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Medicare and the DME

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wiredgeorge +0 points · almost 4 years ago Original Poster Sleep Enthusiast

Prior to become an official geezer (65), I was and still am a member of the government employees heath benefits group. This limits you to a very small area-based choice of insurance carriers; in my case ONE. The option was HMO or PPO. Since neither I nor my missus had many instances of large cost medical issues, we went with HMO. For anyone who doesn't know what that means; it is MANAGED health care. The insurance company does the managing and they are not prone to spending company money when making decisions regarding the need for medical care or equipment BUT, when my primary care doc wrote a referral for a sleep study, well no problem. I was diagnosed with OSA and I came out of it with a prescription. I was left to choose from most any DME in the area and went with one. Should have done some research as I chose them because they were pretty much first in the phone book (name started with the letter A). In any case, I survived their lack of mask fitting and figured the mask part on my own. They sent supplies every 3 and 6 months. I still have PILES of these supplies as I seldom use them.

Fast forward a couple years. I am now a Medicare Part A and B member and also have a part G supplement so Uncle Sam picks up the tab. I still have to pay for the HMO as my wife is not yet 65 and eligible for Medicare. Since I have switched masks and wanted a new Bipap machine, went into my primary care physicians clinic and had my weight and blood pressure checked and asked her to write a new script. Her clinic handled the referral to a DME. (MISTAKE). I live in the boonies and found that since there is competitive bidding among to DMEs to contract with Medicare, my old DME didn't make the cut so I was forced to look for a new one. The PCP's staff had sent my prescription to a DME who was not part of Medicare's network sooooo

After about two weeks and not having heard from the DME (after the initial call), I looked at Medicare's website and didn't see the DME in question as part of their network. Called the DME and asked to speak with a supervisor and she told me "no, we can't service this prescription". Asked her why they hadn't contacted me and to her credit said she would look into it. I went on the hunt for a DME.

There are dozens of choices on the Medicare website based on distance from my zip code. I would look one up and then look up ratings and reviews. Keep in mind that I live about 30 miles from San Antonio Texas and the DMEs in that city are NOT necessarily contracted to service my zip code. There are no DMEs in my county.

I went through the list of DMEs to find that NOT ONE had even a passable review or rating. I looked at YP.com, medical site reviews, the BBB, google.com, etc. Almost all were accused of double billing (govt and patient), not responding to calls, rudeness, lying, etc. One place I looked at had 168 RECENT complaints with the BBB. I continued to look outwards in distance and finally in Conroe Texas (about 270 miles away), I found a place that had decent ratings and reviews. They could service my Medicare account!

I went to their contact page and found they had a business they had purchased in San Antonio that could provide me with a new machine and then subsequent supplies would be mailed out of the Conroe facility and this is set up with a phone call. I spent almost a full day doing the research. Yesterday, I had a 10AM appointment at Alamo Respiratory Services on Babcock Road in San Antonio and was pleasantly surprised to find a professional and pleasant staff with a high degree of competency. I can't judge how well the therapist would have done fitting me for mask and explaining the new machine which is pretty much identical to what I had used for years past since I was already very familiar with the equipement.

If you ever want to amuse yourself, check out the DMEs that serve your zip code on the Medicare website and start looking at ratings. I was shocked that Medicare paid no attention to the quality of these businesses only the cost to the government. Somehow I suspect it costs the taxpayer more to have Medicare do business with slipshod durable medical equipment businesses than more legit companies in the same market space.

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