This is my big chance. Which machine?

[fiveolddogs]

My six year old BASIC Respironics REMStar started making random loud whining / humming sounds so it looks like it's time to retire it. I have a script from the doc for "CPAP", so it looks like I'm restricted to a basic machine. The pressure setting I've been using since my sleep study a few years ago is 9. My insurance will pay 80%.

I'm interested in hearing from people who are happy with their machines. What do you like about it, and where did you buy it?

Thanks.

[Julie]

Have you asked your MD about a script for an Apap? You haven't said anything about insurance, so depending on your status that way, a lot could be suggested, or a little. Are you interested in a machine with a smart card that allows you to put the card into a 'reader' hooked to your computer so you can really track your progress by seeing all the results of each night's sleep parameters, such as your AHI, leak rate, how pressure settings behaved, etc? Can you afford to buy more than a basic machine from Cpap.com and have your insce. cover the much, much lower costs than they'd have to pay through a DME? Or just plain pay it yourself? All of this matters!

[tdm5032c]

I had the same script, and I had the doctor change it to an APAP. My doctor was more than willing to change it once I explained to him why I wanted it and he knew that I was educated. Your doctor might be the same way. It doesn't hurt to try. I am VERY glad that I insisted on my M-Series with A-flex. Great little machine and you have all of the benefits of the other machines. I understand the Resmed Auto's are pretty good too. I have just never used them. It is YOUR therapy and YOUR money. I'd insist on what you want.

Tracy

[JimW203]

My six year old BASIC Respironics REMStar started making random loud whining / humming sounds so it looks like it's time to retire it. I have a script from the doc for "CPAP", so it looks like I'm restricted to a basic machine. The pressure setting I've been using since my sleep study a few years ago is 9. My insurance will pay 80%.

I'm interested in hearing from people who are happy with their machines. What do you like about it, and where did you buy it?

Thanks.

If you can deal with the up-front expense and your insurance will reimburse quickly enough for you, you have an option without a new script through CPAP.com.

If my interpretation of their guidelines is correct, your CPAP script will suffice for an APAP machine from them. I think this assumes you have no specific pressure noted on the script. This from https://www.cpap.com/cpap-faq/Prescriptions.html#133 regarding APAP script format:

Contains one of the following words or phrases "APAP", "AutoPAP", "AutoSet", "Auto CPAP", "Auto Adjusting CPAP", "Self Adjusting CPAP", "CPAP" or "Continuous Positive Airway Pressure" or similar term.
Contains your physicians contact information
Contains your physicians signature
Contains your pressure range (Optional, Not Required)

Example: 4-20 CM/H20
Example: 4-20
Example: 6-18 CM/H2O
Example: 6-18

CPAP prescriptions are accepted for Auto Adjusting (APAP) Machines.

[fiveolddogs]

Have you asked your MD about a script for an Apap? You haven't said anything about insurance, so depending on your status that way, a lot could be suggested, or a little. Are you interested in a machine with a smart card that allows you to put the card into a 'reader' hooked to your computer so you can really track your progress by seeing all the results of each night's sleep parameters, such as your AHI, leak rate, how pressure settings behaved, etc?

What components are necessary to do this? I believe I already have a reader which can read smart cards. When you buy the machine, does the card come with it?

Can you afford to buy more than a basic machine from Cpap.com and have your insce. cover the much, much lower costs than they'd have to pay through a DME? Or just plain pay it yourself?

When I called my insurance, all they would tell me about my coverage was that a new machine would be covered at 80% after meeting my deductable. There was no mention of DMEs or prefered suppliers.

[BeanMeScot]

I'd go for the Respironics M Series with A-Flex.

It comes with a card but you have to have a special card reader to read the data on it.

You can use the CPAP script to buy that machine but probably only online.

[RipVW]

Get an M Series Auto with A-FLEX! It's the "dream machine!"

[Slinky]

1] Call your insurance and ask what local DME suppliers they are contracted with. Hopefully you will have the option of more than one as that increases your bargaining/negotiating power.

2] What is your deductable? Is that an annual deductable? Have you met that annual deductable yet?

3] An APAP has the exact same insurance code as a bare bone CPAP. Insurances pay by insurance code, NOT by brand and model. Of course, they've contracted at one set reimbursement fee for that insurance (HCPCS) CODE, but that's NOT your problem, its the local DME suppliers' problem.

