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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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WalkingZombie
 
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Does Dr. have to prescribe an auto cpap?

Postby WalkingZombie on Tue Oct 11, 2011 2:04 pm

Good news!! BCBS has recieved my info from Pharmacy Trust and is showing that I have met my deductible and my out of pocket expense!
I called my DME to set up my appointment and I started bombarding her with questions. LOL I've read on here to ask certain questions. First I asked if they were gonna be able to provide me with a Resmed S9 autoset or a Respironics PRS1 auto and she told me that the doctor did not prescribe an auto cpap. She said she has to have a specific rx for those particular machines. She said the rx is written for a cpap with a heated humidifier with a setting of 11.
When I go this Thursday, are there certain machines I need to steer clear of? What else do I need to know before meeting with her?

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WalkingZombie
 
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Re: Does Dr. have to prescribe an auto cpap?

Postby WalkingZombie on Tue Oct 11, 2011 2:06 pm

Also, does is every machine capable of recording full data? I've learned from here that I need one that reads full data, not just compliance data.

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Perrybucsdad
 
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Re: Does Dr. have to prescribe an auto cpap?

Postby Perrybucsdad on Tue Oct 11, 2011 2:18 pm

I don't know the answer to the Auto question. My rx said "Auto CPAP, 4-14 CMH2O, Chin Strap, lifetime supplies".

As far as are all full data capable... no. If you want the S9, you want the S9 Autoset which is fully data capable. The code for data capable, vs non is the same, so don't let the DME bully you on that. The insurance company doesn't care if you get fully data capable or not, but the DME will get to keep less because the insurance company pays the same regardless is my understanding.

There are some great posts regarding all this, so do a quick search and you will find some great tips on how to deal with the DME. I wish I could remember who it was, but one member here has some items regarding this in her signature. If I see it I will post it here for you.

- John

_________________
Machine: S9 AutoSet™ CPAP Machine
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: ResScan v3.14; Sleepyhead v0.85

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Perrybucsdad
 
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Re: Does Dr. have to prescribe an auto cpap?

Postby Perrybucsdad on Tue Oct 11, 2011 2:26 pm

Here it is.... and also check out the other articles on that site. All very well done and informative.


LINK to Janknitz's excellent - "WHAT YOU NEED TO KNOW BEFORE YOU MEET YOUR DME Part I"
http://maskarrayed.wordpress.com/what-you-need-to-know-before-you-meet-your-dme-part-i/

_________________
Machine: S9 AutoSet™ CPAP Machine
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: ResScan v3.14; Sleepyhead v0.85

jules
 
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Re: Does Dr. have to prescribe an auto cpap?

Postby jules on Tue Oct 11, 2011 2:27 pm

call her back, ask what machines she can give you with the script she has - get names and model numbers - come back with it and post it

then you will know if you need to go back to the doc for a new script to get full data

mayondair
 
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Re: Does Dr. have to prescribe an auto cpap?

Postby mayondair on Tue Oct 11, 2011 2:28 pm

An auto machine can be set in CPAP mode, your DME may argue with you about providing an auto, you can ask your doc to specify an auto, or shop around for a more cooperative DME. The code EO601 for insurance billing covers any CPAP or AUTOPAP. Your insurance doesn't care which. Not all machines have full data, do not accept any Resmed with Escape in the name or any PR with Plus in the name. Check out janknitz's excellent blog and her advice about meeting with DMEs. You are the customer, you need to be happy with what you get, and it's worth fighting for an auto. You will most likely be using this machine for 5 years, so get the best. good luck, Kathy
Any landing you walk away from is a good one; if you don't break your airplane it's excellent.

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WalkingZombie
 
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Re: Does Dr. have to prescribe an auto cpap?

Postby WalkingZombie on Tue Oct 11, 2011 2:37 pm

Thanks John. I'll be sure and read all I can before Thursday.
I just called the DME back and she said that they mostly sell the Respironics System 1 PR series. She said the Resmed S9 autoset is available, but the doctor has to request it specifically and they only order in a few of those at a time and they usually are reserved. She said that they don't offer those right off because of the cost. I suspect that the DME won't make as much on it? She said they all record full data. She said that my doctor is pretty versatile, so should I call the Dr. and see if he can write and rx for the S9 autoset or will I be fine with the Respironics she's talking about?

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WalkingZombie
 
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Re: Does Dr. have to prescribe an auto cpap?

