New machine choices

[Browndog]

Ok, I call the DME this morning and get the same runaround as before, she says the insurance company won't cover anything other than the basic machine she is talking about. I tell her I am going to check with another DME and if she is right I'll be back and if she is wrong I won't.
Later today the technician calls and asks am I coming to my fitting appointment, I tell him what happened and he tells me which machines that actually have. I end up getting the Dreamstation DSX500S11 with heated tube and heated humidifier. Obviously now I am realizing the girl I've been talking to is not the sharpest knife in the drawer!

I also found out after talking to the "owner of the business" that I can actually get the Quattro cushions for my mask "freakin monthly" I have been getting a new mask quarterly! Really excited to know I can get cushions monthly, in a year I'll have a good stockpile. She said she was going to do some customer training with the dull knife in question! Lol

Thanks everyone for your help. I even shared what one of you said "they are either stupid or lying!" The owner loved that one, she was even more impressed when she said the insurance only cares about the code, and I said E601, and she said E0601, Believe me very, very few people know that, she said most of her staff don't know the code.
I shared this site with the tech and showed him how to do a machine search, you guys are great, thank you thank you thank you....

[Wulfman...]

Ok, I call the DME this morning and get the same runaround as before, she says the insurance company won't cover anything other than the basic machine she is talking about. I tell her I am going to check with another DME and if she is right I'll be back and if she is wrong I won't.
Later today the technician calls and asks am I coming to my fitting appointment, I tell him what happened and he tells me which machines that actually have. I end up getting the Dreamstation DSX500S11 with heated tube and heated humidifier. Obviously now I am realizing the girl I've been talking to is not the sharpest knife in the drawer!

I also found out after talking to the "owner of the business" that I can actually get the Quattro cushions for my mask "freakin monthly" I have been getting a new mask quarterly! Really excited to know I can get cushions monthly, in a year I'll have a good stockpile. She said she was going to do some customer training with the dull knife in question! Lol

Thanks everyone for your help. I even shared what one of you said "they are either stupid or lying!" The owner loved that one, she was even more impressed when she said the insurance only cares about the code, and I said E601, and she said E0601, Believe me very, very few people know that, she said most of her staff don't know the code.
I shared this site with the tech and showed him how to do a machine search, you guys are great, thank you thank you thank you....

CONGRATULATIONS!!!

Ya done good!

Welcome to the forum.


Den

.

[palerider]

I also found out after talking to the "owner of the business" that I can actually get the Quattro cushions for my mask "freakin monthly" I have been getting a new mask quarterly! Really excited to know I can get cushions monthly, in a year I'll have a good stockpile.

considering my first quattro cushion lasted me four years... it sounds like in a year you'd have a lifetime supply... wasteful, give that they're coming out with new masks all the time that are better.

[Browndog]

I also found out after talking to the "owner of the business" that I can actually get the Quattro cushions for my mask "freakin monthly" I have been getting a new mask quarterly! Really excited to know I can get cushions monthly, in a year I'll have a good stockpile.

considering my first quattro cushion lasted me four years... it sounds like in a year you'd have a lifetime supply... wasteful, give that they're coming out with new masks all the time that are better.

I don't know how you get them to last years, mine are good for 2-5 months tops. And I don't care what they come out with I love my Quattro and it's my money and my insurance.

[palerider]

I also found out after talking to the "owner of the business" that I can actually get the Quattro cushions for my mask "freakin monthly" I have been getting a new mask quarterly! Really excited to know I can get cushions monthly, in a year I'll have a good stockpile.

considering my first quattro cushion lasted me four years... it sounds like in a year you'd have a lifetime supply... wasteful, give that they're coming out with new masks all the time that are better.