4] That CPAP script is good for an APAP regardless of the scripted pressure settings w/online DME suppliers - and - can be for the local DME suppliers too whether they like it or not.

5] My personal preference would be for the Resmed S8 II AutoSet w/EPR. Second choice would be the Resmed S8 AutoSet Vantage. Third would be the Resmed S8 Elite II w/EPR and 4th would be the Resmed S8 Elite w/EPR. (The S8s came out in 2006. The S8 IIs came out in 2008). All four of these xPAPs are fully data capable, the first two are APAPs, the second two are "just" fully data capable CPAPs, BUT darn good ones. The Resmeds excell in ease of access to and the amount of data available via the LCD screen. The HCPCs code for any of these 4 xPAPs is e0601.

6] I would be right up front w/the local DME suppliers that I want the fully data capable APAP. YOU are paying for it whether thru insurance or out of pocket, YOU are still the one paying for it. If you have the option of more than one local DME supplier you can DIPLOMATICALLY and FIRMLY make it clear that you CAN go elsewhere. One of them should want your business enough to give you what you want.

7] AND if the local DME supplier is quite adamant about not wanting to supply an APAP, the fully data capable CPAP is a great compromise for both of you. They are the middle ground between what you want and what they want to provide.

8] You can get by quite nicely w/the LCD data of the 4 Resmeds mentioned above until you have the extra money to buy the software and cable reader. The software and cable readers for these xPAPs, whether Resmed or Respironics, are proprietary. Just any cable reader won't cut the mustard.

9] If you opt to explore the prices online keep in mind that Resmed, Respironics and Fisher & Paykel have instituted MAP (minimum advertised price) policies against the online DME suppliers. To get your true price, which can vary from one online DME supplier to another, you need to either call that online supplier's toll-free number and ask if they have an "unadvertised sale price" for the item you want, get and use a special sales code, or add the item to your shopping cart to get the true price to you for that item.

10] Be sure to ask the local DME suppliers' about their mask exchange policy. A lenient mask exchange policy can be very important for those new to the CPAP experience. In your case you most likely KNOW which mask or masks "work" for you and the exchange policy is not so important for you.

[KengEsq]

My six year old BASIC Respironics REMStar started making random loud whining / humming sounds so it looks like it's time to retire it. I have a script from the doc for "CPAP", so it looks like I'm restricted to a basic machine. The pressure setting I've been using since my sleep study a few years ago is 9. My insurance will pay 80%.

I'm interested in hearing from people who are happy with their machines. What do you like about it, and where did you buy it?

Thanks.

I'd ask the doctor to prescribe an APAP (all or most of them can be set in the APAP or the CPAP mode so nothing is lost if the auto is a problem for you). I just happen to love my ResMed S8 AutoSet II because it does a great job for me, is easy to use, the LCD screen readouts are great, it is data reporting and is wisper quiet.

[Julie]

The 'other' machine (not the Autoset) that everyone seems to love and talk about is the Respironics M Series Auto with Aflex (I have a slightly older version of it) and it comes with a 'smart card'. You can get it from Cpap.com alone, or as a bundle with the reader and the software for your computer. The reader is the only one that will work with the software (called Encore Pro, and/or Encore Analyzer - you can't just use any old card reader). The point about DME's is that they will charge your insce. co. a huge price for the equipment, which the companies apparently think is ok as they normally pay it, but not all are willing to pay for an upgraded machine, and almost none that I've heard about pay for the reader or software. They are also notorious for trying to pawn off a low end machine on you, and try to tell you it's all there is, and a bunch of other nonsense, which is why a lot of us just pay Cpap.com (or other co's) directly and then submit to our insce. co. But you do need to speak to your co. to find out what in fact they will cover if you want to do it that way.

[fiveolddogs]

1] Call your insurance and ask what local DME suppliers they are contracted with. Hopefully you will have the option of more than one as that increases your bargaining/negotiating power.

What are the advantages to going with a DME? If they are such a problem, why not just skip them and go with an online supplier?

2] What is your deductable? Is that an annual deductable? Have you met that annual deductable yet?

It's an annual deductable that is easily met each year, but has not been met yet this year.

[KengEsq]

1] Call your insurance and ask what local DME suppliers they are contracted with. Hopefully you will have the option of more than one as that increases your bargaining/negotiating power.

What are the advantages to going with a DME? If they are such a problem, why not just skip them and go with an online supplier?

