Can I buy my own CPAP machine? (USA)

LinkC wrote:On the other hand, the vast majority of OSA patients use "dumb" machines, don't track their results and do just fine. Perhaps with tweaking they could do a bit better, but the difference isn't worth the effort for them. Don't feel guilty if you choose the easy way.

Thanks, Link, I appreciate that. Honestly, I am mostly concerned with saving money. I don't want to end up paying more for a "dumb" machine than I would if I just bought a smart one outright. I dont know if I will go for a smart one, but it would be nice to have the OPTION of the data if I had problems with therapy. On the other hand, if the doctor can tell me how to adjust it to get a better result, I don't mind that, either. I'm not really sure at this point, just trying to cover my bases!

LinkC wrote:On the other hand, the vast majority of OSA patients use "dumb" machines, don't track their results and do just fine. Perhaps with tweaking they could do a bit better, but the difference isn't worth the effort for them. Don't feel guilty if you choose the easy way.

Good point. We tend to berate DMEs so much for giving out dumb machines that we forget that someone who has PSG+titration+dumb CPAP with no tweaking is usually a whole lot better than an untreated apneac.

FINALLY got ahold of my doctor's office (amazing what pushing random buttons will do). They said that THEY actually do bill the CPAP and everything, they use their Tax ID number with the insurance, that's just the way they are able to do it with the particular insurance that I have.

I asked if I could return it and get my own and have the company contact them for an Rx and they said yes, they would work with me on that if I wanted to get my own, they just recommended I check with the insurance company to make sure that's OK.

They said that their monthly billing amount on the rental would be $130, so if I "assume" that that's the allowed amount by my insurance and I am paying 15%, it would be $19.80/mo for 9 months and then $350 in january because of my deductible. then i would own it after 10 months. so i would end up paying $528.20 for a machine that i could get for $399 online? or, if i use the out of network benefits, that i could get for $139.65 online? i think not!

I totally forgot to ask if i could just exchange it for a better machine and rent a better one from them...i wonder if it's even worth asking or if i should just go ahead and pick out the one i want online, order it, and get this going without having to deal with the doctor's office at all...

the doctor's office is telling me I can't get an auto-CPAP without a different prescription- that I would have to talk to the doctor about that. But that if i ordered one that just had more data capabilities, that wouldn't be a problem because it would be the same prescription.

Sara, I think it's that they don't want to give you a substantially better machine if they don't have to.
I just looked at cpap.com and you can get an S9 autoset for about $850, the humidifier is another $250 (these are round numbers). Total $1100, which falls within your insurance cap. Your 35% is $385. So -that's better than buying the $399 machine outright.
You need to ask them what the rental would be on this machine so you can do your co pay figures. Your annual detuctible is kind of a wild card since you have to pay it anyway.
You need to call cpap. com and ask if you can buy the autoset without an RX that specifically states that.
You need to know that most any doctor, even your dentist I think, can write a presciption for apap/cpap. So you have other alternatives.
You also need to know that many people have positional apnea meaning that when sleeping on your back for instance the incidence of apnea is greater. An auto machine is quite helpful under that condition.
You need to know that your Doctor is still going to make money even if you get the top of the line machine - just not as much.
I think your getting close. The answer is not clear to me because I don't know exacty how your insurance works, but I think you are getting close to being able to make an informed deciscion.
Hang in there and keep asking questions.
Jay

Jay Aitchsee wrote:Sara, I think it's that they don't want to give you a substantially better machine if they don't have to.
I just looked at cpap.com and you can get an S9 autoset for about $850, the humidifier is another $250 (these are round numbers). Total $1100, which falls within your insurance cap. Your 35% is $385. So -that's better than buying the $399 machine outright.
You need to ask them what the rental would be on this machine so you can do your co pay figures. Your annual detuctible is kind of a wild card since you have to pay it anyway.
You need to call cpap. com and ask if you can buy the autoset without an RX that specifically states that.
You need to know that most any doctor, even your dentist I think, can write a presciption for apap/cpap. So you have other alternatives.
You also need to know that many people have positional apnea meaning that when sleeping on your back for instance the incidence of apnea is greater. An auto machine is quite helpful under that condition.
You need to know that your Doctor is still going to make money even if you get the top of the line machine - just not as much.
I think your getting close. The answer is not clear to me because I don't know exacty how your insurance works, but I think you are getting close to being able to make an informed deciscion.
Hang in there and keep asking questions.
Jay

I called cpap.com and they said that they can get me an auto set one even if the prespription is just for a "CPAP device" in general.
If the doctor has a problem giving me that Rx, I am sure my psychiatrist could do it.

I am wary of getting one with a separate humidifier because I travel a lot for work and it seems like that's just one more thing i have to carry. Are there any that are good with built in humidifiers?

sarajane82 wrote: I am wary of getting one with a separate humidifier because I travel a lot for work and it seems like that's just one more thing i have to carry. Are there any that are good with built in humidifiers?

A humidifier is a "comfort" addition & I believe you would regret not getting one.

You could just leave the humidifier at home when you travel.

The travel case for CPAPs allows for including the humidifier & you would not have "one more thing to carry".

are there any good ones that do have the humidifier integrated? i am looking at the options and even when i filter down to built in humidifiers it shows me CPAPs where you have to buy the humidifier separately.

also, i believe a separate humidifier would be a different insurance code and i would need to figure out what the allowed amount would be on that.

would it be a bad idea to buy a travel sized one for home use?

i wish this didnt have to be so confusing!

I also responded in your other thread so will only mention this regarding the size of the units and traveling.
They aren't large at all. Humidifier and cpap machine hooked together (once attached no need to take them apart) are about the size of a large novel.
I use PR S1 and it is roughly 10 " long by 7" wide and 4 " tall. This is the combined measurement of both units.
I think ResMed may be a wee bit smaller, not sure as I have not seen one.

Thanks to everyone who responded on this thread and the other one I started. I finally "settled" on the S9 Auto Set and humidifier. I can't wait to get it. If my insurance comes back with some BS about not paying for it, I am going to be PI$$ED!!! But according to the conversations I've had with them today, I should be all set. Fingers crossed!

I think the only way I would skip the humidifier is if I live in one of those places where the humidity never got below 80 percent.

Really impressed! Everything is very, very clear, open is a description of the problem. It contains the information.

purple wrote:I think the only way I would skip the humidifier is if I live in one of those places where the humidity never got below 80 percent.

Well, I DO live in Georgia and it's pretty humid a lot of the time, but I also have tons of sinus issues and I can't imagine what it would be like to use one without the humidifier!!

The last couple machines I bought from CRAIGslist both were under $75. some people buy them and never use them.

OK, of course now I am getting the runaround from the doctor's office. I called yesterday and they claimed that they hadn't received the Rx request from cpap.com, so I had them send the request again, this time to the attention of the CPAP department woman. I got an email today saying cpap.com STILL hasn't received the Rx. I called the office and no one in that department is in today and my doctor is on vacation until Tuesday. OK, so maybe I will give them the benefit of the doubt and assume that they received the fax and are holding it till my doctor returns on Tuesday.

In the meantime, I searched craigslist and as of now, the only ones being sold in my area are priced higher than I would end up paying once my insurance pays its out of network benefits. Has anyone else had luck buying from craigslist? DH says he is hesitant about buying something like this used or even semi-used, but I don't see an issue with it...what do you all think?

Also, am I correct in assuming that ebay won't let people list CPAPs on their site? Cause I searched there and found nothing but accessories and I can't believe that there wouldn't be ONE person selling the actual machine...