PR S1 Series 60 Auto v Resmed unit

[jasont]

I did not find this board and all the resources available until after encountering problems with my DME (like many people, I suspect), and now I'm attempting to rectify some concerns with my DME issued machine.

I'm using employer insurance from UnitedHealthcare (UHC) and my DME provider Rotech has provided me a PR S1 Series 60 Auto w/ humidifier on a 13 month capped rental (after a half dozen calls it is still unclear to me whether UHC only pays for capped rentals or if there is any purchase option available to accelerate all the payments into this calendar year). I like the PR S1; however, I was issued a unit with over 1800 hours of prior use and Rotech refuses to exchange it for a new unit stating 'you get whatever is available'. There is an annoying, but slight, high-pitched squeal I hear at night that might be bearing noise - or might just be normal sound of use, but I don't know since my unit isn't new.

Another local DME (Lincare, who I wish I had found earlier) only provides new equipment and is in-network for my plan, but it is still unclear to me (after the half dozen calls to UHC) how switching now will affect my benefit allowance since Rotech already billed the first month of capped rental, has charged for the humidifier in full, etc. etc.

While I was trying to get Rotech to issue a new machine I discovered I need a heated tube to prevent rainout, so my MD issued a new prescription calling for such. Now my question:

Rotech does not have any PR S1 Auto's available with the heated tube humidifier right now, so they have me scheduled to come in this Tuesday to get a Resmed unit. No idea yet which model, but I suspect it will be a S9 Auto or Airsense 10 Auto. I will do my best to fight for a new unit and if I get one, all is good - I suspect I will be perfectly happy with either an S9 or Airsense 10. If unsuccessful at getting anything other than a new unit, I will continue my fight to switch to Lincare.

If Lincare gives me the option of a PR S1 60 Auto or Resmed (S9 Auto or Airsense 10 auto) is there one you would choose over the other. If so, why?

If Lincare does not work out to be a viable financial solution, I will likely just buy a machine outright. A brand new PR S1 Auto with Heated tube humidifier is on Amazon right now for only $459 - about half the price of a new Resmed unit. If Resmed was your recommendation above, would you switch to the PR S1 given that price difference if you had to buy your own?

Thanks in advance for all the great knowledge sharing from the forum members.

[Cardsfan]

get your heated tube from Lincare. Then ask Lincare to help you get switched to them.

[LSAT]

You absolutely should get a new unit....Let your insurance company know...Even with a capped rental you deserve a new unit. They are charging insurance for a new unit.

[jasont]

You absolutely should get a new unit....Let your insurance company know...Even with a capped rental you deserve a new unit. They are charging insurance for a new unit.

I completely agree I should get a new unit, but apparently this is common practice. I've told UnitedHealthcare and they say they "agree" I should get new equipment, but they will pay the benefits regardless. I have fought this enough the past week to conclude it's legal for the DME to do this, although we can all agree it smells like a load of horsesh*t...

Hopefully I will get a new unit from Rotech on Thursday - but, if not, the question remains: if I go Lincare should I get PR S1 or Resmed...and if I go pay out of pocket does it change that recommendation since the PR S1 is so much cheaper?

[M'ohms]

I have UHC too. After being told that I needed to do a 13 month capped rental, I contacted UHC and asked if I could do an outright purchase instead. I was told that I could. I went back to my DME and gave them this information and asked them to resubmit the claim to read purchase only (as per UHC's instructions). The DME did this and any rental money collected was applied to the purchase price, and I did not have to straddle 2 years' of deductibles. I did this with 3 machines and an oxygen concentrator. It was the cheapest way to pay for my equipment, especially since my deductibles had been met. Even so, I would still only have to pay the insurance negotiated rate, which in my case was still cheaper than buying outside of insurance. I will do all my future purchases the same way. Good luck!

[jasont]

What's maddening is that I am getting different answers almost every time I call UHC. I'm even telling each UHC rep that I am documenting the names and time for each call so that I hopefully don't get flippant answers. I've also asked for my Evidence of Coverage, which supposedly has to be mailed to me.

I have had two separate UHC staffers tell me that my UHC plan requires 13 month capped rentals, no purchase option period.

I have also spoken to two separate "DME claims specialists" who each claimed that the options of 13 month capped rental vs purchase is dictated my the individual contract UHC signed with each DME provider and that they (the claim specialists) have no way of telling me whether any of the three DME providers can submit a purchase claim or if they all have capped rentals only - which is, of course, bullsh*t since the only way they would know as a "claims specialist" whether they should pay a purchase claim would be to know the details of those contracts. The claim specialists said the only way I could find out if purchase options were available was to ask each individual DME provider - and we know you cannot trust DME provider answers.

This is all a game designed to make us - the end user - either just take what they want to give us and pay "our share" or to go outside of insurance on our own. My time is more valuable than endlessly chasing UHC and Rotech around, which leads me back to my question of which machine to request from Lincare or to buy on my own. (although I still hope for a new machine from Rotech this coming week)

The fact that no one has talked up one machine so far over the others implies to me that they are fairly evenly matched and all should work for me.

