My story is rather simple. I was initially prescribed a straight CPAP machine but my dr. told me that he may have to switch me to an auto depending on how things go the first month or so. Well the aerophagia was so unbearable after the first week that I called him and asked if he would change the script to an auto, he did. Over the next week I called my DME and told them what machine I wanted, set up an appointment to pick it up and went and got it.
During my titration study I was "prescribed" a pressure of 12cms. I have my APAP set for a range of 9-12 and in the 51 days that I have been using it I have hit 12 for a total of 26 minutes. I have Healthpartners insurance here in Minnesota.
I forgot to log in as well.
People with DME experience getting APAP vs. CPAP
Hi Travis.
I am not a Doctor, nor do I play one on TV, but I 'Think" that if you are using an Auto-PAP and have been Titrated to 12cm.
Than I "Think" that most people set their auto machine 2 numbers above and 2 numbers below their Titrated pressure.
I was Titrated at 10cm and I have my APAP set to 8-12.
Hopefully some other forum members will chime in here.
Tim
I am not a Doctor, nor do I play one on TV, but I 'Think" that if you are using an Auto-PAP and have been Titrated to 12cm.
Than I "Think" that most people set their auto machine 2 numbers above and 2 numbers below their Titrated pressure.
I was Titrated at 10cm and I have my APAP set to 8-12.
Hopefully some other forum members will chime in here.
Tim
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travismcgee
- Posts: 93
- Joined: Mon Jan 07, 2008 7:28 am
- Location: minnesota
[quote="pratzert"]Hi Travis.
I am not a Doctor, nor do I play one on TV, but I 'Think" that if you are using an Auto-PAP and have been Titrated to 12cm.
Than I "Think" that most people set their auto machine 2 numbers above and 2 numbers below their Titrated pressure.
I was Titrated at 10cm and I have my APAP set to 8-12.
Hopefully some other forum members will chime in here.
Tim
I am not a Doctor, nor do I play one on TV, but I 'Think" that if you are using an Auto-PAP and have been Titrated to 12cm.
Than I "Think" that most people set their auto machine 2 numbers above and 2 numbers below their Titrated pressure.
I was Titrated at 10cm and I have my APAP set to 8-12.
Hopefully some other forum members will chime in here.
Tim
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First off, you don't ask your doctor what other local DME suppliers there are.
You call your INSURANCE COMPANY and ask THEM what local DME CPAP suppliers they are contracted with. Hopefully you have the option of more than one. THEN you shop those options to see who will provide you w/the machine you want at no extra charge and who also have a lenient mask exchange policy.
I have Medicare as my primary and most every local DME accepts Medicare (its usually the bulk of their income) my secondary is thru a self-insured company that utilizes BC/BS for administration. By calling my secondary BC/BS I was able to determine that I had the option of 3 local DME suppliers.
The night of my titration I not only told the tech but also wrote on my paperwork that I would NOT ACCEPT ANY equipment until I had seen the doctor and WE came to a MUTUAL agreement on what equipment was ordered.
I was upfront w/my sleep doctor that I wanted a fully data capable CPAP and preferred the Respironics M Series Pro w/C-Flex. What the DME supplier I indicated provided me w/was a Respironics Plus w/C-Flex - on a Friday afternoon. Friday night I couldn't find a slot for the data card. Monday morning I called them and told them I was returning it. They told me I couldn't return it w/o an order from the doctor. BIG MISTAKE on their part! W/in 1/2 hour I was in their office returning the Plus!
W/in an hour I was at my sleep lab insisting that I would NOT accept anything less than a fully data capable CPAP. The sleep lab manager suggested the new (at that time) Resmed S8 Elite w/EPR and suggested another of the three DME suppliers my secondary was contracted with. I was agreeable, she contacted the doctor and the script was FAXed over. I got the Resmed S8 Elite and have never regretted it.
