Getting the Runaround: Dan's Story

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Comment by 99 on October 7, 2009 at 4:56am

to me all this smacks of greedy people wanting money or more money, they donot care whether you live or die as long as they have their money

Comment by Judy on August 8, 2009 at 12:58pm

Steve, my first local DME supplier's RRT was either not at all knowledgeable about her job - or less than truthful. I had the hard plastic swivel on a CL2 break and the small simple nasal cushion punctured after I had had the CL2 for 3-4 months. When I went in and asked for a replacement swivel and cushion I was first told they didn't have any, that I would have to buy an entire new mask (and headgear) out of pocket since I hadn't had the CL2 for 6 months. I actually had to go home, access the replacment schedule and HCPCS code for the parts to shove under her nose. It took 3 weeks for her to order it in. A third visit their EMT was able to "find" a swivel in the "miscellaenous" stash. When my sleep doctor scripted a 3 week loaner APAP I was provided w/a different brand than my CPAP but because he hadn't specifically included a heated humidifier w/the loaner their RRT told me that one was NOT available. When told even if my sleep doctor wrote another script including a loaner humidifier one was NOT available. My sleep lab was able to come up w/a stand alone passover humidifier but even that didn't help. THANKFULLY, a friend had a stand alone F&P HC 100 stand alone heated humidifier he gave me or that loaner APAP would have been a complete waste as after the third night w/o humidification the interior of my nose was chapped to the raw meat stage. When I needed a nebulizer this same RRT told me that Medicare would NOT pay for one for me. Yet another local DME supplier provided me w/a Medicare paid nebulizer. I was lied to about the data capabilities of the Resmed S8 Elite w/EPR my sleep doctor had scripted for me by this same first supplier's RRT. There's more - but you get the drift. I'm happy w/my second local DME supplier so mine is not sour grapes against all local DME suppliers nor do they have to do w/a lack of education, support and advice from that first supplier..

Comment by Steve T on July 29, 2009 at 6:09pm

BTW, take what is written here, especially negative experiences, with a grain of salt. We have had recorded conversations (for quality assurance) debunk negative "reports" to the Dr office about how horrible the RT was while helping them on the phone... Usually, the DME provider is patient and can help a patient with a multitude of pressure therapy problems. If the problem is NOT related to the performance of the equipment/supplies (and I'll leave you to figure out then where the real problem is) then there's not a lot we can do but be polite and reassuring. If that's not good enough, well, they might get on here and "complain". So, get out the salt shaker when reading some of these "reports"!

Comment by Steve T on July 29, 2009 at 6:04pm

The DME is paid by insurance, or privately, for the purchase or rental of cpap's or any other DME equipment/supplies. They are not paid to actively manage the efficacy of the equipment other than to ensure proper instructions in care and use is given. Although, some physician offices would beg to differ, somehow of the misguided notion that DME providers get paid to anything other than (minimal) payments for rental or purchase of the materials only. There is NO reimbursement for monitoring, for followups, for hand-holding or helping those who need some extra help whether that help is provided in the home or just many hours on the phone. ...Sometimes a LOT of extra help in the beginning!

The four-hour 'mark' is from two things: First, it's a bit of a threshold for the medical community in regard to "using it enough to be effective for the average patient to receive intended benefit from the use of the device". Secondly, Medicare, as of November '08 requires the DME provide proof the patient is using the device for "greater than or equal to four hours per night for 70% of the nights in any 30 day window compliance is viewed from 31 to 91 days after set up", or no reimbursement at all. It's to YOUR benefit that YOU follow the guidelines. So, Mr and Mrs Medicare Recipient, if YOU want to write the checks for YOUR rented medical device then tell your DME to not monitor your use. BTW, when YOU rent an item from your local rental service, let's say a garden tiller, does the business renting the thing to you visit you and ensure it's work'n for you? No. How has the DME RENTAL company been loaded with such responsibility?

I've had many patients "choke and gasp" with cpap/bipap/asv/etc and have, without additional reimbursement at all, helped them by changing from one mask type to another, chin strap, pressure titrations, etc. Sometimes we've actually been thanked for that unpaid help.

Good professional help can be hard to find, yet is easily found. What do I mean? It means you need to be realistic as to what a person or entity can do to help you with your cpap experience. The pressure is prescribed by the physician. The mask seals to your face/nares (depending on mask style). The machine provides pressure. It WORKS as long as your mouth is shut. IT WORKS and performs the intended task. Liking it, putting up with it, learning to appreciate it... That's up to YOU.

Comment by Judy on May 20, 2009 at 1:24pm

dsm, whether the local DME supplier adopted the use of ResTraxx on their own volition or whether they adopted its use and bill insurance isn't as moot as you might assume.

