"Going it alone" if I need to?

[jonny515]

Hi and thanks for all the good help feedback so far.
I wanted to ask if it is possible for a newbie like myself to just get a prescription from his PHCP and buy, say online, if I need to.
Maybe my "all in one place" will be nice and reasonable and prescribe a good machine. But what if otherwise. I know some of you do buy machines, masks, etc. from cpap.com, but what about a newbie? Will I be able to figure out what to do with it and so forth, since I have never used one.

Thanks.

[grayghost4]

Going it alone .... that is what we have all done ... most DME's just hand you the machine and wish you good luck (and many DR's do the same). That is why We are all here to help each-other.

[Sir NoddinOff]

Give the one-stop-shop a try and if it doesn't work then we will always be here to help you.

STLmark, Grayghost and grandpap plus a few others sell lightly used machines a very good prices. They are all trusted. Grayghost has some available now.

EDIT: Wow, Grayghost beat me to the punch by one minute. I guess he's really on the ball.

[jonny515]

I'm gathering my insurance will cover it, unless, of course, I am going to be hit with some godawful deductible, since it's the beginning of the year.

[grayghost4]

how about this one for $500 :

http://sfbay.craigslist.org/eby/hab/5376781629.html

[Pugsy]

Are you talking about going it alone for just the equipment supply needs or the whole DIY thing of diagnosing, etc?

If there is already a confirmed diagnosis from a sleep study and all you are wanting is the cpap equipment and you want to purchase it online or privately....it isn't all that hard to figure out how to use the various machines or masks. Lots of videos available for explaining the features of the machines and how to fit the various masks.
Might be a little more trial and error involved but it isn't rocket science. I bought my machine privately and figured out how to use it pretty easily. Now I already had completed the in lab sleep study for diagnosis and another for desired pressure and I did follow up with my sleep doc within the required (for my insurance) 90 days so that I could use my insurance for masks and the sleep doc was okay with my results. Doctors don't care where you get the machine or equipment...they just want to make sure that it is working. Unless maybe the doc owns the machine equipment supply business and your buying the machine elsewhere means he loses potential income (which is illegal practice anyway for some insurances for the doctor to have a financial interest in where you buy your equipment).

So I use a DME for masks only since I don't have a big deductible for masks. Figure I might as well get my one cpap mask every 6 months through insurance so I can save some money. If I had a really high deductible I would buy all my equipment privately because DME prices even when reduced to allowable per insurance rates are often way higher than buying online.

But it wasn't difficult at all to figure out how to use the machine (set it up to whatever settings were advised) since I bought my machine outside a DME source. That part is really super easy. Mask fitting can be more trial and error but that can happen even when using a DME source.

[jonny515]

Several questions I didn't clarify. I tried to put comments in my user profile but they don't come up when I post.
I have a confirmed dx of moderate OSA. I have the titration study this Sunday (no, not a mistype!). I am in this "one stop type sleep clinic", but I know I didn't sign in my life away. So far, good experience and my insurance has paid 100% of sleep studies.

So it's just DIY with equipment. I am not at all sure re: the beginning of the year deductible thing. Otherwise the insurance pays 80%. The insurance mentions equipment from Remedics, Respironics, etc. but no specific models (at least in the stuff I could find).

Okay it all seems overwhelming. Thanks for very good posts.

Are you talking about going it alone for just the equipment supply needs or the whole DIY thing of diagnosing, etc?

If there is already a confirmed diagnosis from a sleep study and all you are wanting is the cpap equipment and you want to purchase it online or privately....it isn't all that hard to figure out how to use the various machines or masks. Lots of videos available for explaining the features of the machines and how to fit the various masks.
Might be a little more trial and error involved but it isn't rocket science. I bought my machine privately and figured out how to use it pretty easily. Now I already had completed the in lab sleep study for diagnosis and another for desired pressure and I did follow up with my sleep doc within the required (for my insurance) 90 days so that I could use my insurance for masks and the sleep doc was okay with my results. Doctors don't care where you get the machine or equipment...they just want to make sure that it is working. Unless maybe the doc owns the machine equipment supply business and your buying the machine elsewhere means he loses potential income (which is illegal practice anyway for some insurances for the doctor to have a financial interest in where you buy your equipment).

So I use a DME for masks only since I don't have a big deductible for masks. Figure I might as well get my one cpap mask every 6 months through insurance so I can save some money. If I had a really high deductible I would buy all my equipment privately because DME prices even when reduced to allowable per insurance rates are often way higher than buying online.

But it wasn't difficult at all to figure out how to use the machine (set it up to whatever settings were advised) since I bought my machine outside a DME source. That part is really super easy. Mask fitting can be more trial and error but that can happen even when using a DME source.

[Pugsy]

All this can be overwhelming for sure but it won't take you long to get up to speed on things.

First of all check with your insurance to see what the deductible would be for this equipment for the new year.
It all depends on your plan and what counts towards your deductible or isn't covered until the deductible is met.
Also factor in any chance of your needing that deductible to be met for other health issues.
Meaning even if you had to pay totally out of pocket for your equipment using insurance and those allowable amounts being applied to your deductible will help offset other potential health related expenses later.

