do you need on a monthly basis?????? Most CPAP supplies last for many months.

potholerepairman wrote:... [dme] made a decision over the thanksgiving weekend to not accept U.H.C, insurance the way its written but only the way we like to make money. ... My question is if I inform my insurance company that the dme is not taking and treating patients the way the insurance contract is written will they care at all? any thoughts would be great. ...

Several thoughts:

First, don't panic if you are not able to obtain the nasal pillows right away. They generally do not wear out all that quickly, so you should be fine until you can find another DME.

Second, I assume you have some sort of preferred provider option for your insurance. If that is the case, you should call United Healthcare and request a list of DMEs in your area. With this call, do not mention the issue you are having with your current DME. Just get the list of potential DMEs in your area.

Third, I would make another call to United Healthcare and ask to verify the schedule of replacement for the CPAP supplies. If they confirm the schedule (sometimes it changes, and the person from the DME might not have really understood that United Healthcare made the change), then ask United Healthcare what to do if the DME does not want to follow this schedule. Though most of the US health insurance companies feel they can modify their contract on the fly, they tend to take a dim view of the various healthcare suppliers doing the same.

But don't expect a quick resolution on this. You might need to ride through the situation with your current supplies. Hope this helps.

LSAT wrote:Pothole guy...Courious...What supplies do you need on a monthly basis?????? Most CPAP supplies last for many months.

Just a rookie trying to get a few backups really , but now they wont supply anything except for the two mask(one ffm ,one nasel) with no option of nasel pillows at all in the future or a nasel pillow mask.

"First, don't panic if you are not able to obtain the nasal pillows right away. They generally do not wear out all that quickly, so you should be fine until you can find another DME.

Second, I assume you have some sort of preferred provider option for your insurance. If that is the case, you should call United Healthcare and request a list of DMEs in your area. With this call, do not mention the issue you are having with your current DME. Just get the list of potential DMEs in your area.

Third, I would make another call to United Healthcare and ask to verify the schedule of replacement for the CPAP supplies. If they confirm the schedule (sometimes it changes, and the person from the DME might not have really understood that United Healthcare made the change), then ask United Healthcare what to do if the DME does not want to follow this schedule. Though most of the US health insurance companies feel they can modify their contract on the fly, they tend to take a dim view of the various healthcare suppliers doing the same.

But don't expect a quick resolution on this. You might need to ride through the situation with your current supplies. Hope this helps.[/quote]



Thanks your right the nasal pillows don't wear out quickly and are kinda stiff when you start using new ones.

Luckily I still had the dme list for uhc in my area and called one of the big ones and got my supplies from call to in hand under insurance in 2 hours.

Its the dmes new schedule for u.h.c. insurance not my insurances's .The other dme that I went to confirmed the uhc guidlines And handed me supplies to leave with the same as the following month from the first dme.I would totally understand if it was my insurance that changed or if they stopped taking my insurance but the whole "its a business you understand?" junk got me mad as Tiger's wife after a dry bird.

Thanks, most likely will chalk it up to not expecting much from strangers with calculators.

If they are under contract with your health insurance providor they are obligated to supply what that contract allows. If they don't that insurance company would probably like to know.
Gerry

My first thought, like LSAT, was who in the devil needs MONTHLY supplies??? In my experience, these masks, cushions, hoses, etc. all last a LOT longer than 3 months. Even my headgear has lasted longer than the 6 months replacement schedule Medicare allows. Even only getting supplies every 3 months I've had no problem building up a "stash" of supplies. But then my mask is a simple cushion, not a cushion w/thin outer cover, which may account for its still sealing well after 9 months of use. And two extra of everything seemed enough to me so I've just told my local DME provider to just call me every 3 months and ask what if anything I need instead of just routinely sending supplies every 3 months.

Gerryk wrote:If they are under contract with your health insurance providor they are obligated to supply what that contract allows. If they don't that insurance company would probably like to know.
Gerry

Thanks , will be speaking to uhc today so maybe the next person they sell a machine and mask to wont get dumped within sixty days of signing up with them and can at least get pillows for the same mask they sold them.

