Is my local DME crooked or is this normal?

[Sleeprider]

Never use a Doctor owned DME. The conflict of interests should be obvious.

[Michaely6]

I learned my lesson. I will keep that in mind for the future. Does anyone know of any cpap equipment suppliers online that takes insurance?

[SarcasticDave94]

Yeah sleeprider I'm just going to find another provider. I talked to the manager and doctor today who were so unprofessional even though I was calm the whole entire time to the point that he started making unprofessional comments like "I charge $400 an hour and your waisting my time" and also said "you just swing by here to pick up equipment. What do you think this is burger King". I was shocked by the unprofessionalism. I advised him that I'm recording the conversation and he said that's fine. Texas is a one party consent state so I have the right to record. I don't know the rules about uploading to YouTube to expose the unprofessionalism but I may take that route if I am able to legally.

Sounds like an overpriced medical duck for $400 per hr. Repeat after me "you're fired!". Last I checked BK does not offer CPAP nor pay $400 per hr. Reiterate, fire these dopes and replace with a pro who actually cares, not a duck sham like these 2. Sounds like 2 of 3 stooges there. Exit stage right ASAP!

[Fats Drywaller]

Does anyone know of any cpap equipment suppliers online that takes insurance?

Supplier #30

[SuperSleeper]

In addition, some (not all) online DMEs will give provide you with an insurance-compliant itemized invoice that contains applicable insurance billing codes for each item purchased so that if you pay up front, you can apply for reimbursement through your insurance company.

But the key is that you must first get prior approval for that type of purchase from your insurance company, and make absolutely sure they understand that you will make the purchase with your own funds and that you want them to reimburse you after the fact.   Many times online DMEs will be "out of network" so that may be a factor in how much insurance is willing to pay or if they are willing to reimburse you at all. That's when dealing with private insurance; for Medicare and Medicaid in the U.S., I'm pretty sure you're going to be out of luck in trying to get them to reimburse you for any medical equipment unless it's through their pre-approved DMEs.

One of the factors is the actual cost of going through an in-network DME vs. outright purchase with an online DME.  Many folks have found that (because of the higher prices of in-network DMEs), and after you figure out your deductible,  out-of-pocket and/or co-pays for staying in-network, and after you consider all the hassles and waiting that tend to occur with in-network DMEs, it's much easier to simply purchase the machine yourself at the best online price, especially when a high co-pay and deductible is a factor.

Just as an example, a DME may charge insurance $1500 for a CPAP machine, and if insurance pays 80%, you still have to pay $300 yourself, even with insurance.  In those types of case, and especially for people who don't need anything other than a basic CPAP machine, it may be easier just to go out and spend $450 yourself and avoid all the hassles that come with dealing through insurance.  That's $150 you'd have to pay extra in this example, but that might be well worth your time and effort, considering all the stress, wait time and frustration when dealing with an in-network DME.

Now if you have the patience for it, and your insurance covers it, by all means, try to use the in-network DME if that will be less costly for you in the long run.

Either way, you're the patient and you are your own decision-maker, as it should be.

[dmeRT]

interesting discussion, thanks to all who have responded.

appears the prescription issue is DME specific as our DME (medical billers) require a new prescription each year to be safe from insurance audits. But apparently "expiring prescriptions" isn't really a thing.

I'd like to think the DME's aren't intentionally misleading pt.'s, but the consensus here is obvious.

I constantly tell people to search for products online and not buy from DME's if their insurance doesn't cover the item. Also, DME's aren't going to hand out equipment if it doesn't meet the timeline of replacements, because insurances won't pay if it goes against their timetable.

As far as switching companies for products. I believe all you'll need is the original sleep study and prescription.

[BadGoodDeb]

My DME requires a new prescription to be written every year.  My doctor's office has, with a little pressure  (i.e. ask 3 times or so) been willing to write the prescription but only make me come in every other year.  More or less.   My old doctor retired and a new one is there now, so I don't know if he'll be willing to write a new prescription without seeing me again.  It helps when you have a multi-year history of flawless compliance,  missing only for single nights when I'm camping in my trailer while on the road.  When I get to the destination, I have AC power again,  so I religiously use the machine.

tl;dr   Yes, it's fairly common to need a new prescription every year.

[Sleepster]

I have BCBS insurance, but that doesn't mean all BCBS insurance contracts with employers are the same. Starting this year they require an annual prescription renewal. I'm hoping I can get such renewals from my PCP when I do my annual physical and get all my other prescriptions renewed. We shall see.

[Fats Drywaller]

As far as switching companies for products.  I believe all you'll need is the original sleep study and prescription.

The main thing is that the switch has to be approved ahead of time by the insurer, which is to be expected, because as SS said, they want the patient to use an in-network company. They'll recommend a few for the patient to choose from. Getting copies of the sleep study and the prescription, which the patient is legally entitled to in any case, shouldn't be a problem assuming that the doctor's office is responsive. (Mine wasn't because they're all mentally retarded there, and I gave up on it and fired that doc just because I'm lazy and can't be bothered to hassle with it, but then I'm an oddball case.)

All of that is quite do-able. It's analogous to firing an incompetent and/or fraudulent building-trades contractor and hiring a better one. As in that case, it's also advisable to file a formal complaint with whatever state regulatory agency is responsible for that stuff, and to file a complaint with the Better Business Bureau, and to post a nasty review on Yelp. Et cetera.

Y'all been gettin' away with this extortionate crap for too long. I suspect that it's probably because the vast majority of the patients who use your services are old and/or sick and to the greedheads they look like easy pickings. "Never give a sucker an even break, and never smarten up a chump."

[SuperSleeper]

I'd like to think the DME's aren't intentionally misleading pt.'s, but the consensus here is obvious. 

I'll take back my previous terse reply.  Your later response likely indicates that you aren't "part of the problem" such as those DMEs many often deal with here.  Could be you're simply misinformed on some things due to your company's policies and training of staff.

tl;dr   Yes, it's fairly common to need a new prescription every year.

Just to clarify, it's the DME's policy that is making that demand - there is no law nor governmental regulation that requires a new script every year for durable medical equipment & supplies.

DMEs are likely making such yearly script demands in order to protect themselves from potential denials by the insurance companies.  Having a recent script on file likely makes it easier for them to be reimbursed by the insurance company, not (as many DMEs claim to their patients), that "it's the law".  It's not the law at all, it's simply a company policy;  there is a difference.  These are the same DMEs that tell their patients 'It's illegal for you to change your own CPAP pressure", which we all know is false as well.