SmartCards - Are all Fully Data Capable?

[SleepyinWhineCountry]

My Dr. wrote a script for " E0601 NU CPAP Unit w/ C-Flex and SmartCard" (or rather checked that box on the form). My questions is: are all SmartCards fully Data Capable or are some only Compliance data capable. Is there a list somewhere that can tell me which are fully data capable and which are only good for compliance data?

Also, what data is crucial for me to monitor my therapy? My guess is: AHI (should it show apneas and hypoapneas or is that not necessary), non-responsive apnea, leak rate, vibratory snore. Am I missing important data here that will help me manage my therapy?

Many thanks. I am very much a newbie, trying to get the right equipment for me and I feel like a babe in the woods so I really appreciate your patience and help.

[jules]

for respironics machines look at the chart on


http://encore.respironics.com/type.aspx


you can see there is a Plus model with a smart card that doesn't have an X in the last column - that was the one I was referring to last night on your other thread

for the Resmed machines there is the same problem - there is a model with a card (escape) that doesn't have enhanced data

[Goofproof]

The Smart Card is only the media, it's the machine that controls and records the data, Some do full data some are worthless and still use the card. Use the provided for the names and models that get extended data. I think the number you have is the medicare code for XPAP. Jim

REMstar Pro with C-Flex DS400S, DS400HS
REMstar Auto with C-Flex DS500S, DS500HS
REMstar Auto with A-Flex DS510S, DS510HS
BiPAP Auto with Bi-Flex DS700S, DS700HS
BiPAP autoSV 1038917, 1040716

These models all are fully data capable.

[Slinky]

Yep, e0601 is the HCPCS (insurance) code that covers ANY CPAP from bare bone, compliance data only thru fully data capable auto PAPs and those in-between. The bi-levels and SVs, etc. are an entirely different HCPCS code. I've forgotten what the NU stands for. I'd have to look that up.

[Goofproof]

Yep, e0601 is the HCPCS (insurance) code that covers ANY CPAP from bare bone, compliance data only thru fully data capable auto PAPs and those in-between. The bi-levels and SVs, etc. are an entirely different HCPCS code. I've forgotten what the NU stands for. I'd have to look that up.

Could stand for New User, as opposed to replacement. Jim

That's probably wrong, it makes too much sense to be right.

[Slinky]

Darn close guess, GoofProof!!! It indicates New Equipment. It took me awhile to find the list of Modifying Codes last night. *sigh*

[SleepyinWhineCountry]

Wow! There sure is a lot to learn. Thanks for helping me translate all this stuff and try to figure out what it all means.

If E0601 NU is the insurance code for ALL new CPAP and Auto CPAP machines, including fully data capable, compliance data capable only, as well as those that record no data, does that mean that the prescription I have that says "E0601 NU CPAP Unit w/ C-Flex and SmartCard" could be used for either a plain CPAP with compliance data only or an auto CPAP that is fully data capable? It seems to me that the prescription is pretty generic and can be used for pretty much any CPAP machine so the decision as to which machine would be up to the patient(the person paying, either out of pocket or by way of expensive insurance premiums) or by the DME (whose interest is in making the most $$ possible)?

If Medicare and BC insurance works on a 13 month rental (or rent to own) process, if the bare bones, compliance data only CPAP does not work out for me, would I then be able to stop "renting" that one and try a different machine (like a fully data capable, or an auto CPAP). It seems to me that a month by month rental would not commit the patient to the machine since it is not purchased (or am I once again not understanding how all this works)?

Thanks for helping me sort all of this out - it is a different language and a different world out there and not easy to figure it out. I now really understand why the compliance rates are so low (<50% is what I've heard) - more than half of people just give up because it is so hard to negotiate this system and even though there have been so many advances in the technology that makes treatment more tolerable and makes the therapy more successful, it appears many people are not getting access to those options (and don't even know what they are missing).

[jules]

When you get to that stage, check the language in the contract you sign. Ask and demand in writing the answers about canceling the "lease" or changing models. Changing models mid contract is not easy and will need the doctor to write a new prescription and in some cases write letters of medical necessity on why the change is needed.

How many people have leased cars to find out at the end they have this giant balloon payment if they try to get out of the lease early or even at the end of the normal lease?

