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DME frustrations
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JJJ Offline

Advisory Members

Posts: 751
Joined: Apr 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: Most recent: Wisp, Pilairo, Mirage Vista
Humidifier: ResMed S9 Autoset
CPAP Pressure: 17-20
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: USA 97217

Post: #1
DME frustrations
Warning: Long rant, 'cause I just have to vent

Late in March I had a sleep study and was diagnosed with severe sleep apnea. My sleep doc prescribed a PR System One Auto A-Flex and sent the prescription to an outfit I will refer to as "company Q." I live on the outskirts of a metropolitan area of one million. Company Q is located on the opposite corner of the metropolitan area, so it takes me over an hour of swearing through city traffic to get there. Mass transit is even worse, as company Q is not located even remotely near any stops.

On April 3 I went there and picked up the machine and a mask. Company Q's service was perfunctory, not great, not bad. After several more trips to switch masks I gave up and returned the machine (rented). Since the mask and other peripherals were paid for, I kept them.

Later I bought the same model machine on a local Craigslist for $300. The seller threw in a couple masks.

My problem is that none of the masks are working very well. I have a lot of leaks and I need to find something better. But that requires fitting, which is tough to do with online vendors. However, there is another local DME ("company C") that is only a few minutes from my house and has an excellent reputation. I called company C and they said they would be thrilled to help me, but first I need to have company Q fax my prescription to them.

Side rant: What is this obsession with prescriptions? Are they afraid I'm going to overdose on air?

So Monday of this week, after talking to company C, I called company Q and asked them to fax my prescription to company C. They said they would do so. This was about 10 am.

On Wednesday morning I got a call from company C telling me that they had not yet received the prescription from company Q. I called company Q and spoke to the same person who previously said she would fax the prescription. She said she was waiting for approval from her supervisor, and the supervisor was out until after lunch. She promised that she had not forgotten.

This morning I called company C and learned that they still had not received the fax, but that they would be happy to show me the many masks they had in stock. I went to company C and looked at some masks. We discussed the intransigence of company Q and decided that I should just call my sleep doc and have her send the prescription directly to company C. I called the sleep doc (1 pm) and got a recording that their office closed at noon on Fridays. Monday is Memorial day, so I can't do anything until Tuesday.

Now I'm going out to the garage to get some nails to chew on.
05-25-2012 08:09 PM
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PaulaO2 Offline
Wiki Editor
Moderators

Posts: 8,065
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #2
RE: DME frustrations
Next time you call the DME, mention the HIPAA Act. Mention that you know what it is and you are not afraid of filing a complaint.

http://www.hhs.gov/ocr/privacy/

http://www.hhs.gov/ocr/privacy/hipaa/und...index.html

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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.
05-25-2012 08:14 PM
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JJJ Offline

Advisory Members

Posts: 751
Joined: Apr 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: Most recent: Wisp, Pilairo, Mirage Vista
Humidifier: ResMed S9 Autoset
CPAP Pressure: 17-20
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: USA 97217

Post: #3
RE: DME frustrations
(05-25-2012 08:14 PM)PaulaO2 Wrote:  Next time you call the DME, mention the HIPAA Act. Mention that you know what it is and you are not afraid of filing a complaint.

Paula, you are a gem. My nail supply and my teeth thank you. So do I. Big GrinBig Grin
05-25-2012 09:18 PM
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zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #4
RE: DME frustrations
Once you sorted it out get a copy of the prescription for yourself to keep as it can comes handy if ever you need to get some supplies in case of emergency or away from home
05-25-2012 09:53 PM
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PaulaO2 Offline
Wiki Editor
Moderators

Posts: 8,065
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #5
RE: DME frustrations
Exactly. This is a good idea, Zonk.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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.
05-25-2012 10:52 PM
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JJJ Offline

Advisory Members

Posts: 751
Joined: Apr 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: Most recent: Wisp, Pilairo, Mirage Vista
Humidifier: ResMed S9 Autoset
CPAP Pressure: 17-20
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: USA 97217

Post: #6
RE: DME frustrations
Does the HIPAA require pharmacies and/or DMEs to transfer prescriptions? I can't find anything in the law that says so. It seems to related only to the portability of health insurance. I also checked my state law and all it says is "prescriptions may be transferred between pharmacies" (italics mine).
05-27-2012 11:09 AM
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mjbearit Offline

