DME Question

[KibaOokami]

So I haven't gotten my call but I was able to check through my insurance who I'm supposed to call and deal with..and literally the company I'm being assigned to has almost 20 straight 1 star reviews and tons of complaints about them not delivering what was asked, not calling back for weeks and just general issues. Would my insurance let me find another company they'd allow or am I stuck with this company?

[HDCowboy]

Sounds like something you need to ask your insurance company doesn't it?

[Walla Walla]

If you haven't signed anything or received anything from the DME walk away from them and find a better option. Also go to your Doctor and demand your copy of the prescription and advise them you'll arrange for your machine yourself. If you don't have a copy of your sleep study get that too. It's your right by law to have both. Your not required to go the Doctors DME of choice. Insurance doesn't care which DME supplies you.

[kiwii]

I think most insurances will cover any DME within their network, but I'm not familiar with Medicare or the HMO-type companies.

Does your insurance company have a website that allows you to check for in-network providers?

Otherwise you can call them and ask.

[KibaOokami]

If you haven't signed anything or received anything from the DME walk away from them and find a better option. Also go to your Doctor and demand your copy of the prescription and advise them you'll arrange for your machine yourself. If you don't have a copy of your sleep study get that too. It's your right by law to have both. Your not required to go the Doctors DME of choice. Insurance doesn't care which DME supplies you.

Only problem is the doctor is about 40 minutes away with a shared car situation. Makes it harder to get out there. I'm kind of a nervous type/strong anxiety about confrontation and other people so it's hard for me to do so haha. I'll ask for what I can. But if insurance doesn't care which DME supplies me then i'll look online then. Thankeya

[Sleeprider]

What is your insurance like? Do you have co-pay and/or deductible?

Starting at the beginning. Your insurance has a list of in-network providers where they have agreements to reimburse for DME supplies. It's not likely just one company. Get the list and shop around. Be sure you get the machine and equipment you want, and many will deliver to your home.

You should not buy your CPAP from your doctor. That is a conflict of interest. Get the list of in-network suppliers.

If your deductible is fairly high, you may be much better off buying a new Auto CPAP on Amazon. Current price of the Resmed Airsense 10 Autoset is $519, and the Philips Respironics Dreamstation Auto is at $364.

Get copies of your sleep studies and prescription. You can keep those for your personal records and use any supplier as the years go by. It is the most empowering thing you can do.

[KSMatthew]

Online DMEs are valid options. Submit receipts to your insurance company.

For the CPAP - it's simple, order what you want, send a copy of the scrip and request they setup the machine prior to shipment. This forum will help with any other adjustments or configuration questions you might have.

The mask is another story. Probably best to go the the local brick-and-mortar DME to get fitted and swap out masks until you find one that works. After that, order replacements online.

[dracus]

A few things here.

 All Dme provides pretty much stuck some suck less than others. You can do a couple things to make your experience better. 

Read the wiki on this site and know what you need to get (resmed airsense 10 auto, mask off choice, tubing, filters etc) 

Go ahead and call your insurance and get a Dme referal. They will give you a minimum of three as anything else would be kickback territory. 

Then call the doctor and ask his assistant who they deal with. They will also give you a couple choices. 

Then get the list and call them all. Ask about masks, exchanges, fittings, what machines they dispense, which doctors they work with everything you can think of. 

Go down the list... It won't take you long. If their customer service is crap on the phone you can rule out. 

One caveat is most of the equipment is usually dispensed by a respitory therapist and Dme sell a bunch of stuff usually. 

You'll be getting follow-ups with the doctor so getting your script is easy enough. I'm sure they can easily fax, email or send it you. 

It's best to have a Dme closer. You might go through 3-5 masks in the limited 30 day window they give you. 

Best not to do that online honestly unless your deductible is huge. Most online places are selling things for just a bit more than medicare reimbursement. 

The cpap machine is roughly $800 which is just a bit more than medicare pays them however your Dme will "bill" your insurance company 1200 or more so a 20% deductible "could" be more than the machine costs. 

An unscrupulous dme will often try to get you set up supplies which come out of pocket that are not needed etc. Special cpap wipes, etc. 

My Dme works directly with the doctor and was super easy to deal with. Gave me exactly what the doctor ordered. They didn't do much to help choose masks but they did show me how to use the machine and spent 20 minutes with me. They went over the manual on cleaning. 

It seems overwhelming but it's really going to go smoothly. 

We're here for you..

[Sleepster]

But if insurance doesn't care which DME supplies me then i'll look online then.

I don't think there are any insurance companies that will reimburse you if you buy online, but like others have told you, contact your insurance company or look on their website for a list of durable medical equipment suppliers, also search their list for home health providers.

I would call your doctor's office and let them know that the DME they've referred you to is interfering with your ability to get treatment for your affliction. Make it a medical complaint rather than a service complaint because the staff is trained to deal with medical complaints in a much more structured manner. That is, you are more likely to get results that way. One call from the doctor's office to that DME may be enough to get them in gear.

For example, when I told my doctor that I needed my machine because a lack of sleep was having a serious effect on the quality of my life he had his nurse issue a "stat" order. The DME called me a couple hours later and delivered a machine to my home that afternoon.

[KibaOokami]

Online DMEs are valid options.  Submit receipts to your insurance company.

For the CPAP - it's simple, order what you want, send a copy of the scrip and request they setup the machine prior to shipment.  This forum will help with any other adjustments or configuration questions you might have.

The mask is another story.  Probably best to go the the local brick-and-mortar DME to get fitted and swap out masks until you find one that works.  After that, order replacements online.

Luckilly the DME even if bad rated is about 5 miles from me so I was going to go by tomorrow and see if they're open to deal with that. the mask I used at the study was fine but..felt slightly small. So I'll check on that then as well.