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Fee for copy of prescription in Ontario?
#11
(07-29-2013, 02:44 AM)courtney123 Wrote: 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?

I found something on google that might help: the College of Physicians and Surgeons of Ontario. I can't post links (new user restriction I guess) but their "about us" page specifies they can take complaints.

I might launch a complaint with them but I want to be as informed as possible first, the complaint might be thrown out if what the doctor did is not illegal...


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#12
(07-29-2013, 02:31 PM)psimpson130 Wrote: 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.

The annotation at the top of the page the DME gave me upon request (at no charge) states:

"This facsimile is intended to provide the CPAP vendor with information necessary to initiate CPAP therapy. This facsimile is not to be used as a prescription for insurance purposes."

Underneath this disclaimer, it specifies the date, patient name, provider name (ie. "DME"), then it gives very specific instructions on how to set up the machine and what kind of masks can and cannot be used. The name of the doctor at the sleep clinic is listed.

To me, it looks just like a prescription except for that disclaimer at the top.
And I'm assuming without a prescription the DME couldn't have sold me the equipment. Yet this is precisely the document they gave me when I asked the DME for a copy of the prescription the doctor had faxed them.
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#13
(07-29-2013, 02:31 PM)RonWessels Wrote: 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".

I will leave out the name of the clinic until I get some more facts about what happened, but I'll mention I live around the Windsor area...hope that helps somewhat. Again, I don't want to claim they are doing something illegal until I know for sure. For now, let's just say I'm very suspicious of their behaviour and frustrated with the lack of transparency.

No, I haven't considered sending the document as-is. I am thinking though of calling up the insurance company and asking them if this sounds fishy to them. By the way, the fee the sleep clinic wants is $30, not $20...in my part of Ontario it takes a highly trained person to work those newfangled photocopiers!

The idea about applying whiteout: sorry, I can't bring myself to do that. I have a feeling it would actually work but I suspect it may be considered document fraud. I'd rather find out why that disclaimer is there in the first place. Why did the sleep clinic go through the effort of putting it on there? What are they protecting themselves against? What makes a sleep clinic doctor different than my family physician who has never needed such a disclaimer? In appearance, it looks like a way for them to make an easy $30 and lock patients in to certain DMEs. I searched online to compare prices and it was no surprise that I could have obtained the unit at a much cheaper cost via internet provided I had a copy of the prescription in the first place.

Sorry, just thinking out loud, I have a bad feeling if I asked these rather pointed questions at the sleep clinic they would probably just drop me as a patient the moment I demand transparency.
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#14
(07-29-2013, 09:40 PM)JJJ Wrote: I wonder how much evidence for insurance companies, government agencies, tax authorities, and others has been photoshopped.

For a real-world example, this Whitehouse hosted Presidential Birth Certificate has been on their website for a long time now. It's definitely photoshopped. You can even examine the various layers that were combined together if you look closely enough and have the Photoshop suite of software to check it out. It's not even a conspiracy theory - it's a fact that anyone familiar with Photoshop can check out. Snopes says it's legit and they're full of baloney. It's so obvious that even a caveman can check it out.

Obama was born in 1961, and the Hawaiian hospital listed on the document is the new name for the hospital not in use until 1978. The document uses the new, post-1978 name, not the name of the hospital in use in 1961 when his birth certificate was supposedly created. Also, if you look at the signature of the Local Registrar on the document itself, it's signed "U K La Lee". (as in ukulele - the stringed Hawaiian instrument)... almost an in-your-face joke. Thinking-about

http://www.whitehouse.gov/sites/default/...g-form.pdf

Of course the mainstream press simply doesn't report any of this, and paint all "birthers" as conspiracy nuts. Just like they did when "conspiracy theorists" back in the 1970's talked about the super-secret NSA - but the government and press painted them as nutjobs, claiming that no such organization exists. But today, we know it existed back then and they no longer deny it. The "conspiracy theorists" were correct all along.

So, if the Prez can do it, perhaps if you get fined for whiting out your prescription, you can use his example as to why you're justified in doing so. BigwinkToo-funny

SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


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#15
(07-30-2013, 12:45 PM)SuperSleeper Wrote: So, if the Prez can do it, perhaps if you get fined for whiting out your prescription, you can use his example as to why you're justified in doing so. BigwinkToo-funny

Very interesting. Here's the article: http://www.whitehouse.gov/blog/2011/04/2...ertificate
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#16
(07-30-2013, 07:00 AM)sleepzzzwell Wrote: I will leave out the name of the clinic until I get some more facts about what happened, but I'll mention I live around the Windsor area...hope that helps somewhat. Again, I don't want to claim they are doing something illegal until I know for sure. For now, let's just say I'm very suspicious of their behaviour and frustrated with the lack of transparency.

No, I haven't considered sending the document as-is. I am thinking though of calling up the insurance company and asking them if this sounds fishy to them. By the way, the fee the sleep clinic wants is $30, not $20...in my part of Ontario it takes a highly trained person to work those newfangled photocopiers!

The idea about applying whiteout: sorry, I can't bring myself to do that. I have a feeling it would actually work but I suspect it may be considered document fraud. I'd rather find out why that disclaimer is there in the first place. Why did the sleep clinic go through the effort of putting it on there? What are they protecting themselves against? What makes a sleep clinic doctor different than my family physician who has never needed such a disclaimer? In appearance, it looks like a way for them to make an easy $30 and lock patients in to certain DMEs. I searched online to compare prices and it was no surprise that I could have obtained the unit at a much cheaper cost via internet provided I had a copy of the prescription in the first place.

