Whoppers I have been told from DME, techs, etc

Pugsy wrote:

KatyDidAgain wrote:Once the compliance device comes off, but before the machine is paid off by Medicare, am I obligated to let them have access to my reports?

I am not sure when that final compliance check is to satisfy Medicare's requirements.
Are they using a modem to check compliance? I would assume that when it is removed that Medicare requirements have been met and they no longer care. I would doubt the DME would even bother to ask for reports.

I am thinking just prior to the 90 day mark is required compliance to satisfy Medicare. Hours of use is all they want anyway. Medicare is always changing rules, I don't know if they require anything after that 90 day mark or not. They didn't used to.

Medicare has always required additional documentation after the 90 day mark. This documentation is required to be sent to Medicare in the case of an audit. The documentation is a statement from the patient verifying continued use of the device. From the physician, the provider must verify that the physician has documented in the patient's medical record both continued use of the device and that the patient continues to benefit from the therapy. If this documentation is not obtained, then the provider must NOT use a "KX" modifier on the claim. Failure to use a "KX" modifier results in a denial of the claim and the patient owes nothing, unless a properly executed ABN is on file. If, in an audit, this documentation cannot be produced the provider must refund the amount collected and the patient owes nothing.

Hose_Head wrote:In reading this topic, I'm now of the opinion that a primary piece of advice we should provide to newbies (and to practice ourselves) is to take a voice recorder with us when we visit our doctor / DME and to advise them that we are recording the conversation. That way they will know that if they spout any lies or deceptions, they can be called on it at a later date. Any that are caught on tape should be referred to the appropriate licensing agency, and possibly to small claims court, too.

SOMETHING has to be done to weed these bad apples out of the industry.

Something is being done. Medicare, after being forced by the legitimate DME companies, now requires mandatory accreditation (as of October 2009). This raises the bar as to the education level of providers. While not a perfect solution, as most national companies like Lincare and Apria are accredited (I do not know how they passed their surveys), this has weeded out many unscrupulous or poorly educated providers.

A good place to report these abuses is to the DME company's state association as these are their peers and are always looking to improve education in the industry while removing the bad apples.

Janknitz wrote:Were the masks they were providing brand new and in sealed packaging? Was the packaging marked anywhere as "Sample" or "For Short Term Use Only"? Here's the scoop:

1. All of the major mask manufacturers have return programs. If you have a mask that you're not getting along with, you can return it to the DME within 30 days, and they can get "credit" for the mask by the manufacturer by filling out some paperwork. They don't have to physically return the mask, and most DME's will throw the mask away when you return it, because it's too much trouble to clean for someone else to use.

2. All of the major mask manufacturers provide FREE samples to DME's and sleep labs. SOME DME's actually use them for their CUSTOMERS--allowing you to try on the sample masks and even allowing you to take them home and try them before actual purchase (Typically you will buy the first mask, but if it doesn't work out you can try other samples until you find the right one, after that, when it's time to purchase a mask again, you'll get the mask that worked for you). Other DME's sell the sample masks on the grey market (if you look at cpapauction.com, for example, almost all the masks being sold on that site are unopened samples) for their profit and YOUR loss since they make it expensive, difficult, and time consuming for you to find a good mask.

It's my belief that the "30 day" trial period applies to EACH and EVERY mask. So if Mask #1 didn't work out and you returned it within 30 days, you have 30 days for Mask #2, and 30 more days for Mask #3, etc. I'm not sure your DME would agree --if they are giving you "real" masks rather than samples, that's a lot of paperwork the DME has to do each time you return a mask.

So that's why I'm asking whether the subsequent masks you were given were samples or actual purchases (which usually come with an "extra" like strap covers or a fancy carry bag).

It would be illegal and unethical to sell a used mask. The ethical thing to do would be to clean the mask properly and use it for mask fittings, donate these masks to those patients that cannot afford one or donate these masks to local low income clinics.
Most reputable providers use sample masks for fittings. If it works out then you should be sold a different mask of the same kind. Samples should never be sold.
The 30 day trial does apply to each and every mask as long as the replacement is not just a size change.

