DME or online

CSA0890 · Post by **CSA0890** » Thu Oct 26, 2006 5:13 pm

I've got a question, Monday I go to the sleep clinic to get my supplies, I was wondering whether I should just get my mask I go to cpap.com for my machine or should I get both from the DME. I'd much rather get an APAP for the obvious reasons, and I really don't want to get stuck with a 10 year old clunker. My folks' insurance (BCBS) says they will cover at 100% for the whole setup. At my sleep study the tech said that at their DME they only rent so obviously I'd much prefer to have my own machine since I intend to keep at it. I'd like to hear what y'all have to say.
Thanks

bdp522 · Post by **bdp522** » Thu Oct 26, 2006 6:41 pm

If your insurance will pay 100% even if you buy from cpap.com, why wouldn't you? They will let you get the machine you want. You lay out for it and your ins. will reimburse you. Or you can go to billmyinsurace.com and they will take care of it. They are part of cpap.com.

Brenda

Guest · Post by **Guest** » Thu Oct 26, 2006 6:48 pm

Hi and welcome to the site!

As this forum is operated by an online provider you will find that many of the folks here are very very pro online due to bad experiences with DME companies. I would urge you to go whichever route you feel suits you best and not rule either out without checking it out. I strongly feel that both providers fill an important place in the system.

There are good DME companies and there are (obviously) bad ones.

As far as the rental goes, it works out like this:

9 times out of 10 yes an item is a rent to own arrangement. What typically occurs is your insurance will rent for 3 months then convert to a purchase. This is to help shave off some cost for the people for whom CPAP therapy doesn't work. No sense in buying equipment for people who can't use it and all.
Once it's converted to a purchase it is yours, just like anything else you buy. That's another reason for the 3 month rental - to help figure out if you need a different setup.
Generally speaking you can change machines without any difficulty during that initial period.
There are some plans where the rental period may go 12-15 months. There are a few rare cases where Insurance will rent indefinately - though those are the exception rather than the norm.
I also have BCBS and it was a rental for 3 months then converted to purchase.

In many cases you can get an APAP through a traditional DME provider as well. Talk to them before hand and also with your doctor. There are many situations where an APAP can be easily provided and also many situations were a DME can work with your insurance and get special arrangements for an APAP.

Also be aware that if you use an online provider to bill your insurance the rates will be the same as the prices are set by the Insurance Companies rather than the entity submitting the claim.

A traditional DME will often have a showroom available where you can see different models of machines and try on different masks.

An online provider will be able to provide a cash-sale setup usually with less hassle since neither of you have to bother with the insurance red tape nor the governmental red tape (IE - can provide an autopap under a cpap prescription, lower pricing, etc).

Most of all - good luck!

mattman

Wulfman · Post by **Wulfman** » Thu Oct 26, 2006 7:30 pm

One thing you need to be aware of is IF you go for the "rent-to-buy" option AND your insurance deductible goes on a calendar year......in about three months, you're going to get your deductible subtracted out of the contract AGAIN. If for example you've got a $500 deductible, you've probably already met your deductible for this year (with the sleep study and doctors visits), so beginning Jan. 1, it's going to cost you another $500 for your equipment.
When I got my equipment, what my co-pay would have been (by purchasing from a local DME) was very near the price of purchasing everything out-of-pocket. So, I went ahead and purchased all of my equipment from CPAP.COM and then submitted an invoice (from myself) to my insurance provider and they reimbursed me at the in-network rate of 80%. It saved us all a lot of money.
One of the questions I was asked by the locals when I indicated that I was considering purchasing online was "What if you need repairs on your machine?" my answer was that for what they were going to be charging, I could afford to buy at least one other machine to use as a backup in the event the other one needed to be fixed. Which is what I eventually ended up doing.

Best wishes,

Den

snoregirl · Post by **snoregirl** » Thu Oct 26, 2006 7:51 pm

The point about the new copay for deductable is a good one. Some will argue that you will have other expenses to meet that 2007 deductable. Maybe you willl. I don't.

Brick and Mortar DME's do have their place. For people who are not willing to take responsibility for their treatment or can't figure out basic electronics (like a phone answering machine etc.).

For those of us who are even basically competant with simple electronics the DME is usually (not always) but usually more trouble than not. Someone telling you you need a special prescription for APAP, someone telling you you can't adjust your own settings, someone stealing the manual that goes with your machine etc.