The local DME supplier's explanation of their need for such high reimbursement rates is that they provide the education, advice and support necessary for successful CPAP compliance. HOW can they provide that education, advice and support IF they totally ignore the data that tells them the possible reasons for their clients' difficulties w/CPAP compliance?? Or don't receive that data because the CPAP hey provided isn't capable of providing it?

Comment by Judy on May 20, 2009 at 1:05pm

LisaMuth, when you say the same machine I take it you might mean the Resmed S8 Elite II w/EPR??? If so, try pressing the Left and Right buttons and hold them for 4-5 seconds. Efficacy Data should pop up in to the LCD screen. From then on it is simply a matter of Left button to Enter, Right button to Exit, Up button to return to the previous screen, Down button to proceed to the next screen.

If Efficacy Data doesn't appear in the LCD screen then your DME supplier didn't turn access of the advanced patient menu on. This menu allows you access to a goodly share of your nightly data and data averages over specific time periods as you've been using it long enugh W/O being able to accidentally or intentionally change your therapy settings. These xPAPs have an internal, 24 hour, noon to noon clock so you do have to access your previous night's data before noon or it is rolled over into the total averages.

Comment by Judy on February 6, 2009 at 11:16am

I "fault" Resmed only in that they don't do as Respironics recently did and provide a patient version of their professional software - the only difference between the two being the ability in the professional version to make therapy setting changes via the software.

Heck, most of us who are determined and innovative have been able to figure out how to change our settings via the xPAP itself so who cares if it can or can't be done via the software as well?

I reiterate OUR BEEF IS WITH THE AMERICAN MEDICAL PROFESSION!

Comment by Judy on February 6, 2009 at 11:12am

Mike, I certainly didn't mean to leave the impression you were being critical of the manufacturers and/or explicitly Resmed. Resmed has and is doing its best to get their nightly data to the patient. It is the US FDA at the behest of the American medical profession that prevents us from access to the software. Our beef should be w/the AMA and other governing US medical associations. How many of us know who provides accredidation to these "sleep doctors". THAT is the best place to start filing our complaints!!! And the FDA as well. THEY are the "culprits".

Comment by sleepycarol on December 31, 2008 at 1:38pm

We all must become more proactive in our treatment.

Manufacturers have set much of the software available so that only a doctor or dme has access to that data. A lay person is kept in the dark. I feel it is a reasonable expectation for the DME to periodically check your data for any problems that might arise -- after all they are charging premium price for their "services".

Respironics has made available to the end user EncoreViewer. I think they are now agreeing that users should have access to their data -- although they still manufacture devices that do not track anything but compliance. EncoreViewer is not cheap and you have to buy the card reader so you end up with approximately $200.00 or more to track your data. At least it is available.

In my opinion the RT at the DME probably didn't know beans about the data!!!!! At a local DME where I picked up my first machine the RT knew nothing about cpaps or data!!!!! I was prescribed a "smart cpap with heated humidifier with a pressure of 8 -12". I was given an M series Plus machine set at a setting of 10. When I asked about the pressure being set at 10 I was told that it is "the way they do it" A doctor always prescribes a range of pressures and the DME picks the one in the middle to set the machine. When asked what a bipap was this same, RT told me that it was a life support unit for those near death. Obvious again she has no idea what she is talking about (although at the time I was uneducated and took her word on both pressure settings and what a bipap was).

It was never discussed with me that it would take time to become adjusted to pap therapy. After approximately 10 days of feeling worse I asked the DME if she could set my machine to 12 -- after all the script was written for a pressure of 8 - 12. She threw an awful fit and told me she knew what she was doing and she would have to talk to the doctor -- blah blah blah. When asked if she could check my data -- she told me that it "wasn't" necessary. Little did I know that the plus doesn't have any meaningful data except compliance.

Over the week-end I did a lot of research and found that a "smart cpap set at a pressure of 8 - 12" was actually an apap with a RANGE of pressure of 8 - 12. Had she supplied me with the right machine? NO WAY!!

I took their machine back and fired them on the spot. I had contacted my doctor and insurance company and had their blessings to go to another DME. When I took the equipment back into them on the fourteenth day they were very billigerent and told me that THEY KNEW what they were doing and I did have a "PLUS" machine that was considered to be a 'smart" cpap and she argued that the machine provided useful data besides compliance -- which a PLUS machine does NOT do.

How many others are dealing with an incompetent DME such as what I just described above -- far too many people!!

Comment by Mike on December 15, 2008 at 11:46am

Bill -- thanks for your comment. I think ResScan 3.7 might be available in Australia, but not here in the U.S.

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