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Theyre trying to rip me off!!
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LolaBelle Offline

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Posts: 56
Joined: May 2013

Machine: Resmed Autoset S9
Mask Type: Nasal mask
Mask Make & Model: Wisp
Humidifier: H5i Climate Line
CPAP Pressure: 7
CPAP Software: ResScan

Other Comments:

Sex: Female
Location: Pennsylvania

Post: #1
Theyre trying to rip me off!!
Ok so I saw my sleep specialist and she was pretty nice answered most of my questions(not all but that's ok I still don't know what my osa is caused from if its just weight or something to do with my throat and she didn't check BUT I did get my sleep study information which was scary to look at!!!) and showed me the wisp mask which I decided im going to try so she wrote out my prescription and sent it to a DME which I called and the first thing she tells me is that they called my insurance and they are out of net work for my insurance and I will have to cover the first 500$ and than after that 30 percent of everything else So I tell her thank you and I will have to call my insurance and find a place that is IN network because I cant afford that

I call my insurance and they tell me they received no calls and that im 100% covered as long as I have a prescription and I have no deductables and that that place is IN network Thinking-about

SO....I call back and when I tell her that she actually laughs and than proceeds to tell me that they found that information off of my insurances website and I now have made an appointment for Monday to get my machine

My question is this.. Does anyone have any advice for me once I go in there, I know what machine I want and what things I would like to get and my insurance is pretty good my husband works for the county and he is a diabetic (type1) and needed to make sure he found a good job so he would have good insurance and so far from everything ive been through and done my insurance has covered everything accept for a 10$ or 20$ co pay here and there which I am truly blessed for but im scared I will go in there and they will try to tell me something that isn't true and stick me with an old machine and everything I want to get the s9 autoset cause I know ill have it for a long long time and I want the good data reading capabilities and the option for apap and I would like to get the right mask and I wonder if my insurance would cover the humidifier and the climate line tubing? but all my insurance keeps telling me is that im 100% covered with no deductables but I don't know if that means I can pick what I want ? or if it has to be written down from the doctor, I told my doctor what machine I wanted and she told me my insurance most likely wouldn't cover it but I told her they said they would as long as I had a prescription, I just want to be able to go in there and get what I can and not get screwed out of anything because I don't know what im doing, its hard for me to be assertive lol I got so nervous telling the lady over the phone that my insurance said it covers everything with a prescription that I was practically shaking when I got off the phone it was ridiculous! anyways any advice would be appreciated Smile Thank you

Sarah <3
(This post was last modified: 05-16-2013 01:59 PM by LolaBelle.)
05-16-2013 01:44 PM
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PollCat Offline
Apnea Board Polling Administrator
Monitors

Posts: 1,575
Joined: Feb 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: H5i Cleanable with ClimateLine
CPAP Pressure: 10 - 18
CPAP Software: SleepyHead

Other Comments: CPAP-ing since 1995; Type 2 Diabetes; Chronic Asthma; Gout

Sex: Male
Location: Westfield, IN

Post: #2
RE: Theyre trying to rip me off!!
Have your doctor write the prescription either for the precise machine you desire, or have it written (as my sleep doc did) showing that it's up to you to decide which machine works best for you.

While it's nice to use a local DME, especially if you're covered by Medicare, you might find it advantageous to use one of the online DMEs on our suppliers list (See http://www.apneaboard.com/forums/Thread-CPAP-Supplier-List) .


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.
05-16-2013 02:13 PM
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LolaBelle Offline

Preferred Members

Posts: 56
Joined: May 2013

Machine: Resmed Autoset S9
Mask Type: Nasal mask
Mask Make & Model: Wisp
Humidifier: H5i Climate Line
CPAP Pressure: 7
CPAP Software: ResScan

Other Comments:

Sex: Female
Location: Pennsylvania

Post: #3
RE: Theyre trying to rip me off!!
I just called my doctors office and got the lady at the desk and I said I wanted to ask for a copy of my prescription so I know what im getting and to make sure its correct and her words were " Why do you need that" and I said cause I want it I wanna know what im getting and make sure everythings right and she put me on hold and than came back and said " Well why do you need it...Ive never had anyone question me like this before I don't know if im allowed to give that out I will have to call you back after I talk to the doctor" And so im waiting for a call
05-16-2013 02:16 PM
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PollCat Offline
Apnea Board Polling Administrator
Monitors

Posts: 1,575
Joined: Feb 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: H5i Cleanable with ClimateLine
CPAP Pressure: 10 - 18
CPAP Software: SleepyHead

Other Comments: CPAP-ing since 1995; Type 2 Diabetes; Chronic Asthma; Gout

Sex: Male
Location: Westfield, IN

Post: #4
RE: Theyre trying to rip me off!!
It's your right to have a copy of your prescription! Do not let the doctor's office "blow smoke" regarding availability of the prescription. Depending on the distance to your doctor, you may be better served by going to her office and picking the script up.

