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My thought is that bad DME's should be replaced as soon as possible, and reported to any licensing body, etc.
Some patients may be stuck in a bad HMO, where the model is for insurance and DME to conspire against the patient.
If this is the case, the only redress may be to contact the appropriate insurance regulators; and
failing that, the press! I know, privacy goes right out the window! But I suspect that is the plan.

Hello Zoocrewphoto,

Thanks for clarifying!

So you've got a DME that is filing claims for headgear that are not the correct size. The shortest route to a resolution in this case would be to get the manager on the phone and state that you are going to call your insurance and dispute their claims unless you get the exact item you are needing. When you go to your insurance to complain, it adds an entirely new spin on why they need to address your concerns, so I don't believe they will let this remain unresolved.

One thing to point out here for everyone is that if a DME tells you they can't get something, or it doesn't exist, they are not necessarily lying, they may just be unaware. In this case however, since you have given them the item number of the product you need, either they order it, or you will ask your insurance to reverse payment on claims filed. Any reasonable manager will see that your insurance is paying quite well for the items you are receiving and won't want to lose that business.

Hope that helps. Good luck. Please post how things go.

Jim

SleepWellCPAP wrote:Hello Zoocrewphoto,

Thanks for clarifying!

So you've got a DME that is filing claims for headgear that are not the correct size.

Jim

Not exactly. I got the first mask and headgear, and they charged their rates for the mask and headgear. When I asked to order the small headgear, they told me it did not exist. Then said they would not order it. They also told me that the mask comes with the standard headgear and cannot be ordered without it. In other words, if I stayed with them, every time I order the mask, I would have to pay for head gear I can't use and still go online to buy the headgear myself.

The current DME that I use has no problem ordering my small headgear and had no problem ordering my mask without the standard headgear. So, it is quite easy to get what I want without having to pay for what I don't want. The first DME was lying on both counts.

I also believe that the second mask they sold me was already used, but I didn't know better at the time. It was in a large ziplock bag, not a Resmed bag.

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