I have recently completed overnight test and second night titration study. The sleep center sent a pap prescription to their in house DME. I have experienced dumb down responses from the DME refusing to confirm the specific machine, mask, or any other accessories and supplies they propose to satisfy the prescription. As a result I want to terminate any further relationship with that DME.
I feel trapped since they have the prescription. Can I select a different DME and if so how do I rescue the prescription and other documentation and have it sent to the DME of my choice?
I should mention that I have a Medicare Advantage plan and the insurance has already authorized the original provider to fill the prescription.
This is obviously my first experience and I am feeling a bit desperate to find a fair and responsive provider. My diagnosis is severe with near 50% oxygen and over 60 AHI per hour.
03-14-2016, 03:13 PM
(This post was last modified: 03-14-2016, 03:14 PM by justMongo.)
You are entitled under HIPPA to a copy of your Rx and your sleep study.
You should demand those regardless of what path you choose.
You could take that Rx to any provider.
Just because they have authorized the original provider to fill the prescription does not mean you are stuck with it.
Until you take delivery, you have options -- limited options.
Being in a Medicare Advantage Program limits your choice if you wish to take full advantage of their payment.
Will your insurance permit you to go out of network with a higher copay?
Could you afford to pay for a machine out-of-pocket?
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
My plan does allow out of network at a major premium. I think there are adequate providers in network. As to paying out of pocket, I could do that, however, my copay is 20% so I am not too keen on that.
I wonder is it common for a provider to go back to the Md/sleep center to get whatever reports they need or will I find myself in the middle since I am backing out of one DME and seeking a second? (It's obvious I am really squeamish since I have had such inconsiderate treatment from the original DME.)