CPAP Pre-newbie

[JeffV]

Hi all -

I was recently diagnosed with severe sleep apnea, and I'm going to be put on CPAP. Right now I'm still waiting to hear from the equipment provider. The doctor originally sent my prescription to SleepMed, but after not hearing anything for a month they finally let us know that they're out-of-network for my insurance, and today the doctor's office let me know that they're sending my prescription to Apria instead. A google search brought me here, so I've got some questions.

- What should I be expecting from here? Most all of the resources I've been able to find online have been geared for new users of the machine, but I haven't really seen anything for people who are getting set up with a new machine for the first time.

- I searched up Apria online and the results I saw weren't favorable - but many of the reviews I read applied across the board to multiple equipment providers. What should I be ready for in dealing with them for the first time?

- I know very well that there's a great deal I don't know right now. Are there questions I should be asking that I'm not?

Thanks so much in advance for any help you're able to provide!!

[Denial Dave]

here's a great place to start

http://maskarrayed.wordpress.com/what-y ... me-part-i/

[kaiasgram]

here's a great place to start

http://maskarrayed.wordpress.com/what-y ... me-part-i/

Yes, and don't miss the link near the end of her article with the list of data capable machines. If your DME is trying to give you a machine that you don't see listed check back here before accepting it -- there are some newer machines that are full data machines and haven't been added to that list.

[JeffV]

Excellent, that looks like a great article. I've been wanting to call my insurance but I didn't really know what to ask - I think that's exactly what I needed.

Given all the negatives I've been seeing about Apria (Crapria?), should I be seeking a different DME? (Checking with insurance to see what else is in the area, talking to my doctor, etc.) Or would that be an overreaction before I even get going?

[RogerSC]

I'd be looking for an "independent" DME. The large chain ones, LinCare, Apria, etc. all get pretty bad press. You should be able to ask your insurance company what DME's are "in-network" for you, and get a list.

That's what I'd do, anyways *smile*. Good luck getting started, this forum is always available to help.

[sc0ttt]

Jeff - It's really nice to see someone come in here and ask for advice before they get their equipment. Way too often it's the other way around and then we have to tell them they got sucky stuff.

What does your prescription say? Sometimes doctors will write an exact model or specific features that'll make dealing with the provider a lot easier.

[JeffV]

I'd be looking for an "independent" DME. The large chain ones, LinCare, Apria, etc. all get pretty bad press. You should be able to ask your insurance company what DME's are "in-network" for you, and get a list.

I'll see what the insurance says and quite possibly come back here with a list - being new to this I have no idea who's big and who's small! (When I have time to call my insurance, that is - I can make time during my office job to post here, but sitting on hold with BCBS is a bit more difficult.)

What does your prescription say? Sometimes doctors will write an exact model or specific features that'll make dealing with the provider a lot easier.

That's... an excellent question. They never gave me a copy. I gave them a call, they're mailing one out. (Thanks to HIPPA they won't e-mail or fax it, but I'll get one.)

[englandsf]

You can probably give your doctor permission to e-mail you stuff if they insist. HIPAA is usually just an excuse!

[wilsonintexas]

I would say you have to work two fronts:

1) your insurance: find the current DME suppliers....... and be ready to do it in January. Every year most insurance changes (especially if through your work) My work insurance has several DME's in my area and this has changed every year......

2) Once you have a list from them I would talk to your DR, see who they have worked with.

I went through 3 DME's before I found one that I was happy with.

There are horror stories out there.... You learned the first one, take control of things, and do not wait for someone else to do it for you.


My start was rocky much as yours. Script sent, heard nothing (after two weeks) .... tracked it down.. The DME claimed they nevergot anything. Talked to DR, send script, called next day, DME said they never got it.... changed DMEs.

New DME, heard back next day, went to their office that afternoon, or their rep could come out the next day...... things were looking good...... ..

BUT when it came time to go from CPAP, to bipap they had their own internal review. It took a week, but it went through. Then when it was BIPAP to ASV, they rejected the script from the DR. They said I did not qualify....... obviously ... time for the 3rd DME.....

Told DR about it, he had a fit, and we found a 3rd DME.....

So, you need to work with both the insurance and the DR. The insurance could not care less which DME as long as they are in network......

You also need to find a good DR. I was lucky and found a very good one.

My DR took the time to go over the sleepy head reports. It to to the point where I brought in my lap top and we would go over reports in detail....... he was impressed I found the software, and supported my efforts to understand my condition.

I was lucky to find a good DR.

If yours does not take the time, find a new one....

Good luck

Take control of it and do not let it sit for more than a day or tow in the future.....

Good luck


BUT I THINK I HAVE A UNIQUE DR.

