REMStar 60 Series....should I keep it

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Pugsy
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Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: REMStar 60 Series....should I keep it

Post by Pugsy » Sat May 02, 2015 9:00 am

Most insurance companies pay by HCPCS code and not model name or features.
You need to call your insurance company and ask them how they pay. I am betting HCPCS code and the code for the most basic cpap machine is E0601 and the code for the full data cpap/apap machines is also E0601.
Guess why these DMEs tell you that "your insurance only pays for bare bones basic".....so they (DME) make more profit.

If your DME doesn't want to supply you with a full data machine and wants to continue to lie to you....find another DME who will supply what you want.
Not all DMEs will act this way...some actually will try to earn your business.
Call your insurance company and find out what other DMEs in your area work with your insurance.

What insurance do you have? If it is Medicare you may be in a competitive bidding area which may limit your choices but if not Medicare there should be other options available.

Don't ever rely on what a DME says about what "your insurance" does. You need to go directly to the insurance company yourself.

Also...if you can get APAP...with the exception of the S9 Escape Auto, all APAPs are full data.

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sleepynewb
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Joined: Mon Dec 22, 2014 5:58 pm

Re: REMStar 60 Series....should I keep it

Post by sleepynewb » Sat May 02, 2015 9:06 am

Thanks for the continued help! I'll contact my insurance company, Aetna, and see what they say.

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Gasper62
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Location: Central Maryland

Re: REMStar 60 Series....should I keep it

Post by Gasper62 » Sat May 02, 2015 11:33 am

Ask your doctor if he/she will write a new Rx for a specific APAP machine. When they write an Rx for meds, they get very specific as to which drug they're prescribing, right ? My Dr. asked me why I wanted the S9 instead of the newest 10 series, told him I preferred the one that's been around a long time with a proven record. Be firm and persistent, you're the one who pays the premiums that keep the Dr.s-DMEs & insurance companies in business, after all. Good luck.

sleepynewb
Posts: 19
Joined: Mon Dec 22, 2014 5:58 pm

Re: REMStar 60 Series....should I keep it

Post by sleepynewb » Sat May 02, 2015 12:03 pm

Excellent thought. My doc is pretty cool, so I don't see that being an issue.

sleepynewb
Posts: 19
Joined: Mon Dec 22, 2014 5:58 pm

Re: REMStar 60 Series....should I keep it

Post by sleepynewb » Mon May 04, 2015 6:09 pm

Update: Talked with insurance today. Asked about the bare bones unit and if they pay the same just as long as it falls in the usual CPAP code. I couldn't get a straight answer from the rep, she kept saying she had to talk with the nurse. The DME hadn't turned in any paperwork for me yet, so she had nothing on record. She ended up calling the DME and telling them I wanted an upgraded machine, she also called the doc for some of my paperwork. The rest she said would need to come from the nurse.

My wife is seeing the doc tomorrow. I think I'll send her with a note asking to revise the script to request a specific machine. The DME for some reason doesn't yet carry the Airsense 10 AutoSet, so I guess I'll request the S9 AutoSet with ClimateLine tubing.

Would this wording on the script indicate exactly what i would need?

ResMed S9 AutoSet with H5i Humidifier and ClimateLine tubing
Product code 36025

Thanks as always for the guidance!