If you use an online DME (like Supplier #1) they will obtain the script for you and keep in with your online account.

Bob.
05-16-2013 02:32 PM
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LolaBelle Offline

Preferred Members

Posts: 56
Joined: May 2013

Machine: Resmed Autoset S9
Mask Type: Nasal mask
Mask Make & Model: Wisp
Humidifier: H5i Climate Line
CPAP Pressure: 7
CPAP Software: ResScan

Other Comments:

Sex: Female
Location: Pennsylvania

Post: #5
RE: Theyre trying to rip me off!!
I know she just called back and was like " Its fine I guess for you to have it so where would you like me to send it to your Pennsylvania address?" Im down in southern Delaware getting everything why would I want that lol she is just being mean on purpose I think but whatever im going to pick it up tomorrow morning and if anything is wrong on there I will have them change it when im there I cant believe they make you go through all this just to have things done right, Its like im not feeling great to begin with (due to lack of sleep) and they cant do anything right and make a huge deal out of everything and make me feel like im doing something wrong
05-16-2013 02:44 PM
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Shastzi Offline

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Posts: 1,174
Joined: Dec 2012

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: FitLife Total face mask
Humidifier: F&P HC150 with Hybernite heated hose.
CPAP Pressure: 15cm-20cm H2O (auto)
CPAP Software: SleepyHead Other Software

Other Comments: CMS50-F wearable Oximeter; Software: SPO2 Assistant

Sex: Undisclosed
Location: Florida, USA.

Post: #6
RE: Theyre trying to rip me off!!
Good for you, Lola.
Stick to your guns!

Wink

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
05-16-2013 04:25 PM
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LolaBelle Offline

Preferred Members

Posts: 56
Joined: May 2013

Machine: Resmed Autoset S9
Mask Type: Nasal mask
Mask Make & Model: Wisp
Humidifier: H5i Climate Line
CPAP Pressure: 7
CPAP Software: ResScan

Other Comments:

Sex: Female
Location: Pennsylvania

Post: #7
RE: Theyre trying to rip me off!!
(05-16-2013 04:25 PM)Shastzi Wrote:  Good for you, Lola.
Stick to your guns!

Wink

Thank you! Its hard but im trying lol tomorrow is when I go in to pick up my copy of the prescription that's when ill need the luck I wanna make sure everything is on there right and it probably isn't so im gonna have to ask them to put what I wanted on there and im sure that will be a big deal too Rolleyes
05-16-2013 05:37 PM
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iSnooze Offline
Apnea Board Proofreader
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Posts: 239
Joined: Feb 2012

Machine: Respironics PR System One C-Flex+
Mask Type: Nasal mask
Mask Make & Model: Resmed Mirage Micro
Humidifier: System One Heated Humidifier
CPAP Pressure: 11
CPAP Software: SleepyHead

Other Comments: also use a Comfort Gel Full Mask by Respironics

Sex: Female
Location: Indiana

Post: #8
RE: Theyre trying to rip me off!!
After I picked up my machine from the DME I had my family physician write me script in case I ordered supplies from any of the online stores. She didn't have a problem giving me the script but she wasn't sure what to write on it. I know that mine does not state the type of machine, just the pressure.
05-16-2013 07:50 PM
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LolaBelle Offline

Preferred Members

Posts: 56
Joined: May 2013

Machine: Resmed Autoset S9
Mask Type: Nasal mask
Mask Make & Model: Wisp
Humidifier: H5i Climate Line
CPAP Pressure: 7
CPAP Software: ResScan

Other Comments:

Sex: Female
Location: Pennsylvania

Post: #9
RE: Theyre trying to rip me off!!
(05-16-2013 07:50 PM)iSnooze Wrote:  After I picked up my machine from the DME I had my family physician write me script in case I ordered supplies from any of the online stores. She didn't have a problem giving me the script but she wasn't sure what to write on it. I know that mine does not state the type of machine, just the pressure.

That's good to know Im thinking at some point if my insurance covers it I will be moving to an online DME
05-16-2013 08:46 PM
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Shastzi Offline

Advisory Members

Posts: 1,174
Joined: Dec 2012

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: FitLife Total face mask
Humidifier: F&P HC150 with Hybernite heated hose.
CPAP Pressure: 15cm-20cm H2O (auto)
CPAP Software: SleepyHead Other Software

Other Comments: CMS50-F wearable Oximeter; Software: SPO2 Assistant

Sex: Undisclosed
Location: Florida, USA.

Post: #10
RE: Theyre trying to rip me off!!
My doctor offered my prescript to me for pick up.
When the main office gets all cagey about it I get wary....

Anyway, if it's not right, make them do it over.
If they refuse then tell them to hand over your medical files so you can change doctors.
That usually works in your favor. (either way, you WIN!)

=^.^=
Peace, Love and Carrots!

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
05-16-2013 09:03 PM
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