Preferred Members-2

Posts: 605
Joined: May 2012

Machine: REMstar Auto AFlex DS550
Mask Type: Nasal pillows
Mask Make & Model: RESMed Swift FX
Humidifier: Heated humidifier - 2
CPAP Pressure: 12.5-20
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: So Cal

Post: #7
RE: DME frustrations
There are a myriad of complain avenues. Let's start with BBB. While for the most part I find them useless, they are there. I'm sure there is a professional group they all have to belong to to dispense medical equipment (sort of like docs and medical boards) find out that group and send them a complaint. Worst case find you local bulldog from the news station. They eat this kinda stuff up! Poor man cannot breathe and mean company trying to kill him! If you want to take the time, and you have a mean streak, you can cause them a lot of grief. Personally, I find my BP is not worth getting all riled up and I would just get the script from the doc. Since tomorrow is Monday already I suppose it is too late, but never be afraid to leave a message on your doctor's answering service. That is what they pay them for, and you pay him to be available. With this type of thing sometimes you need to be just a tad aggressive.

As always, YMMV! You do not have to agree or disagree, I am not a professional so my mental meanderings are simply recollections of things from my own life.

PRS1 - Auto - A-Flex x2 - 12.50 - 20 - Humid x2 - Swift FX
05-27-2012 11:23 AM
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Cutter Offline

Preferred Members-2

Posts: 324
Joined: Feb 2012

Machine: ResMed S9 Elite
Mask Type: Nasal pillows
Mask Make & Model: Swift LT
Humidifier: Hi5
CPAP Pressure: 12
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Kansas

Post: #8
RE: DME frustrations
Here is some info about patient rights to medical records under HIPPA:

http://headaches.about.com/od/advocacyissues/a/MedRecordsHIPAA.htm

Some states also have laws and regulations in addition to HIPPA.

This post is a natural product. The slight variations in spelling and 
grammar enhance its individual character and beauty and in no way 
are to be considered flaws or defects.
 
05-27-2012 11:25 AM
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PaulaO2 Offline
Wiki Editor
Moderators

Posts: 8,065
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #9
RE: DME frustrations
That prescription is part of your medical record. So, I would assume it fits within HIPAA. Medication prescriptions from a pharmacy are different but I don't see why they should not fit under HIPAA either. I've not looked into it that much.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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.
05-27-2012 02:06 PM
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JJJ Offline

Advisory Members

Posts: 751
Joined: Apr 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: Most recent: Wisp, Pilairo, Mirage Vista
Humidifier: ResMed S9 Autoset
CPAP Pressure: 17-20
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: USA 97217

Post: #10
RE: DME frustrations
(05-27-2012 02:06 PM)PaulaO2 Wrote:  That prescription is part of your medical record. So, I would assume it fits within HIPAA. Medication prescriptions from a pharmacy are different but I don't see why they should not fit under HIPAA either. I've not looked into it that much.

As far as I can tell, HIPAA is The Health Insurance Portability and Accountability Act of 1996 (HIPAA). So it deals with your right to transfer insurance, not necessarily information. At least, that is the way I read it.

And guess what company Q also did? Yesterday the UPS guy knocked on my door to deliver a letter from company Q. Yep. On the day I called to ask them to transfer my prescription to company C they sent me an Advance Beneficiary Notice of Noncoverage with a sticky post-it note saying I had to sign it. It says that Medicare will not pay for the rental of the CPAP machine because I am "non compliant or no follow up with doctor."

What a pile of crap.
  • I was compliant for 20 days during the month I had their expletive deleted machine and the data on the machine that I returned to them proves it. And I kept the SD card containing the data so I can prove it.
  • II followed up with the doctor and her records will prove that I did.
  • I don't have to sign anything.

For that matter, Medicare already paid for the month's rental of the machine and humidifier that I returned. And I already called company Q and paid the co-pay.

On Tuesday I will call Medicare. And then I will go to my doc and have her give a copy of the prescription to me so I can send it to whoever I want.
(This post was last modified: 05-27-2012 04:36 PM by JJJ.)
05-27-2012 04:35 PM
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