Let's clear up some misinformation

ltts wrote:There is no such thing as an online "DME" - online medical equipment companies are companies that are simply unregulated internet shopkeepers, and the majority are operating outside of federal and state regulations.

ltts wrote:No DME is taking anything out on the users. The honest ones are simply confronting you with the actual facts that your insurance company dictates. I personally think each and every DME supplier should tell you the honest truth -- that your insurance company will not pay for the deluxe features you want or believe you need.

Y'know, I don't give a fig about the problems DMEs have with insurance companies.

What I care about is whether or not the DME and its employees can be bothered to do their jobs.

I use a Bipap ASV. It's a blasted expensive machine, but it's what I need. My insurance covered it. In full. No co-pay required. I also monitored the payouts (not what was billed, what was paid) and the DME was paid more than the on-line full price of that machine. So they didn't get screwed over for providing me a "luxury" machine. My doctor, btw, receives a complete set of PDF files, with daily details every time I see her.

What my DME can't get through their heads is SERVICE. Customer SERVICE. This means, when I call and order a new strap for an currently made Respironics mask, they order it, and get it to me. They don't tell me "I can't find it in the system, so you're not allowed to order it." (My insurance disagrees.)

It means when I call and order new nasal pillows for a currently made Respironics mask, they order it and get it to me. In one piece. They don't stick it in a paper envelope and post it, and then expect me to drive 30 miles across town to return the mangled, useless wreck to them. (My insurance was displeased when the DME tried to bill for two sets of nasal pillows in the same month -- I explained what had happened. No, I was not responsible for the wrecked set of nasal pillows: it was their incompetence, so they paid for them.)

It means when I call and order a new data card for my machine -- because whatever you think about efficacy data, it's important to me, and critical to my therapy -- they order it and get it to me. They don't send me the entire card reading unit which goes into my Bipap ASV to record the data. One of those came with my machine. The card retails for around $13. The card reader is around $99. My doctor, btw, receives a complete set of PDF files, with daily details every time I see her.

It means that when I call to order ANYTHING necessary to my therapy, which is covered by my insurance, they order it and get it to me.

The insurance covered brick and mortar DME takes ten days to two weeks, with multiple phone calls to fill any order. (And at least half of the calls are trying to get me to put a credit card number on file "in case your insurance doesn't cover it." I've told them if the insurance doesn't cover it, I won't buy it from them.)

In the three years plus I have suffered with this DME, they have managed to get one, count it, ONE order correct.

For my most recent order, I was told, flat out, that "It's not in the system. You can't order it." So I wrote to Respironics and explained that this DME was declining to sell me their products, products which were readily available. Could their local representative do something about this? Six hours after I sent the email, I had a call from the branch manager explaining that he'd found the "glitch" in the system and that my products were now on order. Uh-huh. I'll lay odds that three months from now, there's another "glitch."

So yes, I do begrudge them their profits, because they waste ten to fifteen hours of my time with every order. Speaking as a person who has worked in customer service since 1979, I know what customer service is. And what I'm getting from my DME is not customer service. It's run around.

Because the employees of this DME do not know what they are doing, it is necessary for me to protect myself from their malpractice by knowing the ins and outs of my machine. I purchased, out of my own pocket, a second ASV because if something happened to mine, my DME would take at least a month to replace it, and I can't sleep upright in a chair that long. I have three back-up masks and several sets of nasal pillows. I have extra straps, hoses, and everything else. All out of pocket.

Because my health is important to me. Far more important than any DME's bottom line.

And it's thanks to the knowledgeable people on this Forum that I could do this.

If my insurance didn't have a contract with "my" DME, I would vote with my feet, and go to the nice little DME a few blocks over with the polite staff, the fitting area for masks, and equipment in the store.

