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The World of DME's
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SleepEZ Offline

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Posts: 37
Joined: Jul 2013

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed H5i
CPAP Pressure: Autoset (7 - 13)
CPAP Software: SleepyHead

Other Comments: Respironics Premium Chinstrap. Had to buy myself. My DME ignored prescription and many requests.

Sex: Male
Location: Des Plaines, IL

Post: #1
The World of DME's
I've been learning a lot about the world of DMEs. We have Blue Cross Blue Shield PPO coverage and, after talking with BCBS, learned that since I've already met my deductible and out-of-pocket limits for the year, all my equipment will be paid for at 100% if I use a Blue Cross contracted DME.

Still awaiting the titration results; and the sleep center has their own DME, whom I've played phone tag with so far ... and who indicated in a voicemail that I have standard deductible and coverage.

The copy of the next report will go to this person first and then I believe she will call me to make an appointment to see them; but from everything I see, they are not a BCBS PPO contracted DME. That being the case, if I go "out of network" and stay with them, there's a whole different set of rules ... higher deductible, coverages are less than my "in network" coverages, etc., so I think I'm going to have to get the second report and head to another (contracted) DME to get the 100% benefit.

I've already got a copy of the initial report and prescription for the CPAP, so I'm hoping that a call to Medical Records at the sleep center will yield a quick copy of the second report that I can take to the other DME without a whole lot of hassle from the sleep center's DME.

Anyone else have wisdom to share related to a situation similar to this?
07-20-2013 08:27 PM
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Sleepster Offline
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Posts: 4,993
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #2
RE: The World of DME's
I've split this to a thread in the main forum where more folks will have a chance to see it.

All you need is the prescription from the doctor for the CPAP machine and you can then go to any DME you want.

The sleep study report goes to the doctor. The doctor then writes a prescription which goes to the DME. You have a right to copies of both the sleep study and the prescription.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
07-20-2013 08:41 PM
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oak Offline

Members

Posts: 70
Joined: Jul 2013

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: Resmed Swift FX for her
Humidifier: S9 Hi5
CPAP Pressure: 9
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Female
Location: Western WI

Post: #3
RE: The World of DME's
All i can say is that my situation was almost identical to yours and I had quite the time talking with the DME. ( my information was automatically faxed to them by the sleep center, since they were in the same group, and which IN network provider I wanted out of 5 providers nearby were not discussed with me).

The DME rep tried to set me up with inferior equipment, tried to tell me I would have to pay for rental of equipment, and was downright rude. It was fun to watch her fall off the chair when I informed her I had already talked to BCBS and set her straight. What a little game they and the sleep clinic had going! Too bad I wrecked it for them!

I wish you luck!! Sleep-well
07-20-2013 08:49 PM
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Paptillian Offline

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Posts: 474
Joined: Jun 2013

Machine: S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i
CPAP Pressure: 4 - 10, EPR x2
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania, USA

Post: #4
RE: The World of DME's
Good of you to get your prescription and results from your doctor. When I had my titration done, they wanted to auto-forward my Rx to a local DME. If I hadn't found this board, I wouldn't have thought to request my prescription and look elsewhere for my supplies.

How does BCBS pay for CPAP equipment? Most policies I believe pay on a 13-month "rent to own" schedule. They make 13 monthly payments to the DME and the CPAP machine becomes yours after the last payment. The thing to be aware of is that even if your deductibles are satisfied at the moment, they will roll over at some point. If your insurance is still making CPAP payments and your deductibles roll over, you need to be ready for that.

Depending on your coverage and deductibles, you might not be saving anything by using insurance. I called a few local DMEs to figure out pricing. It turns out it's the same; insurance just pays by a standard HCPC code for CPAP machines regardless of whether you get a dumb brick or a data-capable Auto CPAP. For me it would have cost me about the same out of pocket to use a DME vs. buying my own online. Actually, a couple hundred cheaper online.
(This post was last modified: 07-20-2013 08:54 PM by Paptillian.)
07-20-2013 08:52 PM
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oak Offline

Members

Posts: 70
Joined: Jul 2013

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: Resmed Swift FX for her
Humidifier: S9 Hi5
CPAP Pressure: 9
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Female
Location: Western WI

Post: #5
RE: The World of DME's
(07-20-2013 08:52 PM)Paptillian Wrote:  Good of you to get your prescription and results from your doctor. When I had my titration done, they wanted to auto-forward my Rx to a local DME. If I hadn't found this board, I wouldn't have thought to request my prescription and look elsewhere for my supplies.

How does BCBS pay for CPAP equipment? Most policies I believe pay on a 13-month "rent to own" schedule. They make 13 monthly payments to the DME and the CPAP machine becomes yours after the last payment. The thing to be aware of is that even if your deductibles are satisfied at the moment, they will roll over at some point. If your insurance is still making CPAP payments and your deductibles roll over, you need to be ready for that.

Depending on your coverage and deductibles, you might not be saving anything by using insurance. I called a few local DMEs to figure out pricing. It turns out it's the same; insurance just pays by a standard HCPC code for CPAP machines regardless of whether you get a dumb brick or a data-capable Auto CPAP. For me it would have cost me about the same out of pocket to use a DME vs. buying my own online. Actually, a couple hundred cheaper online.

