Brand new, need help working with DME.

[Hodr]

I just had my second sleep study on Friday (first with a CPAP). I cant breathe well through my nose so I went with the mirage quattro and honestly had no problem getting to sleep. The tech managed to take my moderate sleep apnea (waking up 20-40 times an hour) down to less than one arousal an hour with a low setting (I think she said I stayed on 6 all night).

The tech told me that with my insurance I would be contacted in 5 days or so and given a list of local equipment providers from which to choose. She also said that if I do a lot of traveling I should request a smaller unit (which would likely result in my getting a better unit as the two are usually connected). She also said that I should be able to get the humidifier as I used one in my study (and still had a bit of dry mouth).

After doing some research I think I would really like to get the resmed s9 autoset or s8 autoset II, but I don't know how much leeway I will have to work with the company I get stuck with.

Can I request a DME provider that uses Resmed? If the prescription doesn't specifically say it needs to be auto adjusting will I have difficulties asking for it (when I took my test I could partially breathe through my nose, but often I can not breathe through it at all; which I think may change the pressure needed)?

I know its in the provider's best interests to stick me with the cheapest machine since they get paid the same amount no matter which setup they give me, are there any sure fire tricks for steering them towards a specific machine?

Any help is appreciated,

[jules]

call your insurance company and get a list of in network providers

prepare a list of questions - begin with do you carry Resmed
then ask based on having Joe Blow insurance is it possible to get a Resmed S9 APAP?
ask what needs to be on the script for you to get an APAP

and find a few more questions to ask too like mask return policy and how often they will contact you for supplies and followup on treatment early on

call each provider and ask them these questions

[JStaggie]

After my sleep study, I had an appointment with one of their doctors and explained that I wanted: 1) a full data capable machine, 2) an APAP just in case we needed to adjust treatment (rather than possibly having to replace a CPAP), and a heated hose to prevent rainout. He was completely happy to write a prescription specifically for an S9 Autoset with the climateline kit. If your doctor is willing to write a similar prescription, then that will help at your DME.

[DreamDiver]

Get a fully-data-capable machine: for instance the S9 Autoset.
Find out what your total costs are for insurance. Add it all up, including out-of-pocket costs.
Find out what it will cost to buy the machine off the web. Call to find out what the price is. It will be cheaper that way.
Chances are it will cost less than your total out-of-pocket alone to buy the same machine from a distributor with a web page than from a local DME.

The smaller travel machines aren't better.
They are generally cheaper because there's nothing too them except a pipe on a blower -- limited or no data.

[Hodr]

I won't actually get to see my Dr. again before they send out the perscription (I will talk to them this morning, but I believe it may already be sent). I have been scheduled to see him again after being on the CPAP for 6 months.

It's nice to see the s9 autoset suggested as that or the s8 autoset II were the two units I had decided would likely work best for me. A co-worker with the same insurance who ended up with a "resmed" (not sure of the model) told me that when all of the charges were eventually totalled up it was in the neighborhood of $400-500, which would be a good deal if I actually got one of those two machines (not so much if I got stuck with a $400 internet special).

-------------------------------

Found out which DME I am likely to get (Lincare) and that my insurance will pay for 70% of the machine cost (and I can request whichever machine I want, but they don't have the S9 Autoset yet, only the S8 Autoset II which they want $1500 for). So, if my insurance pays %70 I end up paying $450 for the machine.

They also said that the insurance rents the machine at $22.50 per month until the cost of the machine is covered.

This seems like it should be a good setup. Can anyone tell me if the S8 Auto II is much worse than the S9 Auto?

[Komodo]

I know its in the provider's best interests to stick me with the cheapest machine since they get paid the same amount no matter which setup they give me, are there any sure fire tricks for steering them towards a specific machine?

Any help is appreciated,

THAT, is why they're telling you to settle for the S8!

If it were me.... I'd tell them to order the S9, and I'd wait until it got there.


ALSO, don't forget about YOUR choice of mask, and let the DME know which one YOU want!!!

[Hodr]

Thanks for the help guys. I talked with the DME that I think I will be using and thay said that if I do not want the S8 Auto II they can order the S9 for me. Further, I talked with the nurse at the Dr's office and she said that it will be a couple more days before they send the script out and that she will call me up right before doing so and will put down the S9 w/ Humidifier and Climateline if I want it. I will probably end up waiting an extra week total, but hopefully it will be worth it (although I am still not sure what the major differences between the S8 Auto II and S9 are).

In the end it should still be cheaper than doing it outside of the insurance (since these guys seem to do about a %50 markup, but insurance pays %70 of the marked up price).

[KC5cychris]

Did you end up with lincare or another DME?
I am fixin to be in your shoes and am in the process of DME seaching now.

Chris

[Hodr]

Went with Lincare as I mentioned. They don't carry the S9 so they have to order it (not sure how long this will take). When all is said and done I should be getting the S9 Autoset with Climatline and the ResMed Mirage Quattro mask. According to Lincare my insurance will cover 70% of the cost so I should make out pretty well on the deal, provided they don't mark up the unit more than 300% (the price they quoted for the S8 Autoset 2, $1500, is nearly a 2x markup over cpap.com, but I would be satisfied if the S9 is similar).

They are located about 35 miles from me, but will have someone drive out to setup the machine and show me how everything works when it comes in.

[KC5cychris]

Glad to see that you are getting the S9.
I too am considering Lincare in my area so am glad to see they carry the S9
Looks like I need to get busy and make some precalls next week so I have more info on my in network DMEs (I do have a list just got to get motivated.
good luck with your new unit

[pam933]

To KC5cychris - just make sure that you check with Lincare on what they'll order because the Lincare people that I dealt with wouldn't order me anything beyond the S8 Escape that they already had because "we don't order those expensive machines." So it sounds like not all Lincare offices are the same.