Is there a way to get a DME (Lincare) to order non formulary

[cpap82]

My Lincare rep just told me her manager is saying they can't order the Airsense 10 for her, because it's not on their forumlary list. Since, I'm stuck with Lincare, is there a work around? Is there something I can do or say to get them to order this machine?


Thanks in advance

[Cardsfan]

Get your Dr. to specifically put it in the prescription. (?) would that work.
Call another Lincare local office and see if they say the same thing. Please let me know, because I am in the same boat with Lincare. And that is the next machine I have my eye on.

[Cardsfan]

I just talked to my Lincare local office. The RT said "No problem, we don't carry that (Airsense 10 for Her), but I can special order it for you". I told them I wanted this machine when my insurance allows it.
I don't know why my Lincare office will order it for me and your local office will not order it for you.

[Janknitz]

It's probably your local Lincare office policy to maximize the profit margins. If you can get your doctor to specify the make and model you want and write "dispense as written" on the RX it might work. But as profit margins tighten up with Medicare cutbacks I expect we'll see more such "formularies".

If you can afford to buy your own new or used machine you can bypass all this. If not, sounds like you are stuck!

[Cardsfan]

Call Lincare corporate office in Tampa and have them step in. Your local office should special order it.
Call another Lincare local office and have them special order and ship it to you. They will have your prescrition in the system. If you PM me, I can give u my local office contact.

[cpap82]

"Formulary" is the exact word they used.

I called another Lincare in a bigger city near me (Austin) and the rep I spoke to at first was all for it, "sure no problem", then I insisted he check with his manager to confirm and sure enough his tune changed.

According to his manager, Lincare orders the airsense 10 by a lot of 5 machines at a time for a discount and can no longer order single units. I asked about the Rx specifying make and model and he said it didn't matter. However, that was his answer, he didn't ask his manager anything in regards to the Rx approach.

I just got off the phone w/my local Lincare agent and she is saying, "they" are telling her the only difference between the "for her" and the regular machine is the "color".

She said she's still trying to get it approved from the manager over her manager. So, I'm going to try and get her some specifications on what the "for her" offers over the regular. I know it offers a lighter pressure.

That's where I'm at.

Cardsfan, I would ask to speak to the manager at your local Lincare to confirm. It seems like this change was recent, because Austin said they special ordered a "for her" 6 months ago.

[Cardsfan]

I have these
Lincare Executive Customer Support Specialist. 855-937-2238
Corp Office 800-284-2006.

I think your local office is the problem.

[cpap82]

Adding to the drama, my sleep doctor is on vacation till 7/13.

[Cardsfan]

I also ck with you Dr and get a prescription with exactly Resmed Airsense 10 For Her as the prescribed machine. Then Lincare can't dispute filling it.

[Pugsy]

I know it offers a lighter pressure.

It's more than a lighter pressure. It's a totally different auto adjusting algorithm.
It has 3 modes of operation instead of the 2 modes in the regular AutoSet
Cpap mode
Auto Mode (apap)
and the special for Her Auto Mode (apap)
and if your local office thinks color is the only difference then it's pretty sad that they don't know their equipment
This stuff isn't rocket science and if medical equipment providers are uneducated on the equipment they are supposed to dispense...makes a person wonder what else they could screw up.
Either they don't know the difference or they told another bald faced lie.

[cpap82]

Update: Just got off the phone with my local lincare rep and she said she spoke to the manager on top of her manager and that manager said, "no". My rep also said this second manager was going to be calling me to speak to me personally so that i know my local rep "isn't just saying this to me", that its coming from the top and also to explain why thy aren't going to order it for me.

[Cardsfan]

try those corporate #'s I gave you. All those Managers still work together to maximize their local district profit. Call the corporate office and get it from the top. PS you don't really know "who" is calling you. I'd be dealing with the corp office at this point.

[cpap82]

I just got off the phone with insurance co and they called Lincare corporate "purchasing dept" and they said if the Rx states a specific make and model, they'll order it—as long as the "higher up manager "okays" it".

My insurance co. explained, the manager's manager already shut down that idea and she said, that was probably the "regional" manager not the district. She also, she was going to call that location and push them in the direction of ordering the machine.

My insurance co. also explained, my
Rx currently doesn't have a specific make or model but I could get one with that info on it when my doctor comes back from vacation on 7/13.

We shall see...

[Cardsfan]

Call the corp office- Tell them you need your machine now, if they can not order it, you will take your business elsewhere.
See what happens.

[cpap82]

I found another DME (Aerocare/Express Medical) in a neighboring town who also services my town once a week. So, they drive 1.5 hours to service people in my area and they are in my network. I thought Lincare was the only DME in my network, but when I originally searched for DMEs on my insurance website I had the "within 50 miles" option selected.

This morning I did another search for DMEs with out that option selected and I found Aerocare/Express Medical. They said they'll order the "For Her" with a general cpap script and they'll deliver it to my front door in person when they service my area.

And right after I got off the phone, the Lincare district manager called saying they'll order the "For Her" machine for me w/a specified script. They know my doctor is on vacation till the 13th, so they're going to put the order in anyways and hope it gets through, because when Lincare orders off formulary it has to be signed off by the district manager, the district manager's manager and corporate. If any of those people ask to see the script, the order will be on hold till my doctor sends in the specified script.

I guess I'm going to wait and see. I think I'm going to stick with Lincare, because It's like I'm in this unhealthy relationship w/them I can't break free of. Also, they're local, but it's good to know I have a back up. We'll see how this plays out, because I still need to get the new script from my doctor. Watch my doctor be like, "um..no".

thanks everyone for all your help and ideas.