Am I Getting the Royal DME Run Around?

[zonk]

I think I will have a glass of wine.

Two better than one ... Enjoy

[drgrimes]

I think I will have a glass of wine.

Two better than one ... Enjoy

ZONK, you boys down under make some fine wine, in fact, that is exactly what i'm having right now. Keep up the good work.
ME50 I am sure you are right about how the insurance works. I'm the one that paid $100 to get what I wanted. Good or bad, right or wrong, i'm happy that it's done. Amazing how good that Aussie wine can make you feel.

[Donna]

Im not even able to talk to anyone at my DME company. They have a local number and local offices but when you try to call, you are transferred to call center in a different state. If you drive to their office (25 miles away), they have a huge sign on the door that says "Appointments Only". I have written letters which go unanswered, leading to a call to 1-800-Customer Service. They had the branch manager call me. Our conversation did not go well, he raised his voice and proceeded to tell me that their 2 week delay in physician ordered care was my fault for mailing in my scripts rather than faxing them. He was very accusatory and i was getting angrier by the minute. I suggested that we both calm down and start all over, at which point he shouted for me not to tell him what to do. I would like to change providers but not sure who is available that accepts my insurance and has an office with real people i could talk to or what process I'd have to go through paperwork-wise to make a change! What is with these DME companies? No one should have to wait weeks for physician ordered care! It would seem to me that there is something illegal about that practice. Or at least against insurance contract with that agency. Maybe one of our attorney friends in this forum could through in a little free advice?

[zonk]

in fact, that is exactly what i'm having right now.

[drgrimes]

Ooooh Donna, that's bad. How big is the city you are in? There has to be other DMEs. Your sleep doctor should not care who fills the RX that they wrote. Start by discussing this dismal situation with your doctor and ask who else can fill your RX. You CAN shop around, even fill it online.

My DME, owns the store, and is a cpap user. I really don't care if he made $100 off me. That was a bargain to solve my problem.

I hope you find someone who values your business, if not shop around. I wish I could help you more. Your story is sad and upsetting.

[archangle]

If the DME is "in network" for your insurance, they can't charge more for an APAP.

If the doctor prescribes a range of pressures, the DME cannot legally dispense anything but an APAP.

Look and see if there are other local DMEs in network for your insurance. Call one of the other DMEs and see if they want your business.

Check the links in my signature about machine choices. Do NOT accept an S9 Escape Auto. An S9 AutoSet or a Philips Respironics PRS1 Auto are fine machines.

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

[RockABye]

Because of all the things I've seen on the forums about both the insurance companies and the DMEs, I decided to call my insurance company today to find out what the replacement schedule is for filters, masks, tubing, etc., so I wouldn't have to rely solely on the word of my DME. (My insurance is BlueCross/Blue Shield.) I explained to the customer service rep that my doctor would be writing the prescription this week for my machine and I wanted to know how often I can replace the parts such as a mask or the filters in the machine. I told her that I was able to find the schedule for Medicare online, but not for BlueCross. The Customer Service Rep I got didn't have a clue what CPAP was and said that they don't have a "schedule" for replacements, it depends on when the items are "medically necessary." She said any parts (even filters) would need a doctor's prescription in order to show that it's "medically necessary!" I know that can't be right, is it? Then she said "well, if after a few months you aren't able to breathe as well with your machine then it's time to replace the filter, so you can call your doctor and ask for the prescription." Have you every heard of anything so crazy?? Am I asking the wrong questions? Do I just rely on the DME to (as Archangle says) tell me it's dark outside?

[me50]

Because of all the things I've seen on the forums about both the insurance companies and the DMEs, I decided to call my insurance company today to find out what the replacement schedule is for filters, masks, tubing, etc., so I wouldn't have to rely solely on the word of my DME. (My insurance is BlueCross/Blue Shield.) I explained to the customer service rep that my doctor would be writing the prescription this week for my machine and I wanted to know how often I can replace the parts such as a mask or the filters in the machine. I told her that I was able to find the schedule for Medicare online, but not for BlueCross. The Customer Service Rep I got didn't have a clue what CPAP was and said that they don't have a "schedule" for replacements, it depends on when the items are "medically necessary." She said any parts (even filters) would need a doctor's prescription in order to show that it's "medically necessary!" I know that can't be right, is it? Then she said "well, if after a few months you aren't able to breathe as well with your machine then it's time to replace the filter, so you can call your doctor and ask for the prescription." Have you every heard of anything so crazy?? Am I asking the wrong questions? Do I just rely on the DME to (as Archangle says) tell me it's dark outside?

since she doesn't know what CPAP is, she definitely is wrong. Insurance companies follow the medicare guidelines. Ask for a supervisor and keep on the phone until you get your answers. I emailed my DME the schedule because they gave me the wrong information and I knew what it was because of buying them for 3 years. My former insurance company was BCBS until this year. The schedule did not change when I switched to Humana. You already know more than the customer service rep and just as much, if not more, than the supervisor. Darn...all they have to do is look at your benefits for DME supplies. It can't be that hard....even if they don't know what CPAP is!

My DME told me everything is every 6 months which is definitely wrong. As they want to make money, you would think they would want everyone to order the supplies according to the medicare guidelines! They don't make as much on the supplies and it makes for extra work.

I found out today that my insurance company is working with Apria because a lot of their insured have complained about billing errors with Apria.

[archangle]

Because of all the things I've seen on the forums about both the insurance companies and the DMEs, I decided to call my insurance company today to find out what the replacement schedule is for filters, masks, tubing, etc., so I wouldn't have to rely solely on the word of my DME. (My insurance is BlueCross/Blue Shield.) I explained to the customer service rep that my doctor would be writing the prescription this week for my machine and I wanted to know how often I can replace the parts such as a mask or the filters in the machine. I told her that I was able to find the schedule for Medicare online, but not for BlueCross. The Customer Service Rep I got didn't have a clue what CPAP was and said that they don't have a "schedule" for replacements, it depends on when the items are "medically necessary." She said any parts (even filters) would need a doctor's prescription in order to show that it's "medically necessary!" I know that can't be right, is it? Then she said "well, if after a few months you aren't able to breathe as well with your machine then it's time to replace the filter, so you can call your doctor and ask for the prescription." Have you every heard of anything so crazy?? Am I asking the wrong questions? Do I just rely on the DME to (as Archangle says) tell me it's dark outside?

The insurance people who help you will not have any knowledge. The people who deny claims and don't speak to the customers will have rules.

What has changed for many companies is that they used to replace certain parts after a certain time. Now many of them require "x months plus something is wrong with the old parts." In this case, the DMEs may actually help you because they have an incentive and know how to fill out the paperwork and what lies to tell.

Many insurers use the medicare CPAP replacement schedule.

Here's a 2012 page from ResMed. It may change from year to year, etc.

http://www.resmed.com/us/documents/10134...sories.pdf

[me50]

When it comes to CPAP supplies, medicare set guidelines of when things can be replaced and I was told that the reason is for sanitary reasons. That is why they allow 2 filters per month, and the cushions monthly (ffm), hose every 3 months, etc.

The headgear is every 6 months and usually mine are pretty worn out by that time (resmed). When I had the sleep study in October, they gave me a medium headgear (I normally use a small headgear) and it is too big and it is uncomfortable.

So, I tell my DME when to order the supplies and since I have the same insurance that I had with my other DME, I know how often they have paid for replacements and am not concerned with them denying my claim.

The DME is the one that stands to make money when they go by the medicare guidelines (albeit a small amount) but you have to have small potatoes to help sustain between the big ones.

Hope this makes sense.