DME story

[nicholb]

I've been using CPAP for almost 20 years. I'm on my 3rd machine, a Resmed Autoset 9. The machine turns 5 in a couple months and I've already met my deductible for the year so its a good time to get a new one. First I called my insurance and confirmed I am eligible. They said as long as my existing machine is older than 3 years I'd be covered. 

So I called a couple DMEs I use and both said due to the age of my prescription I would need a new one. It has also been 5 years since I saw the sleep DR so I made an appointment. That went fine and the Dr noticed I had changed my pressure settings. We talked about it and she was fine with that.

So anyway she says they can send the prescription electronically over to the sleep store in the same building and I can go over there and make arrangements to get the new machine. This is the same DME I got the last machine at so I figured it would be simple enough. 

I go to the store and the first thing the receptionist asks is if my current machine is broken. When I say it isn't but is 5 years old she looks at me like I am crazy. She says insurance won't cover it unless it is broken and the store is unable to repair it. I told her that I already checked and they will. She reluctantly scheduled an appointment to get the new machine. 

Before I even got home they left a voicemail that insurance won't cover the replacement because my existing one is not broken. When I got home I called up the insurance to find out what is up. The lady checked and told me the same thing I was told last time I called. That I am covered as long as the existing machine is over 3 years old. She also looked and said the DME didn't even submit a authorization request so they hadn't denied anything. She told me to have DME submit it and it will go through.

I called back the DME and got the same story about insurance won't cover it unless the machine is broken. She said I would need to talk to the billing person and rattled off the number. I ask if I could be transferred and she sounded like I was really inconveniencing her but did transfer me. The billing lady repeated the same story. When I told her I had called the insurance twice now she immediately said "who did you talk to? Because when I called I talked to X and she said it had to be broken". I confronted her with the fact that she had not even submitted the request. She replies back that she could not because it would be lying to submit a claim that does not meet the criteria. Finally I get her to say she will try submitting it. I basically told her that if she does and it is denied I'll be complaining to the insurance company not her.

So anyway she never calls back with the results and the store cancels the appointment.

Meanwhile the copy of the prescription I requested to be mailed to me arrived from the Dr. I took it to the other DME I occasionally use. No mention of needing a broken machine from them. She says they'll get it submitted to insurance and call me to set up an appointment for pickup when it is approved. 3 days later I get a call and am picking up the new Autoset 10 on Monday.

Best I can figure is the first DME must make a good profit on CPAP repairs and would rather do that then order a replacement.

[justMongo]

To the best of my knowledge, few if any DMEs make repairs. It's a medical device; and they risk incurring significant liability issues.
Seems the lesson is: DME #1 is so lazy, they lost a sale. DME#2 got the sale.
(Or, could be #1 wasn't happy with the contracted reimbursement rate -- IMHO: they should lose their contract with your insurer.)

If you have prescription in hand; and a choice of DMEs in your insurance sphere; shop around until they treat you right.
We see similar stories all the time here.

[Sleeprider]

I think you handled it exactly right. I have no patience with these places that create their own rules and problems for obtaining equipment. The need for a new prescription is kind of questionable, but I see that routinely now. I assume the DME is covering their own butt on that one, not that the old Rx is invalid. Creating rules about broken machines comes from differing requirements with insurers including Medicare. The are apparently going to assume your insurance will be as strict as some others, and will not handle your order until you jump through the hoops. Best to just move along....I certainly would.

[nicholb]

To the best of my knowledge, few if any DMEs make repairs.  It's a medical device; and they risk incurring significant liability issues.

I would think that too, but they were very explicit that they could only order a replacement if they could not fix the CPAP.  Either way I'll not be going back to them.

[Phill]

It sounds as though these people change their minds depending on what day of the week it is, and they are probably not the smartest of cards in the pack.

A friend of mine had a heart monitoring device, hold hand held unit to chest, load data, return unit to base station and data is transmitted to the hospital.

As he no longer needed the equipment he said he would return it to the hospital, they told him not to bother as it could not be re used.

Unhappy with this instruction he contacted the manufacturer who told him that of course it could be refurbished and re issued, had he not checked a couple of hundred dollars worth of kit would have gone to waste.

While being no tree hugger, what a waste of resources, while our hospitals are forever complaining they don't have enough money.

[Homerec130]

My wife just got her spinal cord stimulator (SNS) replaced with a newer, self contained model she longer has to recharge. She asked the SNS rep if he wanted any of the old parts (charging battery, paddles, etc,,,) and he basically said no as he has too many of them. He used to take them back if they were no longer needed so he could reuse the battery if needed aw a spare for another patient. He also said the units have advanced so much the last few years, they are almost obsolete when put in.

Homer

[Sleeprider]

My wife just got a knee replacement today...they kept the old ratty knee full of arthritis and prior surgeries, but I don't know who would want it.

[Walla Walla]

Probably gave it to their dog to bury.

[nicholb]

The second DME did get me my new machine. When it came time to sign the payments they had set it up as a rental instead of the requested purchase I had already verified insurance allowed. So there price for the machine was $1900, but the rental was for 13 months then you own it. So they would end up getting $2600 (minus whatever insurance reduced it by). Understand why they want it as a rental.

So I question them on it and am told my insurance requires the rental. I of course say they don't. The lady is not budging and is obviously not the decision making person. I take the machine and let her know I'll be verifying with my insurance.

Insurance of course says there is no rental requirement and they will do either purchase or rental depending on how the DME submits it. I call the DME and after a couple days finally get to the billing person. She says my insurance company usually requires rental which is why they do it that way but she'll check. She calls back in 10 minutes and confirms my policy does not require a rental and will change it to a purchase for next month's bill. I suppose I'll be out a rental payment as they'll probably charge the full $1900.

You really have to watch these guys like a hawk.

[mogulman]

hmm...maybe I should double check with my insurance. I called my insurance before the DME got my prescription and they told me I could purchase or rent and it would be covered. They said there was no minimum rental limit or anything.

When I asked Apria (DME) about how it was going to be billed, they told me 10 month rental and then they would purchase it. Maybe I should still rent it for a month or two, and then see if I can purchase it earlier? or should I just push them for purchasing it during the first visit. I have my appt to pickup the equipment from Apria in a week or so.