supplies question

Hello,
I have been treated for sleep apnea for almost 10 years, and have tried various masks and machines with moderate success. I am meeting with my DME in the morning, and need to decide on my new machine and equipment. I have been using a Resmed S9 CPAP machine with the Resmed Swift FX for Her nasal pillow mask and climate conrol tubing for the past 4-5 years, but I am thinking about trying a FF mask again (Resmed AirFit™ F10 For Her Full Face Mask) with a Resmed AIRSENSE™ 10 ELITE CPAP machine. My question is, does anyone have experience with these items, and would they be a good option to try (I tend to mouth breath, and chin straps never hold my mouth closed enough. I also have bad allergies/sinus, and I have to go several days at a time where I am unable to use the nasal pillows due to sinus infection/congestion). My insurance will be paying 90% once I reach my $500 deductible, so I think it is time to try the latest equipment and finally be able to monitor my sleeping events. Thank you so much for any advice or suggestions.
Marci

Guest wrote:Hello,
I have been treated for sleep apnea for almost 10 years, and have tried various masks and machines with moderate success. I am meeting with my DME in the morning, and need to decide on my new machine and equipment. I have been using a Resmed S9 CPAP machine with the Resmed Swift FX for Her nasal pillow mask and climate conrol tubing for the past 4-5 years, but I am thinking about trying a FF mask again (Resmed AirFit™ F10 For Her Full Face Mask) with a Resmed AIRSENSE™ 10 ELITE CPAP machine. My question is, does anyone have experience with these items, and would they be a good option to try (I tend to mouth breath, and chin straps never hold my mouth closed enough. I also have bad allergies/sinus, and I have to go several days at a time where I am unable to use the nasal pillows due to sinus infection/congestion). My insurance will be paying 90% once I reach my $500 deductible, so I think it is time to try the latest equipment and finally be able to monitor my sleeping events. Thank you so much for any advice or suggestions.
Marci

Which specific model of S9 have you been using?
The Elite and Autoset are both fully-data-capable machines.

Regarding the costs and deductibles, etc.........do the math.


Den

.

I think it is a good Idea to stick with the same manufacturer as you will know its basic functions. I unfortunately have no experience at all with the latest machines as I am still waiting on my Machine to start therapy after I was diagnosed with Central Sleep Apnea. The wait is literally killing me.

I actually own a S9 Escape, so there are no date capabilities. I have been offerred the AIRSENSE™ 10 ELITE when I go to my DME appointment today, but I am also kind of interested in the difference with the AIRSENSE™ 10 AUTOSET™ FOR HER. My question is, if I have a Rx for a CPAP machine, wold the second one fall under that category since it has CPAP capabilities (I think it also seems to have another setting which makes it variable).

marci537 wrote:My question is, if I have a Rx for a CPAP machine, wold the second one fall under that category since it has CPAP capabilities (I think it also seems to have another setting which makes it variable).

It could/would be satisfied with the apap capable machine simply set to cpap mode. The problem is that sometimes the DME won't do it and will blame it on insurance or the RX when it fact it is the DME wanting to supply the least expensive model machine so they make the most money since insurance companies pay the same for cpap only or apap capable machines.
Some DMEs have stepped up and doing this very thing as standard protocol...supplying apap machines set to cpap mode. It's legal and fulfills the RX requirements.
But unfortunately it isn't common practice simply because of the bottom line profit margin.

An APAP capable machine IS a CPAP machine that just happens to have an extra mode of operation.
For insurance purposes they both are considered E0601 billable machines. The insurance company doesn't care and most of the time doesn't even know exactly which model is given.

Thanks for the information. I am at my DME appointment now, so we shall see what happens. It looks line either model is a huge step up from what I have had for the past five years.

Huge step up, meaning big up charge?

I love my F10 FF ... as a mouth breather, I need aFF. Prior to the F10, I was using Quattro Air, which uses the same cushion as F10, but the headgear and frame are different. What I love about it F10 does not have a forehead strap, and I am much more comfortable... I liked the Air, but the headgear wasn't as comfortable. There was mild discomfort from the hard plastic of the cheek straps, which I solved with strap pads from Pad-A-Cheek.

Pugsy wrote:It could/would be satisfied with the apap capable machine simply set to cpap mode. The problem is that sometimes the DME won't do it and will blame it on insurance or the RX when it fact it is the DME wanting to supply the least expensive model machine so they make the most money since insurance companies pay the same for cpap only or apap capable machines.
Some DMEs have stepped up and doing this very thing as standard protocol...supplying apap machines set to cpap mode. It's legal and fulfills the RX requirements.
But unfortunately it isn't common practice simply because of the bottom line profit margin

