First contact with DME

Ok...had my first contact with DME this morning. Lincare. Asked what type of machines they have and they carry the Resmed S9 Escape told her I don't want it. then she says Resporonics System One. I asked her the model and she says D150HS. What is that? I can't find anything on that. Did she give me the wrong number? I already don't have a warm fuzzy felling about this.

kcellwood wrote: I asked her the model and she says D150HS. What is that?

It's the most basic plain machine that Respironics makes...doesn't even have exhale relief.
You don't want it. You want model 460 or higher. Heck...it isn't even the 160 with the heated hose.

They are going to push the cheapest machines they can. You are likely going to have an uphill battle.
Most insurance don't pay by model number or brand...they pay by HCPCS code and for CPAP machines that code is E0601. Insurance companies pay the same for the basic no data machines as they do for the full data machines but DMEs make more money supplying the basic cheaper machines.

You need to call your insurance company and confirm if they pay by HCPCS code....then you need to find out if there are other DMEs in your area that will accept your insurance...then call them and tell them you are going to be getting a cpap machine..and you want either the ResMed S9 AutoSet or the PR System One 60 series Auto model 560...and will they be willing to supply one or the other....then you tell Lincare to go fly a kite that you want so and so machine and since they won't supply it you will take your business elsewhere...often they will back peddle and "find" one of those models for you.

Typically when a doctor writes a RX for a cpap machine it is a very generic cpap machine ....
CPAP machine and heated humidifier with mask and pressure of so and so.
That's usually all that is written and the S9 Escape brick or the DS 150 does technically satisfy the RX requirements so the the DME can legally get away with it.

If you have no other choice in DMEs but Lincare and they dig in their heels..you may need to get your doctor to write a different RX with wording much more specific so that they can't substitute the cheaper machine.

Or you may elect to just bite the bullet and buy it yourself you you can get what you want without the hassle.

Oh...find out exactly how the payment works with your insurance. Typically they do a rent to own thing for a period of time..then they buy it once compliance requirements have been met. If your deductible resets in January...you may end up paying a lot more for your machine through a DME than you would pay if you bought out of pocket.
Just because you get your machine elsewhere doesn't mean you can't use the DME for masks and other supplies though.

Do the math and figure out what you might be paying over several months and the possible new deductible...you might save money buy just getting a machine from cpap.com.
The PR S1 560 Auto machine is around $740 with the heated hose included....a little more for the S9 AutoSet and their heated hose.

Don't accept a machine that you don't want..don't let them push you around and believe me...they will try. They will also lie...tell you that the Escape or the DS150 (or 250) offers all the data you want.."see the SD card"..yeah..hours of use is all that machine will put on the SD card.

My first DME...was a Lincare branch...they got fired before I ever went to pick up the machine because they lied to me and wouldn't budge when I said I wanted so and so machine. Things got a bit ugly. That's why I call them Lin(I don't)Care.

Read this if you haven't already
http://maskarrayed.wordpress.com/what-y ... me-part-i/
and this
http://maskarrayed.wordpress.com/

The time is now to dig in your heels and fight for what you want. Don't accept a machine that is less than what you want...it gets harder to change once you accept a machine.

The battle begins. Interesting day so far. DME (Lincare) first starts telling me all the cost of the equipment. Monthly rental for 10 months, separate cost up front for total cost of humidifier, plus heated hose, plus, plus plus. She goes on to tell me that my deduct has not been met so I need to pay it all (what? - I know better) She says that is what billing is telling her. I tell her that billing is wrong. I get off phone and call insurance. My deduct is met and BCBS will require a 3 months rental of equipment before purchase. They do bill by code. Back on phone with DME. We start discussing machines she wants to give me. See first post.
I told her I either want a Resmed S9 auto or a PS S1 560. Well she says she can't get the ResMed...after a little more talk she makes the statement about the ResMed being too expensive. I take that to mean they don't make enough money on it based on info I got here on the board. I said I would take the 560 and she said she didn't know about selling that one to me. I told her that is what I want on will she sell it to me. She has to check and will get back to me. I am still waiting for return call. In the mean time I have contacted another DME about this. They stated that if the script says a variable pressure on it then they would give me an auto CPAP. I am not yet sure what my script says from my PCP but I suspect it does not specify anothing but a pressure of 8 which is what I will be. So I've gone this far with Lincare and will give them a chance to sell me what I want before I go down another road.

