Newbie prescription, mask, provider questions

bobmc · Post by **bobmc** » Wed Apr 01, 2015 9:06 pm

Pugsy wrote:Here's the deal on the slight difference between the AirSense 10 AutoSet and the AirSense 10 AutoSet for Her machines.
They both have regular cpap mode and regular apap mode available but the for Her model has an additional special apap mode available that has a different algorithm...which they (ResMed) has marketed towards women as being especially helpful for women but in reality that algorithm could potentially benefit men also.
Plus that special algorithm will flag RERAs (Respiratory Event Related Arousals) and the other regular modes don't.
Now how critical is it to know about RERAs? I don't know that it is something that is urgent but I have always been of the opinion that it's better to have something and not need it than need it and not have it....and that goes with these machines too.

So is the "for Her" model "better"...it might be for some people and we never know who those people might be so I say get it if you can just in case you might be one of those people.

If you haven't seen the provider manual for the AirSense I suggest that you download it and read it as it explains in a little more detail what each model does.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

Now since the for Her model is being target to women...ResMed in its infinite wisdom elected to add flowers to it.
So it is white with some flowers on it...and the other AirSense machines are black.
Now the male species may not be too keen on having a machine with flowers on it...and that's up to them but I don't know about you all but I don't/can't see flowers at night with the lights off and if my husband had OSA and was going to need the apap machine...he would be getting the flowers whether he liked it or not. I don't know that he would even need that other algorithm but he might and that "might" would be good enough reason for me (otherwise known as "she who must be obeyed") to put my foot down.

It's supposed to have a "gentler" response designed for women but there's no reason to think that there might not be some men who could maybe benefit from it.

The flowers are small so not horribly annoying.
https://www.cpap.com/productpage/resmed ... idair.html

Thanks, Pugsy! The provider manual was very helpful.

The flowers won't bother me as much as the white. Couldn't they have made it pink? I'll wear hot pink shirts to work, but not so much white...

So, I take it the recommendation is to change the first line of the prescription to read:

1] ResMed AirSense™ 10 AutoSet for Her with HumidAir™ Heated Humidifier

Should the prescription have anything in there about authorization to purchase? Or should that be addressed separately with the insurance company?

Pugsy · Post by **Pugsy** » Wed Apr 01, 2015 9:16 pm

bobmc wrote:Couldn't they have made it pink?

Well...the S9 for Her model (didn't have that special apap mode) was in pink but it wasn't the prettiest of pinks IMHO.
It was released as part of a breast cancer awareness thing.
There are "skins" available for the S9 but so far I haven't seen any for the AirSense machines. There were some cool skins though.

Up to you if you want that added algorithm or not. If it were me I would want it just in case it might come in useful some day but that's just me. Since the cost is the same in terms of what insurance will pay and your copay...your decision but it's not like the for Her model costs more or anything like that which might impact a person's choice.
Insurance companies pay by that HCPCS billing code and the billing code is E0601 no matter if it is the brick or the white with flowers model.

bobmc · Post by **bobmc** » Wed Apr 01, 2015 9:22 pm

Pugsy wrote:
bobmc wrote:Couldn't they have made it pink?
Well...the S9 for Her model (didn't have that special apap mode) was in pink but it wasn't the prettiest of pinks IMHO.
It was released as part of a breast cancer awareness thing.
There are "skins" available for the S9 but so far I haven't seen any for the AirSense machines. There were some cool skins though.

Up to you if you want that added algorithm or not. If it were me I would want it just in case it might come in useful some day but that's just me. Since the cost is the same in terms of what insurance will pay and your copay...your decision but it's not like the for Her model costs more or anything like that which might impact a person's choice.
Insurance companies pay by that HCPCS billing code and the billing code is E0601 no matter if it is the brick or the white with flowers model.

Thank you, Pugsy--you've convinced me to ask for the 'for Her' AND--with your explanation on the differences and the link to the manual--you've given me info to explain to my PCM why I want the prescription written for a 'for Her' model.

Deep Sleep · Post by **Deep Sleep** » Fri Apr 03, 2015 10:20 am

Hi Bob. I've had OSA for years and am just getting around to getting a referral (through TriCare Prime) to see a sleep doctor. Your thread here has been most enlightening. Please follow up on it to let us know how it goes getting the equipment you want from TriCare. I'm willing to do it all from cpap.com out of pocket, but if TC will pay part of it, I'll go that way. Thanks, and good luck.

bobmc · Post by **bobmc** » Sat Apr 11, 2015 7:43 pm

Deep Sleep wrote:Hi Bob. I've had OSA for years and am just getting around to getting a referral (through TriCare Prime) to see a sleep doctor. Your thread here has been most enlightening. Please follow up on it to let us know how it goes getting the equipment you want from TriCare. I'm willing to do it all from cpap.com out of pocket, but if TC will pay part of it, I'll go that way. Thanks, and good luck.

DS-I haven't received an explanation of benefits yet from Tricare, but I'm not expecting any problems. Tricare needed a prescription, a copy of my sleep study (authorization), and (because I had a machine that was working) a letter of medical necessity stating why I needed a new machine (which in my case was a simple statement from the Dr saying my current machine didn't provide for the download of efficacy and compliance data, and I needed a machine that did provide for the download of that data).