As it is, I continue to battle DME incompetence. And when I need something and don't have the energy for a battle, I pick up the phone and call my online DME. They know their products. Make helpful recommendations. Send the product out the same day I order it, and it is on my doorstep within two days. Not only that, it's the correct items, the ones I actually ordered! Amazing, isn't it? Genuine customer service DOES exist!

Sounds like there are many problems over there in the states, over here we have the NHS, you phone the hospital and tell them what you want and they give it to us. If you want to change your mask to a new one or a new model then no problem, we just ask. I really glad I dont have to go through any Insurance comapanies. Sounds like someones getting ripped off.

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jnk wrote:the poster actually seems to think he or she is making sense and seems sincerely delusional and unable to see how the arguments made come across to customers/patients like us.

Yes, that was fascinating.

The stated goal of the OP was to:

a) get us all to call our insurance companies,

b) demand that they renegotiate their reimbursements upwards

c) and have the insurance companies actually agree to do so.

.....

Does anyone here think that the OP motivated a single person here to commit that astonishingly futile act?

Does anyone here think that even the OP believes that they motivated a single person here to commit that futile act?

Wow.

I hope the OP is paid by the word.



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jnk wrote: But the arguments made here about how to "maximize profits" strike me as just this side of evil

Wait till you meet a cardiologist with a hard-on for a new Porsche™.



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ems wrote:Wait a sec... my doctor wrote a script saying exactly what machine I should have. That was the beginning and the end of it. I then went to the DME to try on two masks, and came home with the exact machine the doctor had ordered and a mask. The DME followed her orders to the letter. They had to. Didn't they??

I think the DME has the option to refuse to fill the prescription. If he fills it, he must follow the prescription.

He may have a contract with the insurance company or medicare to fill certain types of prescriptions.

For instance, he might not carry ResMed machines and would turn down a prescription that says ResMed. He could simply say he's not going to supply that machine because he's not reimbursed enough. He may even have the option to say he chooses not to business with a particular patient because he doesn't like them.

The insurance contracts seem to say he won't be reimbursed more than $X for billing code Y. I don't know if the insurance company mandates he must provide a particular model machine just because it's under billing code Y. (It's possible, but I don't know.)

The insurance companies apparently DO mandate certain things, such as compliance recording machines.

According to ASAA:

"More sophisticated machines with higher costs are not always automatically covered by insurance but may be covered with a specific physician prescription and documented failure to respond to standard PAP treatment. Some machines can . . . record if you had any apneas while using the machine (this can indicate a need to adjust the pressure). Your doctor may want to download this data periodically to verify the adequacy of your treatment."-- http://www.sleepapnea.org/diagnosis-and ... chine.html

So it looks to me that if the DME gives you a hard time about getting an AHI-data machine because of your insurance, simply get the doc to write it on the prescription. If that doesn't work, ask how long you need to 'fail to respond to' your PAP treatment in order to get the machine you need.

Kiralynx wrote:

ltts wrote:There is no such thing as an online "DME" - online medical equipment companies are companies that are simply unregulated internet shopkeepers, and the majority are operating outside of federal and state regulations.

ltts wrote:No DME is taking anything out on the users. The honest ones are simply confronting you with the actual facts that your insurance company dictates. I personally think each and every DME supplier should tell you the honest truth -- that your insurance company will not pay for the deluxe features you want or believe you need.

Y'know, I don't give a fig about the problems DMEs have with insurance companies.

What I care about is whether or not the DME and its employees can be bothered to do their jobs.

I use a Bipap ASV. It's a blasted expensive machine, but it's what I need. My insurance covered it. In full. No co-pay required. I also monitored the payouts (not what was billed, what was paid) and the DME was paid more than the on-line full price of that machine. So they didn't get screwed over for providing me a "luxury" machine. My doctor, btw, receives a complete set of PDF files, with daily details every time I see her.

What my DME can't get through their heads is SERVICE. Customer SERVICE. This means, when I call and order a new strap for an currently made Respironics mask, they order it, and get it to me. They don't tell me "I can't find it in the system, so you're not allowed to order it." (My insurance disagrees.)