I wanted to give an update concerning my DME and the mask thing. He called me last week and said that my Medicare compliance was completed, and that I could bring the wireless modem back to him. He told me that I am allowed to keep both of the masks that I had been trying out(Mirage softgel and Swift FX). So apparently my DME doesn't disinfect masks that have been worn previously, to give to other patients for their mask fit trial. I started CPAP on March 22, so around June 22 I will be able to get a new mask with my insurance. If the cushion part of the mask goes bad before the 3 months is up, I'm able to get another cushion, but I'm not sure what the exact details are concerning the time period?

The DME also had a printed report for me of the data(AHI, leak, etc.) from my S9 Auto set from the past 30 days, and he said he had sent a copy to my sleep doctor too. Unfortunately, I doubt my sleep doctor even looks at data like that, since he was the one who had originally wrote the prescription for me to have the bare bones PR System One Plus machine. Though, at least it goes to show that there are some DME's out there that think a patient should be supplied with a fully data capable machine. Also, another negative, (and this is the worst one) is that I'm not feeling any better at all since starting CPAP. Even though my AHI and leak numbers have been good, I'm still exhausted and sleepy the whole day, with short term memory issues. I see my sleep doctor next week.

I just brought home a shiny new ResMed S9 Elite yesterday, so my experience with the DME is pretty fresh still. The two big ones from yesterday were:

1) A billing agent who was completely incapable of properly calculating my bill. I actually had to walk her step by step through the calculation in order to ensure that she got it right. I was glad that I had had several phone conversations with this woman before I showed up so that she actually had the right info in front of her to do the math.

2) "Normally the insurance does a 3 month rental and then they buy it for you." I spoke directly with my insurance on several occasions and they assured me in very specific terms that for patients already on CPAP therapy, they buy out-right with no rental period. In the case of a switch from CPAP to BiPAP they authorize a 1 month rental trial to make sure that the patient can adapt to the treatment. The DME folks seemed quite out of sorts and almost angry with me that I was insisting on buying the machine rather than doing the customary 3 month rental first.

Before I get to the next one a question: Do RTs typically wear scrubs? That was my assumption, but the person I met with to get the amchine set up did not so I'm confused. I also think she might have managed to distract me long enough to hide away the pillow sizes of my new Swift FX mask that I "wouldn't need". I need to check that after work today.

3) Perhaps the biggest whopper was when I asked the RT if the EPR setting was something I could adjust myself. Her response: "Hmmm... no, uh, uh. Sorry that's not something you can do." Seemed to me that something like EPR, which is strictly a comfort feature, should be adjustable by me. Yeah, turns out it is.

Aditional gripes, but not outright lies: When I picked up the gear, I got about a minute or two to try out the mask and the EPR setting to see if it was going to "work for me". Nothing obvious, but the conditions were nowhere near what you would expect to actually use the machine in. So time for bed. I get myself situated and try to get used to the EPR set on 3 - "it's the most confortable setting", said the DME. Granted I'm coming from an old REMstar that has no pressure relief/flex technology or anything so I'm used to getting the same pressure all the time. Anyway, in the course of 10 minutes or so the smae thing happens about 3 times: on the verge of falling asleep and I wake up with a gasp because it feels like there's not enough air flowing.

So at 11 at night I went online to my new favorite CPAP resource (right here! of course) to find the clinician manual and the secret to unlocking the clinician menus on the machine. A few minutes later I was good to go, tweeked the EPR setting down to 1 and got what felt like a good night's sleep though a bit shorter than I would have liked. This morning I had to consult the clinician manual again as the DME had set it up to not show me anything other than usage data (what a waste!) on the screen. Basically they had dumbed it down as far as they could before handing it over. I don't know what I would do without all you folks and your wealth of experience!

