Newbie feeling steamrolled

[districtsleepy]

Hello everyone! I was just diagnosed with sleep apnea. Apparently, my doctor called SleepMed Therapy and ordered me a ResMed Air Sense 10 without first consulting with me whether (1) this DME worked with my insurance or (2) I wanted this machine. I only found out when the rep called me to schedule an appointment for orientation. I called my insurance (Aetna) and this DME is *not* covered by my insurance, and from even cursory reading of this forum it sounds like the Air Sense 10 is a "brick".

How can I take control of this process back? It's hard for me to say "I don't want the Air Sense, I want X instead" when I don't know what X I should be asking for. What machine should I ask for? And I looked on the websites of the DMEs, most of them didn't even list the brands they supported. (Ones that were listed, if helpful, and may not be comprehensive: Airsense AutoSet, ResMed S9, Fisher & Paycal ICON Auto, and REMStar -- there may also be others).

Help/advice would be appreciated! Thanks!

[palerider]

Hello everyone! I was just diagnosed with sleep apnea. Apparently, my doctor called SleepMed Therapy and ordered me a ResMed Air Sense 10 without first consulting with me whether (1) this DME worked with my insurance or (2) I wanted this machine. I only found out when the rep called me to schedule an appointment for orientation. I called my insurance (Aetna) and this DME is *not* covered by my insurance, and from even cursory reading of this forum it sounds like the Air Sense 10 is a "brick".

How can I take control of this process back? It's hard for me to say "I don't want the Air Sense, I want X instead" when I don't know what X I should be asking for. What machine should I ask for? And I looked on the websites of the DMEs, most of them didn't even list the brands they supported. (Ones that were listed, if helpful, and may not be comprehensive: Airsense AutoSet, ResMed S9, Fisher & Paycal ICON Auto, and REMStar -- there may also be others).

Help/advice would be appreciated! Thanks!

there are four airsense 10 models, one, the CPAP model, is a brick, the Elite, Autoset and Autoset for her are not bricks.

things to avoid: anything with "plus" in the name from respironics (remstar is one of the many names they slap on things), CPAP, escape, escape auto from resmed. those are the two best lines of equipment. F&P will require a bit more research on your part, should you want to go there.

go here, avoid anything that has a NO under data: https://sleep.tnet.com/equipment/cpapmachines

[JDS74]

First things first. Call the DME and tell them that your insurance does not cover working with them and you are so sorry but you are unable to take the machine. No need to be nasty, your lack of coverage for them is not their fault, just a misunderstanding at the doctor's office.

Second, call Aetna back and get a list of DME's that they do accept and see what models they can supply. Be specific as to full data machines that can provide details of the therapy such as AHI, reporting of central apneas, pressure changes if in auto mode, etc. If you can find one that will automatically give you an auto machine even with a single pressure prescription ( auto machines can be set to single pressures ), select that DME.

Third, call your doctor's office and tell them the same insurance coverage story and that you would like the DME you selected to be the one they send the prescription to. Also ask for a copy of the prescription for your personal records as well as a copy of the sleep study and titration study, also for your personal records.

Learn to smile when you speak to these folks as there will be bumps in the road and acting upset doesn't often move the game forward.

[chunkyfrog]

Smile big; and they tend to fall right in.

[Cardsfan]

Also, call your Dr. office and explain to them their DME is not in your network. I had the exact same thing happen to me. It sounds like you have things under control.

I would call a couple of DME's in your network. You can tell a lot over the phone what kind of service they are going to give you.

[Sleeprider]

All good advise above. You should contact your doctor's office and obtain a written copy of your prescription for your records and use. You can use this not only for the current machine, but for future supplies, and to establish an account at places like CPAP.com. Aetna has the lists of DME providers online, and some Aetna policies have DME administered by a second management company called DMEnsion.com. You can call the insurer and find out who manages DME for your policy, or if it is directly by Aetna, obtain the URL or an email with local DME options.

The Resmed Airsense 10 Autoset and Autoset for her are highly regarded machines. It's all in the model as described by Palerider above. For Philips Respironics, either the older System One 60 series Auto or current DreamStation Auto would be ideal. It's beginning to look like Sleepyhead will be catching up to the Dreamstation pretty soon.

Good luck!

[jonny515]

I just talked to my DME* (1.5 rating on Google-- way to go guys!!!) and got the same idea of steamrolling actually. OTOH, it's a Resmed Airsense 10 Auto so I don't think I'll object. I asked re: Dreamstation. They don't appear to like them. The reason they gave me was that they change the settings on the airsense remotely which they can't do with the Respironics. I don't know if this makes any sense-- I mean I know what he was saying but don't know if it true. Though,I can see if I don't have to deal with them in real life it might be an advantage.

But this is a good machine, so...

*The sleep clinic said Apria Health was so much worse.

[flightco]

I went about this a slightly different way, I called the DME my Dr. sent me to (conveniently in the same building) and found out they did not handle ResMed. Got ahold of my ins and had them send me a list of DME's, Called around to find out who handled Resmed and who had them in stock. I made my decision based on who was the most helpful on the phone; once I chose, I called back and asked them to call my sleep Dr and get my prescription which they were happy to do. When I went to their office they tried to give me the same unit yours wanted to give you, I told them it was not acceptable and what I wanted. They said this was on my script; I told them it was a deal breaker and I would talk to my Dr and if he refused I would find another Dr. 20 minutes later I walked out with a ResMed Airsense 10 AutoSet.

It is your health, you need to have the attitude that they work for you and are part of your care team.

[ChicagoGranny]

they change the settings on the airsense remotely

No one changes my settings but me. Neither remotely nor locally.

[OkyDoky]

they change the settings on the airsense remotely

No one changes my settings but me. Neither remotely nor locally.

That's my main complaint about about these monitoring features, because if we educate ourselves and feel the need to change the settings they can change them back without notifying us. They sell this to us as if it is a benefit and maybe for uneducated users it is a benefit but not for the rest of us. You may have to put up with this during the compliance period but I would freely use the airplane mode so changes can't be made without you knowing they are doing it.

[palerider]

they change the settings on the airsense remotely

No one changes my settings but me. Neither remotely nor locally.

That's my main complaint about about these monitoring features, because if we educate ourselves and feel the need to change the settings they can change them back without notifying us. They sell this to us as if it is a benefit and maybe for uneducated users it is a benefit but not for the rest of us. You may have to put up with this during the compliance period but I would freely use the airplane mode so changes can't be made without you knowing they are doing it.

you can always use tatooed lady's method... call 'em up and tell 'em if they ever do it again, she'll come down there and hurt someone. it's worked for her for the last year and a half

[Sir NoddinOff]

districtsleepy : I wish all newbies would be as sharp as you are... way to go!

[districtsleepy]

Thanks for all of the advice, everyone! I'm going to make a bunch of calls tomorrow!

[jonny515]

Good advise from everybody. I think all this remote monitoring stuff is, well for lack of a better word, creepy, Big Brotherish (or is that Big Insurance.