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Can I change DME - new diagnosis - how to do it
#1
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.
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#2
Welcome
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?

Admin Note:
JustMongo passed away in August 2017
Click HERE to read his Memorial Thread

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#3
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.)
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#4
Call your Medicare Advantage Plan and explain your concerns. If they have not yet paid toward that machine, then there should be no reason you can't switch to another DME.

Make sure you understand your coverage, don't believe what a DME tells you, and don't accept anything less than a data capable Auto Cpap. Medicare Advantage Plans pay the exact amount whether it is a straight Cpap or auto Cpap.

Here is a link of current machines, and what ones to avoid.
http://www.apneaboard.com/wiki/index.php...ne_Choices

You should always keep a copy of your script. You would need it if you wanted to buy online too.


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#5
If I understood you correctly, you said that it was the prescribing authority's own DME that is the equipment provider. If so, that is in direct violation of Medicare guidelines. A prescribing entity is not allowed to act as the equipment provider. I encountered this when I was supplied my CPAP by my Pulmonologist while I was on private insurance and then later went on a Medicare Advantage Plan.

Also, like Mongo said, you're entitled to your Rx and Sleep Study.

Good Luck.
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#6
JustMongo and OpalRose have given you great forward thinking advice. My question is this..Is this DME and their response that overwhelmingly unbearing that maybe some mutual agreement between the two of you would allow a smoother relationship. It sure would save you a lot of grief. Is there was something there that you could just "bite the bullet" over.
Yesterday is history; Tomorrow is a mystery; Today is a gift; Thats why its called "The Present".
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#7
(03-14-2016, 04:43 PM)lanCine Wrote: As to paying out of pocket, I could do that, however, my copay is 20% so I am not too keen on that.

That may not be a big deal. 20% of a hugely inflated fantasy price isn't much different than 100% of what you can buy the machine for, with cash.

If I get a machine though my DME, it's roughly $50/month for 10 months, while I can buy the same machine online for $500-$600 cash.

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#8
Hi lanCine,
WELCOME! to the forum.!
Much success to you with your CPAP therapy and good luck getting your DME problems straightened out.
trish6hundred
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#9
Thank you each one! Every reply had something useful to me. Even the thought that maybe I should just try to cool it. I will consider even that.

Once again I appreciate the information and the spirit in which it is given. These forums are a breath of fresh air for me.
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