It means when I call and order new nasal pillows for a currently made Respironics mask, they order it and get it to me. In one piece. They don't stick it in a paper envelope and post it, and then expect me to drive 30 miles across town to return the mangled, useless wreck to them. (My insurance was displeased when the DME tried to bill for two sets of nasal pillows in the same month -- I explained what had happened. No, I was not responsible for the wrecked set of nasal pillows: it was their incompetence, so they paid for them.)

It means when I call and order a new data card for my machine -- because whatever you think about efficacy data, it's important to me, and critical to my therapy -- they order it and get it to me. They don't send me the entire card reading unit which goes into my Bipap ASV to record the data. One of those came with my machine. The card retails for around $13. The card reader is around $99. My doctor, btw, receives a complete set of PDF files, with daily details every time I see her.

It means that when I call to order ANYTHING necessary to my therapy, which is covered by my insurance, they order it and get it to me.

The insurance covered brick and mortar DME takes ten days to two weeks, with multiple phone calls to fill any order. (And at least half of the calls are trying to get me to put a credit card number on file "in case your insurance doesn't cover it." I've told them if the insurance doesn't cover it, I won't buy it from them.)

In the three years plus I have suffered with this DME, they have managed to get one, count it, ONE order correct.

For my most recent order, I was told, flat out, that "It's not in the system. You can't order it." So I wrote to Respironics and explained that this DME was declining to sell me their products, products which were readily available. Could their local representative do something about this? Six hours after I sent the email, I had a call from the branch manager explaining that he'd found the "glitch" in the system and that my products were now on order. Uh-huh. I'll lay odds that three months from now, there's another "glitch."

So yes, I do begrudge them their profits, because they waste ten to fifteen hours of my time with every order. Speaking as a person who has worked in customer service since 1979, I know what customer service is. And what I'm getting from my DME is not customer service. It's run around.

Because the employees of this DME do not know what they are doing, it is necessary for me to protect myself from their malpractice by knowing the ins and outs of my machine. I purchased, out of my own pocket, a second ASV because if something happened to mine, my DME would take at least a month to replace it, and I can't sleep upright in a chair that long. I have three back-up masks and several sets of nasal pillows. I have extra straps, hoses, and everything else. All out of pocket.

Because my health is important to me. Far more important than any DME's bottom line.

And it's thanks to the knowledgeable people on this Forum that I could do this.

If my insurance didn't have a contract with "my" DME, I would vote with my feet, and go to the nice little DME a few blocks over with the polite staff, the fitting area for masks, and equipment in the store.

As it is, I continue to battle DME incompetence. And when I need something and don't have the energy for a battle, I pick up the phone and call my online DME. They know their products. Make helpful recommendations. Send the product out the same day I order it, and it is on my doorstep within two days. Not only that, it's the correct items, the ones I actually ordered! Amazing, isn't it? Genuine customer service DOES exist!

No DME is under any obligation to carry any make and model of supply you want. None. Your insurance company has made you captive to a limited number of DMEs by not allowing others to be in network with them and send a claim. In exchange for that exclusive contract they have demanded / set rock bottom prices for DME reimbursement. And with rock bottom prices come rock bottom service and product selection. it's economics 101, and you have your insurance company to thank for it.

rocklin wrote:.

jnk wrote:the poster actually seems to think he or she is making sense and seems sincerely delusional and unable to see how the arguments made come across to customers/patients like us.

Yes, that was fascinating.

The stated goal of the OP was to:

a) get us all to call our insurance companies,

b) demand that they renegotiate their reimbursements upwards

c) and have the insurance companies actually agree to do so.

.....

Does anyone here think that the OP motivated a single person here to commit that astonishingly futile act?

Does anyone here think that even the OP believes that they motivated a single person here to commit that futile act?

Wow.

