Can a doctor force me to use a specific machine?

IMO, there is a lot of misinformation above. If you want to keep the same physician then you better follow his/her advice. Otherwise, go seek another one. The Sleep Clinic is responsible only to the physician who ordered the test. As a matter of fact according to some State's laws the Clinic under certain conditions can refuse providing you the results.

So you need a cooperation by your Physician and your Insurance. Never mind the DME.

Example: if I wanted to change my S9 Elite, which I got from my DME on Medicare rental, and wanted to change it after a month, to an S9 Autoset, I needed to ask my Sleep Doc to give me a new Rx, and I had to convince him that an S9 Autoset is better for my treatment (also b/c Janknitz was using it at that time). So he agreed. But at this time I had to pay cash from my pockets for the new macine.

Guest wrote:Thank you for your replies. This entire process has been really unpleasant. I've only seen the doctor once, and didn't feel like he was really listening, and some of the technicians and front office employees have been really rude to me. Not explaining things, and acting irritated when I asked questions. I want to switch to a new office as soon as possible.

To be going through any of this is confusing enough since I don't understand why I have OSA other than having too much soft palate tissue. I already feel weird enough about the whole thing without the doctor's office being rude to me. To have someone answer kindly really helps, so thank you!


Oh, okay!! I'll call my primary doctor! Thank you!!

When you say your doctor says you must have a certain brand, and then you say you've only seen him once, and you also say the staff has been rude to you, it makes me wonder whether you really heard these words about the brand right out of your doctor's mouth, or whether you are simply relying on what the employees in the office claim the doctor is saying, or always says. I certainly wouldn't rely on that. In many medical offices and sleep clinics, you will get a lot of "that's what doctor says" or "that's what doctor always does" from the employees. In my case, the office workers told me a lot of silly things, like insisting that I had to lug my whole machine into the office to see how I was doing, when I knew all I had to bring in was the SD card. They also told me I had to start out with a continuous pressure machine for months before I would qualify for a variable pressure (ASV) machine, even though my report said I had central apnea. (They also told me that I could not get a copy of my report to read until after I already had a machine.)

All of this turned out to be nonsense once I sent a nice polite but firm letter certified mail to my doctor, return receipt requested, telling him I never consent to any medical treatment without reading the report and recommendations, and that I would like to select x machine, etc. Once I did that, I got a very friendly personal call from him telling me he was going to have to straighten out some "well-intentioned" people in his office, etc. etc.

In many medical offices, the staff thinks it's their job to shield the doctor from the patients and just tell patients "the doctor said" when actually it is just the routine they would like to follow. And often some staff members are friends with the machine suppliers and may get birthday and Christmas presents from the suppliers (if not more).

Write the doctor a nice, friendly but firm letter, certified mail, return receipt.

Best wishes, Nate

I think you should reread the comments of hyperlexis and Nate. You haven't actually seen the Rx, so you can't be certain what it says. Lots of things are possible.
One is that the Rx is written exactly as reported. If so, the doctor may honestly prefer that machine over others for a number of reasons, could be the only one he's really familiar with, could be he understands the reports of Respironics machines better than those of ResMed, could be he's studied the machines and thinks it's the best, could be gets some kind of kick-back, could be.... Or, it could be written in a more general fashion and that's how the DME always fills it. Again, could be for a lot of reasons.
I think you should go back to the doctor's office first thing Monday morning, be nice to the staff, ask for a copy of your RX, and ask to see the Dr for 2 minutes to discuss it. You really need to know what the doctor is thinking and he, you. As I read your post, you only have the remaining two days of the month to obtain your machine (for insurance purposes). You really don't have time to be switching doctors, so your options are limited.
I wish you the best of luck.
Jay

Nate, that issue with the soft palate that the Guest mentions: "To be going through any of this is confusing enough since I don't understand why I have OSA other than having too much soft palate tissue." , I think that I could explain it without being a physician. It's possible that this "flap" is causing an Upper Airway Resistance to respiration and a CPAP is one way to treat it. Check this thread about it:

