DME legal responsibility to follow Rx?

[PoolQ]

Personally I would call UHC. I have had great luck with BlueShield. they put me on hold and called the DME while I waited, picked up my new machine the same day.
Prescriptions out here anyway work that they must give you what the doctor ordered or get the doctor to change the prescription. They can only change it if they specifically say so: generic, or similar, patient choice (mask)…. if they specify a specific machine, then that is it-period.

[Sleeprider]

If you know what resolution you want, offer it to the DME first. If they satisfy your request, it can all end right there and you'll be whole. The only reason to start with other parties is to potentially "get even", and your risk is that they won't care. Medicare would probably see the Icon as equivalent and it's not worth their time to pursue this; the doctor's office is in the same boat. It's possible they will feel compelled to correct the behavior of the DME, but I'm telling you it's unlikely.

Start by offering a straight up resolution, then escalate if necessary. Personally, I'd ask for the CPAP auto setup in fixed CPAP mode.

[DrMike]

The Dreamstation Pro was specified on the Rx.

I've attached the Rx with doctor/DME blacked out.

Other than the name, what wording should I be requesting?

[Sleeprider]

It's been nearly 2-years. I agree the DME should have dispensed properly. I think in addition to complaining that the prescription was not followed, you need to emphasize that the reason you followed up at this time is because your AHI is excessive, and the machine provided does not offer a clue as to what is going on because it does not differentiate types of apnea. This is why you need the Dreamstation, and why your doctor is going to ask why his directions were not followed. He can't help you with the data from the ICON. The fact the DME saved money by dispensing a cheaper machine that was not as prescribed should not be overlooked.

[DrMike]

Talked with the DME office manager. 

She claims:
   1. That the Dreamstation Pro was a less sophisticated machine than the ICON+ since the Pro has no "Auto" mode and the ICON+ does.
   2. That two years ago when I was being set up, the new Dreamstation was just coming out ... and they had inventory on ICON+ but not the new Dreamstation. Starting in 2017 they began dispensing the new Dreamstation model.
   3. That she is calling the Dr's office to get an Rx for the "Auto" mode on the ICON+.
   4. That if I bring it in either this afternoon or tomorrow morning they will verify the ICON+ is working properly and set it to "Auto" mode.
   5. They correctly dispensed per the Code E0601.

It doesn't sound like I'll get anywhere with them, so will be getting a new machine on my own dime shortly.

So, which of the two in your opinion has the more settings and can give the more info to the Dr: Dreamstation or Airsense 10? Both seem to be in the $900-$1,000 range.

Oh, setting the ICON+ to a fixed pressure of 17 is NOT working for me; two poor nights sleep since bumping from 14 to 17.

[mesenteria]

If you know what resolution you want, offer it to the DME first. If they satisfy your request, it can all end right there and you'll be whole.  The only reason to start with other parties is to potentially "get even", and your risk is that they won't care.  Medicare would probably see the Icon as equivalent and it's not worth their time to pursue this; the doctor's office is in the same boat.  It's possible they will feel compelled to correct the behavior of the DME, but I'm telling you it's unlikely.

Start by offering a straight up resolution, then escalate if necessary.  Personally, I'd ask for the CPAP auto setup in fixed CPAP mode.

It happens that my specialty is human conflict studies.  It has been my experience that an escalated approach is often the best, if longest, way to get a whole bunch of people in a related field or chain of activity kindly disposed to helping us.  It's easy to confront or drop suppliers and helpers when we understand they absolutely will not accede to our requests, and when we can simply find another supplier.  Some cannot...not easily.  So, I feel that Sleeprider's suggestion has a lot of merit; start low 'n slow, and build 'getting your back up' as you encounter unreasonable resistance.  Give each level of support an opportunity to understand your problem, orient themselves to how/if they can help, and then deal with the fallout as it becomes clear to you what it is.  If the DME slaps their forehead and agrees to do what you need them to do, you won't have had to explain yourself, and perhaps provide documentation, to the next level, or to the one after that.

That is my counsel.

[Sleeprider]

I'd choose the Resmed Airsense 10 Autoset over any other CPAP on the market. I've said this many times. It is what we secured for my wife. Resmed has the most responsive auto algorithm and smoothest feeling breathing flow, along with a true bilevel approach to exhale pressure relief. I consistently see better results on people using the Resmed.

You or anyone else can setup the Icon as an auto machine. The clinical manual is available from Apnea Board and the instructions are all over the internet. I don't know why you wouldn't have tried the auto mode.