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Latest Activity

Mary Z replied to Ginny Edmundson's discussion New "Rant" about DME/Wisp
"Ginny, they are probably not doing anything against the law- though it may seem like fraud to us it may be an accepted practice.  I would rather change DME's.  Have you talked to the manager.  They don't want to lose your…"
17 hours ago
Ginny Edmundson replied to Ginny Edmundson's discussion New "Rant" about DME/Wisp
"It really burns me up that they are doing things like this.   Monday I am going to lok up th eMedicare complaint number and give them an ear full.   "
yesterday
RockRpsgt replied to Ginny Edmundson's discussion New "Rant" about DME/Wisp
"Companies like this will have to pay in the end. Medicare is taking no prisoners in their effort to reform medicare fraud."
yesterday
RockRpsgt replied to Mary Z's discussion Symptoms
"I had zero symptoms. I was testing equipment one night and fell asleep hooked up. When I woke up my doc said I had an AHI of 10 with 30 second events. I have been on PAP ever since."
yesterday
Ginny Edmundson replied to Ginny Edmundson's discussion New "Rant" about DME/Wisp
"I just use a large rubber band and safety pin to attach i tho the sheet.  It doesn't exactly kink, but rather seems to have almost bends that don't quite ever go away.  I have one that doesn't but all the others seem to.…"
yesterday
Mary Z replied to Ginny Edmundson's discussion New "Rant" about DME/Wisp
"My light weight tubing does not have a tendency to kink.  It just hangs down from the stand and comes back up to the bed.  I tried a hose hanger, but bought the cheaper travel model and it just wasn't up to the task."
yesterday
Ginny Edmundson replied to Ginny Edmundson's discussion New "Rant" about DME/Wisp
"I was really surprised when the congestion improved without the humidification. Yes, I use the lighter weight tubing too.   Do you have trouble getting the bends and kinks out of them????  I have one favorite that is broken in and I hate…"
Thursday
Mary Z replied to Ginny Edmundson's discussion New "Rant" about DME/Wisp
"The reasoning behind changing the tubing is that it may develop small holes or tears which causing leakage.  I am careful with my tubing and don't have any animals or children playing with the tubing.  I don't feel like they have…"
Thursday
Ginny Edmundson replied to Ginny Edmundson's discussion New "Rant" about DME/Wisp
"I have ben using one of my cushions for 3 months now.  I think I will just see how long I can actually use it without leaks before I replace it.  I wonder if it is OK that I do not replace the tubing but about every 6 months????   I…"
Thursday
Mary Z replied to Ginny Edmundson's discussion New "Rant" about DME/Wisp
"I agree Ginny, it does come out of all our pockets.  I too have Medicare with a Humana supplement and insurance with my partners work.  This is the only year I will have anything but Medicare and supplement.  My last two Medicare…"
Thursday
Terry Vella replied to Mary Z's discussion Symptoms
"Good post Mary, I was like you when I was younger but the the sleep deprivation really started kicking in a few years ago my symptoms change, actually didn't change but got much, much worse. I was diagnosed with depression and on meds for 2…"
Thursday
Mary Z posted a discussion

Symptoms

Just trying to drum up a few posts-What symptoms did you have that got you to the sleep apnea diagnosis?I was excessively tired during the day- falling asleep eating breakfast and standing on my feet.  I couldn't drive or stay awake during appointments.  I thought this was the beginning of my apnea.  Then I remembered the mandatory 4-5 hour naps in the afternoon when I was  dead to the world.  That must have been the real beginning.  I went to my family practice doctor hoping for a prescription…See More
Wednesday
Ginny Edmundson replied to Ginny Edmundson's discussion New "Rant" about DME/Wisp
"My insurance is Medicare plus supplement.  SO I pay nothing out of my pocket.  BUT it is coming out of ALL out pockets...........My DME is a nationally known company.  I am really thinking of calling the medicare hotline.   "
Wednesday
Mary Z replied to Ginny Edmundson's discussion New "Rant" about DME/Wisp
"I think this kind of behavior may be the norm with DMEs.  I happen to have one of the good ones so I'm lucky.  It would be great if you called your insurance company.  You can steal millions if you steal $40 from a bunch of…"
Wednesday
Ginny Edmundson commented on Mary Z's status
"I was thinking the same thing, Mary.  I did make a new post today regarding the Wisp and  my DME."
Tuesday
Ginny Edmundson posted a discussion

