Interesting! They certainly don't tell you about it. In any case, ResMed Autosets are what they are dispensing right now. It would only be a problem for a mask not on formulary. And what a PITA, just for a mask!clownbell wrote: ↑Fri Feb 18, 2022 11:51 pmWith all due respect to Janknitz above, Kaiser has a procedure (in the SF area anyway) whereby the patient can request an item not in the formulary. The patient provides the justification and there is a committee that makes the decision on whether an exception will be made. That may not be true of Kaiser everywhere, but it is true in this area. OP, I suggest having a conversation with your Kaiser doc.
Who decides what CPAP Machine you get?
Re: Who decides what CPAP Machine you get?
_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier |
Mask: DreamWear Nasal CPAP Mask with Headgear |
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm
Re: Who decides what CPAP Machine you get?
Another reason to avoid HMOs
_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier |
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear |
Additional Comments: Not having trouble just joined to read |
Re: Who decides what CPAP Machine you get?
Thanks Okie for your reply. I have yet to consult with my primary doctor, but he is generally receptive to my preferences. Keeping spares on hand sounds sort of expensive - in your situation, there is a good reason however, since you both use CPAP. I will keep that in mind.
- chunkyfrog
- Posts: 34458
- Joined: Mon Jul 12, 2010 5:10 pm
- Location: In the abyss that is Nebraska--wish me luck!
Re: Who decides what CPAP Machine you get?
Reasons to have backups:
---your DME is not open when you are USING your cpap. EVER
---your supplier decides (on a wild hair) to not carry your preferred mask, machine, etc.
---your insurance, also a wild hair, or some other lame excuse--will do a dirty deed--2U.
---Anything can break or die on a weekend. (Murphy wins--again!)
Be in control; because nobody cares for you, like YOU.
---your DME is not open when you are USING your cpap. EVER
---your supplier decides (on a wild hair) to not carry your preferred mask, machine, etc.
---your insurance, also a wild hair, or some other lame excuse--will do a dirty deed--2U.
---Anything can break or die on a weekend. (Murphy wins--again!)
Be in control; because nobody cares for you, like YOU.
_________________
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear |
Additional Comments: Airsense 10 Autoset for Her |
- Okie bipap
- Posts: 3556
- Joined: Thu Oct 15, 2015 4:14 pm
- Location: Central Oklahoma
Re: Who decides what CPAP Machine you get?
Once you get started good, it will be easier to start stockpiling spares items. If you have insurance coverage for your supplies, they will normally allow replacement items much quicker than they actually wear out. We both use a full face mask, and the cushion will last a year or more if it is taken care of. Insurance normally allows for a replacement every month. As far as spare machines go, many of us have purchased used machines that were found on Craig's list or Facebook Marketplace. I found my wife's spare machine here on the forum, and i found my spare machine on Facebook Marketplace. Just keep your eyes open for deals. You can also find replacement mask parts on eBay for less than what you pay at the DME. Even Amazon carries some CPAP supplies. We didn't stock up on spares right at the start, but have done so over the years.oklajohn wrote: ↑Mon Feb 21, 2022 9:35 amThanks Okie for your reply. I have yet to consult with my primary doctor, but he is generally receptive to my preferences. Keeping spares on hand sounds sort of expensive - in your situation, there is a good reason however, since you both use CPAP. I will keep that in mind.
_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier |
Mask: Evora Full Face Mask - Fitpack |
Additional Comments: IPAP 20-25, ps 4, OSCAR software |
Growing old is mandatory, but growing up is optional.
Re: Who decides what CPAP Machine you get?
Don't be too smug. An equivalent may be coming to a medical practice near you, and you won't be given a choice of whether or not to participate: https://www.elderlawanswers.com/advocat ... care-18601Another reason to avoid HMOs
_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier |
Mask: DreamWear Nasal CPAP Mask with Headgear |
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm
Re: Who decides what CPAP Machine you get?