Slinky wrote:My first thought, like LSAT, was who in the devil needs MONTHLY supplies??? In my experience, these masks, cushions, hoses, etc. all last a LOT longer than 3 months. Even my headgear has lasted longer than the 6 months replacement schedule Medicare allows. Even only getting supplies every 3 months I've had no problem building up a "stash" of supplies. But then my mask is a simple cushion, not a cushion w/thin outer cover, which may account for its still sealing well after 9 months of use. And two extra of everything seemed enough to me so I've just told my local DME provider to just call me every 3 months and ask what if anything I need instead of just routinely sending supplies every 3 months.

Thanks , agree most everyting seems to hold up well but all the topics about my nasal pillows going bad quickly got me to want a few more and to go into next year with a few backups.The dme will not supply those nasal pillows next month ,year, or the year after that.The dme had 12-15 mask to try out in the lobby and said all were available for uhc insurance patients under the policy that I had just 60 days back.The no call your canceled way they do business seems to be scummy to me so if I can get uhc on their case , that will be done.

potholerepairman wrote:Thanks , agree most everyting seems to hold up well but all the topics about my nasal pillows going bad quickly got me to want a few more and to go into next year with a few backups.

That's how I'd feel, too, if I were using the Swift LT mask you have.

Here's a post within the topic potholerepairman is probably talking about:

viewtopic.php?p=411916#p411916

tattooyu wrote:I wanted to chime in here and mention that I brought it up to my DME, who is a great guy and very interested in my feedback and my therapy. He spoke with a rep. at ResMed (I don't know what department) and he brought it up to them. According to him, they know about this quality control issue on the nasal pillows but don't want to change anything because, "Patients are allowed new nasal pillows every month anyway."

The entire 13 page topic starts here -- very interesting reading:

MIRAGE SWIFT LT QUALITY POLL--THE RESMED CHARADE???
viewtopic.php?p=366810#p366810

Where in Florida are ya pothole? I am South (East) and I have a pretty good DME...

My Insurance is Empure (Blue Cross Blue Shield) I think and they give me no grief at all... If you want the contact info send me a pm... the lady I deal with (Lynn) is great, and very responsive to requests (which come few and far in between from me).

I have had the current cpap (F&P) for about 3 to 4 months now? I am on the second nasal pillow and still have a new one for when I get bored and feel like switching out. Still using the original water chamber as well as hose and headgear...

I can get new supplies more often then I am from my insurance (no deductible) but it is overkill and would be abusing the system to me, as I take good care of the stuff I have. In any event, if you need a good dme or want to check them out, shoot me a pm and I will send you their info.

drubin007 wrote:Where in Florida are ya pothole? I am South (East) and I have a pretty good DME...

My Insurance is Empure (Blue Cross Blue Shield) I think and they give me no grief at all... If you want the contact info send me a pm... the lady I deal with (Lynn) is great, and very responsive to requests (which come few and far in between from me).

I have had the current cpap (F&P) for about 3 to 4 months now? I am on the second nasal pillow and still have a new one for when I get bored and feel like switching out. Still using the original water chamber as well as hose and headgear...

I can get new supplies more often then I am from my insurance (no deductible) but it is overkill and would be abusing the system to me, as I take good care of the stuff I have. In any event, if you need a good dme or want to check them out, shoot me a pm and I will send you their info.

Thanks drubinoo7, actually I am in the same "Bud''s Chicken" town as you:) went with a large dme to try that out for a change and already switched on monday.My insurance u.h.c. has been great to me for a long time really ,so no complaints on the insurance end.If this dme does not work out I will certainly pm you for the info its a great offer, thanks.

Your lucky you have someone that takes United Health Care. Our school system uses them and they stink!!!!!!!!!!!

No one around here takes them and unless you want to travel for some distance your out of luck -- doctors, etc. say that UHC reimbursements are so minimal that they would rather lose the business than take their insurance. Just my luck our board has decided to continue with them for next year!!