dme shopping question from newbie

sooooooo can i get a list of DME's and shop among them to figure out which one i want to use, or do i have to go with the one the doc told me he uses? i called my insurance and there are a number of DME's in this town...my insurance is pretty standard......so.....how does that work....because i'm thinking maybe i can find a really GOOD dme that has a responsive staff who does a great job vs....someone who is just going through the motions.....the FIRST question i want to know is "Dear DME, is this a new or used machine?" then wait for answer then....can i ask them to show me the # of hours on the clock on the machine?

dang....i'm getting distrustful....i prefer to think of it as "Proactive" and "informed".....i really need some sleep....

1) You don't need to go with the DME your doctor suggested. Particularly if you feel like you're being rushed or pushed into just going with it.

2) You definitely want to FIRST find a really GOOD dme with a responsive staff that does a great job. You write:

the FIRST question i want to know is "Dear DME, is this a new or used machine?" then wait for answer then....can i ask them to show me the # of hours on the clock on the machine?

No, your first question should be: "Will you provide me with a full data capable machine given my prescription?" If the DME won't do that or hems and haws about when they can or cannot do that, they're not a really GOOD dme with a responsive staff.

3) Don't limit yourself to the list of dme's that your insurance provided. Chances are they gave you an abbreviated list of the most commonly used DMEs for all types of claims. But they probably are quite happy to pay additional DMEs as well. So once you find a DME that will provide you with a full data machine, then ask that DME if they'll take your insurance card. If they do, you're home free.

In my case, I had located a very nice DME in a great location for me that specialized in CPAP equipment only that provided only full data machines by on-line searches. But they weren't on that magic list my insurance company had provided me when I called them. Since this DME was located on my way to work, I decided I had nothing to lose by stopping by. After confirming that they provided only full data machines to any patient with a prescription for CPAP/APAP regardless of whether the doctor specified full data or not, I then ask the dreaded question, "Do you take Independent Health?" Their answer was "Of course we do. If you can wait a minute and give us your insurance card, we can give you an estimate of what they'll pay and what your copay will be." Their estimate was exactly the same that another DME had quoted me for a non-data capable machine that was one generation back from the newest available. Picked up my CPAP from the good DME less than a week after I stopped in just to chat.

Good luck!

You're the patient. Purchase you equipment from whatever source you want. Your doctor may have suggestions but you're under no obligation to use the suggested supplier. Good luck.

WOW great info...WHERE is my phonebook!!! one thing that concerned me is i could not find the DME the doc suggested in the phone book or in a google search....that concerned me.

robysue wrote:
3) Don't limit yourself to the list of dme's that your insurance provided. Chances are they gave you an abbreviated list of the most commonly used DMEs for all types of claims. But they probably are quite happy to pay additional DMEs as well. So once you find a DME that will provide you with a full data machine, then ask that DME if they'll take your insurance card. If they do, you're home free.

In my case, I had located a very nice DME in a great location for me that specialized in CPAP equipment only that provided only full data machines by on-line searches. But they weren't on that magic list my insurance company had provided me when I called them. Since this DME was located on my way to work, I decided I had nothing to lose by stopping by. After confirming that they provided only full data machines to any patient with a prescription for CPAP/APAP regardless of whether the doctor specified full data or not, I then ask the dreaded question, "Do you take Independent Health?" Their answer was "Of course we do. If you can wait a minute and give us your insurance card, we can give you an estimate of what they'll pay and what your copay will be."

But do keep in mind that while your insurance may pay toward CPAP equipment from any DME, what you actually pay for the equipment may be cheaper using a DME that has a contract with your insurance carrier. For example, I just purchased a Swift FX for Her mask through my DME. The DME's regular charge for the mask was $151.33. Cpap.com charges $127 for the same mask. The contracted price of the mask is $89.62 of which I pay a 10% co-pay. This is because my insurance carrier has a contract with my DME and the prices are set by the contract. So while it may seem that your insurance carrier isn't giving you the entire list of DMEs in your area, they may be giving you the list of DMEs that they are contracted with.

okay, that makes sense.....question....how often can i get a new mask or a different kind of mask?

All good points jmcd. But in my case, the DME I located has the same contract with my insurance as the DMEs on the partial list the insurance company gave me over the phone. Their price list, their co-pays, and their list of "covered supplies" is exactly the same as the shady DME whose name was given to me by the insurance company. And copays and "covered supplies" were critical in my case since my insurance considers one mask every six months as a "covered supply" and they pay 100% of "covered supplies", while the machine and the humidifier are "durable medical equipment" and have a 50% copay and are billed to the insurance company by code, not brand: Hence I would have paid the same for the non-data capable, older CPAP at the shady DME that I wound up paying for my S9 Auto at the responsible place. And I'm not speculating: Both places gave me the same exact figures and tentative contract for me to consider.