Until I was able to fix that, I had visions of the DME having switched name plates between an S9 Escape and an Elite so they could give me the cheap one without me being the wiser. I think I've at least managed to put that concern behind me now. So for the first time in almost 6.5 years of therapy I had an AHI to look at when I woke up: 2.7 which seems like a fairly decent number. So that was probably longer than you needed, but there ya go.

Good job Snardo.

Don't you just hate being treated like you have no common sense and are a 3 yr old? I hate that worse than I hate the lies.

Better look for those pillows "you won't need" she probably kept them to resell to someone. I actually find I can use the Small and XSmall just fine. Gives me another pillow on hand if I need it. The Medium I trade for one I can use with members here on the forum. Helps them out, helps me out and keeps DME from keeping them. In all fairness to the DME that I use, he has never kept the extra pillows. He has always given me all the pillows when I get a new mask. I never even have to ask about it or worry.

snardo wrote:I just brought home a shiny new ResMed S9 Elite yesterday, so my experience with the DME is pretty fresh still. The two big ones from yesterday were:

1) A billing agent who was completely incapable of properly calculating my bill. I actually had to walk her step by step through the calculation in order to ensure that she got it right. I was glad that I had had several phone conversations with this woman before I showed up so that she actually had the right info in front of her to do the math.

2) "Normally the insurance does a 3 month rental and then they buy it for you." I spoke directly with my insurance on several occasions and they assured me in very specific terms that for patients already on CPAP therapy, they buy out-right with no rental period. In the case of a switch from CPAP to BiPAP they authorize a 1 month rental trial to make sure that the patient can adapt to the treatment. The DME folks seemed quite out of sorts and almost angry with me that I was insisting on buying the machine rather than doing the customary 3 month rental first.

Before I get to the next one a question: Do RTs typically wear scrubs? That was my assumption, but the person I met with to get the amchine set up did not so I'm confused. I also think she might have managed to distract me long enough to hide away the pillow sizes of my new Swift FX mask that I "wouldn't need". I need to check that after work today.

3) Perhaps the biggest whopper was when I asked the RT if the EPR setting was something I could adjust myself. Her response: "Hmmm... no, uh, uh. Sorry that's not something you can do." Seemed to me that something like EPR, which is strictly a comfort feature, should be adjustable by me. Yeah, turns out it is.

Aditional gripes, but not outright lies: When I picked up the gear, I got about a minute or two to try out the mask and the EPR setting to see if it was going to "work for me". Nothing obvious, but the conditions were nowhere near what you would expect to actually use the machine in. So time for bed. I get myself situated and try to get used to the EPR set on 3 - "it's the most confortable setting", said the DME. Granted I'm coming from an old REMstar that has no pressure relief/flex technology or anything so I'm used to getting the same pressure all the time. Anyway, in the course of 10 minutes or so the smae thing happens about 3 times: on the verge of falling asleep and I wake up with a gasp because it feels like there's not enough air flowing.

So at 11 at night I went online to my new favorite CPAP resource (right here! of course) to find the clinician manual and the secret to unlocking the clinician menus on the machine. A few minutes later I was good to go, tweeked the EPR setting down to 1 and got what felt like a good night's sleep though a bit shorter than I would have liked. This morning I had to consult the clinician manual again as the DME had set it up to not show me anything other than usage data (what a waste!) on the screen. Basically they had dumbed it down as far as they could before handing it over. I don't know what I would do without all you folks and your wealth of experience!

Until I was able to fix that, I had visions of the DME having switched name plates between an S9 Escape and an Elite so they could give me the cheap one without me being the wiser. I think I've at least managed to put that concern behind me now. So for the first time in almost 6.5 years of therapy I had an AHI to look at when I woke up: 2.7 which seems like a fairly decent number. So that was probably longer than you needed, but there ya go.

If a person has been using a CPAP and is just replacing a unit from wear and tear or maybe switching to a different insurance then most will allow the outright purchase of the CPAP. But, for persons new to this therapy then most require a compliance period modeled after Medicare. The compliance rate used to be around 40% for beginners. While I have not seen any recent data I believe insurance companies are still of the opinion that, due to the poor compliance rate, a rental period prior to purchasing the unit is prudent. Believe me, I would love to sell CPAPs rather than rent to own. This is less billing, tracking, etc.

