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+--- Thread: Any tips or warnings around DME appointment? (/Thread-Any-tips-or-warnings-around-DME-appointment)
Any tips or warnings around DME appointment? - John24 - 07-02-2019
My doctor order a two night home sleep study back in mid May, which came back with around 50 events an hour. Scheduled an overnight titration study once the results came back, but insurance denied it and wanted a home study instead. I finally got the call today that the DME my doctor sent the prescription to has everything approved and wants me to come in on Friday.
I was told my insurance company requires a 10 month rental (matches what I've found online for my state's BCBS) and will pay $101 a month. We've met our deductible, so I'll be responsible for 20% for the first six months.
The appointment is to be fitted for a mask and get setup with the needed supplies. She said that would be around an additional $500, depending on the mask. She mentioned the humidifier as one of the items, which confused me a little. From what I've seen, that's part of the unit if you buy one outright online. Is it standard to bill separately for it?
Based on what I've seen here and elsewhere, I want to get the Autoset 10 for Her model and there's a chance they'll try to give me the cheapest model they carry. Do I just walk away if they try to pull that? It's my understanding that I can use any DME, and there are a bunch of local ones in network for me.
Does anything sound wrong with what I've been told so far? Anything I should explicitly ask or look out for when I go in on Friday? Any advice would be greatly appreciated.
RE: Any tips or warnings around DME appointment? - sheepless - 07-02-2019
sounds like you have a pretty good handle on it. right on everything including the double charges and possibility of sloughing off a data free fixed pressure machine or a used machine. I wish I had bought online but I didn't know any better at the time. otoh, a good one will provide some support and that's a good thing to have locally if you need it, but it's likely to be a lot more expensive than online purchases and support from forum members. I found after a month on the forum that they didn't know much more than to check for compliance. some will let you try a variety of masks though and that's worth a lot. then the dme will start calling you every month to get you to buy their overpriced supplies (e.g., $85 for a single $25 nasal cushion). that can be a convenience or a PITA, depending on your needs and your pocketbook. as you implied, you are not obligated to buy from them. you can shop around locally or spend less online. not clear what the $500 is for. their service in setting you up? mine did that in return for their outrageous prices. oh, and don't pay the $50 monitoring fee.
RE: Any tips or warnings around DME appointment? - Big Guy - 07-02-2019
I have the Federal version of BC/BS. I had an in-lab two night study. My sleep doctor ordered my ResMed AirSense 10 AutoSet from a local DME supplier.
When I went in to get it, I had no clue as to what was a good machine or not. I was lucky. Mine came with the humidifier, heated hose, and an AirFit F20 complete mask set-up.
My initial upfront, out-of-pocket cost for my machine / accessories was about $64.00 or so. Mine was leased for 13 months and I pay $9.00 per month. It will be mine Oct. 10th.
Many on here say to tell them what you want and stick to your guns. If your doc ordered the AutoSet 10, make sure that's what you leave with. I don't have a clue as to the billing separately for the humidifier.
And, make sure the machine you get is new. Not one that was returned or refurbished. I didn't learn about all that, until I had my machine home and then became a member of this forum. My machine had 52 hrs. of unexplained use on it. It did appear to be new and it came with all the user manuals and a carry bag, that still had tags on it.
RE: Any tips or warnings around DME appointment? - Sleeprider - 07-02-2019
Get a list of in-network DME suppliers and be sure the one that services your prescription dispenses the Autoset. As you know, it is a CPAP for the purposes of reimbursement. Once you select the DME be sure the machine being dispensed meets your expectations and accept nothing else. Having a prescription that specifies the brand and model makes this easy.
Call and verify what is being dispensed. Refuse anything else. No one make money if you don’t pick up the machine and that is your leverage.
RE: Any tips or warnings around DME appointment? - Gideon - 07-02-2019
A caution on deductibles.
They run from plan year to plan year. Is your purchase all within one year?
Your leverage is before you accept delivery.
I would call to "confirm" that your NEW ResMed AutoSet will be ready.
RE: Any tips or warnings around DME appointment? - Hydrangea - 07-02-2019
Know what you want before you go in. Only accept something if it's what you want.
Know how to verify that the thing is the thing you want. Serial numbers on the machine (or another way to know which machine exactly is in front of you). Specific wording on the package. Specific packaging.