Getting the prescription was no problem from my Primary Care Manager. I explained that my old machine was a brick, was 9 years old, and Tricare said I was eligible for a new machine. My PCM wrote the prescription exactly as it ended up earlier in the thread after I explained about the additional mode on the For Her version.

The DME supplier was a little clueless (initially told me they couldn't give me a "for Her" because were designed for women), but as you can see from my profile they WERE able to give me one.

Tricare copay is 20%, which is ~$15/month for 13 months (about $195 total) for a CPAP/APAP machine. My total co-pays were around $100 for the humidifier, tubing, mask, and 1st month rental on the Autoset.
-----------

I also want to thank everyone here. I can not begin to tell you how much I appreciated your help and support, whether it was in direct response to my questions/posts or through posts in other threads that provided a lot of insight.

I ran my first night with the AirSense™ 10 AutoSet For Her and Nuance Pro Nasal Pillow CPAP Mask, with the settings at 7 cm / 15 cm; Autoset for Her mode; and EPR 1. My AHI was 0.27, with one OAI and one CAI event. My old CPAP was set at 7.6; the APAP ran quite a bit higher (Ave pressure = 10.4; 90% = 11.5; Max = 12.5; from SleepyHead, which I'm in the process of figuring out). Obviously, one night isn't nearly large enough sample size, but the new machine / mask combo performed VERY well my first night.

HoseCrusher · Post by **HoseCrusher** » Sat Apr 11, 2015 8:51 pm

Don't you just love it when a plan comes together...

And works.

Deep Sleep · Post by **Deep Sleep** » Sun Apr 12, 2015 5:58 am

Thank you so much for taking the time to compose that detailed response, Bob. That's really great news. My journey begins Tuesday with the first sleep doc consultation.

Congratulations on your initial success. I hope it continues for you!

bobmc · Post by **bobmc** » Sun Apr 12, 2015 6:19 pm

Deep Sleep wrote:Thank you so much for taking the time to compose that detailed response, Bob. That's really great news. My journey begins Tuesday with the first sleep doc consultation.

Congratulations on your initial success. I hope it continues for you!

Thanks, DS!

I would echo the extremely good advice I was given on this forum--TRICARE will pay a set amount for the machine, whether it's top of the line or bottom. The DME will try and give you as inexpensive a machine as they can. Make sure your Dr writes the prescription so they can't.

If your sleep Dr is your DME and doesn't want to write it like that, he doesn't have to be your DME. You can use any TRICARE approved provider. You can get a list of your local ones from your TRICARE site, search for a Provider, and choose Medical Supply Company as the provider type.

National TRICARE providers won't show up in your local TRICARE provider search (because their businesses are not in your local area). I confirmed with my TRICARE region that Optigen was an approved National provider. They had originally told me they weren't because they were in another region, and had to do a search in a separate system to find out they were approved. I didn't talk to them much as I went with a local-local provider.

Let me know how things turn out (and if there's any questions I can (try to) answer).

bobmc · Post by **bobmc** » Sun Apr 12, 2015 9:00 pm

The members of this forum are life-changers. I'm only 2 days into my new machine/mask, and already I can tell a difference. It's not when I wake up, or during the day--it's approaching 10pm, and for years I've dozed off at this point, no matter what I've been doing. And tonight, I'm wide awake. It's amazing--I can't remember ever having felt like this at this time of night.

I can't believe the amount of information available from members of this forum. I'm currently working my way through robysue's SleepyHead Software Beginner's Guide (thanks to Pugsy for the link, in her signature block). All I can say is WOW, robysue! That's an incredible guide.

The stickied threads at the top of the board are also terrific. I can't believe the amount of information in Pugsy's Pointers Collection and Mollette's CPAP Basics (stickied at the top of the boards).

Archangle's Links also contain a tremendous amount of helpful data.

Rested Gal's links were also helpful (and funny), including the Hose Hangers and Lab Rat Trophy links. Rested Gal's link to the S8 recall would have been helpful if I had been aware of this board 8 years ago, when my S8 was recalled (just checked the serial number on my now-backup machine).

And members like palerider, julie, etc who so graciously pass on their experiences and knowledge.

I can't thank you all enough--you've already made quite a difference in my life.

Deep Sleep · Post by **Deep Sleep** » Tue Apr 14, 2015 6:37 am

bobmc wrote:...You can get a list of your local ones from your TRICARE site, search for a Provider, and choose Medical Supply Company as the provider type...Let me know how things turn out (and if there's any questions I can (try to) answer).

Thanks so much for that! I'd looked all over to try to find a list of TriCare authorized DMEs.

After 30 days or so of being compliant, do you have the option to buy the machine rather than continuing the capped rental?

Newbie prescription, mask, provider questions

Re: Newbie prescription, mask, provider questions

Re: Newbie prescription, mask, provider questions

Re: Newbie prescription, mask, provider questions

Re: Newbie prescription, mask, provider questions

Re: Newbie prescription, mask, provider questions

Re: Newbie prescription, mask, provider questions

Re: Newbie prescription, mask, provider questions

Re: Newbie prescription, mask, provider questions

Re: Newbie prescription, mask, provider questions--THANK YOU

Re: Newbie prescription, mask, provider questions