Seeking Upper Airway Resistance Syndrome Success Stories

viewtopic.php?f=1&t=94682&p=875293#p875293

Jay Aitchsee wrote:I think you should reread the comments of hyperlexis and Nate. You haven't actually seen the Rx, so you can't be certain what it says. Lots of things are possible.
One is that the Rx is written exactly as reported. If so, the doctor may honestly prefer that machine over others for a number of reasons, could be the only one he's really familiar with, could be he understands the reports of Respironics machines better than those of ResMed, could be he's studied the machines and thinks it's the best, could be gets some kind of kick-back, could be.... Or, it could be written in a more general fashion and that's how the DME always fills it. Again, could be for a lot of reasons.
I think you should go back to the doctor's office first thing Monday morning, be nice to the staff, ask for a copy of your RX, and ask to see the Dr for 2 minutes to discuss it. You really need to know what the doctor is thinking and he, you. As I read your post, you only have the remaining two days of the month to obtain your machine (for insurance purposes). You really don't have time to be switching doctors, so your options are limited.
I wish you the best of luck.
Jay

What about the part where he says.........

by Guest on Fri Dec 27, 2013 11:46 pm

Hello, everyone! I'm completely new to all of this. I tried searching, but couldn't find relevant information, so forgive me (or redirect me!) if this is a question you get a lot!

I recently went through the testing for sleep apnea, and just found out late this afternoon that my prescription had been finalized. I found a machine I like (Resmed S9 w/humidity), and a supplier who could get it for me for free since I've met my deductible for the year. My doctor's office wouldn't answer my questions about my prescription, and insisted that I must direct my questions to their cpap supplier (who they insist is not affiliated with them). When I called the cpap supplier, they told me that my doctor had written the prescription for a specific machine only (Respironics REMstar Pro with C-Flex), and that I don't get a choice at all. This doesn't seem fair to me since I'm the one who is paying (or my insurance is) for the machine, and I'm the one who's going to be strapping it to my face for 1/3 of my life! Why wouldn't I get a choice if the features are similar?! It seems very shady to me.

So my question is, can they force me to buy only one specific machine? I left a message asking them to change my prescription, but I'm obviously running low on time with the new year around the corner. I have a high deductible, so the difference in cost would be enormous. I hate feeling bullied, but do I have any options?

Thank you for any help or advice!

Sounds like a good deal to me. Maybe "free" really is "free".


Den

.

Wulfman... wrote:

Jay Aitchsee wrote:I think you should reread the comments of hyperlexis and Nate. You haven't actually seen the Rx, so you can't be certain what it says. Lots of things are possible.
One is that the Rx is written exactly as reported. If so, the doctor may honestly prefer that machine over others for a number of reasons, could be the only one he's really familiar with, could be he understands the reports of Respironics machines better than those of ResMed, could be he's studied the machines and thinks it's the best, could be gets some kind of kick-back, could be.... Or, it could be written in a more general fashion and that's how the DME always fills it. Again, could be for a lot of reasons.
I think you should go back to the doctor's office first thing Monday morning, be nice to the staff, ask for a copy of your RX, and ask to see the Dr for 2 minutes to discuss it. You really need to know what the doctor is thinking and he, you. As I read your post, you only have the remaining two days of the month to obtain your machine (for insurance purposes). You really don't have time to be switching doctors, so your options are limited.
I wish you the best of luck.
Jay

What about the part where he says.........

by Guest on Fri Dec 27, 2013 11:46 pm

Hello, everyone! I'm completely new to all of this. I tried searching, but couldn't find relevant information, so forgive me (or redirect me!) if this is a question you get a lot!

I recently went through the testing for sleep apnea, and just found out late this afternoon that my prescription had been finalized. I found a machine I like (Resmed S9 w/humidity), and a supplier who could get it for me for free since I've met my deductible for the year. My doctor's office wouldn't answer my questions about my prescription, and insisted that I must direct my questions to their cpap supplier (who they insist is not affiliated with them). When I called the cpap supplier, they told me that my doctor had written the prescription for a specific machine only (Respironics REMstar Pro with C-Flex), and that I don't get a choice at all. This doesn't seem fair to me since I'm the one who is paying (or my insurance is) for the machine, and I'm the one who's going to be strapping it to my face for 1/3 of my life! Why wouldn't I get a choice if the features are similar?! It seems very shady to me.

