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Dealing with a dishonest Healthcare provider
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herbm Offline

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Machine: ResMed AutoSet S9
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Other Comments: Backup Mask: Innomed Hybrid FFM -- Oral+Nasal Pillows

Sex: Male
Location: Austin, TX

Post: #21
RE: Dealing with a dishonest Healthcare provider
Contact your insurance company for assistance -- some of them get very active if they are paying for something the patient is not receiving.

Also ask if you can switch to another, perhaps even an Internet provider, without losing benefits.

My insurance company (Aetna) was EXTREMELY good about this, even giving me another (mail order) DME to use if I had trouble with the local.

(Aetna also authorized a NEW MASK months before it was due when I explained the mask given to me was unusable by me.)

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
09-13-2014 09:00 PM
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kfujioka Offline

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Joined: Aug 2014

Machine: Bipap system one auto
Mask Type: Nasal mask
Mask Make & Model: Air fit P10 and The Hybrid
Humidifier: System One heated humidifier & heated tube
CPAP Pressure: 12/07 for bipap
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Other Comments: New to sleep apnea however think I have had it for a year because started having symptoms a year ago

Sex: Female
Location: Oahu, Hawaii

Post: #22
RE: Dealing with a dishonest Healthcare provider
I agree with Shastzi. These corrupt DME's should get some serious jail time or at least a really big fine and the proceeds donated to ApneaBoard.

Kimberly from HonoluluSleep-well
09-14-2014 12:28 AM
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kfujioka Offline

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Posts: 63
Joined: Aug 2014

Machine: Bipap system one auto
Mask Type: Nasal mask
Mask Make & Model: Air fit P10 and The Hybrid
Humidifier: System One heated humidifier & heated tube
CPAP Pressure: 12/07 for bipap
CPAP Software: SleepyHead

Other Comments: New to sleep apnea however think I have had it for a year because started having symptoms a year ago

Sex: Female
Location: Oahu, Hawaii

Post: #23
RE: Dealing with a dishonest Healthcare provider
(09-12-2014 07:33 PM)trish6hundred Wrote:  
(09-12-2014 04:37 PM)kfujioka Wrote:  Thanks to everybody who replied. I am feeling better already. I talked to my sleep doctor who recommended a good medical supply company. I contacted them this morning; and they told me what I need to do to,switch. Then I called my health insurance company and actually got a nice person. (Unusual surprise!) The insurance company rep. issued an urgent authorization to switch to the new company; and they are sending a respiratory therapist to my home at 2pm today. He will bring the machine etc. etc.
I am super impressed with the nice people I spoke to on the phone with the new company and even the health insurance company. (Who would guess that things seem to be working out?)
Hopefully I can sleep tonight with a new machine and a working heated humidifier and tube.

Last night I was miserable with my broken (no humidifier) and my stuffed nose and sinus infection.

I can't wait to go to bed tonight. Ha! Ha! Ha!
Hi kfujioka,
Good job.!
It great to hear that you finally got some good results.
Hopefully, things will go better from here on out with the new DME.
SLEEP WELL.!
The new DME is so efficient and the therapist brought the machine to my condo. The second day I thought it wasn't putting out the pressure so he came again to check it. It is fine. With the new heated humidifier and heated tubing, the air seems so smooth that the pressure seems lower to me when it really isn't.
In short, it was. Worth it switching DMEs.
Kim

Kimberly from HonoluluSleep-well
09-14-2014 12:47 AM
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Paralel Offline

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Machine: Respironics PR System One 60 Series REMstar Auto with A-flex
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CPAP Pressure: 10-13
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Mitten State, USA

Post: #24
RE: Dealing with a dishonest Healthcare provider
The big problem is the people/department/agency that is responsible for policing DMEs is extremely understaffed and underfunded. They only have the ability to go after the biggest crooks and even then, not all of them. Building up a bulletproof fraud case takes a large amount of time (years upon years usually) and money.
09-14-2014 10:04 AM
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kfujioka Offline

Preferred Members

Posts: 63
Joined: Aug 2014

Machine: Bipap system one auto
Mask Type: Nasal mask
Mask Make & Model: Air fit P10 and The Hybrid
Humidifier: System One heated humidifier & heated tube
CPAP Pressure: 12/07 for bipap
CPAP Software: SleepyHead

Other Comments: New to sleep apnea however think I have had it for a year because started having symptoms a year ago

Sex: Female
Location: Oahu, Hawaii

Post: #25
RE: Dealing with a dishonest Healthcare provider
(09-13-2014 09:00 PM)herbm Wrote:  Contact your insurance company for assistance -- some of them get very active if they are paying for something the patient is not receiving.

Also ask if you can switch to another, perhaps even an Internet provider, without losing benefits.

My insurance company (Aetna) was EXTREMELY good about this, even giving me another (mail order) DME to use if I had trouble with the local.

(Aetna also authorized a NEW MASK months before it was due when I explained the mask given to me was unusable by me.)

