Please help - need your advice!

[enso]

Sleep dr's assistant called back to say they could just fax in a prescription for me. She recommended a company called Reliable Medical. I have to do 3-4 weeks with an APAP machine, to figure out what pressure I need. The Rx will be written "machine and mask of patient's choice".

I asked if she knew whether RM was a good company to work with in being able to get a machine that gathered usage data, not just compliance...and that's where it started to go downhill. She claimed 1) it wasn't necessary, 2) it was only on APAP machines and I would probably only need a CPAP, and 3) even it some CPAP machines had it, it was probably really new, and RM might not be able to get such machines (and what's more if RM couldn't then certainly no other company could).

!!!

She was getting a little curt by that point, gave me the number to call RM, and said to let her know. I'm afraid to call RM before consulting with y'all.

Is it better to get my "permanent" machine from the same DME I get the "trial" one from?
Should I call up some DMEs and ask them whether they have the specific machines that I might want?
How do I decide which those might be when I don't know anything?
Is there a handy list of the machines that can give usage data?
Is there a ranking of which machines are also quietest?
Do I need to worry about what settings the "trial" machine has on it, or whether they will adjust things if I'm not adjusting to it?

My ins. co. says all local, in-network DMEs are contracted with them at the same rate. My out-of-network coverage (which would include online companies) has a much higher deductible and much lower co-insurance.

The sleep doc also recommended I use Ambien or something like it for a bit at first, to help me get used to it. Any thoughts about this?

I'm trying not to freak out. This is not fun. I don't want to be one of those who gives up, but I can totally see already why so many do. I just want to make this as easy and comfortable as possible. Any help appreciated.

[ww]

Go to the DME and tell them that you want to be sure you will get an Auto CPAP machine that has exhale relief and a humidifier. Insist that you want the machine that you take home for your test to be a brand new machine and mask and that you expect to keep both of them for your permanent machine. Unless they will agree with that, find another DMV. I have sent you a p/m with a little more information that might save you a little research. Good Luck.

[Sleepdeprived]

Sleep dr's assistant called back to say they could just fax in a prescription for me. She recommended a company called Reliable Medical. I have to do 3-4 weeks with an APAP machine, to figure out what pressure I need. The Rx will be written "machine and mask of patient's choice".

I asked if she knew whether RM was a good company to work with in being able to get a machine that gathered usage data, not just compliance...and that's where it started to go downhill. She claimed 1) it wasn't necessary, 2) it was only on APAP machines and I would probably only need a CPAP, and 3) even it some CPAP machines had it, it was probably really new, and RM might not be able to get such machines (and what's more if RM couldn't then certainly no other company could).

!!!

She was getting a little curt by that point, gave me the number to call RM, and said to let her know. I'm afraid to call RM before consulting with y'all.

Is it better to get my "permanent" machine from the same DME I get the "trial" one from?
Should I call up some DMEs and ask them whether they have the specific machines that I might want?
How do I decide which those might be when I don't know anything?
Is there a handy list of the machines that can give usage data?
Is there a ranking of which machines are also quietest?
Do I need to worry about what settings the "trial" machine has on it, or whether they will adjust things if I'm not adjusting to it?

My ins. co. says all local, in-network DMEs are contracted with them at the same rate. My out-of-network coverage (which would include online companies) has a much higher deductible and much lower co-insurance.

The sleep doc also recommended I use Ambien or something like it for a bit at first, to help me get used to it. Any thoughts about this?

I'm trying not to freak out. This is not fun. I don't want to be one of those who gives up, but I can totally see already why so many do. I just want to make this as easy and comfortable as possible. Any help appreciated.

Hi

You can research auto cpaps here.

https://www.cpap.com/advanced-find-cpap ... ting-CPAPS

I like the respironics M series auto with A flex but there are other good ones as well

You can take your cpap prescription to whatever DME your insurrance contracts with.

l had to call a couple to find one which would fill my order as my sleep study affiliated DME

wouldnot/could not fulfill my order for the above named apap.

The point is you have options.

P.S. You might need to specify a particular machine on your prescription along with pressure setting to get what you want


Good luck

Sleepdeprived

[alnhwrd]

Enso,

Here is a link from Rested Gall that lists some machines that have, or don't have, what it seems you want.

viewtopic.php?p=307168#p307168

And just because it is good info, here are some more links for you:

viewtopic.php?t=17435

IMHO, the Drs asst was out of line to take the tack that she did with you. If you encounter the same attitude with RM, you might want to consider other options. The trial period should give you some idea of how they will deal with you. They should set the machine up for you.

