Let's clear up some misinformation

[NateS]

Why don't you take a rest for a moment from telling us what we already know about the unscrupulous practices of private health insurance companies, and instead give us a reference to the medical studies you claim you know of which have concluded that it is not medically necessary for physicians to monitor xPAP patients' sd card data as part of their reasonable standards of care of apnea patients.

I would like to see and read these studies, in reputable professional medical journals, which you claim knowledge of.

And since companies like ResMed state that their ResScan software has been developed and is distributed for use by physicians and related health care professionals, how do you reconcile that with your assertion that the medical profession has concluded that they don't need this information as part of their reasonable standard of care of apnea patients?

I can't post links here, but I would suggest you go to google and search on "autoset cpap studies" …

Don't pass the buck for us to do your research- back up what you have said.

I too am embarrassed by any rudeness directed toward you in the replies from some forum members, but you yourself came on in a combative mood and have to expect to receive varying reply styles.

You continue to dodge my questions. You tell me to look in cpaptalk's wiki to support your position, but there I find:

wiki/index.php/Category:CPAP_Machines#M ... guidelines

which not only does not support your position but contradicts it.

You feign medical knowledge of the standards of care of the medical community, but only defer to the opinions and actions of the very insurance industry which you disdain. Why can't you provide us with the answers to my two questions above?

I personally have no gripe with DMEs because mine has been straightforward, honest and helpful, but it should be no surprise to you that people in general tend to only voice opinions about negative experiences rather than positive ones. And we already know that the health insurance industry is a parasite and that we are virtually the only industrial society which does not provide universal health care. And that the net costs of administration of private health insurance is outrageously high compared to the administration of the allegedly "reviled" medicare system. But tell us something that we don't know but that you assert to be true. Tell us where doctors have said that they don't need the information provided by fully data capable xPAPs in order to effectively manage the care of their apnea patients. That's what you said - let us see it.

Come on, I think we are entitled to see the medical studies you claim exist which state that that it is not medically necessary for physicians to monitor xPAP patients' sd card data as part of their reasonable standard of care of apnea patients.

[Mr Bill]

There are definitely some billing differences.
My sleep studies were billed to Cover Colorado for $2500 each, two of them
Sleep study interpretation was billed at $600 each, two of them
When I was presented with the bill (I have a $5000 deductible) I pointed out I would be paying for it.
The sleep studies became $1600 each and the sleep study interpretations became $400 each. So my total cost that Dec 2010 was closer to $4000 plus the inital costs of the DME.

The DME bought my ASV new and told me it was $8750.00 which they would rent me via my insurance for $121/month. Well they made the assumption that my insurance was covering 80%. Long story short. Cover Colorado does not rent and was not paying any 80%. Six months later the DME was wanting back pay for $470/month but was willing to take $2000 cash in addition to the ~$800 I had paid already. Now I knew the new price in 2010 was $5800 at CPAP.com but it had dropped to $3800 because of the new model that had just come out which now had the $5800 price. Long story short my insurance (after I explained the situation) told me to tell the DME to rebill as of date of delivery for the full price. And they told me they would not pay the $5800 (at the time) if I bought it online, but to go through the DME. The DME rebilled and I am still waiting resolution.

[Mr Bill]

That said, I really like my local DME reps. The corporate guy said he would not have even be trying to deal with me if the local reps had not told him they really liked me. So, it pays to be friendly and polite to everybody you deal with and to make friends if you can. As it stands, the actual cost of my ASV is a complete mystery.

[Ltts]

You know I just checked out the wiki for this forum, and it suddently hit me - I have touched the third rail here. You've all been minsinformed to the point that you are trained to actually believe something that has absolutely NO basis in fact. That a DME provider is obligated to provide you with an Autoset at no additional charge.

You know what's so odd, though? This forum is rife with folks from all over the place each claiming their DME is lying to them when they tell them the truth that insurance payers don't cover that feature or consider it medically necessary.

Now common sense would tell you that these individual DME providers don't know each other. They haven't formed some giant conspiracy against you. Yet they are all saying the same thing.

