Getting equipment next week - have ?s

Hello
I recently had a home sleep study which showed I have sleep apnea. Next week I visit with the DME who is part of the sleep center, to get fitted for the machine. Billing called me yesterday to go over the costs based on my insurance. I am supposed to get the A10. One thing they mentioned is that the insurance doesn’t cover the “wireless data system” so I’ll have to pay $185 for that portion. Does that make sense? Seems like that functionality is integrated to the machine. Is the $185 for the cloud tracking portion? Is that needed?

Another question – when I wake up in the morning my nose (one nostril) is congested. Does this impact whether I can use a nasal pillow mask versus full face mask?

fyi...my at home study results
Respiratory Indices
AHI 27.2
ODI 31.2
Snore index 30%
Longest Apnea 57s
Longest Hypopnea 64s

Saturation
Lowest SpO2 81%
Average SpO2 87.3%

Respiratory Count
Apneas 19
Obstructive 19
Mixed 0
Central 0
Hypopneas 178
Avg Apnea 24 s
Avg Hypopnea 30 s

Other
Non-supine time 99%
Time in bed 7h 14m

thanks
patrick

Call your insurance. The DME may only be trying to pad the bill.
DO NOT TRUST THEM.

That's the first I have heard about charging for the cellular connection data. It's free on the internet.
https://myair.resmed.com/
The same data is on the SD card.
I would be pitching a fit over that charge. I wouldn't be paying it if it were me. They could get it over the internet or I could send a copy of the SD card to them.
Find out what your insurance company needs in terms of any compliance requirements.

Make sure you get the AirSense 10 Elite or AutoSet...they offer full data. The AirSense 10 CPAP offers only extremely limited data and doesn't even offer leak data and it's imperative that people be able to know if leaks are big enough to impact therapy.

You can still use a nasal pillow mask with one clogged nostril if you can comfortable move enough air through one nostril. I often wake up in the morning with one side clogged up totally and I am breathing just fine through the one nostril. It's usually the nostril that is "down" if I am laying on my side that gets clogged. Doesn't happen all that often but it does happen on occasions. Clears right up once I get up.
Now if you can't move enough air through the one nostril and you end up just having to mouth breathe a lot...you need a full face mask. It all depends on how much mouth breathing you end up doing and how long you do it.
The leak data available on the full data machines will tell you if leaks are big enough to be a problem or not and mouth breathing will show up as a leak.

Welcome to the forum.

pm_denver wrote:Hello
I recently had a home sleep study which showed I have sleep apnea. Next week I visit with the DME who is part of the sleep center, to get fitted for the machine. Billing called me yesterday to go over the costs based on my insurance. I am supposed to get the A10. One thing they mentioned is that the insurance doesn’t cover the “wireless data system” so I’ll have to pay $185 for that portion. Does that make sense? Seems like that functionality is integrated to the machine. Is the $185 for the cloud tracking portion? Is that needed?

I have an A10. [Correction: airsense 10 autoset]
I turn off the wireless function.
My doctor downloads the data from the SD card at the doctor visit.
The DME gets the data from the doctor.

I can also print out the data from sleepyhead and send it to the DME if needed.

Talk to your insurance company yourself and get a copy of your specific coverage including what is expected from you to satisfy insurance requirements.

Tell them that you don't want the wireless system and see what they say...Same thing if you say that you don't want the humidifier.......they come with the machine

LSAT wrote:Tell them that you don't want the wireless system and see what they say...Same thing if you say that you don't want the humidifier.......they come with the machine

I like that idea....

Tatooed Lady wrote:

LSAT wrote:Tell them that you don't want the wireless system and see what they say...Same thing if you say that you don't want the humidifier.......they come with the machine

I like that idea....

I like that idea too.

Also Pugsy has a good suggestion above: "Make sure you get the AirSense 10 Elite or AutoSet...they offer full data. The AirSense 10 CPAP offers only extremely limited data and doesn't even offer leak data and it's imperative that people be able to know if leaks are big enough to impact therapy."

If you are not sure what they are offering, call the DME and get the specific machine clarified before your appointment. You have a choice here so don't take home a machine you do not want.

If they are charging you for the data, tell them you don't want/need the data and you will not pay for it. If it's integral to the machine, they are not paying for it either. That's a deal breaker--if they want you to pay for something integral to the machine, you can go elsewhere.

Talk to your insurance company to find out, what--if anything--they need for compliance. There are many ways to provide that compliance data--you can print it out yourself and take it to your doctor.

Thanks for all the advice!

I called my insurance company and their policy is they'll cover "the most cost effective" treatment.
I talked with the receptionist at the clinic and they said i'm getting an APAP. Looks like the A10 is an APAP.... maybe a regular cpap is $185 cheaper? Not convinced of that... I'm too busy at work to deal with this so I'll see what can be done at the appointment.
The clinic seems to be an "one-stop-shop" where they do sleep studies and then sell you the equipment. I should have gotten a prescription then shopped around. Doctors make it hard to do that of course...

It's still not too late to get the prescription from the dr. and shop around. Also, ask for a copy of your sleep study report, if you haven't already gotten it.

Personally, I would NOT deal with a DME affiliated with the sleep study center unless I really trusted the sleep study center. This DME has already shown themselves to be untrustworthy by wanting to charge you for something that the machine comes with. Find out from your insurance company what DMEs are in network, call around, ask questions, and find a DME you're comfortable with. The relationship with the DME is a long-term relationship, as you will be getting supplies and masks from them as well over the years, and you are the consumer.

I have had good experiences with 2 DMEs over the last 5.5 years and only switched because my insurance changed. However, as in any business, quality of customer service at DMEs varies. Some are primarily profit-oriented, while others look out for you and your well being. Obviously, you want the latter. DMEs that provide good customer service and products are not losing money.

In general you should not have to pay a penny more for the APAP vs the CPAP. They are the SAME billing code and the insurer will cover the same for both. Check with your insurer to find out if they set reimbursement based on hcpc code (billing code).

See Don't Pay that Upcharge linked in my blog below.