The point about trying different machines. If you go APAP and your pressure is not really high (might need BiPAP), there is no other machine. The APAP does it all. Only a brand choice.

Masks, yes tough to find the right one, but not all DME's will let you exchange masks or even really try them on. Once mine was out of the box and on my face it was mine. I have read about others letting people trade. Mask trial may indeed be a benefit of a B and M DMEs, but if you have a mask that worked for you at your sleep study, then you already know what you want to start with.

If your insurance will cover a cash purchase you can have the machine you want really quickly with all the manuals and accessories that should be in the box. If your insurance won't cover cash purchase, but will work with Bill-My-Insurance you can pick your machine and have all the stuff that comes with it too.

If you really like a DME treating you like a brainless person and giving you lectures and setting your machine up wrong, waiting days or weeks for "your machine to come in", having the DME try to convince you that you need "only CPAP" by all means go with the B and M DME. Sorry I know that there are good ones out there but I can only speak from my own experience. And by the way, I came to this forum BEFORE my bad experience so I would be here even if I had had a good DME experience for the person who claims that this forum is loaded with dissatisfied DME customers. I expect you would be here too since you are and you haven't gotten a machine yet.

So if I had a choice and it were me I would go online. BUT if you go cash, really make sure the insurance will reimburse 100% for cash purchase as it is not returnable and you don't want to get stuck with the bill when you could deal with the B and M DME and pay nothing out of pocket.

CSA0890 · Post by **CSA0890** » Thu Oct 26, 2006 8:52 pm

Thanks for everyone's reply. I'm pretty sure that I'll get the machine off of BillMyInsurance.com and the mask from the local DME. Although I haven't seen my perscription for CPAP yet I'm sure it isn't for the Auto. So that really leaves me going through the internet, but I'll have to buy the ruturn insurance which leads me to my next question, because my pulmo in St. Louis might want me on a bipap for my breathing issues during the day.

When it says for qualifying products only what does that entail?

Wulfman · Post by **Wulfman** » Thu Oct 26, 2006 9:06 pm

If your doc determines that you need to be on a Bi-PAP, then that would be written on the prescription.

CSA0890 wrote:When it says for qualifying products only what does that entail?

I'm not sure where you read that......billmyinsurance?

Den

CSA0890 · Post by **CSA0890** » Fri Oct 27, 2006 11:05 am

Right now I'm dealing with a sleep doc in Tulsa where I had my sleep study done and a Pulmonologist who specializes in neuromuscular disorders in St. Louis. The reason I'm dealing with this sleep doc in Tulsa is because if I tried to get a PSG through St. Louis I would have had to wait till December to get it done. I haven't talked to the Pulmo since I had my PSGs done but I should see them sometime next month. The sleep doc didn't want to perscribe a Bipap because he has no clue what my how to treat MG. That's why I need to return my CPAP if I have to if my pulmo wants to write a new perscription.

CSA0890 · Post by **CSA0890** » Fri Oct 27, 2006 11:08 am

The qualifying products are only about 30 masks that cpap.com offers. You can find return insurance under Serive Options on the left side of the screen about a quarter of the way down.

snoregirl · Post by **snoregirl** » Fri Oct 27, 2006 12:44 pm

With your situation with the two docs and and whatever neuromuscular issues you are dealing with you just might be one of those that would benefit from a rental for a while.

Wow, did I say that?

If there is a chance that you would need to change machines and they won't be able to predict that, then you want to make sure you have a machine that will work for you before plunking down $ for a purchase. Since your insurance is 100% hopefully your deductable is not excessive and you may do better with the local DME. I would try to get the APAP right off the bat if they want to start on CPAP.

It sounds like you don't have a prescription yet for anything? I hope you see that doc soon and you mean October when you say "this month".
If you don't have a prescription yet, then you can't make any rent vs. buy decision or online vs local DME decision but you are armed with information for your doctor visit!

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, DME, Prescription, APAP

CSA0890 · Post by **CSA0890** » Fri Oct 27, 2006 5:16 pm

I do have a perscription, but I don't have a hard copy. I like your idea about renting for right now. They said that the rental period will end at the end of the year. I will probably be seeing the pulmo in November or December so I might be returning the CPAP for a Bi-Pap after I talk to her.
I seriously doubt they will give me a APAP right off the bat, but I will give it my best shot.

ozij · Post by **ozij** » Sat Oct 28, 2006 2:59 am

On Oct 2 viewtopic.php?p=117679#117679

CSA0890 wrote:I've been reading about cpap and the like for a month or so now trying to understand it and with myasthenia gravis it causes weakining of the muscles including the chest wall and lungs. Back in June I had to be intubated for 3 days because my lungs got so weak, which was no fun for a 15 year old. But Ive been using an oxygen concentrator for quite a while which does nothing at all.
Back on the subject Linda, I've just found the S/T by Respironics and it seems to me that it might be the best for my situation because I'm sure there will be times during the day that it will be extremely difficult for me so it looks to me to be the best. Thanks, Jesse.