At what point does common sense kick in and you start to figure out that maybe the DME isn't actually lying -- maybe you have been misinformed by some yahoo on the internet?

Seriously, no one has ever posted anything from an insurance payer that defines the minumum feature set you are entitled to as including autoset, have they? I know that has never happened because such a document does not exist (because it's simply NOT TRUE). Don't you find it strange that no one is able to post any objective evidence of this thing you believe you are entitled to? Wouldn't you love to have something like that if it was available so you could shake it in the face of the next DME providers that "lies" to you? Wouldn't it be great if someone could post a link to that here, so you wouldn't have to argue with DME providers anymore?

But alas, that proof doesn't exist because what you have been told is simply not true.

Now I am sorry that I disrupted your deeply held beliefs. When I originally posted I naively thought most people would appreciate some actual facts. I did not realize that this misinformation was something posters here had invested a lot of time in believing and were very, very, attached to. I truly apologize for bursting bubbles you hold so dear.

You are joking right?
You are suggesting we are indoctrinated? What? Like this is some kind of cult??

Nobody objected to your "facts".. We objected because you call Deluxe what SIMPLY SHOULDN'T BE CONSIDERED SO - Not buy the insurance companies, not by the manufacturers, and certainly not by DME's, who we have the most contact with.

Most complaints about DME's here are legitimate, because it's us end-users who are getting the raw end of the deal here..

Most users on this forum encourage fellow users to track data, why? because this has been _THE_ KEY to success with CPAP treatment.

Each of us finds this is true rather damn quickly without needing to be brainwashed. Have you considered the possibility, it may damn well be correct??

You are truly an idiot..

I've posted here at least a half a dozen times that "deluxe" is the term insurance companies use. It's NOT my term. Why can't you comprehend that simple fact after having been told that so many times? Similarly, I have posted probably a dozen times that I don't disagree that some patients that are savvy enough to make use of autoset might benefit from. I'm not sure why you can't digest that either.

The issue here is that your insurance payer is not convinced. And they make rules, not the DME provider. Some people's insurance doesn't include DME coverage at all. Is the evil DME provider also to blame for that. You're simply irrational on this subject.

I pity the DME that has to deal with you. I truly do.

[Ltts]

Why don't you take a rest for a moment from telling us what we already know about the unscrupulous practices of private health insurance companies, and instead give us a reference to the medical studies you claim you know of which have concluded that it is not medically necessary for physicians to monitor xPAP patients' sd card data as part of their reasonable standards of care of apnea patients.

I would like to see and read these studies, in reputable professional medical journals, which you claim knowledge of.

And since companies like ResMed state that their ResScan software has been developed and is distributed for use by physicians and related health care professionals, how do you reconcile that with your assertion that the medical profession has concluded that they don't need this information as part of their reasonable standard of care of apnea patients?

I can't post links here, but I would suggest you go to google and search on "autoset cpap studies" …

Don't pass the buck for us to do your research- back up what you have said.

I'm not going to create a log in and as a result I cannot post links. I didn't make that rule either. But anyone can find them by searching google. But I don't have a dog in this hunt, so I'm not sure why you expect me to do your research for you.

I DID NOT MAKE IN THE INSURANCE COMPANY RULES. YOUR DME PROVIDER DID NOT MAKE THE INSURANCE COMPANY RULES.

I'm simply suggesting to you that there are no persuasive studies that show autoset makes a medical difference in the treatment of OSA. The insurance company thinks you should follow-up with your physician periodically to determine if you need pressure changes.

Now by all means, if you can find some persuasive studies do send them to your insurance payer. But Not to me and not to your DME, because we don't make the rules. And it makes no difference if we agree with them or not.

I too am embarrassed by any rudeness directed toward you in the replies from some forum members, but you yourself came on in a combative mood and have to expect to receive varying reply styles.

You continue to dodge my questions. You tell me to look in cpaptalk's wiki to support your position, but there I find:

which not only does not support your position but contradicts it.

You feign medical knowledge of the standards of care of the medical community, but only defer to the opinions and actions of the very insurance industry which you disdain. Why can't you provide us with the answers to my two questions above?

