From diagnosis to DME with no inbetween?

[big_dave]

It's not crazy at all. I bought my machine on Craigslist and I was able to get set up on CPAP without in-person assistance. It just takes the motivation to make it work. I' m close to the three year mark now.

[robysue]

So, is this crazy... I'm thinking of just getting ResMed's AirSense 10 Autoset machine from cpap.com, not going through a DME or a respiratory therapist at all, using the ResMed Mirage FX mask they sent me home with from the sleep study, and just figuring this all out by myself with the help of this great forum. Is that crazy? Do I need in person assistance?

It's not crazy---you've got some support here for when you run into problems.

But there's one caveat: If you wind up wanting to try out additional masks, it is worth springing for the mask return insurance in case the chosen mask really doesn't work out.

[TangledHose]

I've been silent because I've reading, reading, reading. You've all posted great info and links.

I still haven't heard back from the doctor's office about my test results and prescription, but I've gone on cpap.com and asked them to request the script from my doc. One way or the other, I'll get it, along with the sleep study.

So, is this crazy... I'm thinking of just getting ResMed's AirSense 10 Autoset machine from cpap.com, not going through a DME or a respiratory therapist at all, using the ResMed Mirage FX mask they sent me home with from the sleep study, and just figuring this all out by myself with the help of this great forum. Is that crazy? Do I need in person assistance?

I don't think my doctor or anyone in her office is going to be particularly helpful. She's a primary care doc in a big practice, and mostly when I call there I talk to a rotating cast of characters. I do NOT want to rely on someone at a DME. That route is not for me.

Thanks!

As mentioned in an earlier post in this thread, if you do end up just going for the Airsense AutoSet be sure and get the "For Her" model. It has a third algorithm that the regular Autoset does not have. This third therapy mode basically has a more gentle response in terms of pressure changes that Resmed says is better for female patients, but might also be good for some guys as well. It also reports RERA events which the regular AutoSet does not do.......so with the For Her model you get a little better bang for your buck......almost like getting three machines in one.....Standard CPAP, APAP, or APAP For Her depending on which mode you want to run it in.

[PollyCT]

if you do end up just going for the Airsense AutoSet be sure and get the "For Her" model.

Thanks for the reminder, TangledHose. I was going to do a search for messages on the "for her" models, to see if it really made a difference.

This is it then, this is how I'll do it. Now I'm off to call the doctor's office again, to get the report and prescription!!

Thanks all - I'll be back!

[BlackSpinner]

You can also just buy your masks using your insurance from the DME. You don't have to buy all of it from a DME.

The one and only benefit of buying from a bricks and mortar DME is that you can try them on. Treat it like buying an expensive set of shoes that you will have to stand in for 8 hours.

[Sleeprider]

The most common outcome of working with a conventional DME is that you are issued a machine paid through your insurance, with any copay and deductible billed to you. The usual terms are a rental that converts to ownership, but this depends on your insurance. During the first few months of therapy, the patient is monitored for compliance and machine ownership is ultimately dependent on a finding you are compliant and benefit from the therapy.

You are apparently willing and able to short-circuit that process and simply buy out of network, which will limit your reimbursement, but will also greatly reduce your costs. As a side benefit, you won't be waiting, and waiting, and waiting for the machine to be dispensed, and you won't be monitored or assisted and sent automatic supplies.

Sounds great, and we'll help as we can. I recommend you get a Airfit P10 nasal pillows mask with the 30 day return guarantee. You can change masks if it doesn't work. You already have one from your sleep study. The mask fit and comfort is the most difficult part of adapting to CPAP and you want to be sure you can live with whatever you choose. You're very well informed and assertive about what you want, and I'm very confident this will all work out for you.

[chunkyfrog]

The Airsense 10 Autoset for Her is worth getting.
Good sleep hinges on the greatest comfort, and that is what I get with the "for her" mode.
I plan to take mine on vacation, and save my Devillbiss for power outages or whatever.

[Quaffin1]

Hello Polly:
I had the exact same scenario as you are describing.
I also have United Healthcare.

Here is my scenario, it may offer you some comfort.

Dr. sent me to sleep study for possible sleep apnea.
Study showed moderate apnea -
Scheduled for another study for titration
Determined that I needed 12cm to correct OSA

Phy asst. called from Dr. office and gave me short 4 sentence summary of sleep study results and said
Dr had sent prescription to DME (Apria) for CPAP machine with heated humidity with a 12cm pressure setup.

Then I began to research.
Quickly learned from here and other sites that I was in the "perfect storm" for getting screwed with a
DME that had very bad reviews (they are nicknamed Crapia, due to poor reviews)
I had a very basic, generic prescription.
I didn't have a copy of this prescription,
my DME was be pre-selected for me by my Dr.

Needless to say, I began to feel terrible. Wooried constantly about what was about to happen.
I collected all my ammunition and finally drove to see my Doctor.
Dr. couldn't see me, but after discussing all my issue with RN, she said that I definitely needed an appt to speak to my Dr.
Appt set for following week.

Several days later, I get a call from Apria that my CPAP machine was ready for pickup.
I cringed. I knew that I was likely to get handed a "brick" and knew that if I accepted it was likely mine to deal with for a few years.

I began seeking out online suppliers, gently used models and even craigslist.
I was determined that I would just buy the darn thing out-of-pocket before I got screwed with a bad unit.