I thought this was worth repeating.

I am still wondering why Ltts is putting all this time and energy into this thread. Ltts, can you tell us why you are doing this? I ask out of curiosity. I like to know the "why" behind seemingly inexplicable human behavior.

Ltts wrote: . . . rock bottom service and product selection. it's economics 101 . . .

Again, you make our points beautifully for us: It is better to order online than to be stuck with the brick-and-mortar DMEs that give rock-bottom service and product selection.

You can't argue that it is right for brick-and-mortar DMEs to charge more in order to provide product and service and then explain that they do not provide product and service, even if you blame insurance for that fact.

@ResMed:

Do you hear that, ResMed? Brick-and-mortar DMEs do not offer support, service, machine selection, or any help to patients, as ltts has just explained to us here. So why have you positioned yourself at the head of that cartel by enforcing minimum online pricing for Internet dealers, when it is the brick-and-mortar DMEs who refuse to be helpful to patients? Are you ready to fix the silly statement you make here:

http://www.resmed.com/us/dealers/intern ... nc=dealers

"The price you pay for medical equipment includes not only the cost of the products, but also the cost of the medical care you receive. . . . Charging a minimum price for the equipment they sell helps ensure they have enough resources to support their patients. . . . We are concerned that some dealers may sacrifice patient care in order to cut costs. The risks are especially high with Internet dealers . . . We want to do what we can to protect patients from these situations, and our Internet policies were designed for that purpose. . . . If you are not satisfied with the service and care you have received from your equipment dealer, we urge you to talk to your doctor and/or sleep lab. Your doctor and/or sleep lab can be an important check and balance on the service your dealer provides. In addition, if a dealer is giving poor patient service, your doctor should know in case they have other patients who might also be affected. . . . The decision to impose Internet policies is a choice we made in order to help protect patients now and in the future. . . . Our goal is to promote and support high standards of patient care well into the future."

That part that I put in red is rubbish, ResMed. Pure rubbish. Now we have established that the risk is not the Internet dealers. It is the brick-and-mortar DMEs who refuse to offer support or product selection. YOUR products. Please stop your policies which support the people giving the least amount of support to patients and who, instead, lie. Allow market forces to decide what Internet companies can charge for your equipment.

snuginarug wrote: I am still wondering why Ltts is putting all this time and energy into this thread. . . . I like to know the "why" behind seemingly inexplicable human behavior.

I think he/she is doing it to help us. It is sort of a left-handed WikiLeaks sorta thing, letting us know what goes on in the secret backroom meetings where people advise DMEs how to milk more money out of patients. This may be one of the most valuable threads ever posted on this board, IMO. Other threads document the lies being told by DMEs, but this one exposes more directly the exact WHY that the lies are told.

Ltts wrote:No DME is under any obligation to carry any make and model of supply you want. None.

Please take the time to READ Kiralynx's post. She has a specific medical condition---central sleep apnea that is NOT medically treated by any E0601 machine. Her doctor has prescribed an Bipap ASV because it is medically necessary. And hence the DME is under some kind of obligation under the contract with Kiralynx's insurance company to provide the prescribed machine. And the DME did provide this machine to Kiralynx. Moreover Kiralynx states: " I also monitored the payouts (not what was billed, what was paid) and the DME was paid more than the on-line full price of that machine.." So unless on-line places are selling these incredibly expensive, niche market ASV machines at a loss, the DME did receive more than enough money to cover the cost of the machine to the DME. Hence the DME did make some kind of gross profit on the machine and Kiralynx is correct when she say states, "So they didn't get screwed over for providing me a 'luxury' machine."

Your insurance company has made you captive to a limited number of DMEs by not allowing others to be in network with them and send a claim. In exchange for that exclusive contract they have demanded / set rock bottom prices for DME reimbursement.

