Is my DME's RT and idiot, or am I?

Hi everybody - long time lurker, first time poster. Trying to accomplish the "apparently impossible" for my husband. Here's the deal:

He was scheduled for removal of uvula and some soft palate, along with shifting of his septum. This was scheduled for yesterday, and cancelled on Saturday - surgeon passed away. Severe tragedy - he was truly a great physician.

Here's the problem now. Hubby's been suffering for way too many years, health is at serious risk now. Surgery could take ten months to be rescheduled - need help now. PCP agrees it's urgent he get on a CPAP. We agree AutoPap would be the way to go for all the obvious reasons you all already know. We get approval from Anthem, and they suggest I contact LinCare because they're closest. Not too may providers in our area - fairly rural central NH.

Since I've been reading all your posts for about seven months, just in case we needed the machine, I think we want to go with the Remstar Pro2, and Anthem agrees, and will pay for it. So, I call LinCare and ask if they carry it. First girl says "Oh, yes of course!" We chat a few minutes, and then she asks someone else if they carry it and he says, no. Then she refers me to their RT. He disconnects me on his first attempt to answer the call. I call back. He has the personality of squashed grapefruit. He proceeds to tell the idiot on the other end of the line (me) that there is a Remstar Pro CPAP, and there is a Remstar Pro Auto Pap. He insists that they only carry the Remstar Pro CPAP because the AutoPap is far too expensive and most insurance companies won't pay for it. Okay, well my insurance has already told me they'll pay for it. (All the while, I'm thinking about the previous threads discussing the identical code for both machines, and the smaller profit for the DME's - and I'm thinking this guy is blowing smoke up my butt.) So the real question I have is this: Are there REALLY two Remstar Pro's? Because I can't find any evidence to support that. So, am I the idiot or is he? Should I look for another DME? I can't afford to put the money out and wait for reimbursement - the damned deductibles on all the visits and everything else have wiped me out. HELP!

Yes, find another DME. I suggest https://www.cpap.com They have phone support till 10pm and their prices cannot be beat.

Cheers,

Chris

Your both a little wrong. There is a REMstar Pro2 which is a fixed pressure cpap and there is a REMstar Auto which is an auto adjusting cpap. The one you want is the called the REMstar Auto with C-flex. Find out in actual dollars what your deductable and copay will be. You probably would be better off just buying it yourself from cpap.com. Many people on the forum have found this out after it's too late. The prices that many DMEs charge for machines is 3 to 5 times the online price. You may also be able to buy online and file a claim to your insurance yourself (that's what I did). If you have any further questions, post some more. Your DME experience is very common, if you find better you'll be lucky.

Can CPAP.com bill my insurance co? I was under the understanding that I would have to pay up front and wait for reimbursement, which I no longer can afford to do. Am I misunderstanding? Please say I am !!!!!! I would WAY prefer to buy from CPAP.com!!!! WAY!

Sorry, you would have to pay up front and bill your insurance. Be careful though, like I said, many people have found out the hard way that by the time they pay all the out of pocket through the DME they have spent as much or more than buying direct from cpap.com. You'll probably pay the same either way, why not get what you want and get it right away. If you use the DME it will take longer and cause you a lot more grief. With the DME you may not even get what you want. Then you're paying for nothing.

Pepper, I know the names of all the machines can be confusing. Just keep this in mind - if you want an autopap (and I think you should stick with autopap) do not accept any machine with the word "Pro" or "Plus" in its name.

Respironics REMstar Auto with C-flex is the only autopap that has the added relief of a drop in pressure (C-Flex) every time the person exhales.

There are other Respironics machines that also have "C-Flex", but if you want the AUTO with C-Flex, you have to be very, very, very sure the health care supply place (the "DME") understands every word you are saying. Make them write down the full name of the machine to show you they really understand it. And make sure they understand you want the heated humidifier for it too.

You may have only one shot at getting the exact machine you want. If the DME orders the wrong one for you (deliberately or accidentally) you may have a heck of a time getting it swapped. And no telling how they might jerk you around, pricewise, at that point. So fight all you can to make them get the machine you want right from the start.

As Wadersaid, get out your calculator and see if you'd be better off ordering the machine outright online or if you really want to deal with the local DME.

Good luck!

Wow! Thanks Wader and RestedGal! I feel such gratitude for all the info I get on this site - not to mention the belly laughs from Liam's posts! This place actually feels like "home" to me. I truly appreciate the prompt replies, and valuable information provided by everyone.

Wader - I'm going to check with Anthem in the morning and find out how much my deductible and other total costs are. I'm also going to find out how much the cretins at the DME are proposing to bill the insurance co. It looks as though I'd better find a way to borrow some cash and make my purchase through cpap.com. I'd like to make this purchase the right way - once - and at the same time get to experience the gleeful feeling one gets when they outsmart the greedy creeps who think consumers are stupid!