I personally have no gripe with DMEs because mine has been straightforward, honest and helpful, but it should be no surprise to you that people in general tend to only voice opinions about negative experiences rather than positive ones. And we already know that the health insurance industry is a parasite and that we are virtually the only industrial society which does not provide universal health care. And that the net costs of administration of private health insurance is outrageously high compared to the administration of the allegedly "reviled" medicare system. But tell us something that we don't know but that you assert to be true. Tell us where doctors have said that they don't need the information provided by fully data capable xPAPs in order to effectively manage the care of their apnea patients. That's what you said - let us see it.

Come on, I think we are entitled to see the medical studies you claim exist which state that that it is not medically necessary for physicians to monitor xPAP patients' sd card data as part of their reasonable standard of care of apnea patients.

[NateS]

Why don't you take a rest for a moment from telling us what we already know about the unscrupulous practices of private health insurance companies, and instead give us a reference to the medical studies you claim you know of which have concluded that it is not medically necessary for physicians to monitor xPAP patients' sd card data as part of their reasonable standards of care of apnea patients.

I would like to see and read these studies, in reputable professional medical journals, which you claim knowledge of.

And since companies like ResMed state that their ResScan software has been developed and is distributed for use by physicians and related health care professionals, how do you reconcile that with your assertion that the medical profession has concluded that they don't need this information as part of their reasonable standard of care of apnea patients?

I can't post links here, but I would suggest you go to google and search on "autoset cpap studies" …

Don't pass the buck for us to do your research- back up what you have said.

I'm not going to create a log in and as a result I cannot post links. I didn't make that rule either. But anyone can find them by searching google. But I don't have a dog in this hunt, so I'm not sure why you expect me to do your research for you.

I DID NOT MAKE IN THE INSURANCE COMPANY RULES. YOUR DME PROVIDER DID NOT MAKE THE INSURANCE COMPANY RULES.

I'm simply suggesting to you that there are no persuasive studies that show autoset makes a medical difference in the treatment of OSA. The insurance company thinks you should follow-up with your physician periodically to determine if you need pressure changes.

Now by all means, if you can find some persuasive studies do send them to your insurance payer. But Not to me and not to your DME, because we don't make the rules. And it makes no difference if we agree with them or not.

I too am embarrassed by any rudeness directed toward you in the replies from some forum members, but you yourself came on in a combative mood and have to expect to receive varying reply styles.

You continue to dodge my questions. You tell me to look in cpaptalk's wiki to support your position, but there I find:

which not only does not support your position but contradicts it.

You feign medical knowledge of the standards of care of the medical community, but only defer to the opinions and actions of the very insurance industry which you disdain. Why can't you provide us with the answers to my two questions above?

I personally have no gripe with DMEs because mine has been straightforward, honest and helpful, but it should be no surprise to you that people in general tend to only voice opinions about negative experiences rather than positive ones. And we already know that the health insurance industry is a parasite and that we are virtually the only industrial society which does not provide universal health care. And that the net costs of administration of private health insurance is outrageously high compared to the administration of the allegedly "reviled" medicare system. But tell us something that we don't know but that you assert to be true. Tell us where doctors have said that they don't need the information provided by fully data capable xPAPs in order to effectively manage the care of their apnea patients. That's what you said - let us see it.

Come on, I think we are entitled to see the medical studies you claim exist which state that that it is not medically necessary for physicians to monitor xPAP patients' sd card data as part of their reasonable standard of care of apnea patients.

You don't have to post links - just give us the names of the medical journals, the titles of the articles, and the month/year and/or volume/issue and pages numbers.

[jnk]

Billing practices have nothing to do with whether AHI is useful or APAPs are useful. Why would a crutch-salesman's opinion on that matter more than a patient's? The lie occurs when DMEs reply that "insurance won't allow you to have that" instead of replying "we feel we won't make enough money if we give you what you are asking for."

