Another DME story

snoozin' · Post by **snoozin'** » Fri Mar 04, 2005 10:02 am

Now, I know none of the DME people who post on this board would ever do this, but - it happened this morning. It only takes one or two incidents like this to make people start calling and treating ALL DME's as evil.
I work in HR, so it unfortunately is often my job to deal with our insurance company. One of our employees called me this morning. Her doctor had prescribed a DME for her son yesterday, and they had dropped off the prescription at the local DME. The DME said they would get the insurance approval and they could get the machine today. About 8:30 this morning, the DME called them and said that the insurace wouldn't approve the equipment, so they would have to pay for it up front if they wanted it. Well, we have a fantastic (waaay better than average) insurance plan thet usually covers 100% of equipment, so the employee was rather surprised and called me to see if I knew why the insurance wouldn't cover this. I didn't, so I called the insurance company to ask. Basically, I started out by asking if this specific equipment was covered. The CS Rep I had said she had never heard of this equipment, and would need more info - what it was, what it did, etc. So I explained about our employee and that there had been a request that morning which had been refused. She said she hadn't handled it, but would see who did and why it was refused. I held for a couple of minutes while she checked. She came back with the following info: at 8:02 that morning someone had called in from the DME asking for approval on this equipment. (She had names, but you don't need that.) The CS Rep who got the call had said the same thing mine had said - she wasn't familiar with this equipment and wanted more info. She asked what the machine was for and how this would help - the DME person didn't know. She asked for make and model of the machine (figuring she could call the manufacturer and find out) - the DME person didn't know. She asked if this was a purchase or a rental, and if a rental, what was the expected time period - the DME person did not know if it was purchase or rental or time involved. She asked for pricing - you guessed it, the DME person didn't know. So, the insurance rep. asked her to send in a pre-certification letter or something similar, with the information. The CS Rep even gave the DME person her fax number so she could fax the letter. Well, I guess finding out the information was too difficult for the DME person, as she called my employee a few minutes later and said that they would have to pay for it as the insurance refused. Told my employee all this, and she laughed and said that her husband gets off early today and she'd send him in (a nice big man) to stand over the DME until they write and fax the letter. So she should get her equipment later today without paying up front.
Sorry Christine and MelMel and all the other good DME's on here. But a few bad apples like that give all of you a bad name.
Debbie

wading thru the muck! · Post by **wading thru the muck!** » Fri Mar 04, 2005 10:34 am

Debbie,

Thanks for relaying that story. Unfortunately it is more than just a few bad apples. Most of the apples are bad, only a few are good. I called a dozen DME's witthin a 75 mile radius of where I live before I gave up and bought online. The response I got was at best what you described and at worst down right rude. Many just didn't have time for my few questions. I guess they have enough patients that just shut-up and take it. That's not the kind of service I expect when I am spending thousands of dollars, whether my insurance company is paying or not.

Zees Pleez · Post by **Zees Pleez** » Fri Mar 04, 2005 1:10 pm

I just sent a FAX to my DME. That's because I called and got put on hold for several minutes and then told that my RT wasn't in; if I had an emergency usage question another RT could help me but if it is an administrative matter (I was calling to ask that my smart card be returned because my doctor wants me to capture current activity) I needed to call back when she is in. That will probably be later today but she could get another page on her way back to the office and have to go somewhere else. So maybe she will be in tomorrow. Or not...

I am working with a major health care company. This is not a small local DME. This is just unbelievable.

Zees Pleez · Post by **Zees Pleez** » Fri Mar 04, 2005 2:00 pm

Hey, guess what? I got a reply, but with an interesting twist. They want me to come in and have my settings "checked" before they give me the card back. I was given a perscription with a tighter range than the machine was on, but they told me it was fine. Now that my doctor actually wants the activity recorded, they need to check my settings before letting them be recorded.

Guest · Post by **Guest** » Fri Mar 04, 2005 2:26 pm

wading thru the muck! wrote:Debbie,

Thanks for relaying that story. Unfortunately it is more than just a few bad apples. Most of the apples are bad, only a few are good. I called a dozen DME's witthin a 75 mile radius of where I live before I gave up and bought online. The response I got was at best what you described and at worst down right rude. Many just didn't have time for my few questions. I guess they have enough patients that just shut-up and take it. That's not the kind of service I expect when I am spending thousands of dollars, whether my insurance company is paying or not.

(emphasis mine)

Christine here...
I guess that's why we're so nice- we're desperate for patients!

