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DME Question
#1
My daughter got her CPAP machine from a local DME.

After one month, she has yet to get the proper mask. They gave her the wrong size and model due to availability. Despite numerous calls to the local and national call center, she discovered that the proper mask had been shipped today!

She wants to know if she is committed to that DME and if she can change does she need to exchange the machine. By the way, despite the Doctors Order specifically saying AirSense 10 for Her, they gave her the regular Airsense 10.
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#2
The goofed up all around. If the Rx specifies the "for her" machine, they should have dispensed it.
(Their out may be if the script didn't say: "dispense as written.")

Whether she is locked into that DME depends upon which insurance she has.
It's probably a 13 month rental with compliance checks and reports. That's difficult when the person does not have a mask.
Changing DMEs probably means handing back the present machine. Beware of what paperwork was signed, they may try to charge her for the rest of the rental time. And, I hope she did not give them a credit card; they are not to be trusted with a CC.

I wouldn't count on them saying they shipped the mask today... DMEs lie when their lips are moving!

Best Wishes,

Mongo
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#3
Hi Rozenbob,

A DME is just a supplier of durable medical equipment (DME). There is no legal requirement for you to use one DME over another one of your own choice, nor any legal requirement that you stay with the same DME once you have purchased something from them.

Think of them kind of like a pharmacy. You need a prescription to buy certain items, but you can take your prescription and buy those items from any pharmacy you prefer. Some might be "in network" on your insurance plan while others are not. All of them want your business, but you might get a better price "in network".

As for machines versus supplies. Everything you buy is a separate transaction. You can buy some stuff at one DME and other stuff from another DME however you choose. If one DME doesn't treat you right, then take your business to another when it comes time to buy the next thing you need.

If your daughter purchased her machine then it's hers and she can go anywhere she wants for supplies. If she rented the machine, then there may be a minimum rental period (say 3 months) before she can return the machine, but even then she can certainly rent a machine from one DME and buy supplies from another. She certainly won't have to return a machine in order to buy supplies from somewhere else.

She might want to return the machine and get the "for her" model she wanted from this or another DME. If another DME, it may be more complicated since the first DME has surely filed with your insurance and there would be some red tape involved in undoing the first claim so the insurance can pay the second claim at another vendor.

Your insurance may have "in network" agreements or even contractual agreements with certain DMEs. So your choices may be limited by your insurance company if you want the costs paid by your insurance company within your policy. You mention a local and national DME call center, so if it's a big company then maybe you could choose a different local supplier within the same company if that big company is your only in-network choice.

You should be able to insist that the DME give you the "for her" machine that your doctor prescribed. Also giving your poor daughter a mask that doesn't fit because they didn't have one in stock is like buying her shoes that don't fit because one store didn't have her size in stock.

An ill fitting mask will be uncomfortable and won't make a good air seal so it will leak. It's already hard enough for some people to get used to a mask without adding discomfort and leaks from a mask that doesn't fit. In fact it is common for people to try a few different masks in the beginning until they find the one that best suits them. DMEs know this and most will allow you to swap masks in the first month without penalty.

Best resource for sorting out your options might be your insurance company. I would get on the phone with insurance and find out what your options are. Also let them know what this DME has done to your daughter by providing a machine that is different from the one she asked for and the doctor prescribed, and especially the business about the improper size and type of mask because they didn't have the right one in stock, then a month of followup to get it resolved.

DME is a highly competitive business, and they have to compete for your insurance company's business. They are not like doctors who decide which insurance they are willing to take. DMEs bid aggressively against other DMEs to win business from insurance companies. So your insurance company may take this DMEs poor customer service to subscribers into account when the contract comes up for renewal.

Bottom line is the best thing you can do in dealing with DMEs is to be an informed consumer. The DME may feed you a bunch of baloney or only share info or options favorable to them. But if you know your policy and tell them, they will line up with what you want to get your business.

And remember that the DME is not your insurance company, they are just a supplier who wants yours and your insurance company's business. They are a little different from a candy store because some of what they sell requires prescriptions, but they are not terribly different from a pharmacy (well, except that I trust what a pharmacist tells me more than I trust what a DME tells me Smile).

good luck

Saldus Miegas
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#4
The other thing you can do, albeit a tad harsh is you can open a formal complaint against the DME through your insurance co.

My Dr. prescribed a machine. It didn't work for me very well, so a new Rx for a different machine and a SPECIFIC mask was sent to DME 1.

I won't say the DME 1 didn't configure the new ?PAP properly as I never really saw the Rx for the ?PAP. But, they didn't have the mask I was prescribed. Further, DME 1 told me they wouldn't order what I was prescribed for the mask as they just couldn't have everything.

I went to another DME 2 to get the mask. While DME 2 had the mask, they claimed they would sell it to me but they wouldn't bill my insurance Co. while my machine was being "rented" from DME 1 and I had to buy it, then submit to my insurance Co. DME 2 claimed they had difficulty getting paid from the insurance Co.

I called my insurance co, had them talk with DME 1 and DME 1 stated on a recorded line to my insurance co they refused to order what I was prescribed.

I opened a formal complaint with the insurance co against DME 1 while DME 1 was on the phone with my insurance co and me (a 3 way call). My insurance Co. asked what would make me happy and I said:
  • Switch my entire prescription from DME 1 to DME 2
  • Remove DME 1 from an approved DME supplier list of my insurance Co.

When all the dust settled, all my ?PAP needs are being provided from DME 2.

My insurance company's compliance office (not compliance about me using the machine) has called and talked with me at length about DME 1 and all the problems I experienced with them.

Considering DME 1 is on the insurance co's tape stating they refused to order what was prescribed, there's better than even odds they will not be allowed to service any new ?PAP Rx's in the future. The ones that are in place, can stay there.

Sometimes it's worth getting hard nosed.



Warning: Eating chocolate may cause your clothes to shrink!
[Image: ry6XtE9.gif] <---- That's ME!
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#5
After my daughter spoke the DME district manager and listened to their excuses.

She said that she would be compelled to ask her Insurance provider for further assistance.

Guess who is getting a New Airsense10 for Her next week???

Way to go Girl !!.... Appreciate everyone's guidance Thanks
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#6
(08-19-2016, 03:48 PM)rozenbob Wrote: Guess who is getting a New Airsense10 for Her next week???

Way to go Girl !!.... Appreciate everyone's guidance Thanks

Even a small shoe up a tight A$$ can be painful... especially if those shoes are stilettos! Crazy
Warning: Eating chocolate may cause your clothes to shrink!
[Image: ry6XtE9.gif] <---- That's ME!
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#7
(08-19-2016, 03:48 PM)rozenbob Wrote: After my daughter spoke the DME district manager and listened to their excuses.

She said that she would be compelled to ask her Insurance provider for further assistance.

Guess who is getting a New Airsense10 for Her next week???

Way to go Girl !!.... Appreciate everyone's guidance Thanks

Awesome. Guess who's the best dad in the world? (You).
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