DME dilemma

[nightpa]

Hi ALL!  I've been off the forum for a while, used to contribute as nightrt, but system couldn't locate me.  OK, I work as a hospital based PA in PICU.  We also cover a pediatric special care clinic, mostly for chronic kids with trachs, gts, and other chronic disorders.  The clinic owner is the Peds Intensivist. 

I have this one patient who is a cardiac patient and ex-premie with CDH.  He is on a ventilator and gets 24hr HH nursing.  Mother switches DME companies almost monthly.  She sees a new DME popup and she wants to try them out.  This generates TONS of paperwork for me.  Mother is very young and volatile, in the sense that she feels if you are questioning her, she throws tantrums and accuses you of abuse.  Hospital PICUs locally know her well and would rather she go to a tertiary PICU 150 miles away.  This would be her preference too, but that facility has also denies transfers because they are for typical illnesses that can be addressed here, and likely don't want to deal with her as well as they never denies transfers before for other patients.  

Back to the DME issues.  Is it wrong to tell her as far switching companies, I have to be informed of issues first?  We haven't reached out to the insurance case manager because last time we did that when mother requested a bed that we would not approve, they told her we didn't think the bed was necessary (child is only 6 months old and better served with a crib).  They then denied ever talking to her about it!  What about charging for the paperwork?  Another PA suggested that.  I am not sure where to turn as we are the only specialized clinic for these patients.  Thanks in advance!