RTs are not required to wear scrubs but I think it is more professional so I require them to. As far as the EPR setting for your Resmed unit this can be a problem. We have complained to the Resmed representative about this as there is no reason not to allow this.

I find it very odd that the RT would not let you have all the pillows that came with the mask. Maybe, she thought you would develop issues using the wrong size?

Leejbgt, do you own or manage a DME company?

I find it very odd that the RT would not let you have all the pillows that came with the mask. Maybe, she thought you would develop issues using the wrong size?

I would guess that the DME is reselling the other pillows as individual pillows. I think that happens quite often--we've seen people here state that they were only given one set of pillows by the DME (package opened to remove the "unneeded" sizes) and told they could purchase additional sets at $22 or more apiece. Meanwhile the DME has "parted out" a mask that comes packaged together and gets two pillows to sell for pure profit besides.

Another question, what happens to all those used machines from people who do not meet the compliance requirements? They must go somewhere? We surely don't see DME's selling lightly used machines at a discount! Are they cleaning them up and reselling them as new, or what???

I have to post this one, even though the problem was mine.....

First the set-up: I got a call from my DME about a necessary change-over to a new type of machine (CPAP to VPAP). It was a long process, as my insurance company was initially going to purchase the machine outright and before a change could be made the DME had to work with the insurance group to decide how the first machine was going to be handled. In the end, they all made friends (after a time) and the insurance company set up a lease/purchase for the new machine using a 10 month payment process. This costs a little more in the long run, but makes sure that another change isn't costly for anyone. I was set to pay 10% of this monthly lease/purchase (again, no issues and I knew the new machine was going to cost something)...

Now the whopper: The DME's go to lady (she is the poor soul that has to call people and tell them their machine costs and set up appointments for delivery) called me to let me know the final decision and the final costs. She was not given a full sales price, so she gave me the monthly break-down in payments (mine and the insurance company's). I brought up my calculator and decided I'd calculate the end cost (because I'm a member of cpaptalk.com and an informed customer).

When I did the calculation, darned if I didn't multiply by 100, rather than 10... My next words were.... "THE COST OF THE MACHINE IS WHAT? I hope you can sleep at night because I'm not going to sleep if this thing costs that much? Heck, my portion of this scam is more than the machine costs you guys and if you're billing the insurance company 10x more than I'm paying it's theft??!!" I quickly hung up on our poor soul from the DME office and started to dial the insurance company direct, thinking that my insurance company committed to many thousands of dollars for a VPAP machine. Before getting thru, I noticed my calculation error....

Being a respectful person, my next call was to our poor soul at the DME that put up with my frustration. I did a very direct and sincere apology to explaine the error in my calculation. I guess she had a good sense of humor, as she laughed and said she would have also been upset if she thought the price was that much.

In the end, I guess I gave them a good story for the DME to post on some DME web site under "Whoppers I've heard from CPAP users"...

Bandnuts wrote: In the end, I guess I gave them a good story for the DME to post on some DME web site under "Whoppers I've heard from CPAP users"...

Wonder if there is such a website. I used to do some computer help on another forum.. some of the questions were out of this world. Like "how do I turn my computer off and on?" Duh, how'd you get here? stuff like that.

I used to have a little gif that I used often. Mr Smiley guy banging his head against the wall. I sometimes want to use it here too. Can't find it though. Not the same one, it was special...

