Recently Diagnosed with OSA

[JJenkins2005]

Welp, I went to pick up my machine and they had ordered the basic Airsense 10 CPAP.. I told, them that's not what I asked for..... The resp tech acted as if he didn't know there was a difference. He wasn't the one who ordered the machine, so he called the guy who places orders and told him that it was different and they needed to get what I ordered. I took this time to ask about the Autoset machine... They are going to look into that as well..... So, now I have to wait until next week since they are closed Monday and don't think the machine will get here by tomorrow.

[yaconsult]

They lie all the time to put money in their pockets. When I asked for the "For Her" model on my prescription, the respiratory therapist swore up and down that the ONLY difference was the color and that it had flowers on it. I told her exactly what the differences were but she just played dumb. You can not trust these people! While waiting is frustrating, it's important to get the best equipment that you can.

In my case, their out was "we don't carry the "for her" model and can't get it". But at least I got the autoset. And yes, insurance said that they were the only DME that I could deal with.

[Wulfman...]

I started out ( 2005 ) with a straight pressure machine and found that my prescribed pressure was almost twice as high as I needed. I used my prescribed pressure ( 18 cm. ) for about an hour before I reset it to 10 cm. so I could sleep.....and stuck with that for a whole year and it turned out to be real close. I finally settled on 12 cm., but I monitored my therapy with software. My first backup machine was a lightly-used APAP, which I used for a week to see for myself how they worked and what it came up with for a pressure. It turns out that my pressure of 12 cm. was spot on. But, in the process, I also found that a range of pressures really disturbed my sleep and have stuck with straight pressure ever since. Even though I have several APAPs, they're all set for straight pressure like my straight-pressure machines. There are advantages to both modes. An APAP can be set to straight pressure, but a straight-pressure CPAP machine (obviously) can only run in straight pressure.

If you can get the APAP, go for it. But, if you can't, get the data-capable straight pressure machine. And, since we always recommend getting backup machines, maybe down the road you can get an APAP (out-of-pocket) and see how it works for you. There are many affordable machines on the "secondary markets". Many of them are offered for sale by forum members.

And, if your insurance is paying, there is only ONE insurance code for the CPAP category......E0601. That code covers the full range of CPAPs........from the very basic to the high-end auto machines. Might as well take advantage of the opportunity to get the APAP now.


Den

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[JJenkins2005]

Ok, so i just got off the phone with my DME... I asked for the autoset since it's was the same code... He placed me on hold and came back and said well, we will need a new RX since SC Resp Laws require it.. I respond, with could we just get an Autoset and set it to CPAP only mode? He well, yes but if you want to use the AutoSet, you will need to bring the machine back to us with a new RX with pressure ranges... I agreed.

My questions for you guys are:

1. Should this cost me anything additionally?
2. Clearly they are not going to set it to Autoset... Is this something I can do myself? Should I wait until after my compliance period and the machine is mine?

I'm getting a bit excited to get more sleep and lose the overnight headaches..

[Wulfman...]

Ok, so i just got off the phone with my DME... I asked for the autoset since it's was the same code... He placed me on hold and came back and said well, we will need a new RX since SC Resp Laws require it.. I respond, with could we just get an Autoset and set it to CPAP only mode? He well, yes but if you want to use the AutoSet, you will need to bring the machine back to us with a new RX with pressure ranges... I agreed.

My questions for you guys are:

1. Should this cost me anything additionally?
2. Clearly they are not going to set it to Autoset... Is this something I can do myself? Should I wait until after my compliance period and the machine is mine?

I'm getting a bit excited to get more sleep and lose the overnight headaches..

Absolutely NOT! As I added to my previous post and you mentioned, the insurance code is the same. Insurance providers pay by the code.

If you CAN get the Autoset set to straight pressure, by all means, go that route. You can always change it yourself. But, I've always advised users to try their prescribed pressure first.


Den

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[Pugsy]

It shouldn't cost you anything extra...that means an up charge which is illegal in most states if they try to charge you more.
It's really is super easy to change the setting yourself down the road if you want to.
I might wait until any compliance issue stuff is settled though...just not to rock the boat and draw attention to myself.....unless your software reports show a huge urgent need to change something.

Here's the manual...for all the AirSense machines...it explains how to change the various settings.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

[JJenkins2005]

Ok, so i just got off the phone with my DME... I asked for the autoset since it's was the same code... He placed me on hold and came back and said well, we will need a new RX since SC Resp Laws require it.. I respond, with could we just get an Autoset and set it to CPAP only mode? He well, yes but if you want to use the AutoSet, you will need to bring the machine back to us with a new RX with pressure ranges... I agreed.

My questions for you guys are:

1. Should this cost me anything additionally?
2. Clearly they are not going to set it to Autoset... Is this something I can do myself? Should I wait until after my compliance period and the machine is mine?

