HELP!!! I think the DME is lying to me again!

cowlypso wrote:The other funny part is that the RT was kind enough to set the new machine to my prescribed CPAP pressure of 10. Which he did by setting it on Auto, min 10, max 10... No worries, though, I'll be changing that anyway, back down to 8.5.

You realize that your RT is a licensed healthcare provider that is obligated to follow the physician's prescription when setting your device, right? Why is it "funny" that the RT adheres to the laws governing his license?

Do you also expect the pharmacist to give you whatever dosage of medication you think is best regardless of the prescription the physician provided? What is stopping you from contacting your physician to ask for a prescription for an autoset with varying min/max levels instead of the 10 cmh20 the physician has prescribed?

ltts wrote:

cowlypso wrote:The other funny part is that the RT was kind enough to set the new machine to my prescribed CPAP pressure of 10. Which he did by setting it on Auto, min 10, max 10... No worries, though, I'll be changing that anyway, back down to 8.5.

You realize that your RT is a licensed healthcare provider that is obligated to follow the physician's prescription when setting your device, right? Why is it "funny" that the RT adheres to the laws governing his license?

What's funny is that the RT chose to use APAP mode to set up the fixed pressure instead of just using the machine's built-in CPAP mode. Most RTs will first set the mode to CPAP and then set the (one) pressure setting to 10.

ltts wrote:No one wants them? Actually most patients don't have a clue about the deluxe features posters here think they need, and they do just fine with the basic machines that are covered by their insurance payers.

And you are not paying for the machines. The insurance company you freely elected to engage with is paying. That is why they call the shots. If you were paying you could call the shots. But you're not.

What is mind boggling to me is that you seem to think DME providers should just pay the difference out of their pocket because you are engaged with an insurance company that finds no medical necessity in these added features. I do tend to believe that a PAP patient's pressure level does change over time, mostly because they continue to gain weight, so autoset is helpful. And guess what? It saves the insurance company money in that you don't have to have a repeat study every few years to ascertain that.

But when did that become the DME provider's problem and why? Can anyone here explain why a DME provider should continue to provide more expensive machines even as insurance payers markedly decrease their reimbursement rates when the payers themselves don't require the DME to provide these more expensive features? I'd love to hear the rationale for that.

You can get as angry as you want, and scream to the high heavens, but that doesn't make your argument rational.

Sheessh... you have truly lost the plot. There you go again with the "deluxe features" drivel..
Please.. quit it now, you've proven already your nothing but an incompetent troll.

It's the end users who pay the insurance companies. therefore we all pay for the machines.. DME's are just a proxy.

End users have a right to be supplied with the equipment they damn well need for AND are paying the insurance companies for.

If the insurance companies aren't providing enough to cover the costs of these machines, take it up with them on our behalf instead of being an idiot about it.
If there is no law against charging extra for these so called "deluxe" machines, do it..

Just stop trying to offload these pieces of CRAP off on users that aren't suitable for keeping the door open let alone someone's airway.

Take your moaning to the insurance companies, who are screwing you and your clients..
It's idiotic trying to push the blame for your failings on frustrated users!

Stop trying to feed us your drivel!

LTTS: I don't know where you got the idea that I browbeat the DME into giving me an unnecessary upgrade that they are going to have to pay for out of pocket... I walked in with a broken PRS1 Auto that was less than a year old, and I left with a new PRS1 Auto. Absolutely no upgrade involved, other than that they new machine happened to have a more recent version of the firmware installed. But the two machines otherwise were exactly the same and had the same retail value.

I also gave the DME two reasonable options. Since my machine that I was told was new when I got it (it wasn't - they lied to my face to make a sale), I asked that they either have my machine repaired and returned to me, or that they provide me with a new machine. I would have been fine getting my original machine back after repair, if that's the route they wanted to go. They chose to give me a new machine instead.

I do get where the DME is coming from in not being able to give every patient a new machine, since many of them will not meet the 3-month compliance. But why can't the DME have a pool of "compliance machines" that they use for the first 3 months? Then, after 3 months, if a patient has met compliance, they get the option to turn in the used machine and take home a brand new machine to use for the next 4 years and 9 months until insurance will pay for a new one. Sure, it would mean more paperwork for the DME, but it would serve patients better. It isn't fair to the patient to stick them with a machine that's already 2 years old and expect it to last them another 5 years without problems.

ltts wrote:I consult with DME providers and my company manages the billing process for some of them

Quibbles. Consultant, employee... you are in the billing BUSINESS. You have stated numerous times, you are on the other side of the dynamic... whereas we are patients trying to get adequate treatment. It is not your job to care whether we get adequate treatment. It is not our job to care about your business hardships. This is not a forum for the billing business. This is a forum for patients.

You are not going to convince anyone on here to change their behavior.

This is not a rhetorical question... I really do want to know, why do you come somewhere you are not welcome to try to change the minds of people who will not change their minds?

LTTS wrote:I've been doing DME insurance billing for 25 years

So, I guess the Question is:

Do you have 25 years of experience OR do you have 1 year of experience 25 times?

I would humbly suggest the latter. Think about the significance of that.

I am in a large BCBS PPO plan.

There are 6 DME providers within 5 miles from me that accept my plan.
If I extend that radius out to 20 miles, there are 27 DME providers that accept my plan.
WHY - Because they want the access to the thousands of participants in that plan.

They don't have to be providers if they do not want to.
But, by being providers they agree to the rates BCBS has set.
IMHO the rates set by BCBS are reasonable for the equipment one gets.
After all, CPAP, APAP, & other machines are really quite simple contraptions & don't cost that much to make.
If the DME providers don't think they are making enough money, let them discuss that with ResMed & Respironics, etc. & get them to reduce the cost of the machines to the DME providers.

I have been on CPAP for 13 years & just purchased my 3rd machine in late December 2011.

BCBS has never required "rent to own" for me, but when they do "rent to own" that person is given a new machine. If the patient is not compliant, the DME provider takes that machine back & uses it as spares during warranty work & they actually do "rent" some of them out to patients who are no longer in warranty but whose machine requires repair.