Seems to me that a DME can also make choices:

If a particular insurance company (including Medicare) is unwilling to negotiate prices that allows the DME to make a profit and provide the kind of customer service they want to provide, then the DME can choose to not be a participating provider for that insurance company. It's that simple.

And with rock bottom prices come rock bottom service and product selection. it's economics 101, and you have your insurance company to thank for it.

Once a DME has made the choice to become provider for Insurance Company X (or Medicare), they've signed a contract that specifies they will provide appropriate equipment and appropriate customer service to the folks covered by Company X (or Medicare). Now, I'll grant that "appropriate customer service" does not mean elaborate, involved service where a trained tech might spend 30 minutes or more working with a customer to troubleshoot some specific issue. But at its rock-bottom minimum, "appropriate customer service" means competently ordering the correct parts for medically necessary equipment and properly packaging those parts before shipping them.

And what Kiralynx describes is NOT "rock bottom service." What Kiralynx describes falls into the category out right incompetence.

Specifically:

1) Kiralynx never complains about the choice of machines or masks provided by the DME. The original mask she bought was one the DME carries. She never asked for a special mask that would have required a special order. Rather she complains that the DME is incapable of reading the contract the DME signed with her insurance company to determine which replacement parts are covered on what replacement schedule. The replacement strap was for a mask the DME sold her. The nasal pillows were for a mask the DME sold her. Both parts are known to wear out before the rest of the mask does. Both parts were covered by her insurance. And she was requesting parts as allowed by the replacement schedule the insurance company and the DME jointly agreed to in the contract.

2) Kiralynx specifically complains about inadequate packaging for sending the nasal pillows through the mail. It doesn't take much to protect a pair of nasal pillows---a decent padded envelop will suffice. If the DME is unwilling to properly protect equipment that they choose to ship by mail, then the DME should simply be honest and say, "We can't ship them. You need to pick them up." Would such a statement please Kiralynx? Probably not, but at least it would not result in her receiving a mangled set of pillows.

3) Furthermore, when the pillows arrived in an unusable state, "the DME tried to bill for two sets of nasal pillows" once Kiralynx drove to the DME, showed them the unusable pillows, and (properly) demanded a replacement pair since it was clearly the DME's fault that the pillows were mangled to the point of being unusable. If this is not outright insurance fraud, then it's got to be skating awfully close to the line that determines insurance fraud. After all, the DME was the one who shipped the pillows in a paper envelop that failed to provide adequate protection of the product they had sold. And while billing for one pair of "extra" pillows for one customer isn't going to be worth the time and effort for the insurance company to properly investigate, if this kind of behavior happens on a regular basis for many, many patients, then all those very small individual unwarranted "extra" billings for duplicate replacement parts does add up.

4) Finally, it means sending her the equipment or supplies that are actually ORDERED instead of unneeded (and more expensive) equipment that is NOT ordered: Her machine already had the card reading equipment for recording the data because her doc wants to see that data in order to provide the best medical care possible to Kiralynx. The DME had already provided that piece of equipment when they sold Kiralynx the BiPAP ASV machine. What Kiralynx needed was a $13 replacement card and NOT the entire $99 card reader. So why the heck did the DME not bother read the actual order? Why did they not bother to read their contract with the insurance company, which probably would not have allowed a replacement card reader unless the card reader itself was faulty?

In short, Kiralynx sums up her desires with a rather modest definition of "service" of the sort she wishes her DME would provide:

It means that when I call to order ANYTHING necessary to my therapy, which is covered by my insurance, they order it and get it to me.

She is not asking that the DME "carry everything." She is not asking that the DME "give" her things that are not covered by her insurance. She is simply asking that the DME fulfill their end of the contract the DME signed with her insurance company to provide her with medically necessary equipment and parts that her insurance company DOES cover in its contract with DME. In other words, all she is asking for is indeed, "rock-bottom" service: Provide what is medically necessary and covered by her insurance, but provide the service competently so that no one (including the DME) wastes additional time and money fixing the problems caused by incompetent service.

robysue wrote:

Ltts wrote:No DME is under any obligation to carry any make and model of supply you want. None.

