"please keep me updated about oximeters "
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Son-In-Law's Journey Getting His Machine
My son-in-law (Joe) called me last night as I was leaving for work. He told me that he received his paperwork from his titration study, which was done last Thursday Jan. 14, 2010. I told him I would stop by prior to going home.
He was full of questions when I arrived. Good for him!! Wanted to know what the various numbers and terminology meant. I explained what the numbers and terms meant. He seem to soak it up. I think he has caught my drive to learn as much as he can. I will be encouraging him to join the forum.
He asked if I could go to the DME with him. I told him first to call the insurance company to find out about coverage and in-network providers. He hopped right on that and placed the calls. His only option of DME is Lincare. Coverage is 80/20 after deductible has been met. His titration study will catch the deductible probably.
His script is written for a "cpap ----- autocpap with a pressure of 10 to 15/ heated humidifier/ c-flex setting of 2 / full face mask / data capable with smart card.
I called Lincare and asked if they carried the Resmed line. Was told no. I asked if which machine he would be getting (actually on the phone I inferred it was my script). Was told there are several various apaps and it would depend on his script. When I told her that he had a pressure of 10 to 15, was told that he would need another study to determine "which pressure". I explained that no he was ordered an apap and that his pressure would be set to a range of 10 to 15. Again I asked which apaps they carried and was told there were "too many" to go over the phone and she would have to see the script.
We went to the DME after my call. The LPN looked at the script and said "good". I asked for copies of the script and reports. She looked surprised, but copied them and gave them to us. I then asked about machines and was told he would get an M series. I asked about the System One and was told that she had never heard of it and I must be thinking about the M series. I explained no -- she needed to look it up. I asked about the Resmed system and was told they only dealt in Respironics machines. I asked about their mask policy and was told that he could change if it took place within 2 weeks. But then she looked at him and said "we do a good job with fitting and patients do not come back to do exchanges." I asked if he could try different mask before settling on one. She again looked at him and said they could tell which mask by looking at facial features and they "only" carried masks that worked for people and didn't carry those that didn't work. I asked how many they stocked and was told just a few.
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Replies to This Discussion
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Permalink Reply by sleepycarol on
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Today I stopped by my son-in-law's to see if he had heard from the DME. My daughter told him she had forgot to tell him when he came in from work, but that he had message to call them back. He called Lincare and was told that his insurance only covered prescription drugs and he didn't have any other coverage as far as medical goes. Joe pulled his insurance card from his billfold and asked them what number they had called. There are two numbers on the card -- one for medical and one for prescriptions. Yep, they had called the number for prescription coverage. Joe patiently explained that they needed to call the OTHER number on the card. Well they give him a hard time telling them that they had verified the insurance coverage and he only had prescription benefits. It took being very adamant that they had to call the OTHER number to get prior approval for DME benefits. I looked at his insurance card and they are plainly marked which number is for what!!!
Before he made the call I told him to go ahead and ask for the PR System One auto. They had told him at the beginning of the week that he would get the M series auto. They told him he could only get the PR System One auto with a script written for that particular machine. Not a problem, a quick call to the doctor and he picked up the scipt written as requested within a half hour. After he picked up the script he took it to Lincare. When he gave the script to the same lady that had talked to him at the beginning of the week, she said there had to be a mistake since the PR System One was a mask and not a machine. Joe explained that no -- it was a machine and that is the one he wanted and he had the script for it. Then the lady became flustered and told Joe that "doctors around here don't write prescriptions for certain machines since they didn't have any expertise in that area." Joe said "well I have a script for a certain machine and I expect it to be filled as written." She then turned around and told him that "his mother-in-law was troublemaker and didn't have a clue as to which machine was best suited for him." I guess they went around and around about it, but Joe held his ground and told her to get the prescribed machine. He was told that "they would try, but couldn't promise anything since they had never heard of this machine and didn't know if it was any good."
I did download his data from the last three nights. He has good numbers and has averaged 7 hours each night the last 2 nights. His leak line is acceptable (which I told him to try to lower some), AHI was less than 1. He says he already notices a difference in how he feels. He said he gives me the credit for helping him get started.
Unfortunately, his mom is on a cpap. She used the same doctor as we did for the sleep study. Guess which machine she is stuck with -- yep the M series Plus. She wonders why she doesn't feel better. She had taken her "smart card" to the DME to have the info downloaded and was told her "numbers look great". Yep, they look great -- how many days and hours she has used the machine. Too bad for her.
