Next Steps..

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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SleepyEyes21
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Next Steps..

Post by SleepyEyes21 » Mon Aug 18, 2014 6:52 pm

Hello - I am waiting to get results of an in home apnea test. Provided I do need apnea treatment, will my doctor specify the machine brand, specs, features (ie: heated hose, humidifier, ramp, et.), or do I need to ask him to write the order for these particular things?

Thank you,

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Sheriff Buford
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Re: Next Steps..

Post by Sheriff Buford » Mon Aug 18, 2014 7:16 pm

Pray that you don't have sleep apnea. Have the doctor write two prescriptions (and get a copy). One for "mask of patient's choice". The other prescription should read "Resmed S9 Autoset with humidifier". Tell the doctor you want the autoset for comfort and this machine will provide you data. You can use the autoset in the cpap mode (straight air) or the autoset mode (a lower - more comfortable air pressure... until an apnea is detected, then the machine will ramp up to a higher pressure to treat the apnea. After the apnea event is treated, the machine will lower toward the comfortable pressure). Read the tabs above on what a newbie needs to know. Inform yourself BEFORE getting stuck with cheap... almost useless equipment.

Sheriff

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Pugsy
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Re: Next Steps..

Post by Pugsy » Mon Aug 18, 2014 7:33 pm


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SleepyEyes21
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Re: Next Steps..

Post by SleepyEyes21 » Mon Aug 18, 2014 8:14 pm

Sheriff Buford wrote:Pray that you don't have sleep apnea. Have the doctor write two prescriptions (and get a copy). One for "mask of patient's choice". The other prescription should read "Resmed S9 Autoset with humidifier". Tell the doctor you want the autoset for comfort and this machine will provide you data. You can use the autoset in the cpap mode (straight air) or the autoset mode (a lower - more comfortable air pressure... until an apnea is detected, then the machine will ramp up to a higher pressure to treat the apnea. After the apnea event is treated, the machine will lower toward the comfortable pressure). Read the tabs above on what a newbie needs to know. Inform yourself BEFORE getting stuck with cheap... almost useless equipment.

Sheriff
Hi Sheriff - thanks for your advice and suggestions. I will make sure I don't get a cheap "brick" for my first machine. Question: will the type of machine be limited to what my insurance will allow? (regardless, I will pay the difference to get a good machine- just curious.) Also- is 'autoset' the same as APAP? I will continue reading tabs in this forum.

I have a different outlook on an apnea diagnosis at this point in my life. I have some understanding of apnea and CPAP treatment from loved ones, although I've not been the diagnosed/ treated person yet. My perspective is that I will be relieved if it is determined that I do have apnea and can get CPAP treatment, as I have been feeling progressively worse for the past 10+ months and counting. As a former smoker, I would not want it to be a diagnosis worse than apnea, if that makes sense. I think my attitude to not be afraid of or resistant to an apnea diagnosis will help me to be compliant with treatment. Granted - I may have difficulty getting used to treatment, but knowing that many have learned to adjust, I am confident I will be one of them too.

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SleepyEyes21
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Re: Next Steps..

Post by SleepyEyes21 » Mon Aug 18, 2014 8:15 pm

Thanks for the links, Pugsy! Will keep reading and learning

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Sheriff Buford
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Re: Next Steps..

Post by Sheriff Buford » Tue Aug 19, 2014 7:39 am

SleepyEyes21 wrote:Hi Sheriff - thanks for your advice and suggestions. I will make sure I don't get a cheap "brick" for my first machine. Question: will the type of machine be limited to what my insurance will allow? (regardless, I will pay the difference to get a good machine- just curious.) Also- is 'autoset' the same as APAP? I will continue reading tabs in this forum.

I have a different outlook on an apnea diagnosis at this point in my life. I have some understanding of apnea and CPAP treatment from loved ones, although I've not been the diagnosed/ treated person yet. My perspective is that I will be relieved if it is determined that I do have apnea and can get CPAP treatment, as I have been feeling progressively worse for the past 10+ months and counting. As a former smoker, I would not want it to be a diagnosis worse than apnea, if that makes sense. I think my attitude to not be afraid of or resistant to an apnea diagnosis will help me to be compliant with treatment. Granted - I may have difficulty getting used to treatment, but knowing that many have learned to adjust, I am confident I will be one of them too.
The autoset is Resmed's term for the APAP. Insurance-wise... the insurance HAS to give you the machine the doctor writes on the prescription. They try to scam you by giving you a chap machine in order to maximize their profits. That's why I recommended requesting the doctor to write "Resmed S9 Autoset with humidifier". After thinking about it, have the doctor write: "Resmed S9 Autoset with humidifier and climate line hose". The climate line hose is insulated with an electrical heat tracing (of sorts) that keeps the hose warm and reduces rainout. Rainout is when the the water vapor condenses to liquid in the hose and can get into mask and scare the crap outta' you.

