going to bat for autopap

Flower51Terry · Post by **Flower51Terry** » Tue Jul 19, 2005 5:09 pm

My doctor returned my call today and we discussed how he could approach the dme/rt about the fact that I want to keep the autopap instead of doing what they normally do after 2 wks which is exchange it for a cpap or bipap.
I'm hoping he'll go to bat for me on the basis of medical necessity.
Mainly....I'm consistently losing weight and can't afford to go in for sleep studies to adjust titration levels so I need the autopap which will do that for me. Besides the fact that I feel great on autopap and my health has been improving! So...any given to pray please do. Thanks, Terry

chrisp · Post by **chrisp** » Tue Jul 19, 2005 5:20 pm

If it aint broke don't fix it, Stick to your guns.. You could explain to the DME that if you don't get the auto you'll go online and purchase. Returning the auto to him rent paid . A big SEE YA might just be helpfull and save you a few $$$$.

Oh yea, He's the Doc. Don't Drs. tell the dme what to do not the other way. Just ask for the Rx in your hands just in case. Then buy online if you need to. Spend the $$ if you need to.

You may have to forgo new drapes or those high $ bath towels for a few months more. But you're worth it right .

:twis ted:

Guest · Post by **Guest** » Tue Jul 19, 2005 8:50 pm

Hey chrisp its not drapes or bath towels trust me! Its real life....the most recent is our house needs to be "debatted" which I'm waiting to get some estimates on, then our ac died (that's what cold showers are for, right?), our oven broke (that's what thrift store rotiserrie's, weber charcoal grills, crockpots and rangetops are for) and the clothes dryer pooped out...THAT we fixed! I wasn't going to spend hours at the laundromat! And my dh is headed for humanitarian aid trip to Cuba (self funded) Anyway....chrisp my choices are limited here so I'm really hoping for the best w/the dr. Terry

Simply Sue · Post by **Simply Sue** » Tue Jul 19, 2005 10:08 pm

Is it really the insurance company you have to convince. I can't see how a DME co. would not want you to have a more expensive machine...they are in it for the money, right.

I am about to change from a CPAP to an auto and my DME told me insurance does not buy autos .. just rents them till you find your settings. My DR. did give the DME a RX for the auto.

My DME is going to let me pay $100 and I can have whatever auto i want without involving the ins.
Sounds ok to me.

SnoreNoMore2005 · Post by **SnoreNoMore2005** » Wed Jul 20, 2005 8:01 am

My doc prescribed an AutoPap but the DME said I can't have one because the insurance wouldn't cover it. They said there was no code for AUTOPAP for them to submit for insurance.

I settled for a CPAP and the doc gave me a guess setting of 10cm to try After a couple of frustrating weeks, I called my insurance company to ask if they would provide any reimbursement if I simply bought an AUTOPAP on CPAP.COM.

They said NO, but that I should call one of the DME's they had a contract with. I did so and within two days I had an AUTOPAP.

The moral of this story?

If a DME tells you your insurance will not pay for an AUTOPAP, find another DME. There are thousands of DMES out there.

SnoreNoMore2005

SnoreNoMore2005 · Post by **SnoreNoMore2005** » Wed Jul 20, 2005 8:01 am

My doc prescribed an AutoPap but the DME said I can't have one because the insurance wouldn't cover it. They said there was no code for AUTOPAP for them to submit for insurance.

I settled for a CPAP and the doc gave me a guess setting of 10cm to try After a couple of frustrating weeks, I called my insurance company to ask if they would provide any reimbursement if I simply bought an AUTOPAP on CPAP.COM.

They said NO, but that I should call one of the DME's they had a contract with. I did so and within two days I had an AUTOPAP.

The moral of this story?

If a DME tells you your insurance will not pay for an AUTOPAP, find another DME. There are thousands of DMES out there.

SnoreNoMore2005

Guest · Post by **Guest** » Wed Jul 20, 2005 11:35 am

Thanks for the advice Snore.

Sue, from what I've been told by people who've been through this before, the reason dme's try to have you buy straight cpaps or bipaps is that there are separate codes for those two machines. That means they can get more profit from a bipap (bilevel).

If I understand correctly, the automatic cpap (apap/autopap) does not have its own code and is included in the cpap code. That means that the dme gets the same amount of money for the more expensive autopap as they do the straight cpap. So less profit. So there ya go....Terry

going to bat for autopap

going to bat for autopap

dme vs doc vs insurance

dme vs doc vs insurance