Apria said that if I had any questions about benefits or payments due at time of pickup to call their #
So I Did.
I was told that it was going to be a 12 month rental,
IT would cost me $221 at time of pickup. Would be $48/month until my deductible was met, then it would be $9/month
for the rest of the term until 12 months were up. Then I would own it. Looked like it was going to cost about $500-600 by time all was over.
Since we were talking about my money, I figured this was perfect time to ask
"Well what machine are you selling me?"
The phone agent said, lets look at the order.... She told me it said auto-titrating ResMed AirSense 10 Autoset.

I about fell out of my chair!
But still being skeptical, I figured they would likely hand me a standard Airsense 10 CPAP when I stopped to pick it up.
I was determined that I would just refuse to accept it.

I drove to the Apria office. When I arrived The Respiratory Therapist was handing another patient an AirSense 10 Autoset.
This looked promising! She then called me back and couldn't have been nicer.
She spent 1.5 hours with me going over the details of my Sleep Study since I told her that my Doctor hadn't.
Then pulled out the A10 Autoset machine and I smiled. I told her that I was pleasantly surprised, that her company
had very bad reviews and I was expecting a "brick" machine.
She acknowledges the company had issues, mainly with their Customer Service 800 dept.
She said that the new AirSense 10 Autoset was basically the only machine that they messed with for CPAP, at least at their office.
She didn't know why it was a 12 month rental, as these were normally like 3 month rentals. But it came from UHC that way.
I do plan to discuss this with UHC, since in their website, they mention respiratory equipment is done on a 3 month rental/purchase plan.
I hope to get this reduced to a 3 months, as I may want to retire in a few months.

So bottom line, I had a pretty good experience, even tho I worried myself to death initially.
I feel like I likely will get the machine slightly cheaper than I would have, going online.
I will use up my deductible early, so this will have benefits later this year.
The DME did show me the auto plan for supplies, but did not push it one way or the other.
Told me to just let them know how I wanted to proceed with supplies in the future.
Be prepared for a rental agreement with United Healthcare.
Be prepared to certainly have to meet your deductible.

But know that a Autoset full data machine with current technology is not out of the question from our insurance company for straight CPAP.
I realize others have not been so lucky, so do have all your ammunition ready and don't settle for junk.

I wish you good luck.

[archangle]

Hello Polly:
I had the exact same scenario as you are describing.

Thanks for the report.

Yes, you can get excellent service from the local branch of a national DME with a bad rep. Who knows, maybe the whole firm is even cleaning up their act.

It's best to go and be prepared for the worst, take advantage of it if it works out well.

[Morbius]

I have United Healthcare...

Did you have an in-lab study or a take-home test?

[PollyCT]

Hello Polly:
"Well what machine are you selling me?"
The phone agent said, lets look at the order.... She told me it said auto-titrating ResMed AirSense 10 Autoset.

I about fell out of my chair!

Well holy cow!!! I'm kind of speechless! It would be awesome if it went that way for me too!

Given that I haven't heard back from my doc's office yet, despite now having called three times over three days, I'm not sure what will happen first - I hear from the doctor or I hear from the DME. Based on what you've said if I do hear from the DME first I'll ask them what machine they would offer me. Who knows, I may be surprised. But I think if I hear from the doc first, and get the prescription, I'll just go with buying direct and hoping I can get some reimbursement. The DME they selected for me seems pretty small potatoes compared to Apria, but who knows, maybe they'll surprise me. Thanks very much for relating your experience!

[PollyCT]

I have United Healthcare...

Did you have an in-lab study or a take-home test?

It was an in-lab study. When I went to bed the technician said she'd come in around 1am and put a mask on me if she thought it would help, and that's exactly what happened. I haven't seen the results yet though.

[BlackSpinner]

I am really shocked that people don't get to see a doctor over this and just get a phone call. Most places I have lived they were not allowed to give bad news of any kind over the phone. OSA is a major life changing diagnosis and it should not be left to a phone call from some sales guy at a DME.

The medical office should have a proper protocol for dealing with major issues like this. If you have to give people bad news you need to provide support options.

[TexasTom]

I've been silent because I've reading, reading, reading. You've all posted great info and links.

I still haven't heard back from the doctor's office about my test results and prescription, but I've gone on cpap.com and asked them to request the script from my doc. One way or the other, I'll get it, along with the sleep study.

My Doc is a sleep disorder MD. Part of a clinic, that works as a team. Catch is my insurance contracts through APRIA. I've never seen, nor talked to a more screwed up company.

I got a call that I never sent my SD card back for compliance. Well, I never got a letter or new one stating to do that. Next letter says they will not reimburse if I am not compliant, thankfully got a human being at my insurance and explained I never got a new card from Apria nor instructions. So what arrives last week is a MODEM for my machine. Installed it, checked diagnostics and connected by "contact your provider as modem not recognized". Oh fun.... I wonder what they will bill for that. No clue what the charge, what they provide, but just a huge black hole.

[Morbius]

I have United Healthcare...

Did you have an in-lab study or a take-home test?

It was an in-lab study. When I went to bed the technician said she'd come in around 1am and put a mask on me if she thought it would help, and that's exactly what happened. I haven't seen the results yet though.

I can't believe UHC is allowing you guys to get in-lab tests!

Anyway, looking forward to the sleep study.