On the other hand, that DME supplier was a sheister to work with! I then got "auto fever" but too late into my capped rental from the sheister DME to make it worth my while to fight w/them for an autoPAP. So I bought a Respironics pre-M Series Auto w/C-Flex out of pocket. And got excellent therapy w/it - but - I missed the easy access to so much data on the easy to read Resmed LED screen so when a lightly used Resmed S8 AutoSet Vantage became available I scoffed it up and sold the Respirinoics Auto to my son in law for a travel xPAP.
HOWEVER, I have COPD and in due time the new sleep doctor at the sleep lab suggested I needed a bi-level titration. And it was determined that I did need a bi-level. I opted for the new Resmed VPAP Auto bi-level in the S8 body w/EasyBreathe technology. NOT the bi-level many DME's want to provide. These bi-level babies are EXPENSIVE. But w/my history of refusing/returning equipment that was less than what I wanted my sleep lab talked some real turkey w/the first DME supplier since I refused to do business w/the sheister DME supplier. I got the bi-level auto pap I wanted, the Resmed VPAP Auto.
So what you have to do is call your insurance, find out what local DME CPAP suppliers they are contracted with. RETURN or DO NOT ACCEPT any CPAP that isn't what you want WITHIN 30 DAYS. Once you have accepted less than what you want and keep it more than 30 days you are in for a headache. Most local DME suppliers don't submit a bill to your insurance company for about 45 days so you might be able to squeeze an extra day or so beyond 30 days but once that bill is submitted you play heck exchanging or upgrading. IF that current DME supplier is your only option - you are in a world of hurt, they've got you buy the short hairs unless you are willing to buy what you want out of pocket.
The key, really, is to have the option of more than one local DME supplier AND DIPLOMACY, TACT AND FIRMNESS on your part to get what you want. Those who have had the most success in getting an autoPAP w/a CPAP script from their doctor have been those who have been diplomatic but firm. Others, if their sleep doctor won't cooperate to have a cooperative primary care or other doctor who will write a script for an autoPAP.
You call your INSURANCE COMPANY and ask THEM what local DME CPAP suppliers they are contracted with. Hopefully you have the option of more than one. THEN you shop those options to see who will provide you w/the machine you want at no extra charge and who also have a lenient mask exchange policy.
I have Medicare as my primary and most every local DME accepts Medicare (its usually the bulk of their income) my secondary is thru a self-insured company that utilizes BC/BS for administration. By calling my secondary BC/BS I was able to determine that I had the option of 3 local DME suppliers.
The night of my titration I not only told the tech but also wrote on my paperwork that I would NOT ACCEPT ANY equipment until I had seen the doctor and WE came to a MUTUAL agreement on what equipment was ordered.
I was upfront w/my sleep doctor that I wanted a fully data capable CPAP and preferred the Respironics M Series Pro w/C-Flex. What the DME supplier I indicated provided me w/was a Respironics Plus w/C-Flex - on a Friday afternoon. Friday night I couldn't find a slot for the data card. Monday morning I called them and told them I was returning it. They told me I couldn't return it w/o an order from the doctor. BIG MISTAKE on their part! W/in 1/2 hour I was in their office returning the Plus!
W/in an hour I was at my sleep lab insisting that I would NOT accept anything less than a fully data capable CPAP. The sleep lab manager suggested the new (at that time) Resmed S8 Elite w/EPR and suggested another of the three DME suppliers my secondary was contracted with. I was agreeable, she contacted the doctor and the script was FAXed over. I got the Resmed S8 Elite and have never regretted it.
On the other hand, that DME supplier was a sheister to work with! I then got "auto fever" but too late into my capped rental from the sheister DME to make it worth my while to fight w/them for an autoPAP. So I bought a Respironics pre-M Series Auto w/C-Flex out of pocket. And got excellent therapy w/it - but - I missed the easy access to so much data on the easy to read Resmed LED screen so when a lightly used Resmed S8 AutoSet Vantage became available I scoffed it up and sold the Respirinoics Auto to my son in law for a travel xPAP.