Please take the time to READ Kiralynx's post. She has a specific medical condition---central sleep apnea that is NOT medically treated by any E0601 machine. Her doctor has prescribed an Bipap ASV because it is medically necessary. And hence the DME is under some kind of obligation under the contract with Kiralynx's insurance company to provide the prescribed machine. And the DME did provide this machine to Kiralynx. Moreover Kiralynx states: " I also monitored the payouts (not what was billed, what was paid) and the DME was paid more than the on-line full price of that machine.." So unless on-line places are selling these incredibly expensive, niche market ASV machines at a loss, the DME did receive more than enough money to cover the cost of the machine to the DME. Hence the DME did make some kind of gross profit on the machine and Kiralynx is correct when she say states, "So they didn't get screwed over for providing me a 'luxury' machine."

Your insurance company has made you captive to a limited number of DMEs by not allowing others to be in network with them and send a claim. In exchange for that exclusive contract they have demanded / set rock bottom prices for DME reimbursement.

Seems to me that a DME can also make choices:

If a particular insurance company (including Medicare) is unwilling to negotiate prices that allows the DME to make a profit and provide the kind of customer service they want to provide, then the DME can choose to not be a participating provider for that insurance company. It's that simple.

And with rock bottom prices come rock bottom service and product selection. it's economics 101, and you have your insurance company to thank for it.

Once a DME has made the choice to become provider for Insurance Company X (or Medicare), they've signed a contract that specifies they will provide appropriate equipment and appropriate customer service to the folks covered by Company X (or Medicare). Now, I'll grant that "appropriate customer service" does not mean elaborate, involved service where a trained tech might spend 30 minutes or more working with a customer to troubleshoot some specific issue. But at its rock-bottom minimum, "appropriate customer service" means competently ordering the correct parts for medically necessary equipment and properly packaging those parts before shipping them.

And what Kiralynx describes is NOT "rock bottom service." What Kiralynx describes falls into the category out right incompetence.

Specifically:

1) Kiralynx never complains about the choice of machines or masks provided by the DME. The original mask she bought was one the DME carries. She never asked for a special mask that would have required a special order. Rather she complains that the DME is incapable of reading the contract the DME signed with her insurance company to determine which replacement parts are covered on what replacement schedule. The replacement strap was for a mask the DME sold her. The nasal pillows were for a mask the DME sold her. Both parts are known to wear out before the rest of the mask does. Both parts were covered by her insurance. And she was requesting parts as allowed by the replacement schedule the insurance company and the DME jointly agreed to in the contract.

2) Kiralynx specifically complains about inadequate packaging for sending the nasal pillows through the mail. It doesn't take much to protect a pair of nasal pillows---a decent padded envelop will suffice. If the DME is unwilling to properly protect equipment that they choose to ship by mail, then the DME should simply be honest and say, "We can't ship them. You need to pick them up." Would such a statement please Kiralynx? Probably not, but at least it would not result in her receiving a mangled set of pillows.

3) Furthermore, when the pillows arrived in an unusable state, "the DME tried to bill for two sets of nasal pillows" once Kiralynx drove to the DME, showed them the unusable pillows, and (properly) demanded a replacement pair since it was clearly the DME's fault that the pillows were mangled to the point of being unusable. If this is not outright insurance fraud, then it's got to be skating awfully close to the line that determines insurance fraud. After all, the DME was the one who shipped the pillows in a paper envelop that failed to provide adequate protection of the product they had sold. And while billing for one pair of "extra" pillows for one customer isn't going to be worth the time and effort for the insurance company to properly investigate, if this kind of behavior happens on a regular basis for many, many patients, then all those very small in the same month, it does add up.