I'm getting a bit excited to get more sleep and lose the overnight headaches..

Absolutely NOT! As I added to my previous post and you mentioned, the insurance code is the same. Insurance providers pay by the code.

If you CAN get the Autoset set to straight pressure, by all means, go that route. You can always change it yourself. But, I've always advised users to try their prescribed pressure first.


Den

.

That's what I've requested it and he said he was ... I actually called my insurance company about the Autoset and she said they pay by codes so as long as the machine fell under E0601 code, it would be paid as a CPAP.... So if all goes well, I will get an Autoset next week.. Fingers crossed!

[Wulfman...]

If your doctor would write a different prescription specifying an Autoset, but set to a fixed pressure, that might be an option if the DME gets too "difficult".


Den

.

[JJenkins2005]

It shouldn't cost you anything extra...that means an up charge which is illegal in most states if they try to charge you more.
It's really is super easy to change the setting yourself down the road if you want to.
I might wait until any compliance issue stuff is settled though...just not to rock the boat and draw attention to myself.....unless your software reports show a huge urgent need to change something.

Here's the manual...for all the AirSense machines...it explains how to change the various settings.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

Thanks, I plan to keep it as it is, but based on the advice of you guys I just wanted to have the option available without having to jump through any hoops with the Dr and DME later...

[JJenkins2005]

I just picked up my machine today. I received the A10 Autoset that I requested based on the feedback from you guys.... I originally requested the P10 mask but I didn't like how their were no adjustments I could make to the strap to make the fit snug.... I ended up getting the SwiftFX... The few minutes I had it on while at the DME's office, i was pretty pleasant... I know once I get home, that story could change and I may need to try something else...

No supplies auto order (is this normal)? I don't think they are happy with the fact that I'm not going to be a cash cow for them.... My insurance only requires a 3mo rental and I only have to pay this first month since once my SS claim is completed, I will have reached my OOP Max for the year... My plan restarts Apr 1, 16... The next thing is how this was billed. The A10 has a built in HH, yet they billed for in addition to the machine, is this right? They also billed for my mask in different pieces... Which seemed off... I asked and she said they have to bill for each part of the mask... I'm not 100% concerned since I only paid 70 bucks after they removed that extra stuff and I will be sure to get my $$ back once the EOB is processed but, I just wanted to ask the forums since the knowledge here is awesome.

https://drive.google.com/open?id=0B4HQc ... kxQUmMxdk0

[Pugsy]

The separate itemized billing is pretty much standard operating procedure.
Even the separation of the humidifier from the blower even though your machine has humidifier built in.
Masks are always billed out in parts in 99% of the situations...usually headgear one part and frame/cushion/pillows the other part.
It's the way that medicare and other insurance pay the most and actually I guess they expect it that way.

The AirSense line is relatively new and the HCPCS billing codes haven't been adjusted to allow for the humidifier to be included in the blower price. Quite honestly I doubt there will ever be an adjustment like that for just the AirSense model. Perhaps down the road when/if all machines end up being built/sold like the AirSense with the humidifier an integral part of the whole system.
Looks like Respironics may be doing that with their next model (ETA October from what I hear) but that would only make 2 brands be doing the humidifier as part of the whole thing. There are many more brands out there being sold.
As long as the HCPCS coding offers the choices they offer...DMEs are going to maximize profit by separating everything out into each piece. Insurance companies are aware of it...expect it and will pay accordingly.
It is what it is....and while it sort of stinks...it's done by everyone and not illegal. Even Medicare allows the billing to list each item separately even when everything all comes in one package or box.

[JJenkins2005]

The separate itemized billing is pretty much standard operating procedure.
Even the separation of the humidifier from the blower even though your machine has humidifier built in.
Masks are always billed out in parts in 99% of the situations...usually headgear one part and frame/cushion/pillows the other part.
It's the way that medicare and other insurance pay the most and actually I guess they expect it that way.

The AirSense line is relatively new and the HCPCS billing codes haven't been adjusted to allow for the humidifier to be included in the blower price. Quite honestly I doubt there will ever be an adjustment like that for just the AirSense model. Perhaps down the road when/if all machines end up being built/sold like the AirSense with the humidifier an integral part of the whole system.
Looks like Respironics may be doing that with their next model (ETA October from what I hear) but that would only make 2 brands be doing the humidifier as part of the whole thing. There are many more brands out there being sold.
As long as the HCPCS coding offers the choices they offer...DMEs are going to maximize profit by separating everything out into each piece. Insurance companies are aware of it...expect it and will pay accordingly.
It is what it is....and while it sort of stinks...it's done by everyone and not illegal. Even Medicare allows the billing to list each item separately even when everything all comes in one package or box.

Well it's good to know that I didn't get played lol... Thanks a ton!