Know what your insurance pays. (Insurance is THE only reason I can think of to use a DME.) The DME may lie to you about it. My DME tried to convince me my insurance requires compliance, but I already knew (from calling my insurance beforehand) that they don't.
Be willing to walk out empty handed. Better to not have something than to have the wrong thing and be betrothed to them.
Remind yourself that THEY are providing a service TO YOU. They are at your mercy. Again, be willing to walk out empty handed.
RE: Any tips or warnings around DME appointment? - alshayed - 07-02-2019
Also find out for sure if your insurance actually requires a rental period or not, preferably in writing. The DME might be pushing for that because it pays them more rather than it being a real requirement.
RE: Any tips or warnings around DME appointment? - PaulaO2 - 07-03-2019
Add up your expenses. Monthly payment, what you'd have to pay that day ($500? Seriously?)
Then go to SecondWind (Supplier List #2) and check out their prices.
Next check out prices of other online DMEs. I've used #26, #1, and #2.
Then weigh your options.
Which costs more and is cost important to you? Buying it local means repairs are local. But repairs are rarely needed. Usually they just switch it out.
Second Wind means the machine is used, although they do have new ones. Get the manual (link at top of every page) and learn how to quickly look up the machine hours. That cannot be reset. Check the local DME's machine hours before you accept it. (I didn't and I regret it)
If you get your machine elsewhere, you can still get the mask locally. If they have a return policy for mask trials, then that's the best way to go. Some online DMEs now offer mask returns, too.
RE: Any tips or warnings around DME appointment? - Sleeprider - 07-03-2019
Get the Resmed Airsense 10 clinical manual from the forum and learn how to access and understand the setup menu. Plug in the new machine and verify the settings and check the Run Hours in the About menu. They should be near zero. A few members have been dealt used machines. Anyway you will impress the RT.
RE: Any tips or warnings around DME appointment? - John24 - 07-03-2019
(07-03-2019, 12:14 AM)PaulaO2 Wrote: Add up your expenses. Monthly payment, what you'd have to pay that day ($500? Seriously?)The $500 was what she estimated for all the initial supplies, including humidifier and mask. I'd be responsible for 20% of that.
Then go to SecondWind (Supplier List #2) and check out their prices.
Next check out prices of other online DMEs. I've used #26, #1, and #2.
Then weigh your options.
Which costs more and is cost important to you? Buying it local means repairs are local. But repairs are rarely needed. Usually they just switch it out.
Second Wind means the machine is used, although they do have new ones. Get the manual (link at top of every page) and learn how to quickly look up the machine hours. That cannot be reset. Check the local DME's machine hours before you accept it. (I didn't and I regret it)
If you get your machine elsewhere, you can still get the mask locally. If they have a return policy for mask trials, then that's the best way to go. Some online DMEs now offer mask returns, too.
The machine itself will end up costing me around $525 (20% the first 6 months, 100% when deductible resets in January), with my insurance paying an additional $485. Considering I can buy the machine I want for around $750 online, humidifier included, that seems crazy to me. If insurance would just reimburse me half the outright purchase price we'd both save a few hundred dollars.
The local company my doctor sent the prescription to is AeroCare. They've got mixed reviews, some very negative, for the local branch. I also see some good and bad experiences with them here.
I haven't even seen the actual prescription to know what's on it. The doctor's office sent it directly to the DME. The last page of the home sleep study was a generic prescription that she may have used. It just specified Auto-titrating PAP, Nasal Mask, Heated Humidifier, Heated Chamber, Tubing, Disposible Filters and Headgear. I can't imagine she put a specific machine on it, as we never discussed them (aside from one offhand comment she made about the current Resmed machines being a lot quieter than older CPAP machines). Unfortunately I hadn't researched much at that point, as I thought we were doing an in-lab titration study first.
The masks are the main reason I want to try a local provider. I sleep either on my stomach or nearly on my stomach because a pillow is underneath one side, with my arm under the pillow, my mouth open and half my face buried in the pillow. I'm expecting masks to be a nightmare for me. If anyone has any mask recommendations for that type of sleeping position please share.
Thanks to everyone for all of the advice. I'll try to contact my insurance company directly today to verify the 10 month rental policy. I may also reach out to an independent local DME that seems to have legitimate glowing reviews. If anyone happens to have any experience with providers in upstate SC I'd love to hear that as well.