[JeffV]

Ok, I spoke to my insurance today, and while I didn't get a whole lot of info, I did get names of a couple of other DMEs that are in my network. In addition to Apria, I have:
Medical Service Company http://www.medicalserviceco.com
Seeley Medical http://www.seeleymedical.com

Both have an office within easy range of my house, as does Apria. Distance is not an issue with any of the three. Not sure what to look for with any of these - Any input for where to start?

[JeffV]

Also, received a copy of my rX in the mail. Looks pretty generic.
- E0601 CPAP, 7cm H2O
- E0562 Humidifier (heated)
- Fit w/ appropriate mask
No word from Apria yet - if I don't hear by Wednesday I'm calling the Dr. back.

[grayghost4]

You should also ask for a copy of the complete sleep-lab report to have for your own medical records.

[Janknitz]

Do you understand how your insurer will cover the machine? Capped rental or outright purchase? Capped rental for how long? What is your financial out of pocket costs (keeping in mind that you may have to meet a new deductible in January.) what will it cost through the DMEs vs buying it yourself online.

Your next job is to decide which E0601 machine YOU want to sleep with for the next five years (E0601 covers ALL APAPs and CPAPs). When you have decided, start calling around to each DME and ask "my prescription says E0601 and I want X make and model. Will you provide it?"

Be prepared to be lied to. You'll be told that your insurance covers only the most basic machines (not true) or that your prescription doesn't include a CPAP or efficacy data capable machine (not true). If nobody wants to provide what YOU want on that script, you can ask your doctor to specifically prescribe what you want. But be prepared to fight every step of the way.

Or you can just take what they will give you and hope it works because they will give you a brick. If it's not working well for you there will be no way to tell why. CPAP can be challenging but efficacy data can help you get optimal treatment.

[Denial Dave]

Please go back and re-read the information on the link that I provided you. The answers to 98% of your questions are in that.

Then comes the hard part of acclimating to the machine and mask

Ok, I spoke to my insurance today, and while I didn't get a whole lot of info, I did get names of a couple of other DMEs that are in my network. In addition to Apria, I have:
Medical Service Company http://www.medicalserviceco.com
Seeley Medical http://www.seeleymedical.com

Both have an office within easy range of my house, as does Apria. Distance is not an issue with any of the three. Not sure what to look for with any of these - Any input for where to start?

[JeffV]

Do you understand how your insurer will cover the machine? Capped rental or outright purchase? Capped rental for how long? What is your financial out of pocket costs (keeping in mind that you may have to meet a new deductible in January.) what will it cost through the DMEs vs buying it yourself online.

Capped rental for 10 months. $500 deductible (which I've already met for the year, but I'm aware of impending January...) followed by 20% co-insurance up to my annual out-of-pocket max of $3500. My employer also offers a premium insurance plan with much higher premiums (about 2.5 times what I'm paying now) - $250 deductible but no co-insurance. I can enroll in that effective January if the numbers make sense. I wasn't able to get specific dollar amounts for CPAP out of BCBS.

Your next job is to decide which E0601 machine YOU want to sleep with for the next five years (E0601 covers ALL APAPs and CPAPs). When you have decided, start calling around to each DME and ask "my prescription says E0601 and I want X make and model. Will you provide it?"

Be prepared to be lied to. You'll be told that your insurance covers only the most basic machines (not true) or that your prescription doesn't include a CPAP or efficacy data capable machine (not true). If nobody wants to provide what YOU want on that script, you can ask your doctor to specifically prescribe what you want. But be prepared to fight every step of the way.

Right, that's about where I'm at now. I just got a call from Apria to be told they would be calling me once they've completed my order at it would take about nine business days, and I would be called at that point to start setting things up. She had no information, and when I told her repeatedly I wanted a machine with full efficacy data she deferred to the people that would be calling later. (Why does this lady have a job doing this? Our insurance dollars at work...) Is this a typical delay or should I be looking elsewhere in the meantime?

Also, any machine recommendations to start poking around with? I'm a bit overwhelmed with options so far. I know I'm getting a machine with full efficacy data and a humidifier, but beyond that I'm pretty clueless. From the article Denial Dave sent me to (which I have read, multiple times! I promise!) I got to this list of data-capable machines, but that's from 2011 (and still has a load of machines listed). Short of closing my eyes and pointing I have no idea where to start. Is there a shortlist of what I should be shooting for as an acceptable machine?

Or you can just take what they will give you and hope it works because they will give you a brick. If it's not working well for you there will be no way to tell why. CPAP can be challenging but efficacy data can help you get optimal treatment.

Oh no. Already decided that ain't happening. I'm usually a pretty soft-spoken person, but I'm fully prepared to go to bat for myself for this.