[Pugsy]

I have owned both brands of your machine and even the older M series Respironics.

Got the first PR System One 50 series Auto...no heated hose.
Then got a ResMed S9 with heated hose...love it.
Then got a PR S1 60 series auto and added the upgrade kit for the heated hose because it didn't come with one..
There are very minor differences between the 2 heated hose capable machines and I personally don't think they are deal breakers.

If your machine is a 60 series machine already you don't have to get an entirely new machine to add the heated hose but you do need a differently power supply, along with the heated hose and a special lid that has electric available for heating.
That said...I would still push for real new machine and not 1800 hour machine if at all possible. What they did is legal....bit it stinks. You ca bet that you and your insurance were charged full price of new and you didn't get a "used" discount.

Oh....if it matters....I think the ResMed machines are a little less noisy in terms of motor noise. At least all mine have been. I am pretty sure if you get a Resmed machine that you will be happy with it.

[jasont]

I have owned both brands of your machine and even the older M series Respironics.

Got the first PR System One 50 series Auto...no heated hose.
Then got a ResMed S9 with heated hose...love it.
Then got a PR S1 60 series auto and added the upgrade kit for the heated hose because it didn't come with one..
There are very minor differences between the 2 heated hose capable machines and I personally don't think they are deal breakers.

If your machine is a 60 series machine already you don't have to get an entirely new machine to add the heated hose but you do need a differently power supply, along with the heated hose and a special lid that has electric available for heating.
That said...I would still push for real new machine and not 1800 hour machine if at all possible. What they did is legal....bit it stinks. You ca bet that you and your insurance were charged full price of new and you didn't get a "used" discount.

Oh....if it matters....I think the ResMed machines are a little less noisy in terms of motor noise. At least all mine have been. I am pretty sure if you get a Resmed machine that you will be happy with it.

Thank you!! That is exactly the kind of feedback I was hoping to find - it is great that you've used both units and have direct comparison experience.

I sleep with two fans running for white noise, but can still hear the motor in the S1 ramp up and down with my breathing, so I will definitely use this opportunity to push for a new ResMed unit.

[Pugsy]

Bear in mind that machine motor noise and breathing noise can also be amplified by the hose conducting the noise and aren't necessarily the same thing. I found with Respironics machines I would tend to hear my own breathing more on inhale and with the ResMed machines I would hear it on exhale.
Try this experiment....turn your machine and breathe normally and listen for the breathing noise. Stick your fingers in your ears and if you still hear it then the noise is more conducted than it out in the room. There are ways to limit/reduce conducted noise should it continue to be a problem.

My husband has reported that he has never heard any machine motor noise no matter which machine brand/model I have been using. We once did an experiment where I put 2 machines next to each other on the bed (PR S1 and ResMed S9) and tried each one at a time to see what the machine noise was and he had to put his ear right next to the machines to hear anything. He said that maybe, just maybe the ResMed was a tiny bit less noisy. I was on the other end with mask on and was still hearing the Darth Vadar noise though. This was years ago and I was using the Swift FX nasal pillow mask at the time.

I always called that inhale/exhale noise the Darth Vadar noise. It's not necessarily motor noise though.
Now some machines do seem to be noisier than others in terms of real motor noise for various reasons and the fingers in the ear trick will usually eliminate that sound if that is what you are hearing.
Bear in mind that Darth Vadar noise has several contributing factors like pressure used and where the hose is placed and even the mask used. And there is also mask venting noise because not some masks are simply noisier in terms of venting than others. I have never used the Pico nasal mask so I don't know how noisy it might be in terms of that inhale/exhale noise but if it continues to be a problem with the new machine then perhaps consider trying a different mask. I use the ResMed AirFit P10 nasal pillow mask and it is virtually silent in terms of vent noise. I can't hear my inhale/exhale with it no matter how hard I try. The only time I hear the venting is if the bed covers are in the way of the vent holes and the air is hitting the covers.

Finally if what you are hearing is really the Darth Vadar conducted noise and not real motor noise don't get too upset. There are ways to limit/reduce the annoyance and the fact that in time we learn to tune that sound out or learn that is "normal" and no longer so annoying. It's amazing what the brain learns to turn out like living next to railroad tracks and sleeping through the train coming by or like when I live in a dorm over the Emergency Room of a large local hospital and the ambulance sirens that were going on all night. Took a little while but I learned to not even hear them.

I haven't had a chance to try out the latest models in the Respironics brand (DreamStation models) or the ResMed (AirSense 10 models) to compare the noise from each of those brands but I have no reason to think that things didn't do anything but continue to improve in terms of machine noise.

If you continue to have noise issues and it ends up being the Darth Vadar noise come back and ask for input in reducing that noise because there are ways to make it less annoying by limiting the conduction or changing masks.