You have the right attitude about "not being scared" of treating the apnea and I am sympathetic to your sleep issues, but trust me... you want your diagnosis to be something else. No one wants to wear the mask the rest of their lives. Successful folks that have treated their apnea do feel better, healthier and get "their lives back", but at the end of the day... would prefer an alternate means of treating sleep apnea. No other options exist, so we do what we have to do. I'm sure my comment will generate some discussion here, but anyone tells you they"enjoy" wearing the mask is whistlin' dixie.

Sheriff

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49er
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Re: Next Steps..

Post by 49er » Tue Aug 19, 2014 8:37 am

Sheriff Buford wrote:
SleepyEyes21 wrote:Hi Sheriff - thanks for your advice and suggestions. I will make sure I don't get a cheap "brick" for my first machine. Question: will the type of machine be limited to what my insurance will allow? (regardless, I will pay the difference to get a good machine- just curious.) Also- is 'autoset' the same as APAP? I will continue reading tabs in this forum.

I have a different outlook on an apnea diagnosis at this point in my life. I have some understanding of apnea and CPAP treatment from loved ones, although I've not been the diagnosed/ treated person yet. My perspective is that I will be relieved if it is determined that I do have apnea and can get CPAP treatment, as I have been feeling progressively worse for the past 10+ months and counting. As a former smoker, I would not want it to be a diagnosis worse than apnea, if that makes sense. I think my attitude to not be afraid of or resistant to an apnea diagnosis will help me to be compliant with treatment. Granted - I may have difficulty getting used to treatment, but knowing that many have learned to adjust, I am confident I will be one of them too.
The autoset is Resmed's term for the APAP. Insurance-wise... the insurance HAS to give you the machine the doctor writes on the prescription. They try to scam you by giving you a chap machine in order to maximize their profits. That's why I recommended requesting the doctor to write "Resmed S9 Autoset with humidifier". After thinking about it, have the doctor write: "Resmed S9 Autoset with humidifier and climate line hose". The climate line hose is insulated with an electrical heat tracing (of sorts) that keeps the hose warm and reduces rainout. Rainout is when the the water vapor condenses to liquid in the hose and can get into mask and scare the crap outta' you.

You have the right attitude about "not being scared" of treating the apnea and I am sympathetic to your sleep issues, but trust me... you want your diagnosis to be something else. No one wants to wear the mask the rest of their lives. Successful folks that have treated their apnea do feel better, healthier and get "their lives back", but at the end of the day... would prefer an alternate means of treating sleep apnea. No other options exist, so we do what we have to do. I'm sure my comment will generate some discussion here, but anyone tells you they"enjoy" wearing the mask is whistlin' dixie.

Sheriff
Sheriff,

Thank you for your honestly. It is greatly appreciated.

To be honest, if I was able to stay asleep on the machine and received good quality sleep, I wouldn't mind wearing the mask. But that hasn't happened for close to 3 years. Anyway, I don't want to sidetrack this thread but wanted to let you know how I felt about what you said.

SleepyEyes21, I wish you all the luck in the world with your therapy. It sounds like you will do great.

49er

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SleepyEyes21
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Re: Next Steps..

Post by SleepyEyes21 » Tue Aug 19, 2014 5:42 pm

Thanks again, Sheriff, for all of the info and good advice. I just got off the phone with my insurance; now trying to locate my covered DME. I do understand 'no one wants to wear the mask the rest of their lives' and the treatment does not always work well for some (as 49er is attesting to.) I have researched other treatment options in the past, and know that current options don't have great results most times either. We can only hope and/ or pray that there will be medical advances within our lifetimes that provide better treatment procedures and outcomes.

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Re: Next Steps..

Post by SleepyEyes21 » Tue Aug 19, 2014 11:24 pm

SleepyEyes21 wrote:
Hi Pugsy - I read both of these blogs today, everyone's answers/ questions, and then some. Wow!! What great information, and questions to ask insurance and DME's. I have several 'lists' going with all kinds of things to ask, terminology to check out, etc.

I called my insurance yesterday to ask a few things like what they will pay for a CPAP set up, supplies, etc. I found out the DME is not a local company (was given an 800 #, and hoping they are contracting with a local DME), and will call during business hours later today. Unfortunately, I have an HMO insurance plan
The insurance agent I talked with could not answer specifics about my costs; she kept saying 'it depends on the DME and their contracted rate.' Of course, I will ask the DME when I get ahold of them, but do you have a suggestion for how to get this info from my insurance company?