It is the patient's job (hopefully with doc's help) to attempt to get a machine that will be most useful in therapy. It is worth fighting for. APAP and AHI play a vital role in that. And the OP is being dishonest, IMO, in implying that any patient that gets a machine with basic features like APAP and AHI-data has been given an undeserved gift by the DME. Most of the good DMEs I know of ONLY give out AHI-data machines and will give APAP (set to CPAP mode) unless the doc says no. I have heard owners of DMEs say that out loud to rooms full of patients and doctors at A.W.A.K.E. meetings, so I KNOW there are DME owners who think that way. I assume they were not advised by the OP of this thread.

Our position as patients is naturally different from the priorities of DMEs. They know what they want to give us and we know what we want to get. It is a shame that we have to even ask for something as basic as AHI-data. Good DMEs don't make you ask for it. It comes automatically. I agree that sometimes patients have to get their doctors to put "auto" and "AHI data" on the actual Rx in order to keep people like the OP from claiming that the patient is asking for something outlandish when they insist on basic features such as AHI data and autotitration.

DMEs are not qualified to give medical opinions to patients on which features are needed on their machines, so if the DME is uncooperative with a patient's wishes, that patient should by all means get a doctor involved. DMEs tend to listen to medical opinions expressed by doctors more than opinions of patients. In much the same way, patients should ignore any statements about PAP machines made by non-medical people, like DME crutch-salesmen.

I have found CPAP.com to be MUCH more helpful than the brain-damaged people at my local DME. What CPAP.com says is true. What the local DME said was not true.

My thoughts for fellow patients on this subject are found at the link next to my PM button. The following is from that location:

GET A FULL-DATA MACHINE: Your having a machine that can give you leak and apnea-hypopnea index (or, AHI) data will allow you and your medical team to make sure your therapy is as effective and comfortable as possible. Your local DME may not understand that concept (or may pretend not to, for financial reasons), so be sure to get a list of in-network DMEs from your insurance before you speak to any DME. That may allow you to push for a full-data machine, or perhaps allow you to shop around in the interests of fostering healthy competition among businesses. Some users have found it cheaper for them in the long run, and less frustrating, simply to buy their own equipment online instead of paying their insurance co-payments at local-DME prices. Some users have even found ways to get reimbursed from their insurance for online purchases.

GET THE RIGHT KIND OF MACHINE FOR YOU: Straight pressure as delivered by a regular continuous positive airway pressure machine (or, CPAP) does fine for most people with obstructive sleep apnea (or, OSA). But many have found great benefit in the use of an APAP (auto-adjusting machine), and many with high-pressure prescriptions (over 15 cm H2O, for example) have benefited from the use of a bilevel machine (also called Bi-PAP or VPAP). Machine users with a high number of significant central apneas may do better on specialized machines designed to deal with that problem.

If the OP has any suggestions for me for making the above more accurate, I would appreciate that critique.

[fiberfan]

This thread had 1 interesting result for me. I checked what my DME bills and what my insurance company and I pay. Though I occasionally run into some who isn't helpful, I like my DME. They are generally helpful and I have seen people receiving help with mask fitting issues which leads me to believe they want x-pap to work for patients.

It has been too long since I started with an apap machine to quickly find records that would show how much the DME received. I do, however, have info on the S9 VPAP Auto bi-level machine my insurance and I are currently renting to own.

I don't know what MSRP is on the S9 VPAP Auto but cpap.com sells it $1959. The DME is billing $365 a month, my insurance pays $246.38 and I pay $27.37 or $273.75. If the amount the insurance will pay is equivalent to 10 months rental I expect my DME will be paid $2737.50 for the machine.

I also checked a mask purchase from last spring - this was a Quattro FX. My DME billed the insurance company $270, my insurance paid $182.25 and I paid $20.25. That mask sells for $185 on cpap.com and my DME received $202.50.

One experience makes me think my DME is not losing money. When I asked them about the dishwasher safe humidifier chamber for the S9s, I was told they don't sell it because their cost to buy it is more than any insurance company's reimbursement rate. I bought one online a few days later after calling my old DME and finding out they don't carry the chamber either.

The only reason I changed DMEs was because my insurance changed. My cpap and bi-level prescriptions both required AHI and leak data so I don't know what machine the first DME would have provided if my prescription didn't require AHI and leak data. It was a moot point with the bilevel since I didn't want to buy a new humidifier and both isn't S9 VPAP bilevel machines have full data.