So my question is, can they force me to buy only one specific machine? I left a message asking them to change my prescription, but I'm obviously running low on time with the new year around the corner. I have a high deductible, so the difference in cost would be enormous. I hate feeling bullied, but do I have any options?

Thank you for any help or advice!

Sounds like a good deal to me. Maybe "free" really is "free".


Den

.

Only because he's met his deductible for 2013 is the way I read that part. If the transaction is not completed before Jan. 1st, I assume he will have to meet a new deductible. On the other hand, he will probably have other medical expenses next year eating up the deductible anyway if this one doesn't.

Regards, Nate

penuel wrote:Nate, that issue with the soft palate that the Guest mentions: "To be going through any of this is confusing enough since I don't understand why I have OSA other than having too much soft palate tissue." , I think that I could explain it without being a physician. It's possible that this "flap" is causing an Upper Airway Resistance to respiration and a CPAP is one way to treat it. Check this thread about it:

Seeking Upper Airway Resistance Syndrome Success Stories

viewtopic.php?f=1&t=94682&p=875293#p875293

Very interesting. Thanks!

Regards, Nate

Guest, on reading through your posts again it stood out to me that you were being given insurance reimbursement info from the cpap supplier(s) you contacted. Never, never trust that the supplier is giving you accurate or even truthful information about what your insurance covers -- always go straight to your insurance company for that information. You have one DME saying you'll owe nothing, and another saying 20%, but only your Blue Cross/Blue Shield rep can tell you what they will pay and what you should expect to pay.

If you're able to get the prescription for the S9 Autoset, call your insurance company with the make and model and ask what they'll cover and what your cost is with that specific machine.

NateS wrote:

Wulfman... wrote:

Jay Aitchsee wrote:I think you should reread the comments of hyperlexis and Nate. You haven't actually seen the Rx, so you can't be certain what it says. Lots of things are possible.
One is that the Rx is written exactly as reported. If so, the doctor may honestly prefer that machine over others for a number of reasons, could be the only one he's really familiar with, could be he understands the reports of Respironics machines better than those of ResMed, could be he's studied the machines and thinks it's the best, could be gets some kind of kick-back, could be.... Or, it could be written in a more general fashion and that's how the DME always fills it. Again, could be for a lot of reasons.
I think you should go back to the doctor's office first thing Monday morning, be nice to the staff, ask for a copy of your RX, and ask to see the Dr for 2 minutes to discuss it. You really need to know what the doctor is thinking and he, you. As I read your post, you only have the remaining two days of the month to obtain your machine (for insurance purposes). You really don't have time to be switching doctors, so your options are limited.
I wish you the best of luck.
Jay

What about the part where he says.........

by Guest on Fri Dec 27, 2013 11:46 pm

Hello, everyone! I'm completely new to all of this. I tried searching, but couldn't find relevant information, so forgive me (or redirect me!) if this is a question you get a lot!

I recently went through the testing for sleep apnea, and just found out late this afternoon that my prescription had been finalized. I found a machine I like (Resmed S9 w/humidity), and a supplier who could get it for me for free since I've met my deductible for the year. My doctor's office wouldn't answer my questions about my prescription, and insisted that I must direct my questions to their cpap supplier (who they insist is not affiliated with them). When I called the cpap supplier, they told me that my doctor had written the prescription for a specific machine only (Respironics REMstar Pro with C-Flex), and that I don't get a choice at all. This doesn't seem fair to me since I'm the one who is paying (or my insurance is) for the machine, and I'm the one who's going to be strapping it to my face for 1/3 of my life! Why wouldn't I get a choice if the features are similar?! It seems very shady to me.

So my question is, can they force me to buy only one specific machine? I left a message asking them to change my prescription, but I'm obviously running low on time with the new year around the corner. I have a high deductible, so the difference in cost would be enormous. I hate feeling bullied, but do I have any options?