Our forum host CPAP.com have been running various 20% off sales on masks (and other supplies) for the past few weeks. $100 or so out-of-pocket wouldn't prevent me from using my mask of choice.
_________________
Machine: AirSense 10 AutoSet with Heated Humidifer + P10 Nasal Pillow Mask Bundle |
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear |
Additional Comments: AirMini Travel Machine |
Re: Who decides what CPAP Machine you get?
Personally I don't mind paying out of pocket for supplies (a machine is going to be more challenging). I feel like that old American Express Commercial:Our forum host CPAP.com have been running various 20% off sales on masks (and other supplies) for the past few weeks. $100 or so out-of-pocket wouldn't prevent me from using my mask of choice.
Dealing with Crapria to get the wrong item and incorrect billing--$40
Buying a mask out of pocket without having to deal with Crapria--PRICELESS!
I'd rather pay than hassle, given the amount of my precious time and frustration I had to spend with EVERY interaction with Crapria. And some of the stuff I get is less expensive than my co-pays would be anyway.
_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier |
Mask: DreamWear Nasal CPAP Mask with Headgear |
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm
Re: Who decides what CPAP Machine you get?
I feel like if I am paying for the insurance then I have options and they won't ALL be HMOs.Janknitz wrote: ↑Tue Feb 22, 2022 7:26 pmDon't be too smug. An equivalent may be coming to a medical practice near you, and you won't be given a choice of whether or not to participate: https://www.elderlawanswers.com/advocat ... care-18601Another reason to avoid HMOs
In the business world there is always competition.
Are you thinking that one day Apria will be the only choice?
_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier |
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear |
Humidifier: HC150 Heated Humidifier With Hose, 2 Chambers and Stand |
Happiness is being on Dog Slobber pr & zonkers foe list
CrankyGranny is Whale Road + many other ids
They are here to help.
CrankyGranny is Whale Road + many other ids
They are here to help.
zonkers + palerider aka GrumpyHere wrote: ↑What exactly do you think you're adding to this thread?
Re: Who decides what CPAP Machine you get?
Did you read the article?I feel like if I am paying for the insurance then I have options and they won't ALL be HMOs.
In the business world there is always competition.
Are you thinking that one day Apria will be the only choice?
DOCTORS are joining these "Direct Contracting Entities" and
So you won't be given a choice. Your doctors will be in these networks that willTraditional Medicare beneficiaries will be enrolled in these networks, often without their knowledge or consent. The DCEs will be paid a set amount per patient, called a capitation payment, which will vary depending on a patient’s “risk score.” If the patient care costs less than the per-patient amount, the DCE keeps some or all of the difference. If it costs more, the DCE loses money.
As for Crapria, because I was stuck with Kaiser, that's the ONLY DME supplier I could use.extend key aspects of this model [HMO] to other Medicare beneficiaries in 38 states, Washington, D.C., and Puerto Rico, potentially covering 30 million of the 36 million beneficiaries in traditional Medicare. Beneficiaries will not be able to opt out of being “aligned” with a DCE. Medicare will assist the DCEs by searching the claims history of beneficiaries – again without patients’ knowledge or consent -- to see if they have visited a participating DCE provider with which they could be aligned. All this will likely be confusing for Medicare beneficiaries, many of whom will have three different entities processing their claims: the DCE, Medicare, and the beneficiary’s Medicare supplemental insurance (Medigap) plan.
_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier |
Mask: DreamWear Nasal CPAP Mask with Headgear |
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm
Re: Who decides what CPAP Machine you get?
Uncle...
_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier |
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear |
Humidifier: HC150 Heated Humidifier With Hose, 2 Chambers and Stand |
Happiness is being on Dog Slobber pr & zonkers foe list
CrankyGranny is Whale Road + many other ids
They are here to help.
CrankyGranny is Whale Road + many other ids
They are here to help.
zonkers + palerider aka GrumpyHere wrote: ↑What exactly do you think you're adding to this thread?