Make sure they don't give you a ResMed Escape Auto, you want nothing with the word Escape in it.

Yes thanks. That is what they wanted to give me and I said no thank you.

Lincare called this morning. They "can't" order what I want and can only get the two bricks they first offered. So I told her to throw out my paper work as I will go someplace else. I need to go back to PCP to get my prescription and find out exactly what she has written on it.

You are so smart to get your ducks in a row before buying! I didn't do that and now I'm stuck with a machine that is dumb as a rock! The only data I can get is compliance data, and guess what??? I don't need that, I know I'm compliant!

I just spent $75 to order the adapter that will allow me to use the heated tubing with my Respironics DS220. I'm thinking that after the first of the year I will probably keep an eye on the SecondWind website for a DS460 or DS560. It looks like I can use my existing humidifier with that; and then will be able to monitor my therapy results!

You know, it seems odd that your DME would rather lose your business completely than to sell you a unit that gives them less profit.

star444 wrote:You know, it seems odd that your DME would rather lose your business completely than to sell you a unit that gives them less profit.

Some DME's are like that. My local DME lost my business because they would not give me the machine I wanted.

You know, it seems odd that your DME would rather lose your business completely than to sell you a unit that gives them less profit.

Unless most people walk, they could care less. One less customer here or there won make an impact. And most people are too overwhelmed to come here and educate themselves BEFORE getting sucked into accepting a brick.

Yes I was very fortunate to find this place and do my research before getting too far along in the process. I will now be going back to PCP on Friday and will be using North Atlantic Medical. A co-working is using them and very pleased with their service. I have talked to them and the lady told me the only machines they have are the Respironics S1 or the Resmed S9 Auto and I think one other one. Will see how it turns out. I know I have seen both good and bad reviews on them. The other thing about them is I can get an appointment in the evening for them to come to my house if I so choose.

I just picked up my CPAP from Lincare last Friday. (NOTE: I am NOT a representative of Lincare, nor do I know anyone personally who works for the organization) I have to say, I have heard NOTHING but heartache in regards to Lincare. How in the hell can they stay open if they run their business this way? Fortunately, I had a very good experience with them (apparently, one of the few). I received a ResMed S9 Auto Set EPR.

However, after reading your posts about insurance, I'm wondering if I got the one-two sucker punch. They told me the same story about my deductible not being met for the year and that I would have to pay the difference plus the 20% in my 80/20 policy. I think I owed about $240 more for deductible and they stuck me for another $150 (20% of what? $750?). All told, it cost me $390, plus a $20/mo rental fee for 10 months. Did I get screwed?

You normally have to pay for the humidifier and mask up front. The rental is for the machine only. You will need to look at the paperwork from your insurance to figure it out. Any questions should be referred to your ins. co.

chezdan9 wrote:All told, it cost me $390, plus a $20/mo rental fee for 10 months. Did I get screwed?

Typically the first billing includes the humidifier as an upfront purchase...so actually the numbers sound about right.
Total out of pocket...390 plus another 200 for the monthly rental (20 X 10months) so $590
You may get screwed anyway...depends on when your deductible rolls around..if it is Jan 1..that's right around the corner and $20 a month rental copay was likely based on the deductible being already met..so you may have the full rental cost after the first of the year. So your out of pocket costs could be significantly higher...do the math. The S9 AutoSet can be bought online for $724 right now..machine only, with humidifier a little more from cpap.com $883.00.

Have you confirmed with your insurance company (don't rely on what DME says) that they actually do the 10 month rent to own thing?
When the deductible rolls around again??? If Jan 1 you will have to pay full rental and not the 20% copay of the allowed amount.
Is your deductible a high deductible that you normally don't ever meet?
Find out directly from your insurance company...DMEs have been known to say things were "rental" when they weren't or they have been known to say 10 month rental when it was a shorter term.