2] What is your deductable? Is that an annual deductable? Have you met that annual deductable yet?

It's an annual deductable that is easily met each year, but has not been met yet this year.

According to my insurer, my DME provider and my sleep doctor, my insurer may be billed a large number for any machine but the DME and my insurer have a contract whereby my insurer will only pay a fixed price regardless of whether the machine is a CPAP or APAP and the DME has agreed to accept that fixed amount and not bill me personally for the difference. My insurer is BC/BS. I was also told by my sleep doctor that because my DME only gets a fixed payment, that is why the DME pushes the least expensive CPAP on you rather than a more expensive APAP.

[fiveolddogs]

According to my insurer, my DME provider and my sleep doctor, my insurer may be billed a large number for any machine but the DME and my insurer have a contract whereby my insurer will only pay a fixed price regardless of whether the machine is a CPAP or APAP and the DME has agreed to accept that fixed amount and not bill me personally for the difference. My insurer is BC/BS. I was also told by my sleep doctor that because my DME only gets a fixed payment, that is why the DME pushes the least expensive CPAP on you rather than a more expensive APAP.

That makes sense. It also sounds like a good reason to skip these local DMEs and go with an online supplier, unless I'm missing something. For a $600 machine (just to pick a number in the neighborhood of some of the APAP machines), my 20% only amounts to $120 which seems like a low number considering I'll have this thing for the next 5 years at least.

[KengEsq]

According to my insurer, my DME provider and my sleep doctor, my insurer may be billed a large number for any machine but the DME and my insurer have a contract whereby my insurer will only pay a fixed price regardless of whether the machine is a CPAP or APAP and the DME has agreed to accept that fixed amount and not bill me personally for the difference. My insurer is BC/BS. I was also told by my sleep doctor that because my DME only gets a fixed payment, that is why the DME pushes the least expensive CPAP on you rather than a more expensive APAP.

That makes sense. It also sounds like a good reason to skip these local DMEs and go with an online supplier, unless I'm missing something. For a $600 machine (just to pick a number in the neighborhood of some of the APAP machines), my 20% only amounts to $120 which seems like a low number considering I'll have this thing for the next 5 years at least.

Unfortunately, my insurer will not re-imburse me for a machine or any mask or accessory I purchase directly on-line. I have to have them provided by the DME with whom my insurer contracts. Therefore, if I bought a $600.00 machine from an online supplier, it would cost me $600 out of my pocket and I get it free (well, considering my annual medical insurance premium, it is far from free) from my DME.

[PolyMar]

I am an experienced sleep professional (RPSGT) who is on PAP. In my personal experience the APAP sounds great but rarely delivers the optimal pressure that was found during a pt's titration. When I myself went from CPAP to APAP I begin noticing I did not feel as rested, this result prompted me to "download" my device. The information I found when my download was complete is the average pressure my machine was dispensing was 6cwp and my optimal titration pressure is 8cwp. When you are in the sleep lab the professional working with goes to great lengths to find a pressure that helps you consolidate and maintain all stages of sleep, not just REM. When your machine is not dispensing optimal pressure at all times you are losing some of the benefit.

While the idea of APAP is great I myself do not believe it is worth the risk of not getting to sleep at your "perfect pressure". Once I realized my APAP was not working like I thought I decided to test all major APAP devices available on the market, since I am a DME Coordinator I have the benefit of being able to call my manufacurers reps and request to demo there APAP devices at no charge. I received the same result with all APAP devices, none blew at my optimal pressure for my TST (Total Sleep Time).

APAP devices rely on algorithms to determine optimal pressure which eliminates human deductive reasoning and experience. If you are interested in a device that adds additional comfort I recommend you try ResMed's S8 CPAP model which offers EPR(Expiratory Pressure Relief) or Respironics CPAP with C-Flex. What C-Flex and ERP do is minutely drop pressure during exhalation to make breathing more comfortable.

You are prescribed a pressure for a reason, and hopefully you were able to work with an RPSGT, not just a sleep tech, which better assures you proper treatment, this is because RPSGT's have sat for their sleep medicine boards/registry and passed. PAP therapy is a process in the beginning, it takes time to acclimate however it is worth it in the end. Keep in mind that just like any other industry PAP manufacturers have a tendency to push the most expensive product and while this product might look attractive many times you end up losing some theraputic benefit thus doing yourself an injustice.