Frazzled newbie CPAP questions

I'm so overwhelmed by all of this, I still don't have a CPAP machine.

My doctor's office called on Monday to say they want to fax a prescription to a DME and asked me which one I prefer. A few people here suggested I visit this site to decide on a machine. http://maskarrayed.wordpress.com/

The doc's office wont' fork over the prescription (they're 60 miles away and promised to fax it to me, but have yet to do so). As far as I know, I just need a regular CPAP machine with equipment and humidity set for 6cm.

I don't want to decide on a certain DME until I know they can provide one of the machines on the above list. I'm afraid to just take any machine they offer because what if it's a bad one? I've read so many horror stories on here.

The last DME I called said they primarily offer the ResMed AirSense 10 (ID number 37028) that provides wireless info. She said it's data capable, but I don't actually have access to any of the data. That it's only sent to them. HUH? When I asked about a machine that has data that I can view on a screen, she told me there's no such thing.


I'm so confused and upset right now I am literally shaking and about to burst into tears. Again, please consider while I'm a relatively intelligent person, I have no clue what any of this stuff means. I feel like I'm a 5 year old trying to buy a brand new car and all that that entails.

Is this an okay machine?
What does data capable/efficacy data even mean?
A lot of you here report on your numbers and how you're improving. Am I supposed to be able to see data in real time on a machine display?
Do I let the DME tell me what's available or do I call and ask for what I want?

So far, I'm so overwhelmed that I'm ordering NOTHING, which of course, means no CPAP usage.

The 37208 is the Airsense Autoset and has full data. It's a great machine with integrated humidifier. It has been equipped with a wireless device to transmit compliance data to the DME so you are reimbursed by insurance. Did you transpose the model number in your post?

You should try to find out your costs for the machine through that DME, and whether this will be a purchase or rental. It is easy to spend more on a machine from a DME, than if you just bought it outright from an online DME supplier like CPAP.com. You'll need to know your deductible, copay and the approved reimbursement for the machine with humidifier, hose, filters etc. I wish it was simpler, but ask the DME to tell you your costs after insurance. Keep in mind the machine is available online at $883 in the For Her model 37209. https://www.cpap.com/productSearch.php? ... 10+autoset

Keep in mind CPAP.com would likely be an out of network provider. You would be reimbursed based on your policy allowance for that, but it may still be less than the in-network cost of the DME you are working with.

the 37028 is an Airsense auto .... it is data capable, and you will have access to the data with Sleepyhead software on your computer
Ask them for the heated hose to go with the machine

Now all you have to decide on is a mask

Thanks, Sleeprider.

My insurance (United HealthCare) only covers rentals. My yearly deductible is $1,500 but United Health Care only covered a portion of my January CPAP study and what I owe ($1,200) will go towards my deductible. The first sleep study was done through Athem Blue Cross and my portion was only $350. I still can't figure out why I owe so much with United Health Care when everything was billed in-network. Anyhoo --

My insurance recommends three local DMEs as in network.
They said any machine I get will be a rental.
United Health Care pays 80% of eligible expenses after satisfying the deductible.
I've been off of work (FMLA/STD) due to severe exhaustion for a few months (which started all of this). I don't have money to buy a machine outright.

I have a few other doctor visits and a holter monitor test I need to take next week which will eat up more of the deductible.

She said it's data capable, but I don't actually have access to any of the data. That it's only sent to them. HUH? When I asked about a machine that has data that I can view on a screen, she told me there's no such thing.

My blog is a bit out of date as to machine models, but if that's the newest Auto then it's a fine machine.

As to the data, if the machine has efficacy data (and according to what Sleeprider says it does) then absolutely you can get access to the data on the screen and on your computer--we can show you how on this forum.

What you're not understanding is that the DME's like to charge you for your own data and they don't think you have enough brains to look at the data yourself and understand it (most likely they will charge YOU to download your data and won't give it to YOU, they will only give it to your doctor who may or may not care), so they don't want you to know that you can access your own data by yourself. They may not know about the Sleepyhead software which will allow you to look at your data on the computer and they certainly don't want you to know how to get into the clinician's menu on your machine to see your data there because they think it's dangerous for you to do that.

Ever hear that expression "Sometimes I feel like a mushroom because people want to make me sit in the dark while they feed me Bulls**t"? That's how DME's prefer to treat us.

Thanks grayghost4 and Janknitz ....taking deep breaths here.