[jedimark]

You know I just checked out the wiki for this forum, and it suddently hit me - I have touched the third rail here. You've all been minsinformed to the point that you are trained to actually believe something that has absolutely NO basis in fact. That a DME provider is obligated to provide you with an Autoset at no additional charge.

You know what's so odd, though? This forum is rife with folks from all over the place each claiming their DME is lying to them when they tell them the truth that insurance payers don't cover that feature or consider it medically necessary.

Now common sense would tell you that these individual DME providers don't know each other. They haven't formed some giant conspiracy against you. Yet they are all saying the same thing.

At what point does common sense kick in and you start to figure out that maybe the DME isn't actually lying -- maybe you have been misinformed by some yahoo on the internet?

Seriously, no one has ever posted anything from an insurance payer that defines the minumum feature set you are entitled to as including autoset, have they? I know that has never happened because such a document does not exist (because it's simply NOT TRUE). Don't you find it strange that no one is able to post any objective evidence of this thing you believe you are entitled to? Wouldn't you love to have something like that if it was available so you could shake it in the face of the next DME providers that "lies" to you? Wouldn't it be great if someone could post a link to that here, so you wouldn't have to argue with DME providers anymore?

But alas, that proof doesn't exist because what you have been told is simply not true.

Now I am sorry that I disrupted your deeply held beliefs. When I originally posted I naively thought most people would appreciate some actual facts. I did not realize that this misinformation was something posters here had invested a lot of time in believing and were very, very, attached to. I truly apologize for bursting bubbles you hold so dear.

You are joking right?
You are suggesting we are indoctrinated? What? Like this is some kind of cult??

Nobody objected to your "facts".. We objected because you call Deluxe what SIMPLY SHOULDN'T BE CONSIDERED SO - Not buy the insurance companies, not by the manufacturers, and certainly not by DME's, who we have the most contact with.

Most complaints about DME's here are legitimate, because it's us end-users who are getting the raw end of the deal here..

Most users on this forum encourage fellow users to track data, why? because this has been _THE_ KEY to success with CPAP treatment.

Each of us finds this is true rather damn quickly without needing to be brainwashed. Have you considered the possibility, it may damn well be correct??

You are truly an idiot..

I've posted here at least a half a dozen times that "deluxe" is the term insurance companies use. It's NOT my term. Why can't you comprehend that simple fact after having been told that so many times? Similarly, I have posted probably a dozen times that I don't disagree that some patients that are savvy enough to make use of autoset might benefit from. I'm not sure why you can't digest that either.

The issue here is that your insurance payer is not convinced. And they make rules, not the DME provider. Some people's insurance doesn't include DME coverage at all. Is the evil DME provider also to blame for that. You're simply irrational on this subject.

I pity the DME that has to deal with you. I truly do.

READ what I said rather than going on like a headless chook.

Our gripe is with DME's offering these heaps of crap non data capable machines to us in the first place.
I'm not even talking about damn insurance companies.. You brought that up.. We really don't really care about your business side of crap.
It's DME's who are the ones who are providing the rubbish machines that don't provide adequate functionality.

If the insurance doesn't fully cover the difference for a machine that isn't rubbish, charge the extra.. No one is contesting that your right to do that ignoramus.

Being able to track data really does make that much of a difference to us!!!

We are requesting that people in a position such as yours consider data capabilities to be standard, not a deluxe feature.

The 80's wants these old crappy machines back.. (and it can have them)

Edit: I'm not even talking about the autoset.. It sucks (for you that) people always want the absolute best when it comes to medical treatment.. No-one is denying your right to charge extra for them.. No one is calling you greedy for doing so.. Your just being ignorant for not recognizing WHY they want them in the first place.. (because DME's supplied them with utter CRAP, and they didn't know they had a choice!)

[Goofproof]

Are this clown and Therapist related? Hmmmm...

LOL -- is there someone else here also trying to clear up some of the misinformation that is so consistently posted here? Apparently anyone who tries to provide actual facts from a professional perspective is unwanted here. That's quite odd. Most forums love having a person with actual knowledge of the questions they have show up on an internet forum and provide education.

