Long time reader... first time poster

[purple]

IMO: Also a good idea to start thinking about which mask you want. Find out how long you can try different masks for free. Medicare used to be thirty days. Be prepared for having to overcome some difficulties. Many of us have had to overcome some very difficult situations in our road to having successful treatment, and good rest.

In my experience, it is possible to talk to some at DME's who know little about what is going on, and it is possible to find a buddy at the DME who will give you good advice, help with getting your orders straightened out. and so on. Be prepared for both.

[archangle]

Welcome.

There's lots of info in the Useful Links in my signature line at the bottom of this post. Includes good and bad machine models.

Avoid Lincare and Apria. Although many DME's are sleazy.

If it's midnight and a DME tells you it's dark outside, go and check for yourself.

[Pugsy]

Find out how long you can try different masks for free. Medicare used to be thirty days.

Medicare has no such time frame for masks...they have zero swapping time frame.
But DMEs have been known to put the blame on Medicare (or whatever insurance is being used) instead of telling people the truth which is most mask manufacturers allow a 30 day trial where a person can swap out a mask that doesn't work and this 30 day thing is for each mask but DMEs often make their own in house rules and typically it's simply 30 days from the very first day you started on the machine. They don't tell you that you could wait for 25 days and swap it for another mask because they don't want to do the needed paperwork to get credit.

Insurance companies and that includes Medicare will only pay for one mask until the replacement allowance cycle turns around...so any swapping done the DMEs have to do some extra paper work when masks are returned so that they get credit for the mask that was returned (because that one is the one the insurance will pay for and they then get credit for it to offset the cost of the second mask that gets dispensed that they can't bill for because insurance won't pay but once within that allowed time frame.)

DMEs will often blame "you can't swap after 30 days of starting therapy" or "you are allowed only one swap within that first 30 days" on insurance or Medicare rules but it's not true...it's the DMEs in house policy that they don't want to tell you about. It stinks but they are allowed to set their own rules. I would respect them more if they would just tell the truth...that they don't want to do the added paperwork.

[purple]

Once again, I believed what a DME told me, and now Pugsy gives the true skinny.

I now have used Lincare for over a year, and they have been fantastic to me. Maybe it is just the fact that mine is a local office in a more rural area where folks who work for the DME remember how customers should be treated, or it is part of what they have to do to keep customers. The second seems less likely as we have fewer DME's than one would have a high population density city.

[Pugsy]

Once again, I believed what a DME told me, and now Pugsy gives the true skinny.

I now have used Lincare for over a year, and they have been fantastic to me. Maybe it is just the fact that mine is a local office in a more rural area where folks who work for the DME remember how customers should be treated, or it is part of what they have to do to keep customers. The second seems less likely as we have fewer DME's than one would have a high population density city.

My local DME has a 60 day swapping allowance and it doesn't matter if you are a brand new cpap user or a veteran like me.
I can try any mask I want and I can exchange a new mask for any mask they have any number of times within that 60 day period.
I could try 15 masks if I wanted to. They only require that the unwanted mask be returned before they will give me another one to try. They used to have to send the unwanted masks back (or so I was told) but now they don't have to actually physically return the unwanted mask to get credit..they just fill out some paperwork. That's what they came up with for their own "in house" policy on mask swapping.
I have only utilized the swap thing once in nearly 6 years. The boss wanted me to try the Respironics Wisp just to get my input and I told him that there was a real good chance I would be bringing it back and he told me that it was okay and that's when he explained how they got credit for unwanted mask returns. I think it is a very fair mask swapping allowance because it means a cpap veteran like me can try a new type of mask and not be stuck with it if it didn't work out. It's not quite what the mask manufacturers actually offer but in terms of swapping policy...it's a lot better than most people have.

And yes...the Wisp was returned because it didn't work out well for me but that's another story.
They cheerfully gave me my usual (at that time) Swift FX for Her setup when I brought the Wisp back to them.
They aren't a national chain but instead are affiliated with one of the large regional hospitals in my area...so a satellite office that saves me some mileage and aggravation of driving to the big city.
And I never have bought a machine from them...only masks and maybe a hose or filter or nasal pillow replacement every now and then.

[chunkyfrog]

Between Blue Cross and my first two DME's, i gave up getting masks from them entirely,
--opting entirely to go with our hosts, cpap.com.
I purchased their return insurance several times, and even used it when I had bought masks that were totally "not me".
Good thing, too. My face is odd enough I needed to try a few more than average before finding my Goldilocks mask.
The point is that there are a bunch out there that some poopyheads will never tell you about.
You gotta find what you need, and fight for the one that fits best.

