Strange DME conversation

[GrammaBear]

Yesterday I had a strange conversation with the DME where I get my CPAP supplies. They usually call me every 3 months to ask if I need supplies and then they tell me which ones I am 'eligible' to have. Yesterday the person I spoke with asked "Are you using your cpap machine?" I replied "Yes", then she said how many nights a week are you using it? I told her I am 100% compliant, asked her if I needed to provide proof of that compliance in order to be eligible for supplies? She replied, "I don't think so, but I will let you know if you do."

Has anyone else had such a conversation with their DME? Are we now having to prove our compliance for Medicare? The sleep doctor has me come only once a year, but now I'm concerned about this compliance thing.

[AlanE]

My DME says my insurance is similar to Medicare with that regard. I have to stay in compliance for insurance to cover the machine/supplies. Otherwise they will bill me for it. They can tell remotely with my machine I'm guessing. I have to show I use it at least 4 hours a night for at least 21 nights in a 30 day period. I also have to see my doctor between 31 and 91 days of using it. Not a problem for me, my next visit is end of this month.

Looking through the ppw the DME gave me it says "Medicare requires documentation that explicitly addresses the patient's use and benefit of the oxygen therapy." I assume CPAP is grouped into this? It further says "For ongoing supplies and rental DME items, ... there must be information in the beneficiary's medical record to support that the item continues to be used by the beneficiary and remains reasonable and necessary."

Little further down it reads, "documentation can be as simple as 'discussed oxygen use with patient, states they continue to use and benefit.'"

Maybe that's why they asked that.

[retired_guy]

Medicare has always required "proof of compliance" for the machines, but now I'm hearing rumblings that they will be doing that for supplies and such, and more frequently.

So it might be a little hassle, but you're good to go Gramma, you're in great "compliance."

I actually favor Medicare's vain and probably ultimately unsuccessful attempts to make sure the treatments, machines, and supplies they are paying for are actually being used by the intended patient, rather than simply being sold on Amazon or Ebay. In my case I could, if I chose to do so, order up a bunch of stuff from my VA sleep clinic that I don't need and generate a few extra bucks. I'm sure it's done a lot. I'm also sure that helping to drive our system health care costs further up is not really in my, or my grandkids best interests.

So, when they call and ask if you're compliant again? Proudly tell them that yes you are, and would they like a copy of your Sleepyhead report to share with Mr. Medicare.

[justMongo]

I've been asked, when ordering supplies, "Are you using your machine at least 4 hours per night?"
I don't think you have to prove it to Medicare; but I think compliance is required for Medicare reimbursement to the DME.

[GrammaBear]

Medicare has always required "proof of compliance" for the machines, but now I'm hearing rumblings that they will be doing that for supplies and such, and more frequently.

So it might be a little hassle, but you're good to go Gramma, you're in great "compliance."

I actually favor Medicare's vain and probably ultimately unsuccessful attempts to make sure the treatments, machines, and supplies they are paying for are actually being used by the intended patient, rather than simply being sold on Amazon or Ebay. In my case I could, if I chose to do so, order up a bunch of stuff from my VA sleep clinic that I don't need and generate a few extra bucks. I'm sure it's done a lot. I'm also sure that helping to drive our system health care costs further up is not really in my, or my grandkids best interests.

So, when they call and ask if you're compliant again? Proudly tell them that yes you are, and would they like a copy of your Sleepyhead report to share with Mr. Medicare.

Until recently I never knew that cpap supplies could be purchased on Amazon or eBay.....guess I am naive when it comes to that kind of activity. I do know that I bought several of the "cpap pillows" on eBay for a really cheap price. When I got them, they were not in the original bag like the manufacturer puts them in, they were in a ziploc bag. When I contacted the seller with my obvious question, which was "Are these mfg by such and such company"?, he said "Yes, of course they are, I took them out of the mfg bags to save on packing space." Needless to say I filed a complaint against that person and I haven't seen him selling anything on eBay since then.

I've had situations with the DME I deal with now where they call me, take my order and say they will ship my supplies in 5-10 business days. After ten days are up I start looking for my supplies via the mail. Turns out they never came and try and prove that with the DME. I ended up having to buy my own supplies out of pocket.

I almost wish things could go back to cash and carry like it was some years ago. At least you knew who you were dealing with then and hopefully they were honest.

[OpalRose]

GrammaBear,
I've been on CPAP a little over 5 months now, and my DME ask me the same questions the last two months when I was placing an order.
They wanted to know how many hours I used the machine at night, and they wanted to know the date I last saw my Sleep Doctor, and does he still feel that CPAP is necessary! REALLY?
I asked her if she needed proof of compliance and did she want my SD card. She said that proof was not necessary, as long as I told her over the phone that I was in compliance.
For the first three months, they didn't seem to care that I existed!
OpalRose

Also, wanted to comment on the "nasal pillows" packed in ziplock bag. In my frustration in waiting for nasal pillows to be delivered by my DME, I ordered two from one of the suppliers on the list. They came packed in a tiny ziplock type bag, instead of manufactures package. They look new, but I probably won't use them.

[truetopath]

My DME will simply ask and take my yes as gospel. I don't have to send them reports or anything. Of course I don't have Medicare, but my insurance still checks compliance.

[SaldusMiegas]

I've had situations with the DME I deal with now where they call me, take my order and say they will ship my supplies in 5-10 business days. After ten days are up I start looking for my supplies via the mail. Turns out they never came and try and prove that with the DME. I ended up having to buy my own supplies out of pocket.

GrammaBear you are an advisory member so I respect that you have been around the block a few times on purchasing supplies from DMEs and have wisdom about this I need to learn from.

How is it when a DME fails to deliver products you ordered by mail that you end up being responsible for buying your own supplies?

And if that ever happens even one time, then how is it you would continue to refer to this DME in the present tense?

In my experience (non-DME items) the burden is always on the seller to prove that a product was delivered, and not on the buyer to prove it was not delivered. My insurance company would be all over them about it, and they would not get paid if I complained that the products were never delivered to me. If I had other options, that would only ever happen one time -- if the DME didn't make it right I would take my business elsewhere.

Were you locked into some sort of contract or forced by insurance to deal exclusively with this DME no matter what?

Shame on this DME for taking advantage of a GrammaBear.

Saldus Miegas

[Hodor]

My machine has a wifi enabled modem that updates daily by itself. No need to ask if I'm compliant. BIG BROTHER KNOWS.

[OMyMyOHellYes]

My machine has a wifi enabled modem that updates daily by itself. No need to ask if I'm compliant. BIG BROTHER KNOWS.

Is an add on to the System One, right? Can it not be turned off? Removed?

OMMOHY