The DME gets the same $$ from insurance for whatever machine they give you. Since the fancier machines cost them more, they make more money with the "plain jane" models. The DME is allowed to fill the Rx using the cheapest machine possible; some DME's even get the doc to rescind the Rx in favor of something less. The DME is probably not going to be your partner in this.

We may be presenting the worse case scenario, but we read about others experiencing these things and want to prepare you.

The whole mask exchange business is another big problem.

[Slinky]

You've made some pretty darn good observations already, Sleepy. The Resmeds don't offer C-flex, their "equivalent" is EPR and none of the other manufacturers offer any type of expiration pressure relief so I'd venture a guess that it is a Respironics model you are going to get. And there is a Respironics M Series Plus w/C-Flex that is NOT fully data capable that DOES take a data card and reports only compliance data. YOU are paying, whether thru insurance or out of pocket, so stick to your guns, be DIPLOMATIC, but FIRM. Don't accept anything less than the Respironics M Series Pro w/C-Flex.

Medicare's capped rental doesn't work that way. You get a brand new CPAP at the time of the start of the rental, and that is the CPAP you get to keep when the 13 month capped rental is completed. So stick to your guns, you want the Respironics M Series Pro w/C-Flex (or Resmed S8 or S8 II Elite w/EPR if allowed).

You might want to call your BC secondary and ask them what local DME suppliers they are contracted with. Hopefully you have the option of more than one - just in case. Certainly having the option of more than one local DME supplier gives you more bargaining/negotiating room.

Good luck and Happy New Year!

[Wulfman]

Here's a list of the CPAP-related insurance codes.
"NU" is for CPAP purchase.

Den


* E0601 RR is CPAP rental.
* E0601 NU is CPAP purchase.
* A7034 is CPAP nasal mask, including all nasal masks, Nasal Aire, Breeze, Spiritus.
* A7032 is CPAP nasal mask cushion.
* A7030 is CPAP Full Face mask.
* A7031 is CPAP Full Face mask cushion.
* A7044 is CPAP Full Oral Interface.
* A7046 is CPAP Humidifier Chamber.
* A7037 is CPAP tubing, long and short hoses.
* A7038 is CPAP disposable filter.
* A7039 is CPAP gross particle (foam) filter.
* A7035 is CPAP headgear.
* A7033 is CPAP nasal pillows.
* A7036 is CPAP chinstrap.
* E0561 NU is CPAP Passover Humidifier
* E0562 NU is CPAP Heated Humidifier
* E0470 RR is BiPAP rental.
* E0470 NU is BiPAP purchase.
* E0471 RR is BiPAP-ST rental.
* E0471 NU is BiPAP-ST purchase.

Other CPAP items are listed under E1399, which is miscellaneous.

[Goofproof]

If you were to buy out of pocket, you script will get you any APAP or CPAP you want online at viewtopic/t37396/posting.php?mode=reply&f=1&t=37396. Ask for a special price quote. The A-Flex is the latest one more option than C-Flex. You can order supplies at the same time (Filters-Masks) shipping is free on orders over $100. Buying online by-passes many of the hassles.

[SleepyinWhineCountry]

I am considering paying out of pocket and buying online - it may even end up cheaper than to copay for the markup DME's charge.

We just pay so dearly for all this insurance that it seems wrong to not use it just because the DMEs are the way they are. Bottom line is that I need a machine that will work well for me for a long time or all is lost.

Someone said that his insurance reimbursed him (at a lower rate for out of network) for an online purchase - I will check that out and see if it is doable and/or if it makes good sense to do.

There is definately a value to be placed on avoiding the hassels of dealing with the DMEs.....

[jules]

Which is primary? People have not had success getting Medicare to reimburse but your other insurance might. You need to call and ask them.

I took the Pro 2 tank from the DME but a year later bought my APAP. I had data from day 1 with the Pro 2. The humidifier matches the APAP too.

Weight your options as I know you already are doing.

[SleepyinWhineCountry]

What did you not like about the Pro 2?

[jules]

The Pro 2 was fine -- I still use it - used it for a month this fall -

It is a straight cpap however and I found I needed to change pressures depending on which mask (nasal pillows need 8.5 and nasal mask needs 9.5) and I was LAZY and got tired of getting up to change the pressure if I changed the mask - most ppl don't need different pressures for different masks - so I have my APAP range set for 8.5 - 10 usually to cover the different masks

Other than my being lazy, I really don't need an APAP. I bought it thinking it would be greater than it actually is.