You should be fine as long as you stay in network. Tell the DME that your BCBS policy will pay 100% and to "convert from rental to purchase" that way you wont have to deal with paying your deductibles again in 2014 for equipment you got in 2013.
07-20-2013 09:13 PM
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Paptillian Offline

Preferred Members-2

Posts: 474
Joined: Jun 2013

Machine: S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i
CPAP Pressure: 4 - 10, EPR x2
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania, USA

Post: #6
RE: The World of DME's
(07-20-2013 09:13 PM)oak Wrote:  Tell the DME [...] to "convert from rental to purchase" that way you wont have to deal with paying your deductibles again in 2014 for equipment you got in 2013.

Learn something new every day...

My insurance rep didn't even mention that possibility.
(This post was last modified: 07-20-2013 09:18 PM by Paptillian.)
07-20-2013 09:17 PM
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oak Offline

Members

Posts: 70
Joined: Jul 2013

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: Resmed Swift FX for her
Humidifier: S9 Hi5
CPAP Pressure: 9
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Female
Location: Western WI

Post: #7
RE: The World of DME's
doesnt always work. but his BCBS told him 100% so I am assuming its like mine. It has worked with other services and equipment I have received as well.
07-20-2013 09:19 PM
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SleepEZ Offline

Preferred Members

Posts: 37
Joined: Jul 2013

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed H5i
CPAP Pressure: Autoset (7 - 13)
CPAP Software: SleepyHead

Other Comments: Respironics Premium Chinstrap. Had to buy myself. My DME ignored prescription and many requests.

Sex: Male
Location: Des Plaines, IL

Post: #8
RE: The World of DME's
Thanks Sleepster. Not being totally familiar with the way the forum works, I thought I should just continue the thread I originally started.

I had pretty much come to the conclusion that I have a choice of DMEs, but that wasn't readily apparent to me as a novice in the arena of having to acquire durable medical equipment. I was particularly confused because of the way my whole situation developed.

In the interest of helping others avoid misunderstanding of the process, here are some of the details of how my situation developed:

I think it may be a bit out of the ordinary, but my rheumatologist wrote the order for the sleep study after I mentioned to him a warning I had received from an anesthesiologist who had recently put me out for some biopsies; and instead of sending me to see a sleep specialist first, I went right to the lab, then waited for results. Eventually I got a call from my rheumatologist's nurse giving me the verbal diagnosis; but when I asked, she wasn't sure of what I should do next. So, she recommended I make an appointment with the doctor who analyzed my test and wrote the report. She had no contact info, so I had to find him online and call and wait to see him about a week later. It was real odd too, because when I called for the appointment, the person I talked to didn't even know he was affiliated with the sleep center where I had been tested, so I had to go see him at another office (later I found out I could have seen him at the sleep center ... go figure).

The doctor who wrote my report is a neurologist who ultimately spent quite a bit of time going over medical history and doing physical exams (neurological-related). He talked about my diagnosis, but didn't give me a copy of the study ... and it didn't dawn on me or my wife to ask for a copy.

After seeing him, I was later titrated. While there I asked a lot of questions and, among other things, found out that "someone from the sleep center" will call me to start the equipment-ordering process after results are in. So it was after this that we really started doing more intense research with BCBS and checking for contracted DMEs, etc. online. At this point I also contacted the Medical Records Department to get actual copies of my original study and the prescription, which arrived a couple of days ago.

My biggest surprise was that the prescription was signed by my rheumatologist, not the neurologist (sleep specialist) who read my test and wrote the report.

All of the above to say, I don't believe I was well informed about what to expect from whom in this process. Plus, I believe the sleep center's DME wouldn't necessarily inform me about the fact that I might be able save money by using someone other than them. I've essentially been on my own to discover that myself.

I'm hoping this helps someone else avoid heading down a track that may not be the most economical for them. Also, I think things might have moved quicker if everyone was clearly communicating to me as things progressed. My basic conclusion is that it pays to ask lots of questions and talk to your insurance company before proceeding too far down the path of equipment ordering.
07-20-2013 09:53 PM
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Sleepster Offline
Wiki Editor
Moderators

Posts: 4,993
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #9
RE: The World of DME's
(07-20-2013 09:53 PM)SleepEZ Wrote:  My biggest surprise was that the prescription was signed by my rheumatologist, not the neurologist (sleep specialist) who read my test and wrote the report.

He's the doctor who ordered the study, so he's the one who gets the results. All he has to do is follow the recommendation he's been given and write a prescription for the patient. His nurse should have told you that.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
07-20-2013 10:30 PM
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jgjones1972 Offline

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Posts: 516
Joined: Nov 2012

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro FX
Humidifier: ResMed H5i
CPAP Pressure: 18 - 20
CPAP Software: ResScan SleepyHead

Other Comments: CMS50I PulseOx

Sex: Male
Location: Ohio - USA

Post: #10
RE: The World of DME's
Many people like to complain about insurance companies; but, in the realm of cheats, cons, graft and swindles, the insurance companies are rank amateurs compared to brick-and-mortar DMEs. In addition, the insurance company has a financial interest in the apneac getting SUCCESSFUL treatment (complications of unsuccessfully treated or untreated OSA are much more expensive than PAP), while the DME only has a finacial interest in the apneac being "compliant" (ie, ordering over-priced supplies regularly).

The best thing I ever did, in regards to my PAP treatment, was to call my insurance company and work out a way with them for me to get better treatment and save both of us money. They were more than happy to work with me.

Sleep-well
07-21-2013 05:56 AM
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