Need advice on how to make a complaint to Medicare about DME

FoxNewsFan wrote:Has anyone made a complaint to Medicare about their DME? How did it go?

My DME, (which I liked), did not win the competitive bid for cpap supplies which went into effect last July 1. I went on this forum and the internet and picked out a new one. Right from the getgo I was not very happy. They seemed so disorganized but my old DME had already contacted them so I went with the flow.

I had been on my machine for more than 5 yrs. so I was entitled to a new machine according to Medicare guidelines. I sent them all the paperwork. They would ask for a document and I mailed it in by return mail. Then 2-3 wks. would go by and they would ask for another document. This went on so long that I had to go back to my doctor for new face-to-face notes. The notes had to be less than 6 months old. I finally got their OK at 6 months and 3 days so I needed to go back to my doctor again just due to their stalling.

I got the machine last Dec. and supplies last Jan. 21st. They called me April 24th and said I was due to order new supplies. I made my order. The next day they called me and said they needed 5 pieces of paperwork. The exact same pieces that I had supplied to them last Dec. I have not changed my primary or secondary ins., my address or anything else. I said that they must have misplaced my paperwork. They said, too bad, send it all in again.

Ed

If your current DME is a local small company in your area you might be able to file a complaint through your state's pharmacy board if your state's pharmacy board regulates DMEs where you're located. My state's pharmacy board regulates DME providers here in my state. If your DME provider is a big national chain like Lincare or Apria; I can't tell you what to do if that's the case.



Stevoreno_55
MS Gulf Coast
04/27/14

Medicare is so bogged down with complaints right now, they go in one ear and out the other. More than likely they will call the dme with you on the phone and see what the resolution is.

FoxNewsFan wrote:Has anyone made a complaint to Medicare about their DME? How did it go?Ed

I have never made a complaint to Medicare, but here is the procedure (specifically for DMEs).

How do I file a complaint about durable medical equipment (DME)?
With your supplier or with Medicare
You may file a complaint with your supplier, or call 1-800-MEDICARE.

Within 5 calendar days, the supplier must let you know they got your complaint and are investigating it.

Within 14 days, the supplier must send you the result and their response in writing.

With the Competitive Acquisition Ombudsman
Your complaint may also be referred to the Competitive Acquisition Ombudsman. The Ombudsman responds to individual and supplier inquiries, issues, and complaints. The Ombudsman reviews the concerns raised by people with Medicare through 1-800-MEDICARE and through your State Health Insurance Assistance Program (SHIP).

But, IMHO, the best complaint is to just change DMEs & then after you are settled in with your new DME, let the old DME know why they are no longer profiting from your business.

Yes, you may have to send the new DME all of the paperwork again.
But, if you kept copies of everything you sent to the 1st DME, just making copies of the copies & giving that to the new DME is sufficient.

If you did not keep copies, this should reinforce the fact that everyone should acquire & keep copies of EVERYTHING that is sent to someone else on their behalf.

I did make a complaint to Medicare recently regarding my provider. This was a new provider required under Medicare's new rules for competitive bidding. My machine stopped working after 3 years so I was not due a new machine under medicare rules but I did not have a back-up machine and all I wanted was a loaner machine while the logistics were being worked out. All my paper work was filed and acceptable. After 11 nights without sleep, the new provider denied me a back-up machine. Fortunately my old provider, who did not have a Medicare contract, gave me a loaner machine, and subsequently replaced my broken machine. I have no idea what the situation would have been if my old provider had not stepped up. After 3 hours of trying, I was able to talk to a person from Medicare Quality Assurance who said they would further investigate and get back to me in a few days. So far no response. I believe that the lack of service by some low bidder CPAP providers can only be controlled legislatively. There should be a rule requiring Medicare contracted CPAP providers to provide loaner machines to those who need them in their contract area. For the most part Medicare will reimburse for costs of a loaner. Leaving anybody without sleep (and I sleep almost not at all without the CPAP), for 11 nights, borders on malpractice and can result in arrhythmia, stroke, and high blood pressure in addition to all the usual issues of no sleep.

As has been said several times in the last few days by various members, I seriously doubt that Valoool's post is from Jan or Kaiasgram. This software needs to be upgraded or these situations will only continue and get worse.

Maybe someone needs to just comment the line out;
as the code has become meaningless, and sometimes divisive.

FoxNewsFan wrote:

chunkyfrog wrote:Some outfits are so poorly run that I often make the choice to save myself before saving the world.
I know it seems selfish, but that's essentially what we are told on an airplane.
You can't help others until you help yourself---first!
Fixing the system can wait.

I am kinda disappointed in this forum which I hold in high regard because NO ONE has answered my original query.

Sounds to me like you should give up on this forum; call a private attorney and get this taken care of. Why on earth would you think private individuals offering their time for free would hold a candle to an attorney. Go pay for an attorney then report the findings back to us.

Since the original post was about a year and a half ago, it would appear that he's submitted his complaint is now in the waiting cycle for resolution. Might be done in a decade or two?