(06-14-2013 10:27 AM)Paptillian Wrote: 1. How do I go about getting a copy of my prescription so that I can change DMEs later if I feel the need? Is the doctor obligated to provide it to me?
It is part of your medical record and you are allowed a copy of it and any other record. I suggest you get a copy of the prescription and a copy of the sleep study report. They may try to tell you that the report is huge and you'll not understand any of it. Tell them you will manage just fine. Your doctor is not obligated to give you one, you have to ask.
Quote:2. How do I ensure that the DME gives me the machine that I want? One of my questions to the doc. will be whether he can specify it on the script. I don't know if he'll do it. The local DME that I elected has a website but they do not list the machine that I want. They only have an older Resmed model (S8 Escape).
The prescription can be as simple as the pressure amount. Or it can specifically say "AutoPAP with humidifier". If the doc does prescribe a specific machine or type of machine, make sure the "Dispense as written" part is checked.
The S8 is an older model. And Escape means it is a "brick" (collects only compliance data). Run from that one. You do not want a ResMed with "Escape" in the name nor a Phillips-Respironics with the word "Plus" in the name. Here's a good place to learn all that:
Quote:3. Can I request the doctor to not auto-forward my script to a DME, or is he legally obligated to do it? My insurance provider informed me that they will only cover it if the DME is in-network... so I need to shop around. I do not want to be stuck with another large bill at the moment.
You can certainly request they give you the prescription then you can shop around. Ask the insurance company for their approved list.
Quote:4. Will the doctor or insurance company be tracking my usage? Back in January I had heard something about 'compliance.' How do they check? How long do they check for? What are the compliance rules and what happens if I fail?
Nearly every insurance will do compliance checks. Usually this is for 3 months and you must use the machine for an average of at least 4 hrs per night. If you do not comply, they take back the machine. They can check several ways but one is to have you take the memory card to the DME who downloads the data and sends the hrs to the insurance. They can also attach a cellular modem to your machine and it sends it to the DME that way.
Contact the ins. company and ask about their compliance rules.
And, each time you call about any of this, note the time, date, and who you spoke to. Ask for a letter to confirm the information.
Quote:5. When does the machine become mine to keep and do I need to do something now in order to set it up that way? My insurance company said they pay to rent the machine. I asked if it's a "rent to own" type thing and they gave only a vague 'yes' and the guy wasn't too confident. I'm not sure what to expect. I have a high deductible plan with 80/20 coinsurance, so I figure I'll be overpaying for the machine out of pocket anyway after the DME charges ridiculous rates for it. I would like to be at least making payments toward something I will own.
Yeah, it's a rent to own thing. In the time they finish paying the rental, they could have bought you several outright. Medicare pays for rental for 13 mos and at that point, it is yours. Most ins. companies follow this.
Before you sign, find out what your co-pay is. Then go to Supplier #2
in the Supplier's List (link at the top of ever page) and check out their machines. More than likely, it will be cheaper for you to get one on your own vs through a local DME. You will probably have to pay for your own machine supplies (filters and probably hose) but the DME should still do the masks. You want to do this locally until you find one that works.
There's a wide variety of masks, even within the same type. Don't let them give you a full face mask right off the bat. If you sleep with your mouth open, try a chin strap before you go that route. They're great masks but not for everyone. Many DMEs have a mask trial policy where you get to try a mask for a few weeks then try another one if it doesn't work. Some you will know immediately, others you'll need a few nights or more to decide.
Quote:6. Is it customary to see the doctor for a consultation after a titration? They did not indicate that I would be seeing the doctor again. I think the next person I'll hear from is the DME.
Customary? Eh, depends on the doctor. You should speak to him, to get your questions answered. But it is likely you'll just go straight to the DME.
Quote:Sorry for all the questions, but I really do appreciate any advice you can give. Thanks in advance!
Never apologize for asking questions! This is YOUR health. Grab the situation by the...hand and take control.