I don't know how you get them to last years, mine are good for 2-5 months tops. And I don't care what they come out with I love my Quattro and it's my money and my insurance.

waste is waste. your "taking advantage" of your insurance just runs up the expenses for everybody.

as to getting it to last for years, I just washed it weekly with dawn dishwashing soap and warm water, and cleaned it gently. wiped it down nightly with a bit of hand sanitizer and a kleenex to remove facial oils.

[Holden4th]

Shopping around is always the best way to go and the suggestion to ask your insurer for a list of preferred DMEs is to be heeded. If they want your business then they will come to the party. If you go into negotiations armed with enough knowledge then you can get the best deal.

We don't have the luxury of getting a machine supplied via insurance here in Australia and the cost of machines is exorbitant as a result.

I just paid £635 in the UK for an AirSense 10 AutoSet, how does that compare with Aus? This is with Tax removed and MySleep discount

I paid a lot more than this for hearing aids and this device is far more important so I consider it money well spent, even if you have take out a loan.

Edit: I got the 'For Her' model with Pugsy's advice as it has an extra algorithm which I may or may not need, but the machine is the same price so a no brainer really.

So you paid about $AUS1000 for your machine. This is less than half what Aussie suppliers are charging. You did well though you could have got it much cheaper from the US. Then again, cost should not affect what you have to do for your own health so enjoy the benefits.

[Guest]

I don't care what they come out with I love my Quattro and it's my money and my insurance.

It seems that as soon as you find a mask that both fits and you like the mfg will stop making it. So it makes sense to stock up while you can. You'd be a fool to not stock up.

[LSAT]

I also found out after talking to the "owner of the business" that I can actually get the Quattro cushions for my mask "freakin monthly" I have been getting a new mask quarterly! Really excited to know I can get cushions monthly, in a year I'll have a good stockpile.

considering my first quattro cushion lasted me four years... it sounds like in a year you'd have a lifetime supply... wasteful, give that they're coming out with new masks all the time that are better.

I don't know how you get them to last years, mine are good for 2-5 months tops. And I don't care what they come out with I love my Quattro and it's my money and my insurance.

I have also been using the Quattro for almost 8 years. The cushions last a long time. I rarely wash mine. I wipe them daily with a baby wipe and boil them at about 3 months. I am rotating 2...1 is about 9-10 months old and the other is over a year. I always have a back up and If I eventually toss one out, I'll order another. The mask itself lasts forever...it's plastic. The DMEs love when you order monthly...that's the way they make their money. It's your insurance, but attitudes like yours are costing all of us money. Attitudes like that are partially the reason for our health care crisis.

[Browndog]

i plan to get cushions and not complete masks, I'm trying to learn more.
I pay $5500 deductible and will do what makes me the most comfortable, which means if my cushions are leaking I am going to change them no matter what it costs you, ha... I don't know how to save the economy if my cushions are leaking, if they weren't leaking I wouldn't replace them, maybe I have a odd shaped face and can't help it. But I doubt my working and contributions to society, using my medical insurance as allowed is causing anyone any harm.

My total package, Dreamstation 500 with humidifier and heated tube connection (I only got a regular tube) a Quattro mask and 6 filters listed for $1986 and out the door it was $772 after they applied my insurance carriers agreed to contract price. All in all I was happy with the price, (I paid with my flex card (pretax money specifically for medical)) for those that don't know or are out of country.

*** Warning commentary to follow***
I want to add I frequent a number of gun forums and I have never seen people talk to each other or use the language that seems to be ok on this forum. You guys have a wealth of information but geez, try and control yourselves some, show each other a little respect. I'm not talking about attitude or language in this thread but a number of others I have read in the last few days.

[Carlover]

To all of you guys thanks for the tips I have to purchase a machine after I'm done with the loner.

[palerider]

show each other a little respect.

respect is earned.

[D.H.]

I see in your equipment profile that you filled in the Dream Station Auto CPAP; the same one I have. Overall, I like it. Here is my review. It’s my fourth machine since 1999; the others were all “bricks.”