[postitnote]

Lincare not so great and I dealt with them for many years. Their mark-up was outrageous. My old insurance said they would rent my machine for a few months and then buy it. Might have been to make sure I was using it which I was. I saw the bill going through some papers last year and was shocked to see what Lincare billed for my basic, no humidifier cpap! Now mine will pay 100% after I reach a $6000 deductible. So what would I have to come down with to acquire that amount of care? Everything I use other than the DME is covered at a small copay and no deductible.

Good luck to you! Took almost 2 weeks to get my results many years ago.

[Sheriff Buford]

My face is odd enough I needed to try a few more than average before finding my Goldilocks mask.

Froggie faces are hard to fit! Give them a break!

Sheriff

[Chairman Meow]

Y'all are fantastic - the total tonnage of knowledge willingly shared here is so amazing.

I have spoken to my pulmonologist who is writing my Rx for an Airsense 10 Autoset for Her with Climateline Air Tubing - I was told that it's the Medical group policy to send the Rx directly to the DME - although I could choose which DME I wanted them to send it to. So with the question of what type of machine I'm getting being determined by the Rx - what other questions do I need to be asking when I call the DMEs? Their mask return policy, obviously... anything else?

I also called Aetna and found out that their allowable amount for an E0601 through an in-network DME is $429.70 - while speaking with the representative I discovered that my sleep study hasn't been billed yet, therefore my deductible has not technically been met.

So here's an example of what might happen. I go get the machine as prescribed by my doctor and the DME sends their crazily inflated bill in to Aetna - Now - if I've met my deductible, then Aetna pays them $429.70, no matter what their bill says... but lets says that the DME gets their bill in before the Sleep Center does... so Aetna determines that I still haven't met my deductible and now that bill comes to me... right? Am I on the hook for the crazy inflated amount from the DME... or do I get the benefit of Aetna's allowable amount and just pay the $429.70?

Help?

[Pugsy]

still haven't met my deductible and now that bill comes to me... right? Am I on the hook for the crazy inflated amount from the DME... or do I get the benefit of Aetna's allowable amount and just pay the $429.70?

You are only on the hook for the amount the insurance would have been on the hook for if your deductible had been met.
The crazy inflated pie in the sky billed amount should be reduced to the allowable amount and you are only responsible for the allowable amount because that's the contract your insurance has with the DME and part of the "in network" thing.
So the DME has to be happy with the "allowable charge" no matter who pays it...be it you or your insurance and if they try to bill you for the excess amount you need to inform your insurance company about it and they will intervene.

I suspect the humidifier will still be billed separately even though it is built in to the machine itself.

[Chairman Meow]

I suspect the humidifier will still be billed separately even though it is built in to the machine itself.

I'll be okay with that - when I checked with Aetna the E0562 (humidifier) allowable amount was $136.30 and the A4604 (heated hose) is $39.30. I had to 'escalate' my phone call with Aetna to get those numbers... which is ridiculous. So the only things I don't know are the mask/cushion prices - since I don't know what kind I want to get.

During my titration I was on the small/medium wisp which I was comfortable with - but I'd like to try a nasal pillow mask as well.

[Chairman Meow]

Well - so much for that. I got the call this morning from American Homepatient to come pick up my Resmed S9 Autoset. Per the DME my Rx did not request a specific machine, hose or humidier. DME says that even if the Rx had specified the A10 - they have not yet received any of those so they couldn't supply it anyway.

I called the pulmonologist office - spoke with the medical assistant because the doctor is not in the office today - Med Assistant says that doctor doesn't take requests for specific machines - doesn't know why I was told that the Rx would be written that way.

So now I need to either accept the S9 because I'm tired of being tired and I just want to get started... or I can get try and get a copy of my Rx and see if any of the other DMEs in my area have the S10 and if they will provide it without the Rx requesting it specifically.

Can anyone provide the pros/cons of the S9 over the S10?

Thank you!

[Pugsy]

Can you just call any DMEs in your area (that work with your insurance) and just ask them if they will provide you with the AirSense 10 AutoSet for Her if you provide a RX? That way you can find out what they have to offer ahead of time. If no one has that model it is sort of a moot point.

To be honest I don't know that the minor differences between the AirSense 10 AutoSet for Her and the S9 AutoSet are a deal breaker or not. The A10 for her has that extra apap mode is the main difference and I don't know if you really would benefit from that extra (and different) apap mode. It's one of those things where I tell people to get it and have it available because it's nice to have options but it may not be a critical need for you in your situation. It's not like the S9 AutoSet is a piece of crap because it is far from that.