[palerider]

I sleep with two fans running for white noise, but can still hear the motor in the S1 ramp up and down with my breathing, so I will definitely use this opportunity to push for a new ResMed unit.

I made the mistake of buying a system one 560, and got rid of it fairly quickly for the same reason, that up and down whine of the motor.

can't hear *ANY* motor noise out of my resmeds.

[klv329]

I found the two to be quite similar and had to use an upper pressure cut off for both for comfort. If I recall correctly , the respironics had a hunt and peck feature to it where it would experiment for a better pressure for no reason whereas the s9 autoset tended to rise quickly when needed and then drop down faster when pressure wasn't needed. Also, I had to experiment with the respironics system resistance setting to get aflex to work for me. Overall I preferred the resmed autoset. However, it has been awhile since I have used either having switched to ASV resmed.

That is a good price for a new auto cpap, even if it isn't the latest respironics model. Could be a good backup?

[SewTired]

First of all, return that machine to Rotech. You are under no obligation to accept a USED machine for new pricing. Report them to your insurance company for fraud because that is what it is. Be sure to take a photo of the USED hours and the serial number of the machine you are returning so you have proof. It is not technically a rental - it is rent to own as required by your insurance company.

As to which to get, it's a toss of the coin. The PR S1 60 auto didn't work for me. Works fine for many others. You don't know unless you try though.

[jasont]

Try this experiment....turn your machine and breathe normally and listen for the breathing noise. Stick your fingers in your ears and if you still hear it then the noise is more conducted than it out in the room. There are ways to limit/reduce conducted noise should it continue to be a problem.

Thanks! That was a great experiment and made clear that for me it is motor noise I am hearing.

I made the mistake of buying a system one 560, and got rid of it fairly quickly for the same reason, that up and down whine of the motor.

can't hear *ANY* motor noise out of my resmeds.

That's very helpful to me to know your experience, given you were sensitive to the same noise as I am!

I found the two to be quite similar and had to use an upper pressure cut off for both for comfort. If I recall correctly , the respironics had a hunt and peck feature to it where it would experiment for a better pressure for no reason whereas the s9 autoset tended to rise quickly when needed and then drop down faster when pressure wasn't needed. Also, I had to experiment with the respironics system resistance setting to get aflex to work for me. Overall I preferred the resmed autoset. However, it has been awhile since I have used either having switched to ASV resmed.

That is a good price for a new auto cpap, even if it isn't the latest respironics model. Could be a good backup?

More good personal feedback - thanks! And yes, it seems to be a great price on Amazon for a new auto cpap. I am still new enough to therapy that I am waiting to see full efficacy, but if I improve over time (as I hope to do) I will definitely keep a backup around so that I'm never without a machine.

First of all, return that machine to Rotech. You are under no obligation to accept a USED machine for new pricing. Report them to your insurance company for fraud because that is what it is. Be sure to take a photo of the USED hours and the serial number of the machine you are returning so you have proof. It is not technically a rental - it is rent to own as required by your insurance company.

That exactly the way I feel, personally; unfortunately, my insurance company (and the law) seems to disagree. UHC agrees I should get new equipment, but they made it perfectly clear that they pay the same regardless of whether the unit is new or used. We all know 13 month capped rental = rent to own, but I believe it simply counts as a rental in the meantime and therefore used equipment is allowed. Makes no sense to me how that should be legal, but since it is no secret that the DME is providing used equipment and there are no complaints from my insurance about paying for used equipment, it appears allowable by law. Although we all can agree it is a sh*tty way to do business...

[jasont]

As a side note, I started my home therapy with a Nuance Pro nasal pillow, but found I started fighting it on the third night when the pressure ramped up to 11. I switched back to the Pico nasal mask from my sleep study and liked that better at first (it seemed easier to fit firmly to my face so it wouldn't get dislodged in the night). Used that for a week, then found I was beginning to fight that a bit during the night as well.

Switched back to the Nuance nasal pillow last night and seemed to tolerate it just fine this time.

Am I screwing things up by flipping back and forth too much? Should you pick a mask and stay with it for a certain amount of time before trying the other again?

[Janknitz]

I still think you should file a WRITTEN fraud complaint with your insurer and with whatever department governs DME's in your state for fraud for giving you a used CPAP machine for a new rent to own without disclosing that to you. They gave you an older and outdated model to boot. The person you spoke to at UHC who didn't see a problem with giving you a used machine is not the final arbiter of whether that was OK or not. At the very least, a formal complaint will make Rotec have to scramble to respond.

I wouldn't want them to have one more penny of my money or my insurer's money.

Lincare has a bad reputation, so beware of jumping from the frying pan into the fire. If you can afford to buy your own and bypass all these goons, then go for it.

I'm partial to my ResMed Airsense Auto, but the only thing I have to compare it to was a PR 560 (Airsense is SO much better). From what I understand, there's not a huge difference between the Airsense Auto and the PR Dreamstation Auto. So I don't think it's worth the price difference.