RE: Thanks!
Unless the medical group is owned by blue cross they have no say so over what is covered by insurance. Please do call your insurance.
RE: Thanks!
(04-26-2018, 08:46 AM)SoCalCpapGuy Wrote: (04-26-2018, 08:10 AM)Walla Walla Wrote: If you have the prescription from the specialist what's stopping you from picking your own DME? They can't make you go through them. Find another Doctor to handle the followups for insurance and ignore the medical group as far as your sleep apnea treatment goes.
They made it sound like I have to go through them or it won't be paid for... This whole thing has thrown me for a loop... I guess I can contact the Pulmonary doc... When he gave me the prescription, he said they could call him and he would authorize it... and he's the one I'm supposed to meet with in 3 months to go over everything.
I'm suddenly really confused... Maybe I need to check with Blue Shield to make sure it would be paid for if I go on my own without my medical group "approving" it...
I'm sure your pulmonary could help you in the same fashion that your PCP could. It is dishonest and a rip-off to be told you cannot use in-network providers of your choice. There may be a financial interest or other hidden arrangement, and I would be very suspicious of the treatment you got. Provide the pulmonary doc a copy of the sleep study and transfer full care to him. This is just ridiculous.
RE: Thanks!
I don't have the same insurance as you, so I don't know how yours works.
Could you pretend you never saw your PCP, and just continue with what your sleep specialist initiated? What's the worst that could happen? - your insurance could not authorize it... but I'd think you'd be good-to-go once/if the authorization comes through.
Try not to stress about this. All you need is for someone to provide the machine to you, and to provide a machine that you want. Keep that as your sole focus (since you said you don't want to buy one out-of-pocket). It doesn't (seem to) matter who provides it (via your PCP's avenue of a DME, or via your sleep specialist's avenue of a DME)... as long as you get one, and you get the one you want.
Once you have the machine, in the comfort of your own home, you can put it at whichever settings you want.
RE: Thanks!
(04-24-2018, 09:01 PM)SoCalCpapGuy Wrote: I hope this is the right place to put this, but I just wanted to thank everyone for all the amazing information on here... I did my sleep study about a month ago - my AHI was 26 - then a week ago I had my second sleep study/titration... which showed that using a CPAP brought my AHI down to 0...
Today I went to see the doctor who referred me, and because of the Board, I was prepared with all the information I needed to get a prescription for a Resmed Airsense 10 AutoSet with a Heated Humidifier and a Heated Hose... The doctor told me he wished all his patients were as knowledgeable and knew what they wanted... I left there with copies of all my Sleep Studies and a Prescription for the exact machine and mask.
Because of all the info on here, I had checked out all the DME suppliers my insurance will work with within 30 miles, and after checking with a few, found one that seems willing to work with me... I sat down with them and made it clear that I knew what I wanted, and their job is to give me the machine I want, not what's going to make them the most profit. They're now getting authorization from my insurance, and will be ordering the Airsense...
Once it gets authorized, and they let me know they have the machine, I'll be using the clinician manual to make sure the machine is new.
Considering I knew NOTHING about Sleep Apnea, AHIs, sleep studies, machines and how to get the right one before I started coming here, I can't thank everyone enough.
 Brilliant, that is exactly what we would like to hear all the time.
Good you did some research here before you went in knowing nothing and got what they wanted to give you instead of what you think will work best for you. Hope it all works out for you, however, if it does not go as you hope and you do have a problem or two we are here to help.
I am NOT a doctor. I try to help, but do not take what I say as medical advice.
Every journey, however large or small starts with the first step.
RE: Thanks!
Another update...
I believe my going crazy at my PCP's office at least helped a bit... Today when I called to continue my fight with them, they told me that the CPAP had been authorized this morning at 9:00 am... Of course it was sent over to the DME I chose knowing nothing, but I got the info and called them up and was really clear about the machine I want.
Supposedly it'll take 7 to 10 business days to get the machine after the DME has all the information they need, but I can live with that... I told them I will want to go to their office when the machine shows up - they wanted to deliver it and set it up... I figure it's easier to make sure everything is kosher when the machine is still in their office...
So I guess the moral of this story is do your research on here, so you at least appear to know what you're talking about, and don't back down when they try to take advantage of you...
Like Hydrangea said, I'm need to sit back and look at the long term goal - get the machine I want - the place really doesn't matter - the machine does...
Thank God this place is here... without it, I would have had no idea about dealing with ANY of these things!
RE: Thanks!
Nice change of events. I don't doubt your clear preferences and concerns led to success. It's the right outcome. Welcome to the club.
RE: Thanks!
Good. I hope they pull through for you.
I do have to say I'm flabbergasted that these places make patients wait a week or two to get a CPAP. I mean, if their job is to supply CPAPs to patients, shouldn't they always have an inventory of CPAPs on hand?
My sleep "doctor" (who was his own DME... not that I would EVER advocate for that fraudulent co-mingling) had lots of machines on hand. And when I fired him and gave him back his crap machine, *that same day* I went to a real DME and went home with a machine mere hours later.
(Sorry. I had to vent. I'm outraged for those who have to wait.)
RE: Thanks!
Hydrangea
I think they do stock the machines. They don't want to issue one until the insurance approval has come through so they can start to collect insurance payments as soon as you leave with the machine. They have no risk.
RE: Thanks!
(04-27-2018, 05:49 AM)gwc2795 Wrote: Hydrangea
I think they do stock the machines. They don't want to issue one until the insurance approval has come through so they can start to collect insurance payments as soon as you leave with the machine. They have no risk.
Yeah, the guy I spoke with at the DME said something about they'll have the machine as soon as everything gets sorted out with insurance...
I decided to leave him a voicemail this morning making sure he knows I want an AutoSet 10 with heated humidifier and heated hose... When I spoke with him yesterday he said something about a ResMed 10... Wanted to make sure I was clear, so he doesn't waste my time with a different model... 
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