First Experiences with CPAP and DME Provider

Hello,

I was just wondering what some of your first experiences with CPAP and your DME provider was like. I am still in the process of getting everything set up -- have completed both sleep studies and was told to get a CPAP machine. My primary doctor forwarded my information to a local DME provider who is very interested in setting my up with the rental of what will be a $3000 system! I contacted my insurance company (BC/BS) and was told that I should be able to purchase my own system online for around $500 - $1000 but will need my doctor to pre-autorize the purchase (vs rental) in order to apply for an insurance reimbursement. At this point, my doctor will not do this and insists I only use the extremely overpriced, unfriendly and pushy DME provider instead. The few online providers that I checked with will not handle rentals.

I understand my doctor is suggesting this method since most people need to switch machines and/or masks a few times in order to find the overall best fit, but I do not think I should have to pay my insurance percentage (20%) of an overbloated salesman's commission when I can do this myself for much, much less.

Did anyone else have to go through this same process and/or spend 5-6 times the cost (vs online providers) for their equipment? Does anyone know if I have any other options (other than just paying cash and buying the equipment myself)?

Thanks for any comments and/or advice.

I contacted my insurance company (BC/BS) and was told that I should be able to purchase my own system online for around $500 - $1000 but will need my doctor to pre-autorize the purchase (vs rental) in order to apply for an insurance reimbursement. At this point, my doctor will not do this and insists I only use the extremely overpriced, unfriendly and pushy DME provider instead.

Hmmm... does this doctor have a financial connection with the DME supplier he insists you use?

One further thought (and I'm not a health professional of any kind)... if you decide to make your purchase online, you might want to think about doing a little insisting of your own - insisting that the doctor write the prescription for an autopap, rather than a cpap. If he says, "No, you need CPAP not autopap.", you might gently remind him that an autopap can be run in straight cpap mode.

But the beauty of an autopap is that when it's run as an autopap (set for a range of pressure - high and low), it will deliver the pressure you need throughout the night. For example, if your sleep study says you need 12 cmw of pressure, and the autopap is set to, say, 9 - 14 cmw, you may be able to sleep most of the night at 9 or 10 keeping your throat open nicely, instead of having 12 blowing steadily at you all night long. And if it turns out that there are occasions when you need 13 or 14 instead of 12, the machine will do that, and then gradually drop back down to a more comfortable pressure when the event has been cleared.

A lot of people get titrated for a pressure (say 12), and soon start feeling great on a basic cpap machine. Then after 6 months or a year, begin to not feel as good. Sometimes the doctor will just up the pressure a notch or two and all's well again.

But here's what can also happen....the doctor may send you back for another sleep study. You know how long it took you to get appointments and your first study scheduled and the follow-up appointment. Want to go through that again?

So many delays:
1. you don't feel as good, but can't get in to talk to the doctor for several months...a delay.
2. another sleep study is scheduled... a delay.
3. waiting for the doctor to get around to looking at the study results... more delay.
4. you wait for the appointment to go see the doctor so he can tell you he's going to up your pressure a couple of notches... yet more delay.

All that time, the autopap could have been treating you by automatically finding the pressure you need within a set range. It could have been delivering those couple of extra notches you needed from time to time.

I'm not saying that an autopap is a panacea. Or that it's the best type of machine for everyone. But it can be a very useful therapy tool for many people - especially those of us who want to have more than a little say-so in our own treatment.

Sorry to hear of another CPAPer subject to the DME run around.

I anticipated this would happen to me so I researched what machine I wanted and why. I checked into what it would cost online and from several local DMEs and presented this info to my Doc (similar numbers as you)

Luckily for me my Doc did not question my rational and wrote a prescription for the machine I wanted.

Then my insurance questioned my choice in the preapproval process and I told them that this is what my Doc ordered and why - it worked!

I suggest telling your Doc that you could buy several machines and every mask on the market online for the $3000 dollars the local DME wants.

You could nearly buy a basic machine/humidifier/mask online for just your 20% copay.

I then would consider a new Doc if he gives you a problem. He's certainly not looking out for the best interests of his patient.

The sleep clinic that did my sleep study is also a DME and it was a laugh when they called me 3 weeks after my study and 3 days after I already had received my equipment (from cpap.com) and said my doctor wants me to get my equipment from them. I know for a fact he did not. Really makes me confident of the results of my study.

Your instincts are right on this one I would follow them!