Sorry, just thinking out loud, I have a bad feeling if I asked these rather pointed questions at the sleep clinic they would probably just drop me as a patient the moment I demand transparency.

Regarding which sleep clinic you used, it turns out that "Windsor area" is probably enough. A little Google-fu finds a sleep doctor in Windsor Sleep Disorders Clinic a Windsor sleep disorders clinic with the following review comment:
Quote:Dont come away from this doctor with any answers except you have to buy a machine and where to buy it and to pay him cash before you get all paper work you need. Not happy about this experience with this clinic neither were some of the other people that I talked to

Regarding calling the insurance company, that is a good idea. Explain to them you have a copy of the prescription used to purchase the device, and explain the issue and the payment extortion. Explain to them that you would be happy to photoshop the document if that would be better for them. Do be upfront about any "editing" you make on the document. It's not fraud if you point out the "changes" you've made.

And yes, it is pretty clear that the disclaimer is there for the sole purpose of getting another $30 from you.
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#17
Hi Sleepzzzwell, I live in Ontario also, GTA area, and IMO I think you're being swindled! If this is an approved sleep clinic, then you should not be charged for any perscription; is it possible that what was sent to the DME was for a trial CPAP machine? The clinic that I went to and the DME were very professional and I would recommend them to anyone! The doctor not only gave me the original perscription but also faxed a copy to the DME to provide the equipment. Also the clinic emailed me copies of my results from my initial study and also my follow up; all at no charge. Keep in mind that the Province of Ontario covers upto 75% of the cost upto a maximum and you should only have to pay the difference when you pick up your machine. When I contacted my insurance for instructions on how to be reimburssed as I could not find the forms online; they told me I needed a letter from the doctor explaining why I was prescribed an APAP instead of CPAP and that I needed to submit the forms via snail mail; I called the clinic to request a letter for insurance and they emailed me the letter that they sent to the Ministry of Health & Long Term Care; which again was at no charge.

If you were made to pay the full amount out of pocket, I would go back to the place you purchased it from and demand a refund for the difference and if they refuse, let them know that you will be bringing them forward to the Ministry of Health as what they have done is illegal since you need a perscription to acquire a CPAP machine in Ontario. I would also go back to that doctor and check the credentials and demand the doctor give you a valid perscription or you will also bring them forward to the Ministry of Health. Good luck and send me a PM if you want to chat on any specifics.

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#18
(07-30-2013, 07:00 AM)sleepzzzwell Wrote: Sorry, just thinking out loud, I have a bad feeling if I asked these rather pointed questions at the sleep clinic they would probably just drop me as a patient the moment I demand transparency.

And that would be bad because ...?

Isn't that somewhat like a pickpocket threatening to move elsewhere if you insist on stopping them from dipping into your pockets?

From what I have seen, there are at least two other sleep clinics in the Windsor area. I'm sure they would be happy to take you on as a patient, particularly if you explain the treatment you've gotten from your current bunch.
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#19
Sleepzzzwell, My manager was diagnosed and prescribed a cpap and when he showed me the quotes he received from the provider that was recommended by the doctor of his sleep clinic, I told him not to purchase from them as he was being over charged for a Lower level machine; he was being quoted higher for a Philips cpap then what I was charged for a Resmed Autoset; which he would have had to pay a lot more out of pocket then he should. When he went back and discussed the high cost, the clinic told him he can buy from whom he would like and gave him a copy of his perscription. I mentioned this clinic to the provider i purcashed from and he mentioned that the doctor of the sleep clinic might have a vested interest in that specific provider. Keep in mind in Ontario our OHIP is funded by taxes paid by the residences and businesses of Ontario and the Ministry of Health does not take kindly to businesses trying to scam the system. Be fortunate that you live in a place where healthcare is top rate and not just only for the rich! Do not let them get away with scamming you! Stand your ground and if your not sure what/what not you can do, then contact the MoH and ask what your rights are.



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#20
I'm back with some new information.

I called the insurance company and described the situation. The first person I spoke to said the doctor can basically do what he wants when it comes to charging for a prescription, yet she found it odd that the document he sent to the DME stated it wasn't valid for insurance purposes. I read the contents of the document over the phone and the insurance agent said it sure sounded like a prescription. She then asked if I would give permission for an investigator from the insurance company to get more details.

The investigator suggested I simply send in the document to the insurance company as she was quite sure it would be accepted, despite the doctor's printed disclaimer!

I also had a follow-up appointment with the DME and I described my discussion with the insurance investigator. Even the agent at the DME said that the document they received was a VALID prescription and she was puzzled as to why the doctor would claim it wasn't the prescription and that it wasn't valid for insurance purposes.

I haven't reported the case yet to the group that oversees doctors in Ontario, but I think I'll be doing that in the near future.

Now I'm furious that the doctor at the sleep clinic tried to make me pay $30 for:
1) a copy of what the DME provided for free
2) for a document that *IS* a prescription according to the DME and the insurance company, yet the sleep clinic tried to claim it wasn't
3) for having the nerve to include that stupid disclaimer "not valid for insurance purposes" when even the insurance investigator says to ignore it!
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