4) Finally, it means sending her the equipment or supplies that are actually ORDERED instead of unneeded (and more expensive) equipment that is NOT ordered: Her machine already had the card reading equipment for recording the data because her doc wants to see that data in order to provide the best medical care possible to Kiralynx. The DME had already provided that piece of equipment when they sold Kiralynx the BiPAP ASV machine. What Kiralynx needed was a $13 replacement card and NOT the entire $99 card reader. So why the heck did the DME not bother read the actual order? Why did they not bother to read their contract with the insurance company, which probably would not have allowed a replacement card reader unless the card reader itself was faulty?

In short, Kiralynx sums up her desires with a rather modest definition of "service" of the sort she wishes her DME would provide:

It means that when I call to order ANYTHING necessary to my therapy, which is covered by my insurance, they order it and get it to me.

She is not asking that the DME "carry everything." She is not asking that the DME "give" her things that are not covered by her insurance. She is simply asking that the DME fulfill their end of the contract the DME signed with her insurance company to provide her with medically necessary equipment and parts that her insurance company DOES cover in its contract with DME. In other words, all she is asking for is indeed, "rock-bottom" service: Provide what is medically necessary and covered by her insurance, but provide the service competently so that no one (including the DME) wastes additional time and money fixing the problems caused by incompetent service.

Again, I repeat, the DME is under no obligation to carry any supply it does not want to carry. Some supplies cost more than certain insurance carriers reimburse, so they won't carry them. So your idea of what they "must" do is completely incorrect. No insurance carrier contract obligates a DME provider to carry any specific items.

And again, SOME DME is going to take that rock bottom contract. So if that DME doesn't then some other DME will (and the patient will be stuck with that one instead of another one). But you aren't going to get great product selection and service when the insurance contract pays low reimbursement rates. It's like going to MacDonald's and expecting a waiter and a 4 star menu. Not going to happen. And the insurance company does not give a rat's patooty about the service and product selection.

Be aware that Medicare competitive bidding, coming to 90 more cities in 2013, and covering a large bulk of the population will usher in the exact same thing as you are complaining about here. About a year after that other insurance payers will follow with those 25-30% cuts in reimbursement (at least the ones that haven't already). So unless you start looking to the real source of the problem - insurance payers - get used to getting what your insurance company is willing to pay for.

Ltts wrote:

Kiralynx wrote:

ltts wrote:For my most recent order, I was told, flat out, that "It's not in the system. You can't order it." So I wrote to Respironics and explained that this DME was declining to sell me their products, products which were readily available. Could their local representative do something about this? Six hours after I sent the email, I had a call from the branch manager explaining that he'd found the "glitch" in the system and that my products were now on order. Uh-huh. I'll lay odds that three months from now, there's another "glitch."
And it's thanks to the knowledgeable people on this Forum that I could do this.

No DME is under any obligation to carry any make and model of supply you want. None. Your insurance company has made you captive to a limited number of DMEs by not allowing others to be in network with them and send a claim. In exchange for that exclusive contract they have demanded / set rock bottom prices for DME reimbursement. And with rock bottom prices come rock bottom service and product selection. it's economics 101, and you have your insurance company to thank for it.

When we needed to get our first replacement for our Resmed UltraMirage FF mask, we were told the DME didn't stock that mask anymore,they couldn't "special order" it and we'd have to get the "upgraded and much better Quattro" which never worked for us. I called Medicare,the nice lady said the DME should not have a problem ordering it for us, she'd take care of it and 2hrs later we received a call from the DME that some UMs were magically found on "the top shelf" and someone would bring it out to us that day,no mention of the call from "the nice lady at Medicare". We've had no problems since except that they keep forgetting to place and ship the order and it takes a repeat phone call and delayed delivery.

