Any advice or experience is greatly appreciated. I am totally overwhelmed by the experience at the sleep center where the study was done. Also, some of the abbreviations are over my head at this point. I have the IQ of a shoe about the equipment & insurance & dme's. I have United Healthcare Insurance. I have not picked up machine yet.
I have been diagnosed with severe sleep apnea. However my sleep study began at 10:45PM & I walked out the door at 5:30AM. They first put one mask on & it felt like I was drowning. They said mask was leaking & put me in a second full face mask. They said I had 111 episodes an hour with my O2 level going down to 73% in rem. The graph showed the machine to give good rem sleep. I did not like the feel of the mask. It feels strange breathing against the pressure. But I only had it on for a few hours.
The DME does not go to your home. They are doing a rent to own $3200.00
They show you how to fit mask & hand machine. They said it is about 10 minutes of instruction. I asked them how come the prices were so different from the internet. Could not really get an answer.
I have 30 days to change machines w/Dr.'s orders.
My car was hit by someone on a cell phone just as I was stepping out. It I have a deviated septum that makes me breathe threw my mouth. I had two triple cervical fusions. They went threw the front of my throat to put the plates on my cervical spine. I've had the apnea since this procedure I believe. Because of this it is only comfortable to sleep on my left side with a small pillow. My throat is always dry. Oh, here is the kicker: I'm known to sleepwalk. I never remember it. I worry I may jerk the machine or even sling it if I walk.
The Dr. concurred with the staff that 12 cm is the setting I will use.
These are the machines & face mask I have to choose from:
1.Puritan Bennett Goodnight 420S 1 year warranty
2.Fisher Paykel HC234 2 year warranty
Mask:
1. Fisher Paykel Full Face HC431A
2. Comfort Full Resprionics
Are there benefits to go to an auto machine .
Thanks for any help.
Kelly
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CPAPopedia Keywords Contained In This Post (Click For Definition): 420S, DME, auto
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CPAPopedia Keywords Contained In This Post (Click For Definition): 420S, DME, auto
I may be getting screwed too! Brand new & first post -H
11 posts
• Page 1 of 1
I may be getting screwed too! Brand new & first post -H
Last edited by labmanok on Thu Sep 14, 2006 6:11 am, edited 1 time in total.
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| Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control |
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Check your copay by calling your insurance. At 20% or more copay you are copaying $640 on a $3200 bill. You also need to know what the insurance will actually pay. Your copay should be based off of that and if the $3200 is reduced to some negotiated rate (maybe $1600, then your copay will also go down). This might change the decision as to whether to use the local DME or online.
You could buy either of these machines with heated humidifier for less than a 20% copay OF $3200 for cash online. You have to do the math on your own copay and find out the "real price".
The Goodnight appears to have no exhale relief and at a pressure of 12 you may want it (I was titrated at 13)
Why is it only one year warrenty on the goodnight? Cpap.com lists 2 years which seems to be typical for CPAP.
Are these machines new from the local DME?
Fisher Paykel doesn't seem to list any exhale relief either but I am not totally sure.
You seem like a full face mask candidate due to your previous injury but there are more choices that the DME is not giving you. They should give more choices.
Do you have more choices for local DMEs? Or did the doc pick one and not consult you? Call insurance and find out who you can deal with. How many local DME's, and if you can use online vendors.
No matter who you buy from, get your prescription and copy of your sleep study and hold it. You may want it later. It doesn't expire.
Auto is nice for reducing your pressure when you don't need as much (possibly a good portion of the night) and avoiding future titrations ($$) as well as if you have concerns about the accuracy of your titration. I spend quite a bit of time at 10 even though my titration is 13. At a pressure of 12 you might like APAP. If you buy from CPAP.com your current CPAP prescription is valid for APAP. If you go to a local DME you will probably have to get a doc to rewrite for APAP if you want one.
Study the web site and compare machines (CPAP.com) and do the math on your copay after you call the insurance company then make your choice.
You could buy either of these machines with heated humidifier for less than a 20% copay OF $3200 for cash online. You have to do the math on your own copay and find out the "real price".
The Goodnight appears to have no exhale relief and at a pressure of 12 you may want it (I was titrated at 13)
Why is it only one year warrenty on the goodnight? Cpap.com lists 2 years which seems to be typical for CPAP.
Are these machines new from the local DME?
Fisher Paykel doesn't seem to list any exhale relief either but I am not totally sure.
You seem like a full face mask candidate due to your previous injury but there are more choices that the DME is not giving you. They should give more choices.
Do you have more choices for local DMEs? Or did the doc pick one and not consult you? Call insurance and find out who you can deal with. How many local DME's, and if you can use online vendors.
