Slightly frustrating DME visit

Insurance companies don't go through the reports to make sure you are using the original settings. They don't care and they don't look...
Proof of compliance is usually a statement from DME that they have on file..records that prove you are using the machine.
No one at the insurance company is even going to see your actual treatment records to compare anything.

DMEs can squawk, scream, slap your hands and threaten you....about your not using the machine per the exact RX settings but they can't do any thing about it.

If you hadn't ever mentioned it...I bet they wouldn't have even noticed.

To be clear:

On an S9 Autoset "last writer wins" as it does in most computer contexts.

If the DME writes settings to your card then they will take effect the next time you load the card into your machine (this is the same as if YOU had made those settings with Rescan.)

However, IF YOU set the MACHINE while the card is in the machine (with the card set physically to unlock) then the MACHINE settings will prevail and the card will be WRITTEN with you new settings.

The DME has NO special control here -- last writer wins.

You could also just use a new card but that isn't even remotely necessary.


Were a DME to be devious (as I am) then they might TRY to mark the settings files as "read-only" on the card to prevent the card being overwritten (no one much does this in this century), but that would be trivial to remove* and it's not even certain it would matter to the machine.

*
attrib -r -h -s SDCARD_FILESPEC (e.g., H:\Settings\*)

HerbM wrote:To be clear:



*
attrib -r -h -s SDCARD_FILESPEC (e.g., H:\Settings\*)

Or just be lazy and right click on the file go to properties and uncheck read only

The one single biggest reason I joined this forum 6 years ago after 4 years of mistreatment by DME's, was to get access to the Clinician's Manual so I could set up my machine CORRECTLY to give me EFFECTIVE therapy. I have not had ANY problem with DME's since then!!

Whenever I need a new machine (I'm on my 4th), I get the script, the DME provides the new machine, then I go home and download the info I need to access the settings on my new machine, then I set it correctly and move on. Does this work? You tell me--my AHI is consistently under 2, I have 0 leakage, and my compliance averages 6-7 hrs/night.

Just to clarify........I'm not the person who couldn't access their stuff. Fortunately, I've gotten into my new machine, changed the settings to where I used to be. At first I couldn't find the AHI record on the machine and was sure Lincare took away my ability to see it. But I figured it out. But by then my BP was up and I couldn't get to sleep. haha

The doc's office called today and said the doc sent Lincare the Rx for the straight cpap settings. Now I will have to take my machine back in so they can reset it.

I'm not a wimp. I've already yelled at them. But what some of you don't seem to be understanding is our insurance coverage depends on us doing what they say we have to do..........and having Lincare document any changes that the doc has made, is one of them.

Yes, I could have changed my numbers when I got home with the machine.......but I didn't feel like having to look forward to another argument with them in 2-3 months. So, I'll do it their way now, but once that compliance time-period is over, I won't worry about it.
Just wish my doc had a better memory. Every single year I go in there, I have to remind him that I might have changed something, etc. and we have to have the "I know what I'm doing" conversation all over again. I just don't want to burn any bridges.

I'd look the DME right in the eye and tell them "I don't know how that happened. You're the only ones that can change that right?" It's so sad that WAY too many in the medical professions are so poorly informed!! I've had primary care physicians that had no idea what to put on a prescription or that end users could purchase or better yet, free software to monitor their own therapy. Bigger concern in the machine is data capability, so even they, if they know how, could tell what goes on every night!!

Another way to handle it in the future:

1. Allow the doc to write a range as your prescribed settings. That forces the DME to do what it doesn't want to do--give you an APAP. Play along with the doc's game to get you what you want.
2. Take the APAP home and change the setting to the straight pressure that works best for you.
3. If the DME notices what you did, play dumb. Do NOT tell them you changed the pressure; it is none of their business. It may scare them that THEY may have set the wrong pressure. Keep a straight face. Keep playing dumb. Enjoy their panic. If they set it back to the range of pressures, that is OK. Go home and set it back to what you want.
4. By all means stop explaining things to the DME. Logic just makes them angry. If you can pretend to be as dumb as they are, everything works out best for everyone. Practice saying: "Huh! I wonder how that happened?!" and "Hey, I'm just the patient here. All I know is the doc wrote an RX for a full-data APAP" and my favorite "I'll have to talk all this over with my doctor and get back to you on that. Meantime, can I have my machine back please?" I love that one.