You all are making fabulous points. I think ltts has gotten "stuck" in the thinking that the people on this forum want and EXPECT to be GIVEN top of the line equipment and not have to pay for it. I DO understand her point about patients wanting and expecting the best equipment (equipment that includes THERAPY related data capabilities & auto features) and NOT being willing to pay additional for it. If for whatever reason, their doctor doesn't order it, but they want it, it seems reasonable that they might have to incur an additional charge if their insurance will not cover it.

Where she came up with this as the NORM for the people here -- we can only speculate. But she is definitely STUCK in her thinking and nothing we can say is going to change it. But to make the blanket statement that everyone here EXPECTS that, and how naive and ridiculous we all are - is stupid and insulting.

However, she also made a lot of blanket statements that are plain and simply WRONG, plus has elected to ignore any rebuttals we may make her comments. And -- I go back to the EOB'S being EXPLANATION of benefits, not ESTIMATION of Benefits. If she is as experienced in this field as she claims to be, she would know that.

My situation forces me outside the normal thinking regarding DME's (obviously) but before when I was doing cpap & bipap, I had my share of DME screw ups and incompetence. I could write a fricking book on it.

My current DME appears to be knowledgeable and competent. That's not to say they don't screw up, but they accept responsibility for it and fix it every time. They also go above and beyond to help me and in turn, I don't EXPECT anything outside competent service and care.

This DME bought out the old one and inherited me as a patient. The monthly rental on my equipment is over $1,000 PER MONTH and my insurance approves and pays almost all of it. It's NOT one of those situations where the DME tries to bill $1,000 and the insurance only pays $200 -- the insurance pays close to the billed amount (damned close to it).

Assuming I live another 15 years, they will bill and receive over $180,000 from me and my insurance. I don't EXPECT them to give me a damned thing other than what I am entitled to. And they not only give me that, but they do GIVE me extras on top of it.

And I'm on Medicare.

The original DME was so out of their element (and they PUT me on this equipment) that they left me on ONE antibacterial filter for over 9 months, never telling me it needed to be changed monthly (or in my case, about every 15 days because I have indoor cats). When we "realized" that thing was a filter and looked at it, it was BLACK! I almost vomited when I realized I had been breathing that in.

The new DME makes sure everything is handled appropriately. My insurance allows 1 per month, but they give me more if I ask for them.

So if you want me to feel sorry for DME's over insurance problems, I have a hard time doing that. If more DME's knew what they were doing and focused on competent patient care, we wouldn't be griping about them.

ltts wrote:Again, I repeat, the DME is under no obligation to carry any supply it does not want to carry. Some supplies cost more than certain insurance carriers reimburse, so they won't carry them. So your idea of what they "must" do is completely incorrect. No insurance carrier contract obligates a DME provider to carry any specific items.

Come, come. REPLACEMENT PILLOWS???? That is taking things to ridiculous lengths. That has NOTHING to do with insurance companies.

I really am curious why you're doing this. I read/participate in threads such as this purely out of investigation of human behavior. Perhaps, if this is inexplicable to yourself, you could say so?

ems wrote:

Robespierre wrote:So, LTTS, does this mean that every time a doc prescribes an AutoPAP and the DME fills the prescription, the system is such that the DME loses money because insurance will only pay for a brick?

Maybe I'm missing something here... but... the DME has to fill the script exactly as the doctor wrote it, including setting the pressure, whether the doctor ordered a brick or a fully data compatible machine. If the insurance company pays for it (mine paid for exactly what the doctor ordered), where is the problem? Of course, some ins companies pay more, some less, with some having deductibles and co-payments.

I suspect the OP has disappeared, leaving everyone wondering what this was all about.

LTTS has made it crystal clear that insurance only pays a DME for a brick. However, she has not directly addressed the situation in which an APAP is specifically prescribed. I have trouble believing that if an APAP is prescribed, the DME is monitarily penalized by insurance for performing their duty to fill the prescription. The point of my post was to get LTTS to tell us whether a DME gets paid appropriately by insurance for a prescribed APAP. I still would like LTTS to answer.