HOWEVER, I have COPD and in due time the new sleep doctor at the sleep lab suggested I needed a bi-level titration. And it was determined that I did need a bi-level. I opted for the new Resmed VPAP Auto bi-level in the S8 body w/EasyBreathe technology. NOT the bi-level many DME's want to provide. These bi-level babies are EXPENSIVE. But w/my history of refusing/returning equipment that was less than what I wanted my sleep lab talked some real turkey w/the first DME supplier since I refused to do business w/the sheister DME supplier. I got the bi-level auto pap I wanted, the Resmed VPAP Auto.
So what you have to do is call your insurance, find out what local DME CPAP suppliers they are contracted with. RETURN or DO NOT ACCEPT any CPAP that isn't what you want WITHIN 30 DAYS. Once you have accepted less than what you want and keep it more than 30 days you are in for a headache. Most local DME suppliers don't submit a bill to your insurance company for about 45 days so you might be able to squeeze an extra day or so beyond 30 days but once that bill is submitted you play heck exchanging or upgrading. IF that current DME supplier is your only option - you are in a world of hurt, they've got you buy the short hairs unless you are willing to buy what you want out of pocket.
The key, really, is to have the option of more than one local DME supplier AND DIPLOMACY, TACT AND FIRMNESS on your part to get what you want. Those who have had the most success in getting an autoPAP w/a CPAP script from their doctor have been those who have been diplomatic but firm. Others, if their sleep doctor won't cooperate to have a cooperative primary care or other doctor who will write a script for an autoPAP.
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| Additional Comments: PR SystemOne BPAP Auto w/Bi-Flex & Humidifier - EncorePro 2.2 Software - Contec CMS-50D+ Oximeter - Respironics EverFlo Q Concentrator |
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My computer says I need to upgrade my brain to be compatible with its new software.
My computer says I need to upgrade my brain to be compatible with its new software.
OK, here's the latest update from crazyland
I saw another doc yesterday. Brought all my sleep study results and handed them over-- told him I had issues with the UCLA sleep doc not giving me a copy of my own prescription. His response? "Why do you need it?"
WOW. Red flag.
I continued on, asking him questions that the UCLA doc did not answer. I asked him if he would write me a script for an APAP, and he said "I don't think you need it... there is nothing wrong with the prescription that the UCLA doc wrote." OK, fair enough. I'm still happy with the Resmed S8 Elite II that the DME agreed to. But I continued, asking him if he would provide me a new original prescription based on the sleep study data and he asked why. I told him that I did not trust the financial interests of the UCLA doc shoehorning me into going to a specific DME, and I wanted a prescription that I could take to any other DME of my choosing. I then found out that he sells xPAPs directly to his patients! Apparently he has an "on-site" DME, and as part of my registration paperwork I had to acknowledge that the doctor has a major financial stake in the running of this business. (I didn't quite realize what I was signing at first, but after my conversation with him I pieced it together)
Can you imagine? THE DOCTOR IS THE DME. Talk about a HUGE conflict of interest!! Seriously, I was baffled, beside myself.
I then called around to several other DMEs in my network, but none of them were willing to provide me the Resmed S8 Elite II without upcharging. Again, this is apparently a legitimate practice per my insurance's contract.
None of the DMEs I spoke with (including Aircare) sold the highly recommended Aeiomed Headset. In fact though Aeiomed's website, I finally tracked down a local out of network provider who was shocked that I was even asking about it. "I don't think we've ever sold even one of these. Are you sure you want it? I can certainly make you a good deal on it." Her good deal? "Under $200" (includes resp therapist training and access). No exchanges allowed once purchased. (By the way, cpap.com = $99.00.)
So the bottom line... I'm back to Aircare, who is presenting me with basically two headset options... the Resmed swift and the Respironics Optilife. When I asked if they could special order other models, they said "No, we have contracts with specific companies." This was the stock answer from all 3 DMEs I spoke with.
