Is the DME lying?

[Sleeprider]

I think you're handling everything great and you're nearly done. With regard to compliance monitoring, ask your insurance again. If they require the DME to monitor and report compliance, they will tell you. If they don't require it, get the machine from the DME and tell them where to go when they ask you to come in with a data card.

Not a lot of difference between a Resmed S9 and Airsense 10 Autoset. The Airsense is much more integrated with a built in humidifier and wireless modem, while the S9 uses the separate humidifier and modem. The only product that is different is the Airsense 10 Autoset for Her which includes a gentler EPR option and can monitor RERA events, which the regular Autoset cannot do.

You'll do great. Stick with it, and confirm anything the DME claims with the insurance. Beware of any automatic supply subscription and be sure the frequency of mask, cushions, hoses, filters is necessary and reimbursable by insurance. Pretty soon they will get tired of being called on the B.S.

[krelvin]

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.

They should be able to tell you EXACTLY what machine you are getting, which model, what parts are part of the "rental" which parts are the purchase. Once they know your insurance (deductable, percentage of payment etc) they should know what you are getting and how much it is costing.

They should be providing you with a checkout sheet which lists the equipment they are providing, S/N of the devices (the Airsense/Aircurve 10's only have one part), what hose, filters, mask, case and documentation you are taking.

I would personally bring a recording device, put it right on the table when you start asking questions (I always do) and they will know what they are saying is being recorded. You get different answers when they know it is being recorded.

When they talk about compliance, have them spell it out in writing and then check with the insurance company. DME's like to make stuff up and sell you more supplies than you most likely need.

They should not have needed the sleep study (but you should have it) and they should have been able to go off of the RX your doctor wrote.

Your insurance card has on the back of it a providers insurance call in number to help clarify any questions they don't understand.

Going in informed is better for you...

[GWild]

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 P*ssed 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...

I recently had a DME do worse --- after receiving the equipment they claimed I wasn't compliant and turned the bill into collection. Call to my doc and to my insurance showed I was compliant to the insurances satisfaction; but the kicker was insurance had not received invoices to pay. The DME was billing the wrong insurance AND the wrong doctor. The state AG sorted it out for me. Seems the word fraud came up several times.

So in answer to your question, apnea is a DME cash cow, and these folk are worse than used ca salesmen.

[AlanE]

"Is the DME lying?"

Were their lips moving?

[OpalRose]

I don't trust anything my DME says. They have proved themselves untrustworthy!
Not only that, they don't seem to be very knowledgeable about their products.

I only put up with them for now until Medicare is done paying the 13 month rental, then the machine is mine. I buy supplies on line because the DME tends to screw up my orders and overcharge for the privilege.

I can understand your situation if there is no other DME close by and you want it to go through your insurance, but you need to arm yourselves with knowledge before dealing with them.

Oh, and did I say that they "lost" my SD card that had the first 30 days data on it. My CPAP was changed after the first 30 days, so I couldn't even retrieve the data from the first machine.

[MobileBasset]

I have never been as stressed dealing with a service company as I was trying to obtain my latest auto bi-PAP through Apria. I have Medicare so the process is specific. Right way I wished I had just put out the money myself and not used insurance. But I persevered as the Air-Curve V Auto is very expensive. I pushed and nagged and resisted their ridiculous assertions until I got the machine I wanted and nothing I didn't want. At one point they told me my diagnosis didn't match the prescription because the prescription described an ASV (not true) so they couldn't proceed. That took a lot of talking to work them through.
It riles me up to read threads on this topic. I should not read them. I agree with everyone who states/implies that DMEs are unscroupulous businesses. You should hold them to a higher standard than they hold themselves: expect them to do business as other companies do, get the device you want, understand the costs, and be serviced in a timely manner. You must do the work of understanding what you are buying and why, what your insurance requires and provides and what you will be responsible for. Then you can move through the process with the courage of your conviction.

[justMongo]

How to handle a DME.
1) Print out the 127 page SF-86 from the OPM
http://www.opm.gov/Forms/pdf_fill/sf86.pdf
2) Tell them when they have filled it out, you'll arrange for the fingerprinting and polygraph.

[AlanE]

I buy supplies on line because the DME tends to screw up my orders and overcharge for the privilege.

OpalRose,

Do you get reimbursed for the supplies you buy online? or just out of pocket for tax deductions?

[player]

Make sure you know which A10 you are getting because there is a low end model that does not have many reporting features.

[OpalRose]

I buy supplies on line because the DME tends to screw up my orders and overcharge for the privilege.

OpalRose,

Do you get reimbursed for the supplies you buy online? or just out of pocket for tax deductions?

I have a Humana Medicare Advantage plan, and if I buy on line, as long as I submit the required paper work and follow the Medicare schedule, I am reimbursed at 80%. I admit it is more of a hassle to buy on line and submit it to insurance, and insurance takes a longer time to reimburse me.

If I buy from my DME, they usually pay 100% after yearly deductable is met. The crazy part is that my insurance ends up paying more to he DME than what they reimburse me.

My DME has taken as long as 3 to 4 weeks to send me a nasal pillow and fine white filters. At one time, I called to see where my order was, and they claimed I received it. I ask for proof or a tracking number which they couldn't give me.
Then they had the nerve to say that maby I forgot that I received it.
After me pestering them, they admitted that they never placed the order.

Sometimes it's easier to just buy online and avoid the DME and the stress they cause.