Postby WalkingZombie on Tue Oct 11, 2011 2:51 pm

I just called the doctors office and spoke with someone that is going to talk to him tomorrow and see if he'll ok the Resmed S9 autoset or the Respironics PRS1 auto. She acted like it will be no problem at all, like all I had to do was ask. So, we'll see what happens with that. If she can get the ok and fax the rx by Thursday afternoon, I'll be all set. But I may have to cancel the appt. with the DME because they told me they have to special order the S9 in and don't have any in stock.
In looking at my notes, the machines I have written down to steer clear of are the Resmed Escape and Escape Auto, and the PRS1 Plus. I noted to say no to anything Plus and the AutoIQ. Pro and Auto are good. Maybe I can make some sense out of my messy notes. LOL

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rested gal
 
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Re: Does Dr. have to prescribe an auto cpap?

Postby rested gal on Tue Oct 11, 2011 3:12 pm

You got it right, WalkingZombie. You've been doing your homework well! :D

To make it simple, here are the only two machines I'd accept, if I were you:

ResMed S9 AutoSet
(Not the ResMed S9 Escape Auto.)

Philips Respironics System One REMstar Auto
(Not the Philips Respironics System One REMstar Pro with AutoIQ.)

The ResMed S9 AutoSet is the machine I'd want, even if I had to wait for it to be ordered.

Good luck.
S9 VPAP Auto - S9 Auto - BiPAP Auto - 420E auto - Everest 2. ResScan, EncPro & SL3.
Humidifier: F&P HC 150, Aussie heated hose.
Mask: Aeiomed Headrest/homemade straps.
ALL LINKS by rested gal:
http://www.cpaptalk.com/viewtopic.php?t=17435

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Slinky
 
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Re: Does Dr. have to prescribe an auto cpap?

Postby Slinky on Tue Oct 11, 2011 3:14 pm

Call your insurance and ask them what local DME providers they are contracted with. Hopefully you will have the option of more than this one as that gives you more bargaining/negotiating room.

Ask your doctor to re-write your script for the APAP you want. He can't do any more than say no. And even if he is agreeable to doing so if you can get your hands on the current script do so. If later on you want to buy a backup/travel PAP the current generic script will allow you to buy ANY of the online CPAPs/APAPs you want rather than being locked into another APAP like you've chosen as your first PAP.

_________________
Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Additional Comments: PR SystemOne BPAP Auto w/Bi-Flex & Humidifier - EncorePro 2.2 Software - Contec CMS-50D+ Oximeter - Respironics EverFlo Q Concentrator
Women are Angels. And when someone breaks our wings, we simply continue to fly.....on a broomstick. We are flexible like that.
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cowlypso
 
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Re: Does Dr. have to prescribe an auto cpap?

Postby cowlypso on Tue Oct 11, 2011 3:29 pm

Technically, they don't need a prescription specifically for the auto, but most DMEs say that you do. The easiest thing to do is just ask your doctor to write the prescription, rather than argue with them.

If you really want to wait for the Resmed machine, go for it, but the PR S1 auto is just as good a machine. They each have their pros and cons.

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archangle
 
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Re: Does Dr. have to prescribe an auto cpap?

Postby archangle on Tue Oct 11, 2011 3:33 pm

Your DME can provide an auto CPAP even if the prescription specifies a single pressure. The machine would have to be set to manual CPAP mode for the prescribed pressure. It can be changed to auto CPAP later if necessary.

They will make less money so they won't want to give you the auto machine. If your DME is part of a chain, their corporate management may not allow it.

If you have your doctor rewrite the prescription, try to have him specify a range of pressures. The DME may resist dispensing an auto machine if there's not an autopressure range. If he resists having autopressure, see if he'll prescribe a small range. For instance, if he wants 10 cmH20, prescribe 8-12 cmH20. The DME can't dispense a manual CPAP if the script specifies a pressure range.

If it's midnight and the DME tells you it's dark outside, check for yourself. One BIG LIE that DMEs use is "this machine is data capable." They love to sell you machines that record only the hours of use. They'll even show you the data card, but all it tells you is when it was turned on for some machines.

Do not accept:

Any Respironics machine that doesn't say "Philips Respironics." If it doesn't say "Philips," it's an older, less capable model.

ResMed machines that don't say "S9" on the back are also older models.

PRS1 "Plus". Remember "PLUS is a MINUS."
Resmed S9 "Escape" or "Escape Auto." Remember, "If it says ESCAPE, run away and try to escape."