No matter who you buy from, get your prescription and copy of your sleep study and hold it. You may want it later. It doesn't expire.
Auto is nice for reducing your pressure when you don't need as much (possibly a good portion of the night) and avoiding future titrations ($$) as well as if you have concerns about the accuracy of your titration. I spend quite a bit of time at 10 even though my titration is 13. At a pressure of 12 you might like APAP. If you buy from CPAP.com your current CPAP prescription is valid for APAP. If you go to a local DME you will probably have to get a doc to rewrite for APAP if you want one.
Study the web site and compare machines (CPAP.com) and do the math on your copay after you call the insurance company then make your choice.
Subject Post
Snoregirl - Thanks for the great input. I've been trying to find out what my bottom line number is from the DME and Insurance. It's very hard to find out. Also, it appears to be different if I'm renting to own vs. buying. The DME is setting it up as a rent to own.
My Dr. picked the DME which offices in his same office.Do you have more choices for local DMEs? Or did the doc pick one and not consult you? Call insurance and find out who you can deal with. How many local DME's, and if you can use online vendors.
Can I expect my Dr. to give me the prescription if I ask for it? So far he just gives me the person who is the DME rep who acts as if I am a giant annoyance when I asked questions about what my bottom line is. They are not a provider of my insurance, but they say my cost will be limited to the same as if I was getting from a provider. The Dr. and the DME are all part of the Sleep Center where I had my Sleep Study. They are out of network for my Insurance, though the Dr. a pulmonologist, is not. It's very overwhelming. When I'm asking questions it's as if you are rocking the boat.No matter who you buy from, get your prescription and copy of your sleep study and hold it. You may want it later. It doesn't expire.
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oldgearhead
- Posts: 1243
- Joined: Thu Mar 30, 2006 9:53 am
- Location: Indy
Just buy this one:
http://auctions.yahoo.com/i::112821025
..then get a new mask at cpap dot com, and keep reading the forum..
http://auctions.yahoo.com/i::112821025
..then get a new mask at cpap dot com, and keep reading the forum..
+ Aussie heated hose.
....................................................................
People have more fun than anybody..
....................................................................
People have more fun than anybody..
Yes I understand the run around.
I had to practically pull teeth to get the $$ number.
They all wanted to give me a monthy number not the total or how many months to own.
The question needs to go to your insurance company directly from you. "What is my copay for durable medical goods, and do I have to meet my deductable first, and what is that deductale". You can ask what the contract price is but if your insurance co is like mine they tell you they don't know. I asked mine if they didn't know how do they pay the bill when it comes or do they just write a blank check? Very frustrating.
Later I found some customer satisfaction person with the insurance company who claimed she could have interveened and found these numbers so maybe ask for one of those early on when the regular telephone person stumbles.
But if you get the copay and deductable info from the insurance, and pin the DME down to the "total price no matter who pays it" you can actually figure out what you are in for.
You are saying there is little choice and they don't want you to have your prescription ....
I would walk in and tell them that "I have a right to my prescription" and see if that shakes them then run like you know what when you get your hands on it and never look back. I find doctors (and other people) like to tell you stuff that isn't true or hold stuff back, but will cave when confronted with someone who knows what is what. You could call the State medical board or state attorney general's office .... in your state (find it with a yahoo or google search) and ask what your rights are in terms of the prescription.
Find someone new next time you need a sleep study if ever. I see a serious conflict of interest if it is all together (Sleep center, doctor etc, and they are giving you the run around).
You could also have your primary physician ask for the sleep study and any other reports and have him/her write a prescription. It is not difficult to write and any physician can do it. You have rights concerning your health records. You should be able to have copies of everything and or have them transfered to another doc. Maybe a small copying charge but you should have that right.
Look at the prescription tab on the main page of CPAP.com and you will see what CPAP.com needs. Something like CPAP, heated humidifier and pressure. Primary doc can write prescription following the suggestions and put your pressure on from the sleep report.
I get my prescription from my family doc.
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CPAPopedia Keywords Contained In This Post (Click For Definition): humidifier, cpap.com, CPAP, DME, Prescription
I had to practically pull teeth to get the $$ number.
They all wanted to give me a monthy number not the total or how many months to own.
The question needs to go to your insurance company directly from you. "What is my copay for durable medical goods, and do I have to meet my deductable first, and what is that deductale". You can ask what the contract price is but if your insurance co is like mine they tell you they don't know. I asked mine if they didn't know how do they pay the bill when it comes or do they just write a blank check? Very frustrating.
Later I found some customer satisfaction person with the insurance company who claimed she could have interveened and found these numbers so maybe ask for one of those early on when the regular telephone person stumbles.