Jesse,
I may have missed something:
What makes you think an APAP would be the best for you, in your condition?

As you know, Myastenia Gravis causes weakness in your chest muscles, sometime in the oropharynx as well. It's muscle weakness causing your present (mild) obstructive sleep apnea. What can be considered "low pressure" for healthy people could turn out feeling high -even extremely high for you. Therefore, statements about your need of any kind of machine, based on your pressure (or number of events) may be totally wrong.

Seems to me your pulmonolgist knew what he was talking about when he suggested a machine that will give you as much relief as possible on exhaling - a Bi-level machine. You mentioned you might need it during the day - is that your idea or the pulmo's?

You mention the Respironics S/T machine. I don't know enough about your condition to say you need that one - but I know enough to think you might actually be better off with one of those - or some totally different kind of breathing assistance.

I don't think you should buy or rent any machine before you have very thorough consultation with your pulmonologist - you don't want to find yourself struggling to exhale against the incoming pressure of any machine. If you feel its urgent for you to get help in breathing, you must contact the pulmonologist and let him know that you don't feel you can wait till December. Or, if a 15 year old patient can't convince the pulmo of the urgency - can your parents do it?

Take care, and keep us posted.

O.

StillAnotherGuest · Post by **StillAnotherGuest** » Sat Oct 28, 2006 6:07 am

ozij wrote:
CSA0890 wrote:I've been reading about cpap and the like for a month or so now trying to understand it and with myasthenia gravis it causes weakining of the muscles including the chest wall and lungs. Back in June I had to be intubated for 3 days because my lungs got so weak, which was no fun for a 15 year old. But Ive been using an oxygen concentrator for quite a while which does nothing at all.
I don't think you should buy or rent any machine before you have very thorough consultation with your pulmonologist

Whoa, screech, stop, there, Little Grasshopper, and a major ditto on the Oz-advice.

BiPAP was invented to control respiratory insufficiency. It was only until later that it took on the treatment of OSA as a hobby.

There is little doubt in my mind that your major concern is exactly that, respiratory insufficiency, and you need the function of pressure support. From your other post

My AHI per hour was only 8 does this low of a number have any affect on whether or not I get a CPAP or BiPap.

You may not even have OSA, or it's a mild, coincidental component of the MG (you have to take a detailed look at the PSG to see the type and location of events. Like if they're all central, then we really have to think about all this).

Your therapy, then is probably geared towards reduction of pCO2 and resting of respiratory muscles at night in order to get through the day.

And if that's the case, scratch that whole APAP idea immediately. Review therapy goals with the pulmonologist (including the supplemental oxygen)(you might be needing to add that to your therapy as well, and guessing wrong there could also send you down the wrong road at 90 miles an hour).
SAG

CSA0890 · Post by **CSA0890** » Sat Oct 28, 2006 1:04 pm

Most of the time my breathing is not too bad during the day probably the only time I will be using a machine during the day would be if I knew I was going into Resp. Failure. At the sleep center I was on CPAP all night and it wasn't an issue, the only reason Im considering getting a Bipap is for that oh sh** situation. MG does cause chronic muscle weakness, but it is a day by thing day, you might be feeling great one day and intubated the next. The only thing predicatable about MG is its' unpredictability. Until I see the pulmo Im going to either be on CPAP or APAP just because my AHI was only 8 that dosen't mean I don't have OSA Im sure its due mostly to MG but since I have MG on top of resp. problems during the night it makes me feel even worse during the day. The sleep doc Im dealing with in Tulsa had an AHI of 8 and hes on CPAP. Ill probably rent until I get a script for Bipap and then switch to it. Thanks

rested gal · Post by **rested gal** » Sat Oct 28, 2006 7:19 pm

CSA, please check your private messages...a button at upper right of this page.

Wishing the very best for you, and smooth treatment. Please take close heed of what StillAnotherGuest posted in this thread. It doesn't sound like you should get an autopap.

DME or online

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