Rested Gal - thanks for your clarification also! I will indeed make sure I get the heated humidifier. I need to be certain that I've covered every possible problem in advance - because I can't bear to see him suffer much longer, and if I can educate myself and make the best of the information, hopefully it will minimize his "adjustment" time. I can hope for that, can't I?

Of course I do know that no matter how wonderful the apparatus is, and how perfecft the mask is - that first blast will most certainly leave my husband looking like this:
I'll try not to laugh at him - I'll laugh with him I hope!

You guys are great - thanks for helping out the new gal!

Pepper,

Where in NH? If you can get to Lebanon, I highly recommend talking to Kim at Keene Medical Products. (There's a reason most of us refer to LinCare as LinDontCare)

(Their prices are no better than any of the rest, but as an RT, she's really good and will take the time to fit the mask properly. Can't say what her take is on the Auto, but if you call her and tell her you're willing to drive a distance just to see her on recommendation, but ONLY if she can get you the Auto, it might work.)

I can't think of her last name at the moment, but really, given what a lot of people on here have said about masks and DMEs, talk to her.

Alternately, as I've said before, check carefully what your out-of-pocket will be after insurance. I found (after I paid it, damn it) that I would have paid significantly less going without the insurance and ordering directly from cpap.com.

Good luck! If you have any more questions about CPAP in NH, feel free to e-mail me. liam@liamjohnson.net.

Liam, living in NH without a heated hose. He lives on the edge.

Pepper,

You are a very supportive spouse. Your satisfaction will come when you see you husband sleeping peacefully. My wife always comments about how peaceful I sleep now.

FYI cpap.com has a toll free help line that they answer Mon-Sat 9am-10pm CST. They are more than willing to help you out with advise and great service.

By your comments, I think you see where we are all comming from. Your a smart lady and a nice spouse. Glad to have you on the forum.

Liam - the funny thing is, when the "gentleman" at LinDon'tCare became frustrated with my insistance on an APAP, he actually suggested that I call Keene Medical! I guess even he knows that they're superior. If it turns out that I must go through a DME, I'll call them. If we can drive from Winnipesaukee to Dartmouth for his appointments, I see no reason why we couldn't drive that way for the cpap if that became necessary! I would drive to Texas if that's what it took to get things done right!

Wader - cpap.com can definately expect a call from me today! It might take me a few days to pull this all together, but it certainly sounds like we'll be buying through them! If it's going to cost me the same or less - well, that's a no-brainer! One way or another we're going to get some help for him - and one way or another it's going to come from the best-qualified and most caring place I can get it from.

Thanks to all of you who are trying to help this "Desperate Wife", and for not treating me like I can't understand because I'm not the one with OSA. I really appreciate the fact that you folks respect my desire to be of help to my hubster! I'll keep you posted on my progress!

Wow, if he's working with the sleep lab at DHMC (Dartmouth), then he may already have met Kim. Keene Medical works with the DHMC sleep lab, and Kim is there most mornings, helping people who have just been diagnosed figure out what mask to wear.

That drive from here to Winnipesaukee is a bit long, but as you say, worth it if he's in that serious trouble.

So I'll reiterate, depending on your insurance, you should either talk to Kim or go to cpap.com. From Kim you'll get higher prices, but (IMO) an honest wish to get him fitted as well as she can. From cpap.com you'll have a harder time trying different masks, but you'll get the best prices I've found anywhere.

And as I said, if you have any more questions, feel free to ask. I work just across Rte 120 from DHMC.

Liam, probably giving away too much info about where he lives/works.

Liam wrote:Liam, probably giving away too much info about where he lives/works.

Liam, Fifteen of us have booked fights and we'll be outside your house knocking on the door by 4pm. What's for dinner?

No, no, no Wader. You can't go visit Liam tonight. You have the AWAKE meeting to go to. You'll have to go to Liam's tomoorow.
Then you can spend the weekend!

Debbie
Not visiting Liam tonight OR tomorrow. NH is too cold in the winter.

rested gal wrote:
You may have only one shot at getting the exact machine you want. If the DME orders the wrong one for you (deliberately or accidentally) you may have a heck of a time getting it swapped. And no telling how they might jerk you around, pricewise, at that point. So fight all you can to make them get the machine you want right from the start.

How about printing the details of the specific machine from the cpap.com site and hand it to the DME

Definately don't bother with Lin(dont)care


I have Anthem and was told that I had to meet a $200 deductible first, then I would be able to be reimbursed. Personally if I don't get anything (which is doubtful) I think I am still ahead, because a) I have been able to be 100% compliant (minus 2 hrs last night ) because of my Remstar Auto w/cflex and b) I am feeling better.

I would reconsider the surgery also, many folks have said it makes using Cpap more difficult after. (As most surgery is not successful, keep this in mind)