But if you get the copay and deductable info from the insurance, and pin the DME down to the "total price no matter who pays it" you can actually figure out what you are in for.
You are saying there is little choice and they don't want you to have your prescription ....
I would walk in and tell them that "I have a right to my prescription" and see if that shakes them then run like you know what when you get your hands on it and never look back. I find doctors (and other people) like to tell you stuff that isn't true or hold stuff back, but will cave when confronted with someone who knows what is what. You could call the State medical board or state attorney general's office .... in your state (find it with a yahoo or google search) and ask what your rights are in terms of the prescription.
Find someone new next time you need a sleep study if ever. I see a serious conflict of interest if it is all together (Sleep center, doctor etc, and they are giving you the run around).
You could also have your primary physician ask for the sleep study and any other reports and have him/her write a prescription. It is not difficult to write and any physician can do it. You have rights concerning your health records. You should be able to have copies of everything and or have them transfered to another doc. Maybe a small copying charge but you should have that right.
Look at the prescription tab on the main page of CPAP.com and you will see what CPAP.com needs. Something like CPAP, heated humidifier and pressure. Primary doc can write prescription following the suggestions and put your pressure on from the sleep report.
I get my prescription from my family doc.
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): humidifier, cpap.com, CPAP, DME, Prescription
Last edited by snoregirl on Thu Sep 14, 2006 10:32 am, edited 1 time in total.
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Guest
There are quite a few factors to consider here before making a decision.
It's extremely hard to make any real sound assesments over the quality of a provider from the limited information available to people on a website over the internet.
Here is my opinion: You sound like an excellent candidate for rental equipment through a traditional DME provider. Certainly at least for the first 6 to 12 months. From what you've posted here there could be one of two things that would occur. Most likely is that your insurance company will require you to rent the cpap for 3 months to ensure compliance and then they convert this equipment to a purchase. Several other people have posted here who have United Insurance and this is what's happened for them. The 2nd less likely scenario is that your insurance will rent for 15 months and then convert the equipment to a purchase. This isn't uncommon but it doesn't seem to be the standard unless you have Medicare (again based on previous posts here).
I would call the DME company and find out if they have a facility where you can go and try on different masks and see how they feel.
Pinning down a specific dollar figure when you are dealing with an insurance company can sometimes be pretty tough. Insurance companies love to deny claims for all sorts of odd reasons. I have had Hospital claims denied because they showed the procedure was an outpatient procedure even though it wasn't. I've had doctors office visits denied because they showed I was under the care of a different doctor!! Then throw in how gun-shy people are about giving a firm answer to such a question (C'mon, we have all been in the situation where we've had a customer/client/whatever screaming at us with the old "Well that person told me I could do it this way!" when really the other person said MAYBE.)
You could always call the insurance and see if anyone there can give you a straight answer. Ask them if they rent a cpap for a period before converting it to a purchase and if so how long the rental period is.
It seems to be standard operating procedure that a doctor will automatically route the prescription to a DME company that is covered under your insurance without involving you. There should not be a problem getting a copy of the prescription. Just call up the office and politely ask them to mail you a copy of it or even ask if you can come by and pick it up if you want. Mine mailed me a copy when I asked (I wanted it for documentation when I travelled).
Good luck and please stay in touch!
It's extremely hard to make any real sound assesments over the quality of a provider from the limited information available to people on a website over the internet.
Here is my opinion: You sound like an excellent candidate for rental equipment through a traditional DME provider. Certainly at least for the first 6 to 12 months. From what you've posted here there could be one of two things that would occur. Most likely is that your insurance company will require you to rent the cpap for 3 months to ensure compliance and then they convert this equipment to a purchase. Several other people have posted here who have United Insurance and this is what's happened for them. The 2nd less likely scenario is that your insurance will rent for 15 months and then convert the equipment to a purchase. This isn't uncommon but it doesn't seem to be the standard unless you have Medicare (again based on previous posts here).
I would call the DME company and find out if they have a facility where you can go and try on different masks and see how they feel.
Pinning down a specific dollar figure when you are dealing with an insurance company can sometimes be pretty tough. Insurance companies love to deny claims for all sorts of odd reasons. I have had Hospital claims denied because they showed the procedure was an outpatient procedure even though it wasn't. I've had doctors office visits denied because they showed I was under the care of a different doctor!! Then throw in how gun-shy people are about giving a firm answer to such a question (C'mon, we have all been in the situation where we've had a customer/client/whatever screaming at us with the old "Well that person told me I could do it this way!" when really the other person said MAYBE.)
You could always call the insurance and see if anyone there can give you a straight answer. Ask them if they rent a cpap for a period before converting it to a purchase and if so how long the rental period is.
