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Fee for copy of prescription in Ontario?
#1
G'day forum,
I'm a new member in Ontario, Canada. I went to a sleep clinic, was diagnosed with sleep apnea and told to buy a cpap machine and mask. The sleep clinic doctor never gave me a prescription. Instead, he gave me a list of acceptable places where I could purchase the equipment. I chose one of the providers and informed the sleep clinic so they could fax the required information to the medical equipment provider. I do have insurance coverage, but was told I'd have to buy the equipment first and would then be reimbursed for expenses.

After submitting my expenses, the insurance company said they couldn't reimburse me without receiving an official copy of the prescription. I went to the cpap provider and they gave me a copy of what the sleep clinic's doctor had faxed them. Problem is, this document states it is not valid for insurance purposes! So I called the sleep clinic and the secretary told me I now have to pay a fee if I want a copy of the prescription. I thought the cpap machine couldn't be purchased without an official prescription, and yet the paper that the cpap store received looked just like a prescription except for that statement on it claiming it wasn't valid for insurance purposes. This smells like a scam.

I'm wondering if this is legal in Ontario? I realize that some doctors here do charge fees for prescription refills, but in my case it is not a refill but rather the original prescription which should have been created at some point but was never in my possession, nor was an actual prescription sent to the medical goods store!

Why didn't the doctor just hand me a written prescription to take to the cpap provider? I would then have been able to photocopy it for the insurance company at a much lower cost than what the sleep clinic wants!

My family physician doesn't charge me a fee every time he writes a prescription for medication (but I'm assuming it is because OHIP will cover his fee). Wouldn't OHIP also be responsible for covering the prescription fee written by a sleep clinic? If yes, then the doctor's office would be double billing for the same service, no?

I'm so frustrated that I feel like just paying the exorbitant fee but felt the need to explore the issue further.


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#2
I'm no lawyer and realize the medical system is different up north but that sounds plain crazy.
Do you have some sort of medical oversight board where you can get a straight answer?
Aloha,
MrCourtney
Honolulu, HI
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#3
I wish I understood why these places are so weird about giving a copy of the prescription to the patient. I had a similar experience and I live in the US. $%#@%^!!!!!
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#4
(07-29-2013, 11:51 AM)oak Wrote: I wish I understood why these places are so weird about giving a copy of the prescription to the patient. I had a similar experience and I live in the US. $%#@%^!!!!!

I wonder if there's some kind of unwritten/unspoken deal between doctor offices and local DMEs to "keep the business" between them, so to speak.

Thinking-about
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#5
Hi sleepzzzwell,
WELCOME! to the forum.!
Hang in there for more answers to your questions and hopefully you can get this straightened out so you can get on with life and sleeping better.
trish6hundred
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#6
My DME gave me a copy of the script the doctor sent. It has no annotations about not being valid for insurance purposes and no one has ever questioned it.
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#7
Wow. Please do tell us which sleep clinic you used, because yes that does sound like a scam and I want to make sure that a friend of mine that is looking for a sleep clinic doesn't use them.

I also live in Ontario, and here's how it worked for me. I told my family doctor that I wanted a sleep study. He referred me to a sleep doctor. I went for a (brief) visit with him, and he set up a sleep study. After the sleep study, I went back to the sleep doctor, who went over the high points of the report, answered my questions, then wrote out and gave me a prescription for a CPAP unit. He also gave me a brochure for a DME. I went to the DME, overpaid for the machine (compared to online prices), and got two copies of the invoice, one stapled to a photocopy of the prescription with a sticky note "for insurance", the second invoice for my records, and the original prescription. [ The DME also let me try several masks, and when my power brick ended up being defective, arranged for an exchange and loaned me a spare in the meantime. So I'm not going to begrudge their profit _too_ much. ]

Edit:

By the way, sleepzzzwell, did you consider simply sending the "not valid for insurance" document to the insurance? If the insurance balks, simply claim that this is the prescription used to purchase the machine, as they requested. If they continue to balk, point out the $20 fee and ask them how _they_ want to pay that. If they then continue to be troublesome, take a photocopy of the "not valid for insurance" document, apply whiteout (or whatever) to the "not valid for insurance" part, photocopy that (so the whiteout is not directly evident), and send that last photocopy. It is a copy of the prescription used to purchase the machine, and it does not say "not valid for insurance purposes".
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#8
(07-29-2013, 11:51 AM)oak Wrote: I wish I understood why these places are so weird about giving a copy of the prescription to the patient. I had a similar experience and I live in the US. $%#@%^!!!!!

Hi oak,

I trust you have gotten a copy of your prescription by now. And a copy of the full Sleep Study Report, if you have had a sleep study. It is your right to have copies of these. Don't let them refuse to give you these.

Sometimes we need to educate the medical community. If you do not yet have copies, I suggest you explain you will need to show a copy of the prescription if you want to take your machine on a plane as medical equipment, and you will need to fax or email a copy to any on-line CPAP supply site you may in future want to purchase from, as is your right. In other words, you are expected to have a copy of your prescription, and at some point you will surely need to have it.

Take care,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#9
(07-29-2013, 02:31 PM)RonWessels Wrote: If they then continue to be troublesome, take a photocopy of the "not valid for insurance" document, apply whiteout (or whatever) to the "not valid for insurance" part, photocopy that (so the whiteout is not directly evident), and send that last photocopy. It is a copy of the prescription used to purchase the machine, and it does not say "not valid for insurance purposes".

Good idea Ron, but it may need to be done with PhotoShop or a similar program, if the prescription is written on paper with a background pattern which would make the white-out stand out in a photocopy.

Take care,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#10
(07-29-2013, 07:25 PM)vsheline Wrote: Good idea Ron, but it may need to be done with PhotoShop or a similar program, if the prescription is written on paper with a background pattern which would make the white-out stand out in a photocopy.

The online edition of the Oxford English Dictionary lists "to photoshop" as a verb.

I wonder how much evidence for insurance companies, government agencies, tax authorities, and others has been photoshopped.
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