New "Rant" about DME/Wisp

Well, it had been three months since I received my original Wisp.  And while it is still working well I wanted a "spare" on hand...just in case!   So I called my DME to ask if they had the one with the fabric frame in stock.   They did.  The next day I drove there and picked up the new mask and one extra cushion. All to be billed to my Insurance.  When I got home I realized they had the clear frame and not the fabric.  I called and told them I would take it back today and exchange for the…See More
Tuesday
Jackie Chan left a comment for Mike
"Mike when is the next Manhattan Awake meeting? I would like to attend"
May 12
Mary Z replied to ZolliStar's discussion Beware: It's possible to have sleep apnea AND insomnia
"Yeah, Dr.  Krakow on a YouTube video addresses insomnia while on CPAP.  Some people just do not for many reasons adapt to CPAP and may have numerous arousals during the night.  These people don't feel rested in the morning or…"
May 11
Mary Z replied to Louise's discussion An Article that was shared on the radio this morning
"Good the see you Rock. Do you mean CPAP as opposed to BPAP, AUTO, and ASV?  Barry Krakow has several videos on YouTube talking about this subject.  Many people just don't tolerate CPAP.  Dr. Krakow said the central apneas that…"
May 11
RockRpsgt replied to Louise's discussion An Article that was shared on the radio this morning
"I believe that CPAP will be cycled out of the equation.  "
May 11

I have been talking to my DME off and on all day.  Here's the deal, for our purposes let's just say that a CPAP costs $1000 and an APAP costs $2000 (because they told me the APAP is "about $1000 more than the CPAP).

 

The code for a CPAP and an APAP is the same code for medical billing.  My insurance would only reimburse my DME about $800 for the CPAP.  DME loses $200.  I need an APAP.  My insurance STILL only reimburses the $800.  DME loses $1200.  This is how it was explained to me today.  The girl I spoke to in billing was VERY nice.  She just had no authority.  She turned my case over to the owner of the DME and, last I heard, "He's working on it."

 

I am nosey.  I googled "wholesale cpap".  Lookie what I found:

 

http://www.directhomemedical.com/machines-cpap-bipap/intellipap-aut...

 

That is EXACTLY what was prescribed to me.  I realize I would need the hose and the mask and headgear. 

 

This machine is about 1/4 of what she explained to me that mine will cost.

 

I'm pretty close to fired up.  Real close, in fact. 

 

They are supposed to call me in the morning. 

 

I would appreciate insights and suggestions.  I promise when I get all this taken care of I'll quit bugging the crap out of everyone and do normal posts.

 

Thanks,

 

Fired up in Bama

Views: 1244

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Sorry, I had to delete my previous reply and fix the wording, which was incorrect...

I am sure that you provide excellent support, however, the cost simply does not justify it. When the cost of a NEW machine mail order is FOUR TIMES less than the cost of one through a local company, I could EASILY have a second machine sitting there doing NOTHING, just waiting for the first one to fail before I use it. Then, when the 1st one fails I can figure out what to do.

Even local companies only provide the support during RENTAL. Once you actually PURCHASE the machine - if something happens to it, you are responsible for the cost. The sad fact is that these machine rent for outrageous sums of money - enough such that you could easily OWN it after only FOUR MONTHS. Why then, do insurance companies insist on 12 months of rental? Why would they do that? It seems to me they could easily lower their own costs and by doing so, lower the cost to the employer and ultimately, to the employee.

What has happened is that insurance companies have all become fat - fat because they simply pass along extra costs and MARK THEM UP. That's right - when they incur extra costs, they also make EXTRA PROFIT.

This model is broken badly. REAL HEALTH CARE REFORM is needed, not that crappy obamacare that will only help guarantee that more jobs will be moved overseas.

Sheri Fellat said:
Good morning,

As the sales manager for a reputable and ACCREDITED DME company, I would like to offer this comment.