It seems to be standard operating procedure that a doctor will automatically route the prescription to a DME company that is covered under your insurance without involving you. There should not be a problem getting a copy of the prescription. Just call up the office and politely ask them to mail you a copy of it or even ask if you can come by and pick it up if you want. Mine mailed me a copy when I asked (I wanted it for documentation when I travelled).
Good luck and please stay in touch!
Re: I may be getting screwed too! Brand new & first pos
RUN!labmanok wrote:These are the machines & face mask I have to choose from:
1.Puritan Bennett Goodnight 420S 1 year warranty
2.Fisher Paykel HC234 2 year warranty
Mask:
1. Fisher Paykel Full Face HC431A
2. Comfort Full Resprionics
don't even call them back, they are trying to sell you your choice of a $380 machine for $3200. You will certainly spend more than $380 by the time they are through with you, not to mention what they will collect from your insurance. I am also not comfortable with the doctor shoving you to the DME next door with which he is undoubtably invested. To answer your question, YES, YOU ARE GETTING SCREWED.
I also have UHC insurance. I got a Respironics AUTO with C-Flex for a mere $150 out-of-pocket, straight purchase, not a rent-to-own. You can do the same, but I'm sure your doctor and your DME will do everything they can think of to prevent it. Truth is, there are many DMEs who will match that, with no hassle, and won't try to talk you out of it. PM me if necessary. And they will even contact your doctor to get the prescription transferred. A copy of your prescription is your RIGHT, you don't have to kiss up to the DME and persuade them of anything, and you DON'T have to put up with the vague answers about price and all the nonsense they are obviously feeding you. Snoregirl is right, get a copy of your sleep study and your prescription before you talk business.
Here is my suggestion, call other DMEs in the area, or as far away as necessary. Tell them you have UHC, a prescription, ask if they will sell you a Remstar AUTO with C-Flex to purchase and NOT to rent. Your prescription is good for that. If not, keep dialing until you get the right answer. Any DME serious about doing business will meet your requirements and do the negotiations with your insurance. And don't let them talk you DOWN to a Ford Pinto like your current DME is trying to sell you for the price of a Rolls Royce. Unfortunately the "billmyinsurance.com" indicates they don't deal with UHC. There are plenty of DMEs who do.
The gimmick about "rent to own" usually amounts to nothing more than a slick sales tactic. It implies that if you don't like the machine, you can swap it for another until you find one you like. What it usually comes down to is you can swap it if you get a new prescription from your doctor and permission from your insurance provider and a note from the governor, the mayor, the FDA, and your local dog-catcher. What most people learn too late is that you're basically stuck with what you walked out with, so sad, too bad. Very few people are successful with exchanging machines in the middle of a rental agreement. And not because they are in love with the mickey-mouse aquarium pump the DME sold them with broad smiles and grandiose assurances. Remember, it's a business, and a very competitive one. Buying a CPAP is not unlike buying a car. And you're generally stuck with it for many years.
And for what it's worth, the routine practice of DMEs selling you the cheapest possible equipment at the most outrageous prices is a big part of why the overall compliance for CPAP therapy is a dismal less than 50%. As David Horowitz would say, "FIGHT BACK!".
YES!labmanok wrote:Are there benefits to go to an auto machine?
-Ric
He who dies with the most masks wins.
Kelly,
Did that $3200 even include a heated humidifier?.....hose? That's where they also tack on another few hundred bucks.
Read Mile High Sleeper's Blogspot. It has excellent information in one location.
You wouldn't let your car dealer pick out your car for you or your clothing store pick our your clothes for you.....RIGHT? This is no different. Far too many of these sleep doctors and DMEs have been trying to take advantage of the "sleep deprived" customers for too long. The patients/customers/users need to get better educated on what is happening with this therapy (preferably BEFORE they get started). The statistics have shown that far too many people give up on this therapy and we're trying to change that.
Best wishes,
Den
Did that $3200 even include a heated humidifier?.....hose? That's where they also tack on another few hundred bucks.
Read Mile High Sleeper's Blogspot. It has excellent information in one location.
You wouldn't let your car dealer pick out your car for you or your clothing store pick our your clothes for you.....RIGHT? This is no different. Far too many of these sleep doctors and DMEs have been trying to take advantage of the "sleep deprived" customers for too long. The patients/customers/users need to get better educated on what is happening with this therapy (preferably BEFORE they get started). The statistics have shown that far too many people give up on this therapy and we're trying to change that.
Best wishes,
Den
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05
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harikarishimari
- Posts: 70
- Joined: Thu Dec 15, 2005 6:22 pm
- Location: NV
11 posts
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