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DME’s refusing a brand
#1
DME’s refusing a brand
Under Medicare contract rules...can a DME refuse to order ResMed machines because “they don’t get enough for it”  or “they want to charge us too much for their brand”. Or “they simply don’t want to carry that brand for whatever reason they choose?


I understand I won’t have a great relationship with them if I force them to order the brand I choose ....and that’s unfortunate ...but that’s the least of my worries.
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#2
RE: DME’s refusing a brand
I don't believe there are any Medicare rules against this practice. My DME, up until this year, carried most brands. At the start of 2018 they stopped carrying ResMed machines, but will sell ResMed masks.

I did inquire about this practice to my insurance and they told me that a DME has the right to sell whatever products they want. If a doctor writes on your prescription a certain brand and they carry it, then they have to honor that script. I guess your only choice is to see who your insurance contracts with and start making phone calls.
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#3
RE: DME’s refusing a brand
Medicare has no requirement to carry certain brands. Just find another DME in your network. The DME for me and my brother only carries Resmed and Respironics masks. None of them work for my brother since his stroke so I'm going to have to switch him back to Lincare in order to get the right mask. His insurance pays 100% for the mask, so there is no sense in going through online retailers for something his insurance will pay for.
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#4
RE: DME’s refusing a brand
Thankyou mosquitobait and Opalrose for your info.

I just went to a different DME because my present one refused to order a ResMed machine due to Resmed’s pricing under Medicare.

A different DME will order a ResMed Airsense Auto machine under Medicare but won’t order the water tank or heated hose under Medicare because of the Medicare reimbursement amount.

It appears that ResMed may be committing business suicide if they lock out the many older Medicare covered clients if they price themselves out to Medicare customers who want ResMed equipment.

This begs the question...can a Medicare covered person go to ANY DME to order a item because it’s covered there by Medicare....and go to a different DME to order a different item that the other DME won’t cover under Medicare? In other words can you have more than one Medicare DME account at the same time because of the question of different item by item Medicare coverage ?

Anyone out there who is doing this please chime in . Any advice would be helpful.
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#5
RE: DME’s refusing a brand
You have to have all your cpap supplies under one DME. They don't let you cherry pick, but you can switch your account after your machine has been paid for (13 months). My water tank has lasted over 3 years. My heated hose would have lasted as long, but I stepped on it and broke the wire. My suggestion would be to go with the DME who covers your machine. Then buy those two items from Supplier #1 when they have a free shipping sale. They are simply for backup. After your machine is paid for, switch your account to a supplier who will cover the supplies you need.

FWIW, I don't need a heated hose year around. I just use the broken hose, but you could use whatever hose they supply you with and just use the heated hose when you start running into problems. Here's the problem. The only Resmed brand hose you will get, if it is not heated, is the first one that comes with the machine. Otherwise, your DME is going to give you a knockoff. Not a problem, still works, but much louder and less flexible than the brand name hose. It doesn't hurt to ask for the Resmed Slimline hose. I use a Resmed Slimline hose in my backup device.
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#6
RE: DME’s refusing a brand
Ok, one more post. I looked up on Medicare and it appears that unlike me, you are not in a competitive bid area. That means you have a lot more choices unless you have an Advantage account (I have one next year, so don't know yet what's covered). Lincare provides all of what you want but I don't know how good your local office is. I had no problem getting Resmed anything except for the filters (the folks at the office sent those to me directly as they aren't stocked at the warehouse). Otherwise, call other competitors in the area and tell them you have original medicare and want to know if they take assignment and will they provide a Resmed machine along with supplies like the heated hose and humidifier bin.
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#7
RE: DME’s refusing a brand
Thanks to everyone for the good advice
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