Interesting phone call from the DME today.....

So I'm at work this afternoon and my cell phone rings. It's the DME saying my doctor had ordered an overnight oxygen saturation test to make sure my CPAP settings are correct and that they need to drop off this thing I need to wear on my finger overnight. I'm new at this and from reading here know that this is a valid test but I was really busy and didn't want to take the time to figure out when I could take off work to meet them so I blew them off for a few days. I got to thinking about it and it just didn't pass the smell test so I called my doctor's office. They said that there were no orders in my chart since November 12th when he ordered the CPAP titration test.

So - any devious ideas on how to deal with them? McSnoresalot - can I borrow some pepper spray when you're done with it?

Randy

Devious ideas? Right up my alley! Maybe I’m just in a bad mood, but I’d be inclined to “give them enough rope to hang themselves”.

In theory, what would happen IF:
a.) you allowed them to do the test, then
b.) let them bill your insurance (or medicare). After which
c.) ask them for written proof of your “doctors order” for the test. Then
d.) turn them in for insurance fraud.

The RT at the DME may just want proof in the files that O2 has been normalized, and may not plan on billing anyone. Either way, they shouldn't have a problem explaining to the patient what or who is prompting the test, I wouldn't think.

It could just be a DME trying to get one more bill in before the end of the year. Is it one of the big national DME's? We had one that told us that we had to do this test or they were going to take the concentrator away. Checked with my insurance company and they did not have that requirement, stated that the sleep study documentation from a hospital stay documented the need. Would not need to re-certify the need for 6 months.

Ask for a written copy of the order first, or it may get denied by your insurance.

Dave

I requested an overnight oximeter test from my DME about 4 months into therapy. They got the okay from the doctor and it was done. I never saw a bill for it. Never received any notice about insurance paying for it.

When in doubt ask if there is a charge for the service or not.

Perhaps it is just part of their follow up to make sure things are going well. It could be a money machine and it could just be thoughtful service. We seem to think the worst..and I fully understand why but there are a few good honest hard working and caring DMEs out there..
So just ask how much the charge is for this overnight test. Ease your mind.

retrodave15 wrote:It could just be a DME trying to get one more bill in before the end of the year. Is it one of the big national DME's? We had one that told us that we had to do this test or they were going to take the concentrator away. Checked with my insurance company and they did not have that requirement, stated that the sleep study documentation from a hospital stay documented the need. Would not need to re-certify the need for 6 months.

Ask for a written copy of the order first, or it may get denied by your insurance.

Dave

If I remember your previous posts correctly Dave it's a national company you're familiar with - Lincare.

Randy

jnk wrote:The RT at the DME may just want proof in the files that O2 has been normalized, and may not plan on billing anyone.

OK - I'll give you that. But why did they say *my doctor* had ordered the tests?

Randy

I've got an email in to my insurance company making sure this isn't something they've asked for although I've been in pretty good contact with them and they've never mentioned anything like this before.

Randy

Then again, something sounds vaguely familiar . . .

http://www.crowell.com/pdf/medicaldevic ... rvices.pdf



(DMEs have been accused of participating in scams involving oximetry before, although the above is more specifically related to a case involving accusations of billing Medicare for full diagnostic tests when docs thought they were only ordering oximetry tests for people needing home O2, I think.)

Randyp1234 wrote:I've got an email in to my insurance company making sure this isn't something they've asked for although I've been in pretty good contact with them and they've never mentioned anything like this before.

Randy

Confirmed that this isn't something my insurance wanted.

Randy

I thought this thread "smelled" like the the antics of Linn Care. One of the best things about this forum is the knowledge we spread. If we fight back against these practices; the care and customer service will be better for everyone, as the rotten apples will be weeded out. It may not be a symptom of an overall culture of corruption at Linn Care; but a few overzealous local managers that are trying to make or improve their numbers for the month or year.

Talk with your insurance company to let them know what is going on. I bet they have an internal audit program to look at the billing practices of a provider. My wife worked for a provider that went through a insurance audit, they passed, but it was the worst 3 weeks of her life.

Dave

I recall this same situation being posted by another member in the last year. I wonder how many times they get by with it.
My Dad had an overnight oximetry and it was billed at over $300.00, for one night and the data was "inconclusive".

Hopefully I'll have a chance to call Lincare tomorrow and ask them how much this is going to cost and to tell them I want faxed copy of "my doctor's" orders.

Randy

We always hear about the bad DMEs. There are good and honest ones out there. We need a user supported rating service for DMEs. That way we can report on The Good, The Bad, and The Ugly.

In central Ohio-
My wife had a bad one - Linn Care
I got to a good one: HomeReach

I have heard good things about DASCO

With information like this, people can vote with their feet and the market will take care of the bad ones.

The other issues are, the rules that apply to big pharma and the reps that would wine and dine the doctors offices for business do not apply to DMEs. Linn Care spreads lots of lunches around the doctors offices. The Cardiologist my wife worked for routinely dropped off lunch for the office staff. When it comes to what DME gets the script faxed to it's the office staff that sends it out and not the doctor. The doctors are just to busy to worry what DME got an order for a CPAP.

Dave

Good Luck and let us know!