There is a place for both on line as well as brick and mortar companies. What you may fail to realize is the we as a brick and mortar DME's, are required to become accredited. That means we must spend the time and resources to ensure not only that we provide excellent service and equipment, but that we do necessary follow-ups to ensure our patients get the most benefit from their treatment as well as their dollars! We perform downloads on a consistent basis and change masks out to ensure patient comfort acceptance and successful therapy. Online operations are not held to the same standards, typically wont file insurance and don't accept mask changes or perform downloads. They also don't have anyone to fit you properly! Those marks you get on your face are typically a result of a poor fit. Wasted money and time!!!!! We talk the masks back and ensure your comfort through our mask guarantee!

The other major distinction that has never been discussed here is that the insurance companies typically follow Medicare guidelines. What does this mean?
They require that we RENT to PURCHASE over 13 months!!!! That includes all the supplies necessary, typically sent quarterly but only with the patients consent.
Not only must we wait to be paid, but we must assure the patient is compliant and by downloading reports that reflect the patient is using their machine for a minimum of 4 hours per day for a period of 30 consecutive days. Then they must have face to face follow up visits with their doctors. We, the DME are responsible to maintain these records to ensure we remain accredited or the insurance companies will NOT PAY!!! Online companies don't have to do any of this. We also keep the doctors aware of their patients treatment an to help keep them aware of technology advances and benefits for the patient. If a patient was prescribed a cpap, but fails and needs to be moved to bi-level therapy, how would the unit you bought from the online company help you there? They would not, why? You own the unit, and they will gladly seel you another bi-;pap at your expense. We on the other hand, will exchange the unit, and continue to assist you in your therapy to ensure your success.

We take alot of pride in what we do as well as being tremendous patient advocates.

When is the last time an online provider came to your house on Sunday evening because your cpap failed? I do it all the time.

Sheri

j n k said:
Ms. Hertel,

I've been reading posts on apnea boards for a while, and yours ranks right up there as one of the most beautifully worded, most informative, and bravest posts I've ever read. It actually brought a lump to my throat. Good stuff.

Personally, I don't mind the arrangements from the honest brick-and-mortar DMEs when they actually provide something to the patients that keeps the patients happy and compliant and successful. I only resent the places that lie and milk the patients and do more to make the patients unhappy, non-compliant, and unsuccessful than to help. It is obvious that you are one of the good guys and gals.

Is there any chance you would be willing to go further on record to explain the following statement and make any suggestions about how to do it? (Not for me; I already buy online and get reimbursed, but not exactly by an insurance company.) It might help those in circumstances who need to do so.

"Most insurance companies will reimburse you if you pay cash."

Thanks. Truly a VERY nice post. And I'm not easily impressed. :-)

-jeff
Carl, Well said. The worst is yet to come thanks to our corrupt governments.
Good lord you guys! Maybe some of you should go over seas with those jobs. All you guys ever do is bitch.
Did you try adjusting the Apnea and Hypopnea settings? You can set the IntelliPAP Auto to respond more aggressively to both events.



Donald R. Byrd said:
Hi,

I'm a RRT for a Home care company, DME, I also use Cpap therapy to treat my OSA.

My Company provides a fair amount of cpap and service to many patients each month. I always put the patient first in every situation. My Company believes patient care must be first and is a core value that we practice every day.

Our patient cpap compliance rate is very high (you probably wouldn't believe me if I told the %) we are successful because we realize most people need clinical support initially and ongoing in order to treat OSA successfully.

Know what you’re buying. All CPAP machines are not equal, some cpap machines will treat your apnea better than others. Please trust that I'm telling you the truth, if you spend $500 on a machine that is not going to meet your needs well this is money that has been wasted and most importantly has not meet your health care needs. In all fairness I must say a percentage of patients may benefit from this type of unit, but it is a gamble, a gamble I would choose to avoid myself.

I believe an experienced Healthcare provider must support your every step starting at the beginning of cpap therapy. Insurance reimbursement decline is definitely affecting the quality of healthcare which is unfortunate for all us. without sufficient support most people will fail CPAP therapy which will result in poor quality of life and increase healthcare cost.

I was able to try the CPAP machine you are considering purchasing its brand new technology from this Manufacturer. A Representative let me have a cpap machine, I tried it for 4 days, it did not prform well for me. My OSA symptoms returned i.e., frequent awakenings, increased AHI, daytime naps :( so I switched back to my previous CPAP machine. My life is much better now.

A lot’s been said here I hope it helps you.

P.S. a happy patient is the best.

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