It seems that the only way to have a good, high quality experience in securing CPAP is to buy the damned thing youself. Then the DME's won't fight you on anything, since they're getting paid no matter what. It's no wonder the US has such a low rate of compliance. I can't imagine this happens in a system where the care of the patient is put before profit of the company.
So.... how do you recommend securing the Aeiomed headset? Is it even possible? I don't want to go out of pocket for it, because it will be an ongoing expense that I cannot afford.
Thanks everyone
I saw another doc yesterday. Brought all my sleep study results and handed them over-- told him I had issues with the UCLA sleep doc not giving me a copy of my own prescription. His response? "Why do you need it?"
WOW. Red flag.
I continued on, asking him questions that the UCLA doc did not answer. I asked him if he would write me a script for an APAP, and he said "I don't think you need it... there is nothing wrong with the prescription that the UCLA doc wrote." OK, fair enough. I'm still happy with the Resmed S8 Elite II that the DME agreed to. But I continued, asking him if he would provide me a new original prescription based on the sleep study data and he asked why. I told him that I did not trust the financial interests of the UCLA doc shoehorning me into going to a specific DME, and I wanted a prescription that I could take to any other DME of my choosing. I then found out that he sells xPAPs directly to his patients! Apparently he has an "on-site" DME, and as part of my registration paperwork I had to acknowledge that the doctor has a major financial stake in the running of this business. (I didn't quite realize what I was signing at first, but after my conversation with him I pieced it together)
Can you imagine? THE DOCTOR IS THE DME. Talk about a HUGE conflict of interest!! Seriously, I was baffled, beside myself.
I then called around to several other DMEs in my network, but none of them were willing to provide me the Resmed S8 Elite II without upcharging. Again, this is apparently a legitimate practice per my insurance's contract.
None of the DMEs I spoke with (including Aircare) sold the highly recommended Aeiomed Headset. In fact though Aeiomed's website, I finally tracked down a local out of network provider who was shocked that I was even asking about it. "I don't think we've ever sold even one of these. Are you sure you want it? I can certainly make you a good deal on it." Her good deal? "Under $200" (includes resp therapist training and access). No exchanges allowed once purchased. (By the way, cpap.com = $99.00.)
So the bottom line... I'm back to Aircare, who is presenting me with basically two headset options... the Resmed swift and the Respironics Optilife. When I asked if they could special order other models, they said "No, we have contracts with specific companies." This was the stock answer from all 3 DMEs I spoke with.
It seems that the only way to have a good, high quality experience in securing CPAP is to buy the damned thing youself. Then the DME's won't fight you on anything, since they're getting paid no matter what. It's no wonder the US has such a low rate of compliance. I can't imagine this happens in a system where the care of the patient is put before profit of the company.
So.... how do you recommend securing the Aeiomed headset? Is it even possible? I don't want to go out of pocket for it, because it will be an ongoing expense that I cannot afford.
Thanks everyone
In Dec. 2006, I received my 1st machine a Respironics M Series Pro w/C-Flex. I used this until May 8 2008 when I received my new REMStar Auto M Series with A-Flex.
Anna at my DME handled everything, she called my doctor Informed him of my need for the auto. She got his ok and a new script for it. Then she called the insurance company for approval.
She is a very helpful person.
Anna at my DME handled everything, she called my doctor Informed him of my need for the auto. She got his ok and a new script for it. Then she called the insurance company for approval.
She is a very helpful person.
I had trouble with DME, LifePlus, when they gave a CPAP that only provided compliance data. I fought for two weeks to get a data compliant machine, and after a new script they finally provided a Remstar APAP. Other than that issue I have never had a problem.. I now only call the 800 number to order my supplies from Apria. Still have to pay my 20% co-pay, which is much cheaper than out of pocket for filters, masks, hoses and replacement tanks. I do not deal directly with the DME, LifePlus. I think the supplies are shipped and billed from the DME but I do not have to deal with them. Don't know why there are so many horror stories about APRIA,...do they differ by regiion, insurance companies, and DME?
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