DME says must use "default machine"

[Japparis]

Hi there. I recently started CPAP and am happy with my set up. However, my sister just had a home sleep study done. AHI 5.3, SATs dropped to around 72%. She has some cognitive impairment due to surgery for a ruptured aneurysm 5 years ago. I called to set up the appt. and asked about the machine. They told me that unless the doctor ordered a specific machine, that I had to go with their default machine. It would be all set up when we got there, so I couldn't make any changes unless it didn't work for her. They said they now default to the Dream Station machine. I was hoping to get the ResMed Airsense 10 for her. I like how it's gentle and I know how to work it. If she gets rushes of sure, she may freak out and not use it. Does it have audible alarms? That may freak her out as well. They told me people don't have the option of requesting a certain machine. They were actually highly recommended. Thought?

[palerider]

Hi there. I recently started CPAP and am happy with my set up. However, my sister just had a home sleep study done. AHI 5.3, SATs dropped to around 72%. She has some cognitive impairment due to surgery for a ruptured aneurysm 5 years ago. I called to set up the appt. and asked about the machine. They told me that unless the doctor ordered a specific machine, that I had to go with their default machine. It would be all set up when we got there, so I couldn't make any changes unless it didn't work for her. They said they now default to the Dream Station machine. I was hoping to get the ResMed Airsense 10 for her. I like how it's gentle and I know how to work it. If she gets rushes of sure, she may freak out and not use it. Does it have audible alarms? That may freak her out as well. They told me people don't have the option of requesting a certain machine. They were actually highly recommended. Thought?

Tell the autocratic assholes to go pound sand... you'll get your sister a better machine elsewhere.

[Becca8104]

My prescription specifically states what machine I was to have. I asked for a copy of my prescription from my DME and they had no problem giving me a copy. I would do the same if you or your sister in law don't have a copy already. If her prescription says Airsense 10, then she should be getting one. If it says Dreamstation, then that is what she will get. You can always go back to the doctor if necessary & try to appeal to them to change the prescription to the Airsense 10.

[Becca8104]

Or do as Palerider suggests...

[greatunclebill]

My experience is that nurses get better results than doctors. Call your doctor's nurse and have her get the resmed set up. if the doc needs to get involved she can do that. If it don't work out some people on the forum sell lightly used machines at huge discounts for cash.

[palerider]

My prescription specifically states what machine I was to have. I asked for a copy of my prescription from my DME and they had no problem giving me a copy. I would do the same if you or your sister in law don't have a copy already. If her prescription says Airsense 10, then she should be getting one. If it says Dreamstation, then that is what she will get. You can always go back to the doctor if necessary & try to appeal to them to change the prescription to the Airsense 10.

"airsense 10" is a *generic* term for all of Resmeds single pressure devices, including the junk, don't want it, brick.

"Dreamstation" is a generic term for *ALL* of Respironics current machines.

Neither of those terms are worth anything at all on a prescription.

"advice" like that is how people end up getting stuck with a "CPAP" (no data) model the Airsense 10 CPAP or the Dreamstation CPAP are both terrible machines, and both are perfectly proper with that advice.

[LSAT]

Get a copy of the prescription...Call her insurance to find out what other DME is in Network...Go to a different DME.

[Janknitz]

Hi there. I recently started CPAP and am happy with my set up. However, my sister just had a home sleep study done. AHI 5.3, SATs dropped to around 72%. She has some cognitive impairment due to surgery for a ruptured aneurysm 5 years ago. I called to set up the appt. and asked about the machine. They told me that unless the doctor ordered a specific machine, that I had to go with their default machine. It would be all set up when we got there, so I couldn't make any changes unless it didn't work for her. They said they now default to the Dream Station machine. I was hoping to get the ResMed Airsense 10 for her. I like how it's gentle and I know how to work it. If she gets rushes of sure, she may freak out and not use it. Does it have audible alarms? That may freak her out as well. They told me people don't have the option of requesting a certain machine. They were actually highly recommended. Thought?

Important to understand that unless she is with an HMO that is actually her provider (and the DME just the supplier), insurance will pay for ANY CPAP or APAP. It does help to have the exact model you want on the prescription and ask the doctor to state "dispense as written" on the prescription, but barring that your sister has a few choices:

1. She can accept the Dreamstation they are offering but:
a. She should have an APAP
b. It MUST have full efficacy data. Make sure you look up which Dreamstations do and check the model to make sure.
I would highly advise her not to accept a CPAP or one with compliance data only unless this is the ONLY DME she can use and she has to have insurance pay for it (really worth comparing out of pocket costs to buying a gently used model online).

2. She can go to another DME if her insurance has any options.

3. She can buy online from CPAP.com new or used from Secondwind.com or a trusted member of the forum.


Good luck, while her AHI is low, her oxygen level is terrible. She really needs this ASAP

[Becca8104]

I had no idea that Resmed Airsense 10 was a "generic" name. I thought it was the name of a particular machine. To be precise, I have an Airsense10 autoset.

[LSAT]

I had no idea that Resmed Airsense 10 was a "generic" name. I thought it was the name of a particular machine. To be precise, I have an Airsense10 autoset.

Also..
Airsense 10 Elite
Airsense 10 CPAP
Airsense 10 For Her

[palerider]

I had no idea that Resmed Airsense 10 was a "generic" name. I thought it was the name of a particular machine. To be precise, I have an Airsense10 autoset.

Now you know... as to 'dreamstation', they're in the chart:

wiki/index.php/CPAP_models

[raisedfist]

Tell the doctor the exact machine you want. If they won't write the prescription, tell them c ya later and find a new physician.

[Japparis]

Thanks everyone. I'm going to call the NP that wrote the order. She's really cool and I'm sure she'll change to whatever machine I request. When they sent the order, she hadn't specified which machine, so DME said their default was what she would have to take. I'll get it cleared up tomorrow. Without you guys, I would never have known that choice was even an option!! Does the DME get some kick back from the CPAP company they promote? Why would they default to one specific machine? Weird. Anyway, thanks so much!!

[chunkyfrog]

Thanks everyone. I'm going to call the NP that wrote the order. She's really cool and I'm sure she'll change to whatever machine I request. When they sent the order, she hadn't specified which machine, so DME said their default was what she would have to take. I'll get it cleared up tomorrow. Without you guys, I would never have known that choice was even an option!! Does the DME get some kick back from the CPAP company they promote? Why would they default to one specific machine? Weird. Anyway, thanks so much!!

They get paid the same for a really good, smart machine as for a bottom level, DUMB machine.
They make more profit if they stick you with a bare bones, barely works POS.
Kickbacks are always possible, but they would have to be kept a secret.
Secrets are getting harder to keep all the time. Too many whistle-blowers.
Safer to just legally cheat the patient.
Smart patients get what they paid for-- insurance isn't cheap.

[Pugsy]

Does the DME get some kick back from the CPAP company they promote? Why would they default to one specific machine?

DMEs will usually stock the brand that they got the best wholesale contract price on so they can make the most profit.
Remember that insurance pays by HCPCS billing code and not by brand or model. Insurance pays DMEs the same amount for any E0601 (cpap/apap) machine and they are going to dispense whichever they can make the most money on unless they are forced to dispense something else. They will still make money on another brand or model...just not as much as they would make on the one they stock that they got a better wholesale price on and carry in bulk.