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Permalink Reply by RockRpsgt on
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Sorry about the way they treated your son Carol. I hope everything works out for him. It sounds like he is in great hands though.
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Permalink Reply by claudette paluch on
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Hi Carol, You were a great help to your son-in-law....Its nice to hear that he is feeling better.....Claudette
sleepycarol said:Today I stopped by my son-in-law's to see if he had heard from the DME. My daughter told him she had forgot to tell him when he came in from work, but that he had message to call them back. He called Lincare and was told that his insurance only covered prescription drugs and he didn't have any other coverage as far as medical goes. Joe pulled his insurance card from his billfold and asked them what number they had called. There are two numbers on the card -- one for medical and one for prescriptions. Yep, they had called the number for prescription coverage. Joe patiently explained that they needed to call the OTHER number on the card. Well they give him a hard time telling them that they had verified the insurance coverage and he only had prescription benefits. It took being very adamant that they had to call the OTHER number to get prior approval for DME benefits. I looked at his insurance card and they are plainly marked which number is for what!!!
Before he made the call I told him to go ahead and ask for the PR System One auto. They had told him at the beginning of the week that he would get the M series auto. They told him he could only get the PR System One auto with a script written for that particular machine. Not a problem, a quick call to the doctor and he picked up the scipt written as requested within a half hour. After he picked up the script he took it to Lincare. When he gave the script to the same lady that had talked to him at the beginning of the week, she said there had to be a mistake since the PR System One was a mask and not a machine. Joe explained that no -- it was a machine and that is the one he wanted and he had the script for it. Then the lady became flustered and told Joe that "doctors around here don't write prescriptions for certain machines since they didn't have any expertise in that area." Joe said "well I have a script for a certain machine and I expect it to be filled as written." She then turned around and told him that "his mother-in-law was troublemaker and didn't have a clue as to which machine was best suited for him." I guess they went around and around about it, but Joe held his ground and told her to get the prescribed machine. He was told that "they would try, but couldn't promise anything since they had never heard of this machine and didn't know if it was any good."
I did download his data from the last three nights. He has good numbers and has averaged 7 hours each night the last 2 nights. His leak line is acceptable (which I told him to try to lower some), AHI was less than 1. He says he already notices a difference in how he feels. He said he gives me the credit for helping him get started.
Unfortunately, his mom is on a cpap. She used the same doctor as we did for the sleep study. Guess which machine she is stuck with -- yep the M series Plus. She wonders why she doesn't feel better. She had taken her "smart card" to the DME to have the info downloaded and was told her "numbers look great". Yep, they look great -- how many days and hours she has used the machine. Too bad for her.
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Permalink Reply by Mary Z on
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Yes sleepycarol, I really like a good start. I hope he got the machine he wanted and found a good mask. I's nice that his machine is data capable and you can run the numbers and tell him how is's doing. Hope y'all have continuing good luck.
Mary Z.
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Lincare has been a real pain in my side as well.
I specifically asked for the S9 Elite, and they gave me the S9 Escape. Difference in price? $50-60, difference in service..
Escape: Hours of usage
S9 Elite: MORE than Hours of Usage (lol)
I paid $400 out of my own pocket thinking I had the S9 Elite, only to find out it was the escape.
So, I failed my last 2 compliance, and now my insurance company no longer wants to pay. Try calling BCBSFL about CPAPs, and you'll get a wide variety of reactions, from it being an "oxygen machine", to it being an "inhaler".. But these are the people who we have to rely on.
So, here I am, giving my machine back to Lincare today, and now have no CPAP anymore, out $400, and will soon be out of a job when my boss finds out or I start falling asleep at work again. Unfortunately there are no other DME in the area my insurance will cooperate with, as the last one, RoTech, was a nightmare and lied about their acceptance of BCBS only to get a $1200 rental bill so far because my doctor hasn't authorized me to return it yet.
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Permalink Reply by 99 on
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for those wantinig a p rticular machine a PR1 system or the s9 by resmed take a photopicture of the machine from off of the web and the speciftions to your DME take both pictures and when they contradict you pull out the picture and specification and shove it hard under their tiny noses
better still is to get resmed and or respionics to send you literaure of their machines
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can we have an offical photo page on our site so newbies can down load for presentation to stubburn DME
you can call it a presentation pack
only two pages required
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I hope things get better for your son in law. Good luck to him!
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