Thank you for any help or advice!

Sounds like a good deal to me. Maybe "free" really is "free".


Den

.

Only because he's met his deductible for 2013 is the way I read that part. If the transaction is not completed before Jan. 1st, I assume he will have to meet a new deductible. On the other hand, he will probably have other medical expenses next year eating up the deductible anyway if this one doesn't.

Regards, Nate

Of course. I'm sure that's why he's scrambling (and asking questions) to get this done before 12/31.


Den

.

The other supplier I found was the same percentage (80%) that my insurance would pay, but they were willing to write off the 20% so I wouldn't pay anything.

I was told yesterday that my results and prescription would be mailed to me, so I was thrilled to see the envelope in my mailbox today. I read through the results, and...nothing. No prescription. It says, "We have sent the prescription order for your PAP supplies to (their DME that they insist they aren't affiliated with). If they are not an in-network provider for your insurance plan, they will forward the order to a DME company that is in-network with your insurance plan."

It seems they don't intend for me to see my prescription.

Guest wrote:The other supplier I found was the same percentage (80%) that my insurance would pay, but they were willing to write off the 20% so I wouldn't pay anything.

I was told yesterday that my results and prescription would be mailed to me, so I was thrilled to see the envelope in my mailbox today. I read through the results, and...nothing. No prescription. It says, "We have sent the prescription order for your PAP supplies to (their DME that they insist they aren't affiliated with). If they are not an in-network provider for your insurance plan, they will forward the order to a DME company that is in-network with your insurance plan."

It seems they don't intend for me to see my prescription.

Federal Law (HIPPA) requires that they give you a copy. Get in your car and drive to their office and get it. Take a short signed letter with you asking for it.

The more you stand on your rights now, the less horsing around you will get from these people in the future.

Regards, Nate

Nate is right. And, I don't know if a DME can just pass your prescription to another DME.

Does anyone have the official ruling that says that the doctor cannot refuse to write the prescription? I was only able to find the prescription release rule for eyeglasses (http://www.fda.gov/ohrms/dockets/dailys ... 1-vol3.pdf)

HIPAA refers to who can see your prescription, but I've never found where it requires the doctor to give it to you. If you guys have a reference, I'd appreciate it because I'd like to get my prescription. I know that they said they'd write one for someone else, but only for 1 year. I don't want to see this guy again!

MitzyG wrote:Does anyone have the official ruling that says that the doctor cannot refuse to write the prescription? I was only able to find the prescription release rule for eyeglasses (http://www.fda.gov/ohrms/dockets/dailys ... 1-vol3.pdf)

HIPAA refers to who can see your prescription, but I've never found where it requires the doctor to give it to you. If you guys have a reference, I'd appreciate it because I'd like to get my prescription. I know that they said they'd write one for someone else, but only for 1 year. I don't want to see this guy again!

HIPPA is much broader than what you said above. It is not limited in the way you described.

A doctor must keep a record of any Rx he writes, and that copy is part of your medical record. You have a right to a copy of all your medical records.

http://www.hhs.gov/ocr/privacy/hipaa/un ... index.html

What Rights Does The Privacy Rule Give Me Over My Health Information

Health Insurers and Providers who are covered entities must comply with your right to:

Ask to see and get a copy of your health records
Have corrections added to your health information
Receive a notice that tells you how your health information may be used and shared
Decide if you want to give your permission before your health information can be used or shared for certain purposes, such as for marketing
Get a report on when and why your health information was shared for certain purposes
If you believe your rights are being denied or your health information isn’t being protected, you can
File a complaint with your provider or health insurer
File a complaint with the U.S. Government
You should get to know these important rights, which help you protect your health information.

Regards, Nate

PS - Any time you want to know what your rights are on any topic, don't ask the person to whom you are going to address the exercise thereof. They may not fully know, even though they should, or they may be motivated to describe your right more narrowly than those given to you.
Go to an independent third party source. In this case the Federal Govt. websites.

Got it...I hadn't seen the part where it said that you have a right to a copy of the records, nor had I clued in that the prescription is a written part of the record. Sorry for being dense...