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DME frustrations
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SuperSleeper Offline

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Posts: 9,972
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #11
RE: DME frustrations
For me, I wouldn't even care about the laws or rules or whatever. Just got an email where a patient was trying to get a copy of their CPAP prescription and was refused.

If I paid a sleep center, doctor, etc., to diagnose me and they wrote up a prescription for me I would:

1. Demand that prescription that I paid for and make myself a complete nuisance with them so that they would hand it over just to get rid of me.

or, if that didn't work,

2. Demand a complete and total refund of all fees paid to their offices, including a check make out to me for any out-of-pocket or co-pays and a check made out to the insurance company for their share of the fees.

It's not about laws with me... it's about medical professionals treating patients like they should (you know, treating them like human beings, instead of like cash cows hooked up to a checking account sucking machine).

I don't have a habit of paying dearly for medical services and then not getting what I pay for. I would become the biggest thorn in their side they have ever seen. It's about HONORING their word.... if they agree to take my money (my insurance company's money paid through my premiums, or my own out-of-pocket or co-pays) then BY GOLLY, they'd better DELIVER THE GOODS. Anything less than this is THEFT of funds.

I'd be nice, polite at first, of course. But I sure as heck wouldn't stand around and get robbed by some money-grubbing medical facility. That just ain't gonna happen. With me, it's a matter of PRINCIPAL. These idiots get away with all sorts of theft. I get stories sent to me all the time like this.

Okay, off my rant for now. Too much coffee today. I shouldn't post when my caffeine blood levels are closing in on 50%. Coffee Bigwink Too-funny

SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


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 05:09 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: #12
RE: DME frustrations
I use Medicare as well and I have never had to report any kind of compliance data. So either they really don't care or my DME is faking the numbers.

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 09:11 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: #13
RE: DME frustrations
Today I went to the sleep doc's office first before calling Medicare or company Q about the Advance Beneficiary Notice of Noncoverage. I explained at the front desk the problem and the lovely lady there said I needed to speak to Jason, as he knew everything and was also plenipotentiary.

It turns out they were mostly right. Jason could not explain the Advance Beneficiary Notice of Noncoverage, but he faxed my prescription to company C while I sat in his office and insisted on giving me a copy as well, so that in the future I can just take it wherever I choose. He totally sympathized with my approach of buying my own machine and figuring things out on my own.

From there I went to company C, but since I arrived without an appointment the respiratory tech was not in. I have an appointment to see him tomorrow at 3 pm. They told me they had just received the fax from Jason.

At each place I asked about the Advance Beneficiary Notice of Noncoverage from company Q. Everyone shook their head, agreeing that it made little sense. I think that tomorrow I will call company Q and ask them why they sent it to me since I was compliant, I had a follow-up with the doc, and Medicare already paid them. It will be interesting to see what they have to say.

Now that I have the copy of the prescription I am thinking about just buying a mask from [link removed] or elsewhere online. But I have leak problems with the two masks I have now, so perhaps it would be better to have the benefit of being fitted while sitting in front of an experienced tech.


JJJ was referencing Supplier #1. - PaulaO2
-----
Moderator Action: Link Removed
To maintain our status as an educational organization, the only commercial links allowed in this forum are to CPAP-related manufacturer websites. This is stated in the Apnea Board Rules with details given in the Commercial Links Policy section.
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05-29-2012 08:10 PM
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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: #14
RE: DME frustrations
If medicare will cover it, fit the mask with a tech that has several to offer. From there on you can spend your own money, but really, if they are already paying for it, take advantage of your benefits. Masks are a bit on the expensive side to buy one after another on the hopes of getting one that works for you! JMHO!
Mike

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
05-29-2012 10:01 PM
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CHanlon Offline

Advisory Members

Posts: 292
Joined: Mar 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: ResMed Activa LT
Humidifier: ResMed Hi5
CPAP Pressure: 12 -20
CPAP Software: ResScan SleepyHead

Other Comments: Mirage Activa LT nasal mask

Sex: Male
Location: Ontario, Canada

Post: #15
RE: DME frustrations
(05-27-2012 05:09 PM)SuperSleeper Wrote:  I don't have a habit of paying dearly for medical services and then not getting what I pay for. I would become the biggest thorn in their side they have ever seen. It's about HONORING their word.... if they agree to take my money (my insurance company's money paid through my premiums, or my own out-of-pocket or co-pays) then BY GOLLY, they'd better DELIVER THE GOODS. Anything less than this is THEFT of funds.
You sound a lot like me. Nothing, absolutely nothing, irritates me more then having something lie a 2 pm appointment, getting there early, and then having to sit there for more then an hour just to get into the exam room...where you sit for another 40 minutes. A 15 minute appointment shouldn't mean you need to take 2+ hours out of your day.

I bill my time out, for customer service calls, at $65 an hour. So I've gotten in the habit of starting the clock at 15 minutes after the appointment time... and then sending them an invoice for my time.

You'd love some of the phone calls I've gotten about it.

Haven't gotten paid yet... but if they tick me off enough, I send 'em to a collection agent.
05-30-2012 02:10 PM
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RespTherapist Offline

Members

Posts: 6
Joined: May 2012

Machine: None
Mask Type: Not using mask
Mask Make & Model:
Humidifier: None
CPAP Pressure: None
CPAP Software: Not using software

Other Comments:

Sex: Female
Location:

Post: #16
RE: DME frustrations
(05-27-2012 11:09 AM)JJJ Wrote:  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).

It does not require them to do so. It might be easier to call your physician and have them send a new script. The DME is required to have a script to dispense.
05-30-2012 03:35 PM
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