An issue of "Rights?" Or - not completely Free

Too soon old, too late schmart - an old saying, is still too applicable.

I was not advised by my local CRAP-DME (yeah, she's survived the local onslaught - so far) that I would be renting my machine until I (not actually) determined it was the correct/proper one for me, then I could purchase one, and the rental money would apply towards the purchase. Sounded good at the time.

Enter telcon with insurance rep.: Oh no, you only get to rent that machine for 9 months, and then it's yours, it's considered paid (for). So, since you're in your 7th month (of real labor, I tell you!) if I switch machines, then we just don't know what to do about that! What??? I know that I 'get' a new machine every so often, but you are shoving this particular model down my throat, or up my patoozie? I have a new Rx, for a better machine, and the rep told me they don't carry that one! And it's not even fishing season. Well, it seems to me that if they are unable to fulfill my needs, they and 'the deal with THEM' IS NULL AND VOID, but transferrable to a different DME. I know, the first ones get all the money, so what do they care.

Who the heck do I talk to about them fulfilling my new Rx? Get dressed up and demand to see the person in charge of 'everything around here'??

I think I need help again, folks.

Yes, I have ordered new machine and different type humidifier, card reader, etc.

BUT if I'm 2 months away from "Delivery", why not take it? (assuming I can 'get' it. Insurance would only reimburse me for remaining two months toward my outside purchase anyway. This way, for that difference, I would have two machines, one pd for by me, and the other by the insurance company and me.

Well, I've NEVER in my LIFE been in my "7th month", but it seems I need to act quickly or I'll have one heck of a spontaneous!!

If you've 'been there', know about that place, any words of wisdom, PLEASE pass them on to me.

Yes, I'm the same person who thought she'd won the war just a few days ago, hollering I'm free, I'm free. Well, yeah, to a point, but I don't want to end up GIVING the DME something for which I helped pay. And while I'm at it, may as well get one that is prescribed as of late.

I was sort of in that position. If I bought through my DME, it didn't cost me a dime, it was 100% covered. If I buy from a non participating DME, I have a $300 deductable and I have to pay 20% after that. Since I hear it is next to impossible to have a CPAP services by a DME that you did not buy it from, I decided to get a CPAP from the DME (a Remstar Plus with cflex was the best they would give me), and I ordered an Autopap from cpap.com. I would have had to pay much more than what I paid to cpap.com to get the upgrade to an autopap from the DME. Now I have 2 machines, and if I ever have to send my autopap in for service, I have a spare.

Sleepy Dog Lover:

Seems like we're in that same 'boat'.
My situation exactly, as of now, and it seems that every problem occurs on a FRIDAY - need to wait until Monday to pursue this further.

I am fortunate that I have a second and third insurance, but as we know, I'll most likely still "have to pay"

I still don't know how to force a supplier to comply with a prescription.
Hello, lawyer? Have I a deal for you!!!

I changed machines 4 times during my 10 month rental period. Finally ended up with what I wanted - a Remstar Auto/c-flex. MD kept changing until I got it. I wasn't sure if my 10 month started anew everytime I changed cpaps or not. Really didn't care. I paid $20.20 per month. But 10 months after starting on Resmed 7, the Remstar Auto was mine. Between these I tried a Resmed Auto, and a Remstar Plus/C-flex. MD wrote them a new script each time. I was fortunate, that they never tried to make me take a lesser machine. But they did not even know that there was an Remstar auto. Told them that I'd like to try it and they told me that they didn't think there was such a thing but if there was they would order it for me. Thanks to this site, I knew that there was and said so so they ordered it pronto. Took about 3 days to get it. So no matter what I ended up with, I paid the same amount for it, and got to try several plus different humidifiers. Also they swapped out a humidifier, after the 10 months were up in December. So I really can't complain about the Evil DME. They were most accommodating. However the young man who took care of me has left American Home Patient, so don't know how the new girl will be. I have heard of some other patients here who were not so lucky. But everyone there has been very, very helpful to me. Don't know what will take place next tho. My MD has moved to PA so I have a new one and he has suggested a BiPap for me at next visit in June. DME has told me that my insurance will cover it as it is a different therapy. We will see. If not, I cannot afford it right now. Good luck to you in your quest for a successful treatment.

Kathleen,

You've got a point there. If you're that far into your "rent-to-own" terms, it would probably be worth it to let them pay for another two months and you would have a second/backup machine.

Best wishes,

Den

Offerocker,

Your insurance plan includes certain coverage for Durable medical equipment. It may be that just because you have a new prescription doesn't mean that your insurance plan is obligated to pay for it. Also, it's likely that when you got your original machine from the DME that you signed some sort of paper that included some kind of fine print that obligated you to accept whatever arrangement was set-up between the DME and your insurance plan. Unfortunately, the healthcare/insurance industry is NOT a very consumer friendly arena. I may be all wrong in regard to your particular situation, but don't be surprised if you ultimately "agreed" to things that you were completely unaware of. The moral of the story is "trust no one... ask a lot of questions and don't feel you have to agree to anything, even if you are told you have no choice." ...you ALWAYS have a choice.

1. Elliejose:

My MD has moved to PA

You're kidding! doctors are FLEEING this state right and left due to overactive sue glands in people and lawyers, thus higher insurance rates.
We really take good care of the ones we hold dear, as best we can.

2. Wading thru the muck!
MUCK is so accurate!

...you ALWAYS have a choice

Well, my "choices" are dwindling, as I see them. Play the game to the best of my ability I guess. Will re-call the insurance co on Monday, and hopefully get more significant information. The one today misinformed me. I talked to the one in TX due to CPAP.COM being based there. She told me I COULD go 'out of preferred provider range" due to the level of insurance I have. Cheez, another phone call. then another call to the ditzy dme brat. She was helpful for awhile, until I became more informed than she.

3. Den, I think you hit the nail on the head. I just may use that nail some day - it's long enough to punture tires, isn't it? Joking - Oh, I just wish!!!
I'll try to locate the paperwork from that infamous Day 1 , when I was at step 1: relief and happy. Step 2: Wake up to reality!

Thanks for your support. I like roller coasters, but only when I'm in the front seat!!
I'll try to make the weekend a 'to heck with it" type of weekend.
Your words and support have been a great help.

Heck, it's just the reaction to GREED that we get this way.

I've been through worse. 8 1/2 months in a body cast was nothing to this ordeal! Maybe because once I made the decision for the surgery, there were NO MORE DECISIONS to be made. But, there was a wicked one then too...the guy who attacked me with that blade at my throat, stomach, and elsewhere, 'trimming' my 3M cast. He didn't bother to tell me that it didn't cut through flesh!!

I promise to "make nice" - at least for awhile on Monday.

Well, in about another week or so I'll find out how nasty my soon to be former DME is. They were unwilling to order the more travel friendly M series Respironics machine and I told them they were going to be getting this one back (after 2 months of use and still on a rental). They said FINE. I contacted my insurance and told them I was bringing this machine back severing my ties to the DME and going with Apria instead, who have ordered the machine my MD gave them the RX for. The insurance person said NO problem and that I would not be billed any more as a result of the change. So far so good......stay tuned.

Roadwarrior: H O O R R A A Y Y Y Y !!!

Yup.......still quacky......got a little cartoon I'd like to share, but don't know how........