Bear in mind that when insurance is involved that the actual cost (and thus the amount that counts toward your deductible) aren't always what is billed out initially by DMEs for this equipment. Most often there is a substantial reduction between billed amount and actual amount allowed and the DME has to write off the difference.

Example....DME might bill out the machine and humidifier at $2500 but your insurance might only allow $1500 so you would only be responsible for the allowed $1500 and if you had a deductible of $1500 then your deductible would be met for the rest of the year. The $1000 difference gets written off.
What's hard is find out exactly what the insurance will actually allow for this stuff ahead of time.
Then you do the math and try to figure out if you would be money ahead to just go ahead and meet the deductible and have subsequent medical care and supplies covered per your contract or risk maybe having to meet it later. If you are basically healthy without other health issues and your chances of meeting your deductible or needing to is slim...you probably will be money ahead to buy out of pocket and not use your insurance. So a lot of it depends on if your deductible is on the low end or high end and your overall health and risk of needing something expensive later or not.

Make sure you know the brand and model of the machine that the sleep center wants to dispense...and the final cost to you (that allowable amount) and then do the math.
Make sure the model is a full efficacy data model....if unsure about that part come here and tell us the model name or number and we can tell you. Sometimes the sleep centers will dispense the most basic of machines that don't offer data because if you have problems they get to tell you "let's do another sleep study" instead of reviewing the data to see if anything there points to a potential problem. They make more money with more sleep studies.
Sometimes sleep centers will do the right thing for the patient though and not what makes them more money and will dispense full efficacy data machines right from the start.
DMEs and sleep centers don't always dispense the el cheapo bricks...some actually will do it right with the patient in mind first.

If your deductible is high (say 2500 or more) and you are basically healthy then you would most likely save money by buying out of pocket. The machine is the most expensive item anyway and masks can be purchased from places like cpap.com with either free return insurance or return insurance for a nominal fee so that if you hate the mask you can return it and get your money back. So there are ways to minimize annual costs that don't come near a high deductible. Now if your deductible is under $1000....I would probably say use the insurance as long as you get a good machine out of the deal. In between 1000 and 2500 is where the deductible vs out of pocket takes more thought (at least it would for me).

There are pros and cons to both ways...you just have to weigh each to figure out which suits your needs the best. A sleep center/DME would probably furnish you with a loaner machine if your machine failed under warranty...online machine retailers can't do that for free but it's part of the risk we assume when we save money up front on the cost of the machine.

Mask trial experiments have the potential to be the most costly investment but even when paying totally out of pocket there are ways to minimize that cost....either using the return insurance available or maybe just getting a mask from a forum member...if slight used doesn't freak you out, often you can find a good experiment mask for next to nothing here...then if you really hate it then you aren't how much money.
If you love it then you can buy a brand new one and know it will work well for you.
That's how I tried all the masks that I tried during my first 6 months of therapy...I either got one for free from a forum member (I paid the postage) or for a small fee for a gently used mask....then if I hated it I passed the deal along to someone else who wanted to experiment but not at full price. I probably tried 10 masks during my first 6 months of therapy..not because I hated my original mask but because I just wanted to try something else (it's how I am still yet) but I couldn't afford full price and my insurance only allowed 1 per 6 months.
I bet I spent a total less than $100 including postage for those 10 masks and I learned a lot about my own personal preferences in the process.

Machine filters...buy them in bulk online...lots cheaper.

Comfort items...wait till you see if you even need or want an additional comfort item...like hose cozies or mask liners or hose management systems.

There ware ways to save money even without using insurance with all this stuff.

[Pesser]

If I have know just how good the people of this forum are I would never have gone in to see a DME.

[nanwilson]

Jonny
I do this on my own too, if it wasn't for the great folks on this forum I would have failed miserably. I was sold a brick as I had no insurance almost 6 years ago, it cost me $1500 and included a mask. With the help of this group I then bought a used M series auto for $60 from one of the members, and got most of my masks via trading or from CPAP.COM. When My M series died I bought a brand new Respironics 60 series auto for $1000......,... what a big difference... $1500 for a brick and a mask from my local DME or $1000 for a super machine from an online supplier Since I could not buy my new machine from CPAP.COM, (I am in Canada) I had to go to a Canadian supplier, but as far as I am concerned I won! I have yet to hear from the original DME to even ask how I was doing or to sell me anything else and that original cpap was from a *one stop shop* too. I guess they figured they sold me a machine at inflated priced, so didn't have to follow up to even see if I was still alive or not.
As you can see, if you have to purchase your equipment on your own the guys and gals on this forum will do their best to help you succeed. There are many of us here that had to go the same route with help from others, but we are the winners as we are all successful hosers .
Cheers and good luck
Nan

[mikejerome]

I am self-diagnosed, and set up my pressures myself (started with a wide range of pressures and narrowed down after reviewing my data). I purchased a machine off of amazon and read up on the forums to figure everything out. I also read the manuals for my machine. I have several family members with sleep apnea that spent $5,000+ for sleep study and machine. You can also get a home sleep study done for a few hundred dollars. I just bought the machine and with the help of others was able to get everything working and now I'm sleeping great. Of course this is not for everyone, but it worked for me.

You will be able to buy the machine without a prescription but when you order masks and stuff I'm pretty sure you need to purchase the pieces individually as 'replacement parts'. I'm not 100% sure on this as I got my masks from a family member.