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Is the DME lying?
#1
I started a thread earlier about helping my hubby get new equipment, see post "So many questions where to begin" for more details.

We went to the DME together because he had tried on two different occasions to get new equipment and both times he left frustrated and with no new equipment. I have to sleep with the man and he is miserable when he's not getting sleep so I was on a mission.... The lady at the DME told us we had to have a current prescription, but that was not all, we also had to have a copy of the sleep study, and chart notes from the doc. She told us without those things, they could not provide equipment. My hubby got pissed with her and went out the door, same story, different day. We had explained earlier that this DME had changed hands and they no longer had his records. The sleep study doc no longer had sleep study info because it had been 8 years. Hubby did not want to go through all that again to be told he had OSA.

I asked for more details as to why a prescription wasn't good enough. She told me that our insurance (which at this point, she didn't even know who our insurance was) would not pay claims unless they had a sleep study on file. I argued with her a little and got no where, she was not a pleasant person to deal with. I then called our insurance company while I was there, they put us on a conference call where my insurance company basically backed us up and told the DME that they did not have to have a sleep study on file. The DME lady then insists that we have to have chart notes and demographics as well as a new prescription during this call. The insurance company again stated they did not need these items, only a prescription, that none of this stuff had to be pre-authorized, yada yada yada.

Fast forward, we get a new prescription from the doc that covers all our bases for an APAP with heated hose, etc. Go back to the DME, get the same lovely lady to help us. She fills out all the information she needs, asks for our credit card. We ask what type of machine they will be giving, she states either an A10 or S9. Then she states hubby will have to come in every 3 months and upload data, get new supplies, and here's the part I don't think is true on top of everything she said earlier, "he had to do this or he wouldn't be compliant and that our insurance company would take the machine back" I thought we were buying the machine? yes, but she states that if he wasn't compliant they could take it back. Our insurance company has never required him to do anything in the past. Is this all nonsense?

Hubby goes to DME tomorrow to find out what machine he gets and to have the DME's respiratory therapist fit him. I'm worried after all of this that they will pull more crap with us. Is this all normal? Are we overreacting? Is there anything else we should watch out for? Getting paranoid...
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#2
It sounds like you are dealing with Crapria I hope you did Not give them a CC.
You can buy a new A10 and a mask for about a grand. Look really hard at getting your machine from one of the supplies at the top of the page cause this women sounds like she is going to make your lives heck.
The A10 has a cellular modem built in so it is BS you would have to make a data trip
My 2c
I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
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#3
You have a prescription. Why are you fooling with this DME? They will end up charging you more than if you just go to one of the on-line suppliers and buy your own machine. Your husband isn't new at this, so setting it up should not be a big problem.

Besides, your insurance will probably reimburse you if you do purchase on line. It'll save them a bundle of cash as well.

You do not need a DME. Be done with that.
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#4
(06-03-2015, 08:26 PM)Mark Douglas Wrote: It sounds like you are dealing with Crapria I hope you did Not give them a CC.
You can buy a new A10 and a mask for about a grand. Look really hard at getting your machine from one of the supplies at the top of the page cause this women sounds like she is going to make your lives heck.
The A10 has a cellular modem built in so it is BS you would have to make a data trip
My 2c

It's actually a little place in a small town, we live in the middle of nowhere. I looked them up on the internet and they are linked to an online company called medical service company, unless the company you mentioned is also related? They are basically the only DME that is in network with our insurance. We did give the CC, but was told it would be used for the 20% that we would have to pay, our insurance picking up the 80. She quoted somewhere in the higher $200 range for the machine. So it isn't normal to require CC either?


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#5
Ask specifically what your cost is. Then check online at Supplier #2. If your cost is about the same or less, go with the local folks. If it is more, then get an open box machine with SecondWind and tell this DME to stuff it. They have a monopoly and they know it. They know they can do anything they want and get away with it.

Compliance time is typical but it rarely goes more than 6 months. Usually it is only 3. What this means is your husband has to prove he is using the machine X number of hours for X number of days. Usually 70% of the time or roughly 4 hrs a day for however long it is. They prove this by looking at the compliance hours on the card.

If your insurance is buying this, once you are beyond the compliance, they don't "take it away" after the compliance is over. It is yours. They don't care if you adjust the pressure. All they care about is he is compliant.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


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#6
There are a LOT of horror stories about peoples financial lives literally being destroyed by the crap some of the national DMEs pull and so my comment.
Apria is the one I would been forced into by Cigna. I searched and I could find THOUSANDS of complaints about them and I could not find ANY positive reviews. This is what convinced me to get my own machine and with the help of the good people here manage my therapy without any additional complications.
You might try to find out if your local DME is in bed with one of the nationals.
I think it is Archangel who says if a DME tells you at midnight the sky is dark go out and check yourself. Truly what little experience I have had convinced me by and large it is a snake pit.
I wish you well.
Don't forget no one is as interested in one's health as oneself.
I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
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#7
Thanks everyone for your comments. Should we request the A10 over the S9 or is there really not a big enough difference between the two to put up a fight? I have already decided if they give us any more grief, we will walk out. Putting up with the DME hoping that the quote of the upper $200's would be a lot less than around a grand buying online.
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#8
I was told by my DME that they are no longer making the S9...because I was going to change from the A10 to the S9...I wounder if that was B.S. I'm dealing with Apria....and they are a nightmare.
It's exactly like that. . . . only totally different. . . . Sleep-well
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#9
(06-03-2015, 09:34 PM)sleepybeaver Wrote: I was told by my DME that they are no longer making the S9...because I was going to change from the A10 to the S9...I wounder if that was B.S. I'm dealing with Apria....and they are a nightmare.

What didn't you like about the A10?
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#10
If the DME was able to estimate your part would be $200 why not ask for the $200 and be done with it?
I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
Post Reply Post Reply


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