I'm new, haven't chosen a machine or mask yet, but the

photogal · Post by **photogal** » Wed Mar 16, 2005 10:10 am

Resperonics AutoPap with Cflex & heated humidifier was recommended by people on this site. Also recommended was the ResMed Ultra Mirage Full Face mask. ResMed is a different company than Resperonics, right?
So these two products work well together?
I surfed the cpap.com site, and didn't see that mask, although there was a place that said "Equivilant" and when I clicked on it, it looked like it might be the right mask.
I'm just trying to find the right equipment.
Can someone explain about the ResMed Ultra Mirage mask and why it is better than other full-face masks?
I'm trying to gather my information to:
1. Get my doctor to write a new rx for autopap instead of the plain machine he wrote it for.
2. Have some prices on what I want, so I can talk to my insurance company about them paying for it. The DME (same place I got the sleep study) wants $1600 for the plain constant-pressure CPap and everything else needed, mask, hoses, etc.

Question: Wouldn't an insurance company be happy to pay LESS for a better machine for the patient?
I'm looking for that tiny light at the end of the tunnel.

Zees Pleez · Post by **Zees Pleez** » Wed Mar 16, 2005 11:04 am

First call your insurance company. Some want to deal with the DME exclusively (mine is that way) and the cost savings may not be what you think (my insurer pays my DME less than half what they bill) so insurance companies aren't always swayed by low price quotes. But if they are and allow you to buy elsewhere, you can get an APAP with a fixed pressure prescription; but it will be set to just the single pressure when it is shipped to you. Then if you talk to your doctor about the benefits of APAP and talk him into trying that, you just have to change the settings, not get a new machine.

snoozin' · Post by **snoozin'** » Wed Mar 16, 2005 11:41 am

If you purchase online, you can purchase an autopap with the straight cpap prescription. If the insurance company will reimburse for online purchases, you can just fax the prescription in to the online company and get whichever machine you want. The one you mentioned - RemStar auto with c-flex, with hose, mask, heated humidifier AND software and card reader, will run a bit over $1000 at cpap.com, depending on the mask you choose. Less, of course, without the software, which wasn't even an option with the straight cpap you were quoted $1600 for.
Debbie

photogal · Post by **photogal** » Wed Mar 16, 2005 3:41 pm

I gather I don't have to talk to my doctor, then. I need to talk to my insurance company. But then, if I want them to pay for an autopap, they might tend to do that more easily if my doctor recommends it.
I don't think anybody considered my asthma. It isn't a constant thing, and was not an issue when I had my study. But...when I get any sort of a cold, infection, etc., it goes straight to my chest and I get acute asthma. It's hard to breathe then, especially on the exhale. That's why I feel an autopap would be best for me.

Mikesus · Post by **Mikesus** » Wed Mar 16, 2005 6:42 pm

As luck would have it, I have the Respironics Remstar Auto w/Cflex with the heated humidifier and I have a ultra mirage ff mask. I find the Cflex makes breathing very easy. Definately get a heated humidifier, the dry air can dry out your mouth if you are a mouth breather.

I have found that with this combo with the Resmed Ultra Mirage Full Face mask, I have no problems with this setup making compliance very easy...

nodding off · Post by **nodding off** » Wed Mar 16, 2005 9:22 pm

I found a dme that charged me a $200 upgrade fee for an apap. It was cheaper for me than buying it myself, and they gave me no hassle. Everyone, including me was happy. If 1 dme won't work with you to satisfy your needs, get a list of providers from your insurance company and make some calls. If you are in Mass, pm me and I'll give you the name of my dme.

Zees Pleez · Post by **Zees Pleez** » Wed Mar 16, 2005 10:47 pm

I should have added that in my case I had to use the DME so I did go back to my doctor and have my prescription written for an APAP with a range. I am very fortunate to have a good doc that will have conversations with me (where he actually lends some credence to what I say if I have researched it) and do what I ask if it makes sense.

But my point was that the next piece of information that I think you need is fom your insurance company - must you deal with the DME or do you have other options?

snoozin' · Post by **snoozin'** » Thu Mar 17, 2005 7:14 am

photogal,
The billing code for a cpap machine and for an autopap are exactly the same. So if your insurance allows you to buy on line and submit the bill for reimbursement, you will be submitting exactly the same billing code (which is the only thing the insurance goes by) whether you purchase a cpap or an autopap.
Debbie

photogal · Post by **photogal** » Fri Mar 18, 2005 5:02 pm

I haven't talked to my insurance company yet, but considering the place that did the sleep study also sells the equipment, and had already gotten an "OK" from my insurance for a straight machine that cost $1600 with the Ultra Mirage FF mask, it seems reasonable that they would OK the autoPap considering I can save them and me money. But that is a reasonable person's conclusions, and we all know insurance companies aren't always reasonable. The insurance will pay either 70% or 80% I've heard.
I will try to get the information from them next week. I do want to get the machine from cpap.com.
I also have a great physician, who, I'm sure, will rewrite the prescription for an autopap when I present my case to him. I don't feel he would turn me down considering I finished up my cancer treatment 4 months ago and he would want to help me as much as possible.
You guys/gals are just great! Mike, glad to know you have the same setup I want and it works well. Makes me feel good about what I've gleaned from this forum.
Betty

I'm new, haven't chosen a machine or mask yet, but the

I'm new, haven't chosen a machine or mask yet, but the

Thanks for filling me in on some of the ins & outs.

Thanks! All that information is very useful.