Advantages:
• Automatic means that it will raise the pressure as needed when is senses distress (provided it’s set that way). I think I fell more refreshed than before.
• Good statistics are generated, so you can see how you slept, and make adjustments as needed. In addition, stats are good for your doctor to see how you are doing.
• Machine is very quiet.
• Heated hose is very good; never had rainout despite full setting on humidity.
• Automatic altitude adjustment (good for travel).
• Leak compensation.
• Auto/on and auto/off can be activated and deactivated separately.
• Puts out the prescribed pressure more precisely than my old machine (yes, I verified this).


Disadvantages:
• Machine is a bit larger than the major competing machine.
• Sometimes, there is a burning smell, especially after a potty break. I’m pretty sure it’s harmless.
• Frequently, the water does not last the whole night. I generally wake up at least once overnight, so I refill it at that time. This might not work for everybody.
• Some have complained about the brightness of the display when you turn it off and back on, such as for a potty break. I don’t find this a problem. In fact, I use the light to put my mask back on.
• Power cord has proprietary signal, so you cannot use a different cord, even if the voltage, wattage, amperage, and fitting are all identical. This means that if you need a replacement cord, and/or want to use a battery (such as for camping and electrical outages), you'll have to get a proprietary replacement cord. For camping, you'll need to get an $80 proprietary device to generate this signal if you're using a battery or DC generator.

[sc0ttt]

Insurance pays by the applicable insurance code......E0601......which is the very same code for ANY CPAP.......from the lowliest "brick" to the top-of-the-line APAP. You might as well get the best one you can get for the money.

I don't understand this; I've seen comments like this before.

Are you saying the insurance pays the same amount for any CPAP machine? Or the same percentage of the cost for any CPAP machine? Or the patient pays the same deductible for any CPAP machine?

How would the same insurance (let's ignore rental requirements) handle the purchase of a full data $650 Auto CPAP vs a $450 brick?

From my EoB, the insurance had a negotiated lower base price on the unit and accessories, and paid 80% of the adjusted cost after my deductible. I don't see how the DME would be lining their pockets by pushing cheaper machines; which it seems you and others are claiming they do.

[Pugsy]

Are you saying the insurance pays the same amount for any CPAP machine?

Insurance pays by HCPCS billing code...not by brand...not by model.
They pay the same for a bare bones basic no data brick as they do for a full data apap.
DMEs know this and that's why they will often dispense the model that they make the most money on.

How would the same insurance (let's ignore rental requirements) handle the purchase of a full data $650 Auto CPAP vs a $450 brick?

From my EoB, the insurance had a negotiated lower base price on the unit and accessories, and paid 80% of the adjusted cost after my deductible. I don't see how the DME would be lining their pockets by pushing cheaper machines; which it seems you and others are claiming they do.

Insurance doesn't care about data or cpap vs apap. They pay X amount of dollars for the billing code E0601.
If they "allow" (and pay) $800 total for a machine and humidifier...and the DME has a choice of dispensing a brick that costs them 350 or a full data apap for 450...guess which one they would rather dispense? The one that has that extra 100 profit built in. They are in the business to make money after all.
Retail online prices mean nothing to insurance companies or to DMEs for that matter.

DMEs are supposed to fulfill the RX/order though...but when the order just says "cpap at X pressure with heated humidity/humidifier" and nothing else then that brick will fulfill the requirements.
They can legally dispense the brick and make more money in the process.

Now an apap is a cpap machine...it just has that additional mode of operation where the pressure can auto adjust.
DMEs could dispense an apap even with the above generic wording if they would just do it. APAP machines have cpap mode available and the machine could be set to a fixed pressure in cpap mode and legally the RX requirements have been met.

Remember it's the billing code that insurance companies pay by...not anything else.
E0601 covers all the cpap/apap single pressure machines out there.

[Browndog]

show each other a little respect.

respect is earned.

Ha, I'm glad to see you read the comment I left. Lol