I just want people to be clear on this. Their is only one billing code, E0601, for all CPAP therapy. This means one reimbursement amount regardless of what device is given. There are CPAP's that record compliance data (hrs of use), CPAP's that record efficacy data (AHI & leak) and there are Auto CPAP's. Each one costs significantly more than the other because of the technology that goes into manufacturing them. Unfortunately, the insurance companies don't acknowledge the clinical benefits of one device over the other. If they did, they would allow for a separate billing code for an Aoto CPAP that carried a higher reimbursement than E0601. As it stands now in California, because of a 60% cut over the last two years in the reimbursed amount for E0601, my company looses approximately $23 every time we give out an Auto CPAP to a Medicare patient. 30% of the CPAP units we put out we don't get paid for because the patient's don't meet their insurances compliance criteria. And of course a lot of the insurances are beginning to follow Medicare's example. This has resulted in my company having to shut down several branches and lay off over a hundred people in the last two years. So you see, when it comes to Auto CPAP's, it's not always a case of "wont" do it, it could very well be '"afraid to go out of business" if we continue to do this.

kcodeblue wrote:I just want people to be clear on this. Their is only one billing code, E0601, for all CPAP therapy. This means one reimbursement amount regardless of what device is given. There are CPAP's that record compliance data (hrs of use), CPAP's that record efficacy data (AHI & leak) and there are Auto CPAP's. Each one costs significantly more than the other because of the technology that goes into manufacturing them. Unfortunately, the insurance companies don't acknowledge the clinical benefits of one device over the other. If they did, they would allow for a separate billing code for an Aoto CPAP that carried a higher reimbursement than E0601. As it stands now in California, because of a 60% cut over the last two years in the reimbursed amount for E0601, my company looses approximately $23 every time we give out an Auto CPAP to a Medicare patient. 30% of the CPAP units we put out we don't get paid for because the patient's don't meet their insurances compliance criteria. And of course a lot of the insurances are beginning to follow Medicare's example. This has resulted in my company having to shut down several branches and lay off over a hundred people in the last two years. So you see, when it comes to Auto CPAP's, it's not always a case of "wont" do it, it could very well be '"afraid to go out of business" if we continue to do this.

Cry me a river! A Lot of DME's screw you over and line their pockets because they are the DEVIL

library lady wrote:I love my F10 FF ... as a mouth breather, I need aFF. Prior to the F10, I was using Quattro Air, which uses the same cushion as F10, but the headgear and frame are different. What I love about it F10 does not have a forehead strap, and I am much more comfortable... I liked the Air, but the headgear wasn't as comfortable. There was mild discomfort from the hard plastic of the cheek straps, which I solved with strap pads from Pad-A-Cheek.

I found I also had a problem with the hard-plastic. It felt uncomfortable around the temples of my head. I ended switching back to the air. I don't care for the head-piece but at least I'm not getting the pain anymore by the temples. One more thing: I tried the 'For Her' options for both masks and had to go back to the standard model. I think either it's because my head is too large or my hair is too thick. The standard model does come down a little too low on the back of my neck but I'm living with that.

kcodeblue wrote:Their is only one billing code, E0601, for all CPAP therapy.

True. I think I said that.

kcodeblue wrote:my company looses approximately $23 every time we give out an Auto CPAP to a Medicare patient.

So you work for a DME...
It's sure odd that other DMEs can supply APAPs as standard protocol to Medicare patients routinely so if done routinely I would think they are making money.
Medicare reimbursement rates vary by region so it's a bit difficult to figure out exactly what the rates are but from a ball park average of the cap rental allowable schedule rates I have seen...roughly $100 a month for 13 months and that's just for the blower.
If profit cannot be made....I am scratching my head as to why not unless there is a lot of extra overhead or whatever.

Pugsy wrote:the problem is that sometimes the DME won't do it and will blame it on insurance or the RX when it fact it is the DME wanting to supply the least expensive model machine so they make the most money since insurance companies pay the same for cpap only or apap capable machines.

Looks like this is another thing my DME lied to me about. They told me my insurance would only pay for the bottom of the line machine unless there was some reason I needed a better one. I got the approval letter from Manulife (my extended health plan here in Canada) and it said they approved cpap/APAP, as if there was no difference.

kcodeblue wrote: This has resulted in my company having to shut down several branches and lay off over a hundred people in the last two years.

what, do you work for crapria?

winnie wrote:Looks like this is another thing my DME lied to me about. They told me my insurance would only pay for the bottom of the line machine unless there was some reason I needed a better one. I got the approval letter from Manulife (my extended health plan here in Canada) and it said they approved cpap/APAP, as if there was no difference.

The Canadian system is a little different than what we have in the US and from what I hear can vary among the provinces as to what is or is not covered.
99.9% of the insurance companies out there don't pay by model or features or brand name...they pay by that billing code and in the US E0601 covers both cpap and apap capable machines.
Not sure what the Canadian system uses but here in the US I always tell people to go directly to the insurance company to find out how they pay for this stuff...never rely on what the DME says as to what the insurance company pays for or how they even do the paying. Not all plans are the same and it would be impossible for a DME to have ALL plan specs in front of them.

Big surprise though ...DMEs in Canada aren't known for their honesty or even if we give them the benefit of the doubt...what every plan in Canada might do.