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[Equipment] I'm having a go round with the DME and the insurance company. Buncha scammers!
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SpeedyD Offline

Preferred Members

Posts: 73
Joined: Nov 2015

Machine: Airsense 10 Autoset FH
Mask Type: Full face mask
Mask Make & Model: Respironics Amara view
Humidifier: Built in
CPAP Pressure: 5-18
CPAP Software: SleepyHead

Other Comments:

Sex: Female
Location: USA

Post: #1
Angry I'm having a go round with the DME and the insurance company. Buncha scammers!
First of all, thanks for all your help. I have been very informed about my rights and this process thanks to many of you.Thanks Immediately after my prescription was given to me I was on the cell with my insurance company checking my benefits. I was told that my company provided me with 85% of DME and I was responsible for 15%. Ok... What about deductible? Well, your deductible has been met for the year. Hurrah!
We dropped off my script at the DME later in the day on Tuesday and I waited. Yesterday I called and gave them my request for a specific machine. (Resmed airsense 10 autoset for her) they didn't know anything about their ability to provide that specific machine. I told them they can order it from the Internet and I'll wait until they get it. I've been prescribed this for life and I'm going to be provided the machine I want. Unsure she said she would make a note in my chart.
She then told me that I would owe $24.95 for the first 2 months and $120.00 for the next 3 that "my insurance company was REQUIRING me to rent the machine for 5 months. I hung up and called the insurance company back. The insurance company said they would provide for the rental until the purchase price is met OR straight out purchase. I told her great and hung up. I called back the DME and informed them that INDEED my insurance company did not require a rental and they said the DME should just get the machine I want and submit a claim. So if it all works out I should not have to pay over $400 for the apap. Just the 15% which is what my benefit provides. Laugh-a-lot I'm prepared to put my foot down more if I have to. After all, these people work for me...not the other way around. By the way, I was super nice the whole time.SHa_biggrin5
Hopefully the autoset will take care of my open airway events 12% and I don't have to do this
over for an ASV! Dancing
11-20-2015 05:14 PM
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otrpu Offline

Preferred Members

Posts: 79
Joined: Jun 2015

Machine: AirSense 10 Autoset w/Oxi
Mask Type: Hybrid
Mask Make & Model: RespCareHYB500
Humidifier: ClimateLine, Socked, set 3
CPAP Pressure: 9-17
CPAP Software: SleepyHead

Other Comments: COPD

Sex: Male
Location: East of Rockies

Post: #2
RE: I'm having a go round with the DME and the insurance company. Buncha scammers!
SpeedyD,

Good on ya. Let us know what happens.

Cheers,
otrpu

Love your family, treat your friend(s) well, and don't waste your time. Everything else is just so much BS. Sleep-well
11-20-2015 05:32 PM
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Mosquitobait Offline

Advisory Members

Posts: 746
Joined: Apr 2015

Machine: Resmed AirSense 10 For Her
Mask Type: Nasal pillows
Mask Make & Model: Airfit P10
Humidifier: integrated, Climate line tube
CPAP Pressure: 9-12
CPAP Software: ResScan SleepyHead

Other Comments: RLS and Bradycardia

Sex: Female
Location: Minneapolis

Post: #3
RE: I'm having a go round with the DME and the insurance company. Buncha scammers!
Good for you for checking. They may not be a bunch of scammers though. That could be the requirement for some of the insurance company contracts with your insurance company. My brother and I both had Blue Cross of MN, but my contract (individual policy) covered more than his (work policy).
11-20-2015 08:02 PM
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trish6hundred Offline

Advisory Members

Posts: 6,446
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #4
RE: I'm having a go round with the DME and the insurance company. Buncha scammers!
Hi SpeedyD,
Good job on standing up for yourself; you’re right, they do work for you.
Keep up the good work.

trish6hundred
11-20-2015 09:33 PM
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Tacoma Droner Offline

Preferred Members

Posts: 52
Joined: Sep 2015

Machine: PR System One autoSV BiPap
Mask Type: Nasal pillows
Mask Make & Model: Optilife
Humidifier: PR System One
CPAP Pressure: 9-18
CPAP Software: SleepyHead

Other Comments: Became a hosehead in 2004-still going strong!

Sex: Male
Location: TACOMA WA

Post: #5
RE: I'm having a go round with the DME and the insurance company. Buncha scammers!
In the "bunch scammers" department, we have a 10% sales tax in Washington. First time I bought a machine the DME told me that the insurance did not cover sales tax. So I was responsible for my 15% co-pay plus another 10% sales tax, for a total of 25%. This was, of course, total bull. Their scam was to bill the insurance company for the sales tax (which is of course covered) then pocket the extra 10% from me. This scam didn't work since I was on to them, but I had to wonder how many hundreds of other customers got scammed who weren't quick enough to recognize the rip-off.

One thing I'll say for CPAP therapy, ya gotta stay on yer toes! Dancing
11-21-2015 01:54 PM
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DeepBreathing Offline
Wiki Editor
Moderators

Posts: 2,295
Joined: Sep 2013

Machine: Resmed S9 VPAP Adapt
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: EPAP: 9 - 15 PS: 3 - 10
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Perth, Western Australia

Post: #6
RE: I'm having a go round with the DME and the insurance company. Buncha scammers!
(11-21-2015 01:54 PM)Tacoma Droner Wrote:  One thing I'll say for CPAP therapy, ya gotta stay on yer toes! Dancing

Is it just CPAP or is the whole DME industry like this?

DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


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11-21-2015 05:06 PM
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Ghost1958 Offline

Advisory Members

Posts: 957
Joined: Aug 2014

Machine: PRS1 Series Sixty Auto Aflex
Mask Type: Nasal mask
Mask Make & Model: F&P Eson
Humidifier: PRS1 with Heated Hose
CPAP Pressure: 10.5 min 16 max
CPAP Software: SleepyHead EncoreBasic

Other Comments: Moderate to Severe SA Obstructive. Rapid O2 desat off the machine.

Sex: Male
Location: KY

Post: #7
RE: I'm having a go round with the DME and the insurance company. Buncha scammers!
(11-21-2015 05:06 PM)DeepBreathing Wrote:  
(11-21-2015 01:54 PM)Tacoma Droner Wrote:  One thing I'll say for CPAP therapy, ya gotta stay on yer toes! Dancing

Is it just CPAP or is the whole DME industry like this?

Pretty much the whole DME industry.
Cpap is just easier to fool people with than say oxygen concentrater or diabetic supplies etc.:
11-21-2015 10:34 PM
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