Durable Medical Equipment Puns

So I’m starting a new career in my 40s. I left a toxic job for a new job that I’m totally green. I know nothing. I’ll be an office manager as well in this field in charge of 6 people. I’m excited to have a M-F job. Weekends and holidays off. 830-5 hours. But I’m nervous and really scared about the risk I’m taking jumping careers. My wife has my back 100 percent. The new job knows I’m coming in with zero experience except I’ve been a correctional officer for 13 years so I’ve been managing people for awhile just not law abiding kind. I’m trying to breathe and be more positive. I’m putting too much pressure on myself to know it all now an I’ve only worked one week. They told me I’d have all this training and they haven’t provided much training at all and they expect to me to manage this team NOW and make them hit call goals ie: 40 calls per shift. (The team calls out , based on referrals, and asks doctors and patients for chart notes and insurance verification..etc). Plus the transition from law enforcement to civilian/corporate work has been way harder than I expected.

My wife is amazing and supportive and said just try my best an give it a chance and if it’s meant to be it’s meant to be. If not, I’ll find another office job I like. But I hate feeling like a failure if it doesn’t work out.

Any suggestions or advice or moral support is appreciated

Given the size of Kaiser in the US, I'm surprised to see so little discussion of their policies and coverage.

I'm a member of Kaiser via the Affordable Care Act, and my policy clearly states the "Durable Medical Equipment" is covered 60% by them when prescribed. No other exceptions or exclusions in any document I can find. I've already paid my annual out-of-pocket-max for 2021, due to a surgery, so as far as I can tell they should be paying 100%.

So after my sleep study, I was classified as a "severe" case by the Kaiser doctor and he submitted the claim to purchase a CPAP, it was flat out denied as "not covered". I requested an "expedited 3 day appeal", and was denied. I'm not waiting for the results of the 30 day appeal.

I've "borrowed" a CPAP from a friend, and have a 2nd sleep study (to see results with CPAP) scheduled this week. I emailed the person (a doctor? not sure) I'll be talking to my OSCAR reports, and mentioned my denied insurance claim. Her response is below. If any other Kaiser members have had experience with this, I'm wondering how they handled it and if it was successful. If denied again I will take this to the California insurance appeals board for their review.

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Response from a Kaiser employee:

There are 2 levels of durable medical equipment coverage. The basic level, which is part of nearly any Kaiser healthcare plan, is paid for out of the patient's own premium. The items covered under the basic level of coverage are minimal and cover a handful of prescribed medical equipment products. Since this coverage is also labeled as 'durable medical equipment' it often confuses even the people at Membership services who don't always understand that different items are covered under different umbrellas. The majority of durable medical equipment products, including CPAP machines and oxygen equipment, are covered under something called a durable medical equipment supplement. There are only 3 types of durable medical equipment supplements that cover these items. One is a supplement paid to Kaiser by Medicare. One is a supplement paid to Kaiser by Medi-Cal. The 3rd is called formulary or commercial coverage, which is only made available to commercial purchasers. The cost of that coverage is absorbed or subsidized by the employer rather than the insured as part of a benefits package. Kaiser does not include supplemental coverage in any plan that is sold exclusively to an individual or family du

I work with Durable Medical Equipment and we are seeing bottlenecks from overseas shipping on over 25% of our products. We are now facing 12 to 20 week wait times as well as 10 to 50% surcharges. We literally can't afford to do business with how much insurance pays us for the equipment.

New Maryland Program

The Maryland Department of Aging is providing durable medical equipment (DME) to Marylanders with any illness, injury, or disability, regardless of age, at no cost. All equipment will be sanitized, repaired, and redistributed to Marylanders in need.  This service will improve the quality of life for many Maryland residents and provides them the opportunity to avoid costlier levels of care.