PRS1 Pro (not PLUS) is a good manual CPAP with full data. PRS1 Auto is a PRO machine with Auto CPAP.
I would not accept the PRS1 "AutoIQ" or "PRO AutoIQ," because it's not really an AUTO CPAP machine.

ResMed S9 Elite (NOT Escape) is a good manual CPAP. The S9 AutoSet (NOT ESCAPE AUTO) is an Elite machine with Auto CPAP.

Be careful if the DME says it's an "S9 AUTO." You need "AutoSET."

PRS1 machines have the model name above or below the display.

S9 machines have the model name near the on/off button.

_________________
Machine: S9 AutoSet™ CPAP Machine
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Also SleepyHead, PRS1 Auto, Respironics Auto M series, Legacy Auto, and Legacy Plus
Please enter your equipment in your profile so we can help you.
Click here for information on the most common alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check for yourself.

Useful Links.

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Slinky
 
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Re: Does Dr. have to prescribe an auto cpap?

Postby Slinky on Wed Oct 12, 2011 8:54 am

Just tell them you really want and have your heart set on the pretty pink Resmed For Her PAP machine. :lol:

(Resmed just introduced the S9 AutoSet for Her which is pink instead of silver). RobySue is the one who suggested telling the DME you want the pretty pink Resmed PAP if you're female.

_________________
Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Additional Comments: PR SystemOne BPAP Auto w/Bi-Flex & Humidifier - EncorePro 2.2 Software - Contec CMS-50D+ Oximeter - Respironics EverFlo Q Concentrator
Women are Angels. And when someone breaks our wings, we simply continue to fly.....on a broomstick. We are flexible like that.
My computer says I need to upgrade my brain to be compatible with its new software.

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EO_123
 
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Re: Does Dr. have to prescribe an auto cpap?

Postby EO_123 on Wed Oct 12, 2011 7:14 pm

WalkingZombie - go for the pink one! And come back and post pictures!

The advice you are getting is all correct, I'm only chiming in because I went through this exact fight maybe 2 months ago. Janknitz's article was a huge help to me. Make sure you have read it. You may need to quote it to yourself to assure yourself the DME is crazy and not you.

First, your prescription does not have to say, However, if you can get your doctor to add auto to the script, it will be easier. I fired my first DME over this issue. The code for ALL cpap machines is e0601, The only thing that is a different code is a bipap, that's a much more complex machine, and much more expensive. Why does the code matter? Because all these machines are the same to your insurance company. It's true that the bottom line for the DME is the only factor between you and this machine.

One helpful thing that I did was compare prices of these machines based on the sponsors site. I printed out the machines I wanted with the cost, then I printed what they were offering me. I also looked at other cpap sites, the prices were VERY comparable. All in all, I did not find more than a $120 difference in the lowest ResMed Cpap and the highest (auto set) model. $120 bucks, that s basically what all the fuss is about. The DME cries like you are stealing their Christmas presents. I don't know why. But don't be afraid to show them you know how much the machines cost retail. Although their wholesale prices are different, it's illogical to think there is that much difference, or that wholesale is a higher cost than retail.... That's not how it works. And just in case they throw up "that price doesn't include the humidifier" that's fine, but every s9 uses the same humidifier, so the cost is the same....

One of the best reasons to want an auto pap is the future, you don't know how your needs will change, and another sleep study is more expensive than getting the right machine. I told my doctor - this machine means you will never have to guess about my care, and it doesn't cost me or my insurance a dime more.

Also, I would print the machine specs from the ResMed (or PR) site. Having manufacturer data and stats showing what a machine can and cannot do is powerful. They can't argue with the manufacturer. I also called ResMed several times during my saga to verify certain facts. And I told the DME "when I spoke with ResMed, they told me..... ". Believe me, when they see you have done your homework, it gets their attention. I do have a good DME now, so it is possible to get what you want. Keep up the good fight!

_________________
Machine: S9 AutoSet™ CPAP Machine
Mask: Profile Lite Gel Nasal CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: And sometimes Mirage FX for Her Nasal Mask
Just call me E0_601 ;)

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NightMonkey
 
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Re: Does Dr. have to prescribe an auto cpap?

Postby NightMonkey on Wed Oct 12, 2011 8:40 pm

Slinky wrote:Just tell them you really want and have your heart set on the pretty pink Resmed For Her PAP machine. :lol:

(Resmed just introduced the S9 AutoSet for Her which is pink instead of silver). RobySue is the one who suggested telling the DME you want the pretty pink Resmed PAP if you're female.



Cool: http://www.cpap.com/productpage/resmed- ... fier+.html


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