Just make sure that the model says "AutoSet" and not "Escape Auto" though if you decide to go with the S9 model. The Escape Auto isn't anything like the AutoSet except that it has apap mode capability...it uses an older algorithm that IMHO is inferior to the new algorithm and it doesn't even flag leaks which is kinda important to know if leaks are maybe impacting therapy.

[chunkyfrog]

Even Medicare treats the Airsense machines as two parts, paying the humidifier allowable up front,
and a monthly rental for the blower. Expecting intelligence on that planet will only cause logic burnout.

[Chairman Meow]

I hope it's okay that I just continue to return to this thread to ask quetions and report progress. I like the idea of having a thread that I can look back on one day and see how far I've come.

So I chose American Homepatient as my DME. At this point I'm feeling like my local office is pretty upfront. When I spoke with them to schedule my appointment (same day, so I was already inclined to view them favorably) I expressed my disappointment that my pulmonologist hadn't prescribed the A10 for Her - the RT explained that they hadn't yet received any A10s. She asked me what the Rx was supposed to be written for - I told her the A10 for Her, the ClimateLine hose and a mask of my choice.

When I arrived at the DME (no homevisit) the RT showed me the original Rx that was simply for a CPAP set with a pressure of 12 and an EPR of 3 and a Wisp mask, however, she said after she spoke with me she called the pulmonologists office and requested an Rx that included the H5i heated humidifier and Climateline hose so that my insurance company would cover that as well. She told me (and I don't know if it's true or not) that if it hadn't been on the Rx, I would have had to pay for those things out of pocket.

The mask that she had pulled to give me was the same type of Wisp mask that I used during the Titration part of my sleep study... and I agreed that I hadn't had any trouble with it, but said that I'd really like to try a nasal pillow mask. She said that with my pressure being so high (12) she didn't think I would like it... but she let me try a Swift Fx - and I loved how it felt compared to the Wisp - until she turned the machine on... it was VERY hard for me to exhale, there was a lot of noise on exhale, and a lot of air blown into my eyes are these things normal with nasal pillows? So I went with the Wisp.

When I got home I set everything up, downloaded SleepyHead (thanks to everyone who helped) and went to bed. Here are the things I discovered through the night - I'd love to get feedback to know if some these things are normal:

• I do not like the headgear for the Wisp - the large piece at the back that connects the top and bottom straps is very uncomfortable with the way it mashes my hair against the back of my head (hair is too short for a ponytail, too long for it to be comfortable bunched under the fabric) - I also had a problem with the bottom straps pushing against my ears and folding them in a way that was painful.
  
  The exhaust blew directly in my eyes unless I kept the hose at a certain angle.
  
  The air pressure felt very intrusive at first, but I woke up several times during the night and had to open my mouth to be sure the machine was still on because I couldn't feel it 'blowing.'
  
  Other than checking the SleepyHead data (which I'll do as soon as I get home today, no time this morning) I'm not sure if I can tell when/if the mask is leaking. The exhaust blowing in my eyes may have actually been a leak and I didn't realize it.
  
  As a side-sleeper who nuzzles the pillows, it seems like I woke up several times and had to reposition so that I wasn't putting pressure on the cushion.
  
  The air I was breathing felt neither warm nor moist (the air during the titration was overwhelmingly both) and while I actually think I liked the cooler air... my sinues seem kind of dried out today and I wonder if I need to adjust the humidity. Also - the water level in my humidifer seemed only a tiny bit down.
  
  It wasn't nearly as hard to adjust to having something on my face as it was to adjust to the feeling of the headgear on the back of my head
  
  I only got tangled in the hose one time (*note to self, purchase of hose management is in my future )
  
  There were 0 bathroom breaks last night, down from the usual 3+ WOOT!!!
  
  When I first woke up I felt groggy and incredibly stiff - but I was chatting with my husband as we both got ready for work and he was all, "WOW, you are so much perkier than usual..." and I realized that while I don't feel like I had a life-changing night of sleep - I definitely feel more energetic and alert than usual (and I didn't fall asleep behind the wheel and drive off the road on the way to work this morning.) So that's a huge plus.

I'm going to give the Wisp a few more nights... but I'm already eyeing the Fx Nano or the AirFit10. I just really wish the nasal pillows had worked. If I end up changing masks, do I have to do anything to the machine? Or is it simply a matter of plugging the new mask into the hose?