The AirSense 10 Autoset with HumidAir is the SKU #37208. The "For Her" model carries a SKU# 37210. The "for Her" has an additional algorithm that adds an additional pressure profile to your option list. Plus it comes in a decorative color. I just know that the color alone (especially in the dark) will make you sleep better.

As far as the DME telling you that you can't access the data, just say; "R-R-I-I-G-G-H-H-T-T!" I'm beginning to believe that some of the associates that work for a DME are being told this and they don't know any better.

Keep us posted on your saga.

It would not be unreasonable to ask them for the airsense for Her machine ... since you are a woman ... I think according to the avaitar

Tracy1968 wrote:Thanks, Sleeprider.

My insurance (United HealthCare) only covers rentals. My yearly deductible is $1,500 but United Health Care only covered a portion of my January CPAP study and what I owe ($1,200) will go towards my deductible. The first sleep study was done through Athem Blue Cross and my portion was only $350. I still can't figure out why I owe so much with United Health Care when everything was billed in-network. Anyhoo --.

Talk with the DME and ask what the monthly rental will be. Also ask what accessories you will be charged for that cannot be rented. Pay attention here, I have seen DMEs charge separately for the integrated humidifier and humidifier water chamber, adding substantially to the cost of the machine. You will also be billed for the mask, hose, filters and everything else they can possibly itemize. It is not unforeseeable that you pay over $3000 for a machine that sells for under $900 online, and never end up owning it. Don't let that happen to you.

The DME / Insurance horror stories are true. You might check your options here and use this as a competitive bid: http://www.easybreathe.com/UnitedHealth ... nt-59.html

Tracy1968 wrote:I have a few other doctor visits and a holter monitor test I need to take next week which will eat up more of the deductible.

Before you get the Holter monitor, PLEASE check to make sure that the monitor provider is in network. I didn't do this and found out after the observation period that they purposely don't participate with insurance companies so they can go after you for the difference that the insurance company decides not to pay them. In my case it was $2400.00. Only after complaining to my cardiologist's office, which is owned by a major hospital group, did the provider decide to write-off the balance.

Remember: C.Y.A.

I appreciate all the help, but 'm absolutely in a puddle of tears here and about to throw up. I didn't realize everything is billed separately.

I'm trying to deal with one DME 45 miles away (the one that told me about the AirSense 10) and playing phone tag with one 24 miles away that only responded via voice mail by saying they only offer Phillips. I called back and again got voice mail and asked if she could please provide me with model numbers based on what I'll need.

The doctor's office still hasn't sent me the a copy of the prescription and said the DME will need to talk to them directly before anything is ordered. The doc's office is acting annoyed that I'm requesting additional info, just wants me to give them the name of a nearby DME and have them order what's best.

It's 4:20 on a Friday and I've been dealing with this all week and all day today. Looks like a CPAP won't be ordered for me this week, either.

I no longer want to deal with any of this. I don't mind putting a huge mask over my face and trying to sleep. That's the least of my worries. The rest of this is too overwhelming. I'm so exhausted, have serious brain fog and feel like I'm trying to solve complex math problems.

I appreciate your frustration. Please try and put everything in perspective. You didn't just come down with sleep apnea overnight.(or did you?) Chances are that you have had it for a while. So a week or so, in the grand scheme of things, shouldn't make a big difference. You've done the hard part. Now you just have to put up with some additional antics from a bunch of twits.

Tracy, this is just a thought -- what about calling the doctor's office and telling them you have decided to private pay for your equipment and therefore need your prescription ASAP so that you can order what you need online. Even if you don't intend to private pay it might help get that Rx to you sooner rather than later. If they protest, remind them that you are legally entitled to your prescription. It is part of your medical record.

With your prescription in hand you can be at least a little more in control.

Excellent advise Kaiasgram!

Tracy, I didn't mean for you to be upset, and the DME you are working with may be very good. Just go in with your eyes open at to what some of them do...legally. The medical system is for some reason set up to keep you from knowing important information, like the cost to you of medical equipment before you buy.

Your doctor's office is legally required to provide you with copies of all prescriptions and medical records. Don't let a receptionist blow you off.

Tracy1968 wrote:I appreciate all the help,

I'm so exhausted, have serious brain fog and feel like I'm trying to solve complex math problems.

Check this out Tracy: I broke out the costs from my DME and insurance (both pretty nice to deal with).
This will give you a base-line of what you'll be looking at. I suggest you re-create this table with the equipment you want and see how much it would be to purchase outright. Then if you get the sense that your DME and insurance company are yanking you around, you'll know when to step away.

Renting makes things a little trickier - but maybe a purchase would make sense if it costs less than 3 years of renting for example.