Country4ever wrote:Just to clarify........I'm not the person who couldn't access their stuff. Fortunately, I've gotten into my new machine, changed the settings to where I used to be. At first I couldn't find the AHI record on the machine and was sure Lincare took away my ability to see it. But I figured it out. But by then my BP was up and I couldn't get to sleep. haha

The doc's office called today and said the doc sent Lincare the Rx for the straight cpap settings. Now I will have to take my machine back in so they can reset it.

I'm not a wimp. I've already yelled at them. But what some of you don't seem to be understanding is our insurance coverage depends on us doing what they say we have to do..........and having Lincare document any changes that the doc has made, is one of them.

Yes, I could have changed my numbers when I got home with the machine.......but I didn't feel like having to look forward to another argument with them in 2-3 months. So, I'll do it their way now, but once that compliance time-period is over, I won't worry about it.
Just wish my doc had a better memory. Every single year I go in there, I have to remind him that I might have changed something, etc. and we have to have the "I know what I'm doing" conversation all over again. I just don't want to burn any bridges.

I'm confused. Why would you have to take the machine in to have them set it when you've already done that?

The "compliance" is that you're using it......they don't give a rat's patootie what the settings are.

Den

.

HerbM wrote:To be clear:

On an S9 Autoset "last writer wins" as it does in most computer contexts.

If the DME writes settings to your card then they will take effect the next time you load the card into your machine (this is the same as if YOU had made those settings with Rescan.)

However, IF YOU set the MACHINE while the card is in the machine (with the card set physically to unlock) then the MACHINE settings will prevail and the card will be WRITTEN with you new settings.

The DME has NO special control here -- last writer wins.

OK, that is contrary to what JDS74 & Pugsy write & to which I concur.

I wish I could find the couple (or more) of threads quite a while back where people had that problem & the settings put on the SD card by the DME kept overriding their changed settings they made on the machine. Formatting the SD card was the only way they overcame it.

Is it possible that a newer version of the internal software in the S9s corrected that problem?

Lincare told me that THEY had to be the ones who punched in the settings, as required by my insurance.

Ask insurance if you want the truth.
It has been observed here, probably hundreds of times, that DME's have "difficulty" with the truth,
especially if it stands between them and more money.

Lincare said

Never, never, never, ever, ever, ever believe what a DME says. But let them set it if it makes you feel better-I know it can be hard to ignore someone in an "authority" position. You can always change your settings at home. Your insurance does not care as long as you are using the machine.

Country4ever wrote:Lincare told me that THEY had to be the ones who punched in the settings, as required by my insurance.

If it's midnight and a DME tells you it's dark outside, go and check for yourself.

HerbM wrote:To be clear:

On an S9 Autoset "last writer wins" as it does in most computer contexts.

On the PRS1 machines, Encore can set the SD card to "lock down" the settings. If you change the settings in the clinician's menu, it will reset them every time the card is put back into the machine. It's a choice you make when you save settings to the card with Encore.

I don't think the S9 ResScan has a similar setting.

All S9 and PRS1 machines store compliance data on the machine itself in addition to the SD card. If the data on the card somehow gets erased, or the card gets lost, you can stick a fresh SD card into the machine and the machine will write the compliance data to the card. You can also read the compliance data directly off the machine with no SD card.

If your machine has a wireless modem on it, they can see what you're doing that way. Look for a little box on the back with an antenna. They can also change your pressure with the wireless modem.

I agree about not telling the DME anything.