BCBS, preferred DME, and nonpreferred, oh my!

[YogaKitty]

While I am waiting on my doctor to get reports and give me my scrip, I have called my insurance. We have a Blue Cross PPO plan. While it sounds like they will cover everything at 80% (I have already met this year's deductible) I am now very confused about what to do. There are apparently two preferred DMEs at a larger town about 15 miles away from my home. They are Apria and Group Care Medical. I am also allowed to use any DME and they will pay the same. But the service rep reminded me other DMEs aren't tied to their allowables, so it could cost me more.

the DME next door to the sleep center I used (only aboout 4 miles from home) has already called me and told me to come get set up with a machine and go over my reports, that they had the orders. I refused to go in without talking to my doctor's office and having copies of my scrip.

So here goes the confusion: Is it better dealing with a preferred DME farther away, or a local DME? Are any of these companies particularly good or bad based on others' experience??
Might a nonpreferred be more likely to give me exactly what I want?

And don't even get me started on equipment confusion.... I did get the person at local DME to tell me they were planning to set me up with a DeVilbiss. I have done all kind of reading already and know I need a completely data capable machine. The Smart Codes on the Devilbiss look easy to use.

Help!, Please?? I don't want to be a good little sheep and just go in the direction I'm herded. (Unless it's the right direction!)

[Pugsy]

Which Devilbiss was the local DME prepared to give you? Devilbiss makes a machine that doesn't offer full data. Need to know which model....
My personal preferences are still for either the ResMed S9 full data or equivalent in the PR S1 machines because of the data offered with easily obtained software. They offer wave form flow graphs and Devilbiss doesn't even on their full data machines.
I wouldn't want F & P because the software is a royal PITA to use when you can find it. A nightmare to install.

You need to educate yourself on which models of whatever brand offers full data since you know you want that.
Up to you which brand you want.

Apria is often called Crapria here...for a reason. I think it depends a lot on each local office. Some good and some bad.
Who do you feel more comfortable with and who will give you what you want?
Have no idea about any history with the other one you mentioned.

[chunkyfrog]

The more aggessively they pursue you, the faster you must run away.
Seriously, it sounds like there is some back door hand-shaking going on.
Out of network will cost you more money--maybe a LOT more!

[LSAT]

15 miles is not a long way to travel. If it was me...I would take a ride and stop in to talk to each DME. See what machines they are willing to give you...see how knowledgeable the reps seem. Once you have your equipment there is no reason to visit the DME on a regular basis. Often they will send you any supplies that you need. My experience with Apria was only mediocre, but my brother in law in another city thinks they are great.

[greatunclebill]

i agree, go see each of them. see what they will offer and what it will cost. if they deal with your insurance, they know exactly what it will cost. take notes and compare at home. also ask which masks they carry.

ask specifically how they will bill the cpap. i use tricare insurance that pays 80% and the unit is paid out in 13 months. one time we went to a local dme that billed out the entire 20% in one billing. when asked why, they said because we can. apparently tricare allows dme's to bill in one payment if they choose. problem is they didn't tell us first. they are a former dme because of that. virtually all dme's bill tricare as 13 months.

i had bad experience with my local apria and will never go back to them. true, the problems could be because of local management and other local offices may be fine, but company policies and procedures generally are dictated from the top, down. i will never step in the door of another apria office.

[chunkyfrog]

Your supplies do not have to come from the same DME as your machine.
You can change DME's any time.
Go for an in-network supplier as long as they will get you what you want/need; it will save you money.
Pay attention to the timing of insurance-allowed supplies.

[YogaKitty]

Good advice! So much to think about!! Still waiting for my doctors office to call back.

[Janknitz]

Choose the machine YOU want, not the one the DME wants to give you. You're the one who has to sleep with it for the next five years! Then get the prescription in your hand to make sure that it will support what you want. If it does not, deal with your doctor first and request that the script be rewritten to specify a machine that meets your wishes.

NOW you are ready to deal with DME's. Start by calling the preferred DME's. Tell them you have a script for a CPAP/APAP and that you would like the _____________ (manufacturer and model). Ask them if they can provide it. If they start giving you the song and dance about what your insurance will and will not cover, explain to them that you've already checked with your insurance that _______________ is covered and if they are able to supply it then you will choose them as your DME. Don't be surprised if you find that you're not going to get anywhere with the preferred providers, but you may get lucky. In any case, you might want to buy masks from the preferred provider, so ask if they will work with you on masks alone (some won't want to bother because the profit margin is low).

Now, before you call the non-preferred providers, find out if BCBS will reimburse you if you use an online supplier instead of a brick and mortar non-preferred provider. If so, do a little online shopping and calculate your out of pocket costs for exactly what you want. Now call the non-preferred providers and see how much it will cost you out of pocket for what you want (and whether they will provide exactly what you want). Ultimately, it's up to you to choose how you want to be treated and who you want to do business with. Luckily, you have options.