Here is what I am considering after all the reading and suggestions: since there are only 4 months left in the 2014 benefit year, and I know without a doubt that I will be changing insurance companies for 2015, I am wondering if it would be better for me to just purchase a used machine out of pocket, or possibly buy a data capable DevilBliss (due to lower cost)? I could use this first machine as a backup; I will also check with my insurer to see if they will reimburse me for costs if I buy online or from someone other than the preferred DME. Do you (or anyone else) have any thoughts on this? Also - does anyone know how insurance companies in general, are handling purchasing of equipment/ supplies for their patients, now that more people are signing up for insurance coverage, and many already have apnea equipment/ needs?

Thank you!

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Pugsy
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Re: Next Steps..

Post by Pugsy » Wed Aug 20, 2014 6:25 am

As you have already found out HMOs aren't typical insurance and they do their own little thing. I have no idea how to get pricing from them.
Someone in the insurance claims department should have an idea though. HMOs don't abide by the normal "rules" that other insurance companies normally use.

Check out secondwindcpap.com for purchase of used equipment.

The Devilbiss is a nice machine but it requires an additional purchase of a special module if you want more detailed data as the onscreen smart codes are limited. By the time you buy the additional module you are pretty much up to the price of the other full data machines.
Plus it doesn't do flow rate graphs at all which can come in handy.

A good majority of traditional insurance companies follow the Medicare replacement guide in terms of how often the mask and other accessory equipment can be replaced. Not all though.....but a good many. It will give you a starting point.
BTW pretty much all of these items don't HAVE to be replaced this frequently.
Example...I am using the AirFit P10 nasal pillow mask. Medicare says I can have 2 per month replacement nasal pillows. I have been using the same nasal pillow I started with back mid Jan of this year. The exact same single nasal pillow and it stills seals great.

Here's the general Medicare guide below. Your insurance may or may not follow it but it should give you an idea where to start.
Filters...I buy in bulk from EBay or cpap.com. It's cheaper that way than using my insurance.

Regarding online purchase and having insurance reimburse....just have to ask but most won't do it. Now if you were to use some of your Flex account money (if you had that benefit) I do believe that you can use Flex money online.

Image

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SleepyEyes21
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Re: Next Steps..

Post by SleepyEyes21 » Wed Aug 20, 2014 9:06 pm

Thanks so much for all the great info and feedback, Pugsy! Whew - it has been a long day.. I called the insurance DME and within my first 2 questions, I knew I would not be giving them my business! The girl was absolutely clueless, and I had to explain to her the difference between simply compliance data and efficacy data

After another call to my insurance and then a local DME who has a GREAT reputation in our county, I'm fairly certain I will be purchasing a used machine to start. The local DME has used PR's and ResMeds - the RT is checking to see if she has a ResMed Auto as Sheriff recommended to me, for $300. I understand this may not include the humidifier; she is calling me back in the morning. I also checked second wind as you suggested, and they have some good deals also.

I am back to read/ try to find more info on the PR systems, find suggestions on a full face mask for beginners (I'm a mouth breather), and to try to figure out the difference between AFlex and CFlex.

Do you or anyone know where I can find info on how many hours are 'acceptable' for used machines that still have 'life' in them?

Many thanks to you (and all) once again!

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Pugsy
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Re: Next Steps..

Post by Pugsy » Wed Aug 20, 2014 9:20 pm

Respironics Flex exhale relief explanations...such as they are
http://aflex.respironics.com/

How many hours is "used too much"? There really isn't any hard fast rule. These machines can sometimes die a couple of months into therapy and they can also last 5, 10 or 15 years. I wouldn't want to pay premo dollar for a 3K hour machine though.

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Re: Next Steps..

Post by SleepyToo2 » Wed Aug 20, 2014 9:25 pm

If you reckon on 3,000 hours/year, you will be able to estimate approximately how old the machine is (use machine hours, not therapy hours). My machine is coming up to 5 years old, so I guess it has run for about 15,000 hours. I would be looking for a real good price on anything in excess of about 5-6,000 hours.

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Re: Next Steps..

Post by palerider » Wed Aug 20, 2014 10:01 pm

SleepyEyes21 wrote:the RT is checking to see if she has a ResMed Auto
you need to be careful with your phrasing, "resmed auto" is a fairly broad list.

you need to make sure you get a "resmed s9 autoSET" not just 'auto'.

lest you end up with the undesirable 's9 escape auto'.

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SleepyEyes21
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Re: Next Steps..

Post by SleepyEyes21 » Wed Aug 20, 2014 11:02 pm

palerider wrote:
SleepyEyes21 wrote:the RT is checking to see if she has a ResMed Auto
you need to be careful with your phrasing, "resmed auto" is a fairly broad list.

you need to make sure you get a "resmed s9 autoSET" not just 'auto'.

lest you end up with the undesirable 's9 escape auto'.

Thanks for the tip, palerider! I will avoid that dreaded "Escape." Also - thanks again, Pugsy and SleepyToo2 - great tips to add to the 'toolkit.'

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