In my case I think that the person on the phone when I called the insurance company didn't really want to read me a full list of several dozen (or more) local DMEs that they work with, and just read me the top 10 names---none of which specialized in CPAP equipment. She was unwilling to send me (by snail mail or email) a full list of DMEs that they would ok.

That depends on your insurance policy. Typically it's every 3 or 6 months.

okay....looks like tomorrow is DME day....IF i'm not too dizzy to drive..i just looked up in the yelow pages and there are FIVE sleep disorder clinics in this town now.....WOW. that gives me some options if i have to get a diff doc. I'll call insurance in the morning -- NO, i'll go by the insurance office...eyeball to eyeball is sometimes better....and i'll get a list of DME's...and i'm compiling my own from the phone book also.

so much to learn....so little time.

okay, that makes sense.....question....how often can i get a new mask or a different kind of mask?

The SECOND question you need to ask the DME's you are interviewing is what is their mask return policy. You want a DME with a liberal return policy. No matter how well they fit you for your first mask (and many DME's don't fit you very well at all), when you have tried to sleep in it you may find it's not the mask for you. So you need a DME that will give you at least 30 days to return any mask they supply to you--if one mask isn't working out, you can trade it for another. Never put up with a mask that's hurting your nose, leaking into your eyes, or just too uncomfortable to sleep in.

Don't let the DME make you think they are doing you any great favor by allowing you to trade in the mask, either. 1) Major mask manufacturers will take masks back for just this purpose and 2) most manufacturers give the DME's samples for free or low cost just to let you try masks and find the right one. The best DME's will even let you keep the sample masks (because they don't want to bother cleaning them), so you might end up with a back up mask in case something happens to your favorite mask or you have a cold and need a full face mask when you have progressed to a nasal mask or pillows.

WOW....now THAT is darn useful information. Thank you. I'm going to print out all this and put it in my SLEEP binder in the morning. I can't print now. Dear hub is asleep on other side of the wall and don't want to wake him up. This HP printer is so noisy!

you know now that i think about it at the titration study they said he had picked out a FFM for me. That doesn't sound like he was going to have his DME have me try some out. It's a good thing I'm learning this stuff beforehand. Wow. you know i work with a guy who has a sleep mask sent to him by mail every 30 days, and he pays $23 dollars for it (probably his co-pay). This guy didn't know very much about cpap though. He didn't know what brand of machine he had...or what type of mask....or who the dme was.....it was odd, he didn't know much about it, I don't think he is real compliant from some other things he said, plus he was (bless his heart) sort of gray looking. I don't know if that was from lack of sleep or smoking.....sigh

Prescription copy....i need to ask if that is ready yet.....that is something I need to get a hold of also. And I need a copy of the sleep titration study also.

Depending on your policy, weigh the benefits of owning vs buying a machine. If you must rent, be aware that you may have to meet your yearly co-pays before the insurance kicks in. That happens every year. If you start with your own machine you can still use your Rx later. My insurance will only allow a new machine every 5 years. If you've already met your co-pays get as many supplies as you can this year. If you regularly exceed your minimums anyway - no problem.
Your DME should already have a copy of your Rx. They should have no problem giving it to you. Make sure they offer a large selection of masks. I'm afraid the big box DME was the best for me. They purchase so many masks that they get a better price and don't have to limit their selection to what they can make a profit on. As a small business owner I hate to say this.

Wow, I had no idea that I could go anywhere else other than the DME that provide my masks at the sleep study. They called me a few days after my study and setup the machine. I assumed the doctor would only use this particular DME service. How would you get the prescription to go elsehere?

I assumed the doctor would only use this particular DME service. How would you get the prescription to go elsehere?

Once you locate the DME you want to use, call the dr's office and tell them where you want the prescription sent. They should then be obligated to call the prescription in for you.

You should also ask the dr's office for a written copy of your prescription and your sleep reports---at least the summaries. Tell them to send the reports and the prescription to you by mail or offer to pick them up if the dr's office is close enough by you where that's not a problem.

Good luck.

Junebug999 wrote: I'll call insurance in the morning -- NO, i'll go by the insurance office...eyeball to eyeball is sometimes better....and i'll get a list of DME's...

Don't forget to ask about your annual deductable!!! If you haven't already met it, you could end up paying more out-of-pocket with insurance than buying your xpap outright online.
Also check when your insurance year starts/ends. Is it Jan.-Dec, or July-June? If it's Jan-Dec, and you're renting the xpap, you'll have to meet your deductable all over again in Jan. That could mean a HEFTY bill every month.

As far as the DME goes, you've already received some good advice here. Keep in mind that you have the RIGHT to get a BRAND NEW xpap! Don't let the DME talk you into accepting a used one!!!!!!

Good luck, and let us know how you make out.