Donations needed:

• Wheelchairs

• Power Wheelchairs & Power Scooter

• Rollators and Walkers

• Toilet and Shower Supports

• All Pediatric Equipment

• Bathroom aids

• Hospital beds

​Easterseals – Montgomery County

1420 Spring St. Silver Spring, MD 20910

Tues & Thurs 10:00am – 3:00pm

Phone: 301-920-9765 ​

Directions: Pull up to the main entrance, upon arrival call 301-920-9765 to alert staff you are outside with a medical equipment donation. Staff will then come out to retrieve your donation. ​

Rockville Senior Center

1150 Carnation Dr, Rockville, MD 20850

Monday - Friday 9:00am - 3:00pm

Directions: Donation collection container is in the back parking lot – drive past the Senior Center main entrance (on your right), take a right after the main entrance towards the back parking lot, the container is in the back left corner of the parking lot. Please place donations INSIDE the container.​

Marylanders can get free medical equipment under pioneering durable reuse program

I have a heavy duty arm sling I ended up not needing. It’s unused, sealed in the bag. Is there any place I can donate this to?

My brother, a quadriplegic for 27 years post vehicle accident, finally decided he'd done what he was here to do. He passed away this past week. The last 20 months he spent basically isolation with very few visitors because of COVID. He went into the hospital for pneumonia in Dec 19, and has.been there the entire time except for 5 month stint at a SNF.

So, now as executor of his estate, I have donated literally thousands of dollars worth or medical equipment that he had specific people and places for it to go. Now I have a number of items that he wanted to have sold for just enough to cover any expense or estate tax etc, issues.

These are high-quality high value equipment like very nice power chairs, custom powered gurney beds, lift systems, many adaptive technologies head mouse set ups, puff switches, etc most never even opened and still in sealed packaging.

Where can I post this.stuff for sale? He wanted us to do everything we could to ensure it went to people that needed it, but not to those who will buy it cheap and sell it to make money. I know I can't control what people do after they buy it, but I need to do my part to try and make his desires met.

Any ideas? Aside from.facebook, craigslist, ebay etc?

My doctor gave me a list of DME providers in the area (for a CPAP machine), so I’m wondering if anyone has any experience with Advanced Medical Solutions, Health Care DME, Binson’s Medical, or Mitchell Home Medical? Or if there’s anyone else local that you’d recommend? I found a few reviews online, but they weren’t that helpful. Thanks!

Just putting this out there in case someone can avoid the mistake I made. I was on the 670g closed loop hybrid and both the pump and cgm were paid as durable medical equipment (after a hefty deductible). I made the decision to switch to the tandem/dexcom and didn’t realize the cgm would be billed as pharmacy. I paid the deductible for the pump but will still have a copay now every month for my dexcom cgm and supplies. It will end up costing me over $1,000/year.

I was in an accident a few months ago, I made my way through several very fancy leg braces and crutches, I was wondering if anyone knows of a location in the Fairfax/NoVa area that could use these supplies. Some were used for less than a week. I don’t really want to toss them but if they can’t be utilized I will.

They look like this

Has anyone had any first-hand experience with an insurance provider that uses the InterQual Criteria to determine the necessity of CGMs?

For those with direct knowledge of the criteria they use, are CGMs generally accepted as necessary?

I don't qualify for asking for help since I am well below the karma level so can I ask for leads instead?

My CPAP mask broke and it is holding together with duct tape at the moment. Is anyone here familiar with places, people, groups that help people on disability replace DME for a low cost? Medicare covers 80/20 but I need a prescription and my Dr is telling me I need a new sleep study before I can get a new prescription.

I have no idea how long I can keep this one rigged up and working.

Suggestions?

If there is a better place for me to ask this I apologize and would appreciate the direction, I just figured you all might have some experience in this.

As it comes times to choose an insurance plan for 2021 I'm finding it difficult to really see what my costs may be with each plan. Through my company I'm offered Blue Cross MA with 3 different plan options. Prescriptions such as insulin and test strips and easy enough to find, but I see no mention of DME, which would be my pump supplies and cgm. Theres nothing about it on the infograph my company sent about the plans, and looking through the website does not help either.

My question is would it be possible for me to find out exactly would be covered with each plan before choosing one and then getting quotes when I go to order? I've had diabetes for 10 years and this all still confuses me. If anyone has any advice I'd really appreciate it.

Hi all, I'm working on a research project related to rehabilitation for neurological conditions (and general quality of life improvements), using wearable devices. We've been searching for resources to better understand the process physical therapists must go through to purchase and prescribe such devices, based on the varied FDA classes, but have not been able to gain much insight into the finer details.

Would this be the right place to ask these sorts of questions?