Janelle · Post by **Janelle** » Fri Mar 04, 2005 3:12 pm

Got another good one for you. I started CPAP (APAP) early Dec. Here is is March and I just got a copy of a letter from our insurance asking the DME for a letter of certification of need for my machine, etc., effective date and length of need. You'd think, of all people, they would know to send that kind of stuff in to the insurance wouldn't you????

snoozin' · Post by **snoozin'** » Fri Mar 04, 2005 3:51 pm

Unfortunately, Janelle, many suppliers (and not just DMEs) don't like to be bothered with the paperwork. They often just ignore stuff like this, and if the insurance company doesn't pay, they bill the patient. Sometimes it drags out so long that the insurance company won't pay even if they supply the required information. But the supplier doesn't care becasue they can always take the patient to court or turn the patient over to a collection agency. The supplier generally gets paid - one way or another. Many uninformed patients will pay when the supplier threatens collection, because they are afraid of damaging their credit report.
I deal with this frequently. A few years ago, there was a lab in our town which had changed to an e-billing system. They submitted their bills to the insurance companies via email or web, and no longer wanted to go to the bother of actually printing and mailing bills. The insurance company we had at that time was not e-bill capapble, and required paper bills. The lab was constantly sending my employees past due notices or notices that their insurance hadn't paid for lab work, when the lab had NEVER sent the insurance company the bill. Once I found out what was going on, I informed all our employees and had them get copies of their bills whenever they needed lab work done at this lab. Then either the employee or I would fill out the forms and mail in to our insurance company. It was a pain, but it was the biggest and closest lab, and using another would also have been a problem. Boy, was I glad when our insurance finally got e-bill capable.
Debbie

wading thru the muck! · Post by **wading thru the muck!** » Fri Mar 04, 2005 4:58 pm

Christine,

If you weren't three hours away from me, I would have called on you and been blissfully happy with my DME experience. Instead I called cpap.com and am equally happy. All's well that ends well.

butterfly · Post by **butterfly** » Sat Mar 05, 2005 12:35 pm

I'm a brand new CPAP user, and already disgusted with my DME (Apria), and ended up gong direct to Innomed for help and THEY were WONDERFUL. My DME measured me for my NasalAire mask,and put me at a size 4 prong. What I got was size HUMUNGOUS, and I tried it several times but it just wasn't working. I called Apria .. left a message (was told I had to speak with "repiratory" and IF THEY decided I needed a different size, they would order it. So ... left a DETAILED message with Respiratory. Waited. No response. Called the next day. THREE TIMES. No response. Called the next day. No response. Went on line, found Innomed's site, emailed and asked if they would sell just little old private me ONE nasal prong. THe woman who helped me was great. I had my new prong in 4 days (and by the way, at HALF the price CPAP.COM or it might have been another site) would have charged me.

So I have joined the ranks of those disgusted with their DME, and I advocate the on-line route, either through a site like cpap.com, or direct to the manufacturer! I had to shell out $40 out of my own pocket, but it was worth it. I think I am finally on the way to working out "the kinks" and hopefully on my way to better sleep and better health. No thanks to Apria.

"Butterfly"

Zees Pleez · Post by **Zees Pleez** » Thu Mar 10, 2005 11:06 am

My saga continues, but I am finally free of the DME maze until the 6 month mask replacement or have to get a report done. This morning I went in and they adjusted my machine to my prescribed pressure range and gave me my smart card back. When I first got the machine, they told me that insurance required me to try a passover, unheated humidifer for 30 days and if that didn't work well enough, they couold get me a heated one. Well it was only 21 days today, but I called my insurer to beg for a variance since I was going in to the DME anyway and I fully intend to ask for the upgrade in 9 days anyway. They told me they had no such policy and that I could have asked for a heated humidifer right off the bat. The DME was happy to provide the new one, but then told me all humidifers are sold and they could not take back the one I had. Sounds like to me they have come up with a way to drum up a few extra humidifer sales.

wading thru the muck! · Post by **wading thru the muck!** » Thu Mar 10, 2005 12:37 pm

Zees Pleez,

Is your insurance going to pay for two humidifiers in 30 days? Are you going to get stuck paying for the Heated Humidifier at the inflated DME price?

Did you tell the DME that your insurance company told you they have no such 30 day non-heated requirement?

Where do they get these people that work for the DMEs?

Zees Pleez · Post by **Zees Pleez** » Thu Mar 10, 2005 1:06 pm

My guess is that yes, my insurance company will pay for two humidifiers in 30 days. The way it is set up, I have no liability. The DME wrote up an order requesting it and FAXed it over to my doctor to sign and return. I am pretty sure he will do it. They lay out a nice paper trail that looks like I tried to save money using the cheaper product, but it proved to be inadequate so they are getting the better one. My insurer won't actually pay the full amount. I told the DME that I called, but I was talking to the RT and she was talking to their insurance people who still insisted that this is the way my insurer prefers it. That might be true - the insurer might prefer that paitents be given the cheaper one first, because I bet a whole lot of them never even question whether there is a better alternative, or follow up even if told there is.

My insurance has been stellar; I am only out of pocket $15 for a copay on my visit to my GP that kicked this off. Now the DME is telling me that I am free to dispose of the humidifier however I wish. If I sell it, I could end up in the black...

wading thru the muck! · Post by **wading thru the muck!** » Thu Mar 10, 2005 1:20 pm

Zees,

Glad to hear things seem to be working out well for you. I never understand how insurance companies think trying the cheap piece of you know what first will save them money. The only way it would is if the patient just continues to suffer through it not knowing any better.

Glad to hear you're on top of things!