In any case, as I have said over and over again, please don't take my word for it. My purpose here is to provide enough information to make folks understand what they may not be aware of, and can then verify with their individual insurance provider. You can't verify if you don't know what you don't know.

EVEN A BROKEN CLOCK IS RIGHT TWICE A DAY, UNLESS IT'S A SUN DIAL. DME's seldom get to that level of training. Jim

A DME should be trained to throw their voice, then maybe it wouldn't be as easy to catch them in a lie. Lips moving are a dead giveaway.

[BlackSpinner]

I don't understand the reference to "french" Canada and Australia? It seems the problems with DMEs must be universal and not only affecting the US?

Yes it is universal! stupidity , ignorance and arrogance of the DME's crosses all boundaries. "No it is not leaking into your eyes, your mask fits " from across a desk while I hold the mask up, the mask only mind you. That and of the 1/2 hour appointment 20 minutes was to fill in forms and that was without any insurance being involved! Great service, I haven't heard from in 2 years.

[portiemom]

Just to clarify my "Simple Question needs a Simple Answer" My Primary Care Physician wrote my Rx for the machine I asked her do write it for. I went back to the DME that 8 years ago issued me my first Cpap machine, they in turn asked me for a copy of my sleep study, which they first called my PCP to get, she in turn called me to let me know they requested it. Mad as hell I called my insurance company and told them I refused to give a DME my medical information (sleep study) at which time they asked me what the RX read, I got an approval from my insurance company right then for that machine, they logged it on their computer that it was approved, shot the approval to the DME and I was set up with a delivery date, so NO I DID NOT GET A FREE UPGRADE. Still the insurance company would NOT tell me their allowable payment to the DME, and the DME who distributes loads of that machine paid for by my insurance company to customers and just to let you know I work for the city and loads of us have the same insurance and use the same equipment. SO PLEASE STOP TRYING TO JUSTIFY THE FACT THAT MY INSURANCE COMPANY AND MY DME DISTRIBUTOR ARE NOT TRYING TO SNOW ME!!!! I am from NYC, AND OLD ENOUGH TO REMEMBER WHAT A SNOW IS AND WHEN I AM IN THE MIDDLE OF A "SNOWJOB!!!

[BlackSpinner]

[
Okay, let's use a little analogy. Let's say you're sick and you need to be admitted to the hospital. Your insurance only covers a semi-private room, but somone on the internet told you (while providing no proof whatsoever) that you were entitled to a private room, and the hospital can't charge you any extra for that.

Oh stop comparing apples to squid. AHI data is not comparable to a private room or a camoe coloured wheelchair. It is more like expecting a real bed in a room and not a gurney in the corridor.

[RocketGirl]

I've been doing a little reading and research on DME "Consultants" as ltts states he/she is.

It's an interesting read. I invite anyone interested to simply google "DME consultants" and see what pops up.

It seems that one of the main things these firms do is help DMEs to maximize their profits. (No surprise, really, otherwise why would anyone hire a consultant to help their business?)

So... ltts is here trying very hard here to get patients to stop insisting on machines that actually help improve therapy, which is completely consistent with his vested business interest in the matter.

He has, I see, bulldozed into several threads here for that purpose.

All the while, ltts's google hits are going up because every post gets him a new one.

Folks - we're being used.

[BlackSpinner]

I've been doing a little reading and research on DME "Consultants" as ltts states he/she is.

It's an interesting read. I invite anyone interested to simply google "DME consultants" and see what pops up.

It seems that one of the main things these firms do is help DMEs to maximize their profits. (No surprise, really, otherwise why would anyone hire a consultant to help their business?)

So... ltts is here trying very hard here to get patients to stop insisting on machines that actually help improve therapy, which is completely consistent with his vested business interest in the matter.

He has, I see, bulldozed into several threads here for that purpose.

All the while, ltts's google hits are going up because every post gets him a new one.

Folks - we're being used.

Not to worry - he won't name his company so google is no help to him. Besides the pimp has had so much flack he looks like an idiot.