Thank you! Yes, I have a new DME as of two days ago. A respiratory specialist has already come to my home with the new machine.
He seems concerned and friendly and efficient. My sleep doctor recommended them.
They know my sleep doctor well so I think it will make future prescriptions delivered more smoothly.
Thanks for your suggestion.
Kim

Kimberly from HonoluluSleep-well
09-14-2014 05:11 PM
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herbm Offline

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Posts: 852
Joined: Jan 2014

Machine: ResMed AutoSet S9
Mask Type: Oral
Mask Make & Model: ResMed Airfit P10 Nasal Pillow
Humidifier: ResMed H5i
CPAP Pressure: 11-16
CPAP Software: ResScan SleepyHead

Other Comments: Backup Mask: Innomed Hybrid FFM -- Oral+Nasal Pillows

Sex: Male
Location: Austin, TX

Post: #26
RE: Dealing with a dishonest Healthcare provider
Good that it is working better. People have suggested "jail" for these dishonest DMEs and mentioned how unlikely that is.

So you have to hit them where it MATTERS: MONEY.

If they lose an insurance company they lose LOTS OF MONEY, especially if it is a large insurance company.

If they lose a Dr.s recommendations they may lose some money as well

Use the leverage you have to get what you need, and after that to punish them if practical.

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
09-14-2014 05:49 PM
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Sleepster Offline
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CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #27
RE: Dealing with a dishonest Healthcare provider
That's a good idea. Writing letters of complaint to insurance companies about questionable practices by health care providers. Insurance companies love that kind of stuff and if they get enough letters it may make a difference.

Vote early and often.

Sleepster
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www.ApneaBoard.com


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09-14-2014 09:27 PM
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PsychoMike Offline

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Machine: ResMed S9 AutoSet
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Mask Make & Model: Varies with mood, ResMed F10 is my primary
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CPAP Pressure: 12-17
CPAP Software: SleepyHead

Other Comments: asthma, cyclist upgraditis, just a little crazy (honest :D )

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Location: Alberta, Canada

Post: #28
RE: Dealing with a dishonest Healthcare provider
(09-14-2014 09:27 PM)Sleepster Wrote:  That's a good idea. Writing letters of complaint to insurance companies about questionable practices by health care providers. Insurance companies love that kind of stuff and if they get enough letters it may make a difference.

Vote early and often.

Yup....let insurance know. But then also let anyone you know locally on CPAP or friends going into therapy know about your experience. No need to slag them, just be honest. Eventually, no insurance dealings + poor reputation (you can bet you're not the only one that they treated this way) = no customers...at that point it is change or die.

kfujioka, I left my previous DME because of numerous issues whereas at my current one I deal with one person who treats me like his patient, not his profit. He's doing the same for Mrs. Psycho and she's already doing so much better since we switched (better fitting and more comfy mask = better results and better sleep). Good on ya and I'm glad things are going much better for you.
09-15-2014 12:01 PM
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herbm Offline

Preferred Members-2

Posts: 852
Joined: Jan 2014

Machine: ResMed AutoSet S9
Mask Type: Oral
Mask Make & Model: ResMed Airfit P10 Nasal Pillow
Humidifier: ResMed H5i
CPAP Pressure: 11-16
CPAP Software: ResScan SleepyHead

Other Comments: Backup Mask: Innomed Hybrid FFM -- Oral+Nasal Pillows

Sex: Male
Location: Austin, TX

Post: #29
RE: Dealing with a dishonest Healthcare provider
Mike, the difference is that most of us don't know that MANY people who also use a DME and even if we all our friends stopped using a bad DME the DME might not even notice due to no direct connection between a SPECIFIC PROBLEM or CUSTOMER and the (small) loss of business.

With an Insurance company threatening to pull the DME "out of network" the DME will get the message IMMEDIATELY.

Similar for a Doctor on a smaller scale IF the doc takes the time to call the DME and explain why no more patients are coming to them from his practice -- if this or something similar doesn't occur, the DME still may not notice.

This is especially true of large chain DMEs -- when the "headquarters" finds out a local manager is losing them (a lot of) business then heads roll and people change their behavior.

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
09-15-2014 06:03 PM
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PsychoMike Offline

Advisory Members

Posts: 551
Joined: Aug 2013

Machine: ResMed S9 AutoSet
Mask Type: Other
Mask Make & Model: Varies with mood, ResMed F10 is my primary
Humidifier: ResMed H5i
CPAP Pressure: 12-17
CPAP Software: SleepyHead

Other Comments: asthma, cyclist upgraditis, just a little crazy (honest :D )

Sex: Male
Location: Alberta, Canada

Post: #30
RE: Dealing with a dishonest Healthcare provider
Herb,

I do agree that a client based "revolt" may or may not be noticed by the DME....depends on their size. A local shop with low volume may get the hint if they have clients telling them "I'm going elsewhere because you're jerking me around"...especially if you're telling the owner directly. Just dropping them (without saying anything) is the least effective method of getting the point across.

The only reason I was at my previous DME as long as I was is that I was able to tell the owner things directly and she tried...but I think she needs to roll some heads before she's out of business.

I agree, though...esp. in the US...if a DME is going to get turfed from network, they're going to get the hint a lot faster. The big chain DMEs especially.
09-16-2014 12:06 PM
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