My RX was written for a bipap auto sv and a F&P Eson nasal mask. First of all, it took Lincare nearly 2 months to get me my machine because they sold the one they ordered for me to someone esle. When I finally went in to pick up my machine and get fitted for my mask the RT told me that the mask my doctor prescribed would not work because my pressure was too high and that I needed a full face mask. I had terrible problems with dry mouth using this mask and subsequently did not use my machine much. I called my RT to consult with her about my problem and was told I simply needed to turn my humidifier to a higher setting and if that didn't work to buy an additional humidifier to go in my room. A couple weeks later it was time for my checkup with my doctor. He requested that I bring my sleep data with me and that I needed to have the report printed out by my DME. I took my data card in and was presented with a report that, as I know now, was basically a report of my compliance. I was expecting something more detailed so I asked if that was all the information available and I was assured that it was. Anyway, I get to my doctors appointment and tell him about the problems I was having and he tells me that from what little he can tell from the woefully incomplete report was that my problems were being caused by my mask leaking and that it didn't matter how many humidifiers I had it wasn't going to solve my problem because of the amount of air that was flowing through. I went back and got the mask I was originally prescribed and my problem went away and I was able to sleep all night.

More recently, I stopped by to ask about my machine noise. It seems to be unusually loud. They offered for me to bring it in and test it which I thought was great. Well, their method of testing it was to just turn it on and let it run for a few hours which was of zero help because its not too terribly load when it is providing constant pressure. Also, I was told by a different RT that the machine I have is the only one available for the type of machine I was prescribed... not true... and when recanting my story about the full face mask problem I was given the same useless humidifier advice.

Sorry, I know that's kind of both slam Lincare and whopper story but that's my experience with my DME.

at the age of 29, and healthy, i was experiencing nighttime awakenings, gasps, and strange sensations in breathing and pulse.

I saw 2 primary care doctors who told me they didn't think I had sleep apnea.

I then went to one of the "better" sleep facilities in the twin cities. Their head doctor laughed at me as if i were an IDIOT, for telling him that after tons of research, I suspect I might have central apnea. He said that CSA is usually only seen in babies or really sick people who have cardiac or brain issues. He told me he wouldn't advise a sleep study.

Well, I had a sleep study done anyways. Midway through the night the tech came in while I was awake and said verbatim: "well, you certainly do have central sleep apnea"



After I was diagnosed and in a meeting with the doctor who owns the clinic, he told me and my family that apnea will not kill me. He said, and I quote "Central apnea won't kill you, but CPAP will help you age a little more gracefully"

He also told me that he didn't think an ASV was needed, and that BiPap should be sufficient to treat my CSA. I had to be very stern with him that I wanted an ASV.

It's sad to keep hearing confirmation of such spectacular ignorance.

The manufacturers used to ship clinical manuals with machines. I believe the FDA stopped that and they no longer do it. My recent machine of last week, Resmed AirCurve 10 VAuto I requested the manual. He did not bring one. He did show me how to access the setup. (Simple) I got the manual from here however. Even the manuals don't tell all. It does have wifi built into the machine to send data. Guessing they would be SOL if one didn't have wireless Internet? Would have to read the card. I did ask about a card and he said it did not have one. I open the side door and said what is this then? He said oh, I guess it does. I suppose he is the one that put it in. I did tell them what machine I wanted and they ordered it. Not sure what Medicare will pay yet on the rental. He did mention after the compliance it didn't matter so it must probably be the first 3 months. I know the rules are constantly changing. I was surprised at getting the Auto but they are the same price when purchased online. Now, one Internet supply provider told me according to FDA they do not come with a manual. At cpap, they agreed but said they could email it to me. Big difference in the two, the first did not mention emailing me a copy. My last machine I could have purchased here for $1500 but the DME charged Medicare about $3500 with me paying above $700-$800 of that over a year. No one ever checked compliance then. This DME also gave me the providers manual. They tell me DME's bid on Medicare contracts now. My previous provider which I liked said they lost their contract, Hi-Tech Healthcare. I guess now I need a head band I can wear from chin to head to keep my mouth closed at night so it will stop reading mask leaks.

sthnreb wrote:It does have wifi built into the machine to send data. Guessing they would be SOL if one didn't have wireless Internet?

It is not a WiFi modem and does not use your Internet connection. It uses the cellular network like a phone instead assuming it was configured and an account was setup to use it.