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+--- Thread: Stuck with my DME?? (/Thread-Stuck-with-my-DME)
Stuck with my DME?? - macamon - 12-11-2017
Help!
A few years ago I got my S9 through Crapria, they forced me to rent for a year before it was purchased, caused major problems with my insurance company and damage to my credit as I was hard headed and tried to fight it. Needless to say I wouldn't pee on them if they were on fire let alone do business with them again.
After being informed of this, my doctor is telling me I can't change DME without my original sleep study. Is this true? My original study was almost 20 years ago. What are my options?
Thanks in advance for your assistance.
Best regards,
RE: Stuck with my DME?? - SarcasticDave94 - 12-11-2017
I think the answer somewhat depends on what DME you are dealing with. Do you have a copy of the sleep study (PSG)? Do you have a copy of the prescription? BTW, of the two, the script is more important. Some DME's may accept the script, while others may want both the script and the PSG. To the best I recall, the script is required, while the PSG is not.
If you have the script, and assuming it's not expired, that should be all you need to switch to another DME. If it is expired, then it is possible you could be required to not only get a new script but also a new sleep study. FWIW, my script states it's for 99 years, AKA "lifetime".
Since I enrolled onto Apnea Board, lesson ONE was get copies of ALL scripts and PSGs.
Dave
RE: Stuck with my DME?? - Sleeprider - 12-11-2017
All that is required is a prescription and sufficient history for your insurance to authorize coverage. In some cases that may at least a copy of your diagnostic sleep study, but more likely a request for coverage can be submitted by any DME on your behalf with a prescription. If a study is needed, then a home study is acceptable to most insurers, especially if you have a history of CPAP use.
And then here is Amazon. Depending on the day of the week and pricing, you can get the Resmed Airsense 10 Autoset and for Her models from the high $400s to mid $500s. No study, no prescription no hassle.
I'm not sure about your doctor, but I use my primary care physician. I gave him a copy of my 2008 sleep study and original prescription with some useage data. Then I wrote my own prescription for him to issue. A little back and forth with the DME and I got a bilevel.
RE: Stuck with my DME?? - srlevine1 - 12-11-2017
(12-11-2017, 06:24 PM)macamon Wrote: Help!
A few years ago I got my S9 through Crapria, they forced me to rent for a year before it was purchased, caused major problems with my insurance company and damage to my credit as I was hard headed and tried to fight it. Needless to say I wouldn't pee on them if they were on fire let alone do business with them again.
After being informed of this, my doctor is telling me I can't change DME without my original sleep study. Is this true? My original study was almost 20 years ago. What are my options?
Thanks in advance for your assistance.
Best regards,
Funny, I have had excellent service through Apria (from private corporate insurance using HealthNet to service through Medicare) since 2008 and nary a problem until they lost their Medicare competitive bidding certificate and switched their customers to Verus.
It is true that your new DME will need a copy of your sleep study and a prescription for the initial device settings. It is my understanding that these are legal requirements -- not some made-up DME bullpucky. But it appears that with some DMEs the sleep study may be optional and the prescription is all that they may need.
If Apria has your old sleep study on file, they will send it along with a transfer package -- just ask for the transfer department of both Apria and your new company.
The trick to dealing with Apria is to get names, numbers, emails, and establish some level of personal contact. Document everything. I have found that most people get angry with the DME for errors or omissions actually made by the insurance companies or the clerical staff at physician's offices. Of course, pricing is outrageous no matter where you go.
Best of luck sorting out your issues.
RE: Stuck with my DME?? - KSMatthew - 12-11-2017
Have you and your doc been following up with each other?
If so, he or she shouldn't have a problem writing another scrip or making a copy of your current prescription. Make a copy, and find any DME, not just the "preferred" that your doc or insurance company works with. It's your money. Online DMEs are much cheaper than your local Apria. Turn in your receipt for your ins co to apply to the deductible. Pay for it with your HSA if you have one. Most online DMEs will say they need a prescription, but many times they'll take your word for it. Make sure to request they configure it for you, or you can come here for help.
RE: Stuck with my DME?? - macamon - 12-12-2017
My original sleep study pre-dates my experience here. I don't have the prescription, nor do I have the sleep study. The hospital that did my original study only has records back to 2002, my study pre-dates that.
RE: Stuck with my DME?? - KSMatthew - 12-12-2017
Whoever issued your CPAP might still have a copy of the prescription, they had to know how to configure the CPAP somehow. Ask for a copy.
Your current doc might not be comfortable writing a new prescription without supporting records, that might be why a new sleep study is being suggested. A copy of the old scrip might help.
RE: Stuck with my DME?? - Sleeprider - 12-12-2017
Just a thought. If Crapria is a problem, make their life even better by asking them for a records dump. Get your prescription and all records of filling that prescription including insurance reimbursement invoices and correspondence, so that information can be used by your doctor and future DME. I think these records are protected for your use under HIPAA. If Apria can continue dispensing without a sleep study, then so can anyone else. Any medical record is portable and yours to use or provide to another caretaker. Similarly, your own insurance has been supposedly paying for supplies on the basis of a prescribed medical need. I sincerely doubt they will turn around and deny you now. Get your records from them too.
RE: Stuck with my DME?? - Mosquitobait - 12-13-2017
Options as i see it.
1. Get another sleep study. After 20 years, you probably do need one, although if you had an auto-S9 and it's working for you, then kindof pointless to have a lab study. Consider enquiring about a home study.
2. Buy a unit off Craigslist. A number of people on this board have never paid full price nor gone through insurance for their machine and even most of their supplies. While this is often due to high deductibles, it is also often due to the hassle of compliance.
3. Ask your insurance company - THEY are the ones who determine if they need a sleep study in order to continue coverage for a new machine and/or supplies. Your doctor is not usually involved with the insurance company unless you are dealing with Kaiser. I never lived in CA so have no experience of Kaiser.
4. I presume the Sleep Center is out of business and doesn't have records of your original. Apria more than likely has a copy and contacting the regional office will probably help you get them. Be patient and remind yourself that they aren't out to get you. They are just office drones and not in charge of the organization of that stupid company.
From now on, get copies of all your records and keep them safe. Medical places go out of business, your chart is lost, some calamity happens. You never know when you will need them.
<<Apria can continue dispensing without a sleep study, then so can anyone else. >>
No, at some point, Apria has HAD a copy of the sleep study. Even if it is lost now, they would have passed audits by the state so can continue to sell products to the OP. If the OPs new dispensing doctor has a copy of the sleep study, s/he can CHOOSE whether to accept a 20 year old study. It is your insurance company or doctor who decides if you need a new study. Unless you are missing a leg or something, many diagnoses have to be updated periodically because things change. On the other hand, kudos to you for getting such mileage out of a study! Most folks have to get a repeat study at 10 years or insurance won't cover.
RE: Stuck with my DME?? - Melman - 12-15-2017
I got fed up with apria and told my Dr's nurse practitioner I wanted to switch. She told me local patients were more satisfied with Lincare and made the arrangements. I didn't have t do anything except start ordering from Lincare. So in my case the switch was easy and Ive been satisfied.