One thing that is very important is that you get a copy of your Drs prescription for your cpap machine. It is good for life and by law no retailer, online or otherwise, can sell you a cpap without it. You should check, even with the higher deductible sometimes the online dealers (insert shameless plug for Cpap.com, our gracious hosts, here!!) can give you a price low enough to definitely make it worth dealing with them. My DME charged my insurance twice the price I found online for the same machine, and then billed me for each part of the machine seperately.

Good luck, I hope some of this was helpful to you.

[roster]

.......The sleep doc also recommended I use Ambien or something like it for a bit at first, to help me get used to it. Any thoughts about this?

........

Enso,

I have some opinions about everything.

Ambien is a powerful drug with a lot of side effects. It is appropriate at times. But docs should not be prescribing it routinely for patients to use when starting CPAP. Maybe you will take to CPAP like a duck to water from the first night. No need to start out drugged up with Ambien if that is the case.

If you have a big leak in the middle of the night, with Ambien you might sleep right through it or be too drunk/drowsy to fix it.

If you feel like crap the next day, you won't know whether it is due to poor CPAP therapy or side effects from Ambien.

I would start CPAP without any drugs and see how things go for a few nights. If you have problems, and you probably will, get people here to help you. No need to introduce a nasty variable like Ambien at this early point in the game. If the doc gives you a prescription, hold onto the script for the slim chance that it might be appropriate treatment later on.

You seem to be going about everything the right way so far and this is a good indication that you will be successful.

Regards,

[JoyD.]

The Rx will be written "machine and mask of patient's choice".

enso,

My suggestion would be not to bother discussing things with the Sleep Doc's assistant - just talk to us and we will answer your questions and make recommendations for you. Probably the less you say to her, the easier it will be on you since you say thaT YOU WERE ALREADY PROMISED THE RX WRITTEN AS ABOVE. With that wording you can get an AutoCPAP. The great thing about AutoCPAP's is that they are like "two machines in one" -- you can use than as a regular CPAP with fixed pressure, or you can use them in Auto Mode where you set a "pressure range" and the machine "finds" the most effective pressure throughout the night. You also get "pressure relief" in either mode if you want it.

TO MAKE IT EASIER FOR YOU TO DECIDE . . . BELOW I'VE LISTED EXCELLENT MACHINES:

The two most popular AutoCPAP machines are the following:

** ResMed S8 Autoset II + Integrated H4i Heated Humidifier (Quieter than the Respironics & has better LED Display)

** Respironics M Series AutoCPAP with AFlex + Integrated Heated Humidifier (The one I have)

You can't go wrong with either. They are both top of the line machines. Since you mentioned quietness being important to you, I'd suggest the ResMed. (Both are fully data capable to allow you to use software which you will have to buy separately along with a Card Reader - insurance will not cover the software/reader.)

If you have insurance, you will want to find out what various DME's charge for your preferred machine + humidifier. Then, call your insurance and find out how much of that price they will cover. Once you know what you will have to pay, you can compare that with online prices like that of cpap.com if you pay outright. (Some people have found that it was cheaper for them to pay the cpap.com price outright than to pay the difference after insurance paid the DME price.)
__________________________

However, if the AutoCPAP turns out to be too expensive for you from the DME after insurance (or direct from cpap.com), then the two most popular regular CPAP machines are the following:

** Resmed S8 Series "Elite II" CPAP Machine + H3i Integrated Heated Humidifier (Quieter & better LED display)

** Respironics M Series "PRO" CPAP with CFlex + Integrated Heated Humidifier
(Both are fully data capable to allow you to use software which you will have to buy separately along with a Card Reader - insurance will not cover the software/reader.)

Hope this helps,
Joy

[JoyD.]

Enso asked:
Is it better to get my "permanent" machine from the same DME I get the "trial" one from?
Not better - shop around once you have the script that, hopefully, says "machine of patient's choice", and see who carries what you want and what their exact price is for the machine + humidifier

Should I call up some DMEs and ask them whether they have the specific machines that I might want?
Yes (see above)

How do I decide which those might be when I don't know anything?
Is there a handy list of the machines that can give usage data?
Is there a ranking of which machines are also quietest?
See post above this one with exact names & info you are asking for. I've narrowed it down to the two most popular

Do I need to worry about what settings the "trial" machine has on it, or whether they will adjust things if I'm not adjusting to it?
Don't worry about that now - we will guide you and show you how to change the pressure on your machine to find your "sweet spot" if you want us to, and if they are not helping you.

Joy

[enso]

Thank you, thank you! I have tears of relief and gratitude in my eyes as I type this. I really feel supported and empowered by these helpful responses--you guys ROCK! I'm printing everything out to refer to as needed. A couple follow-up questions, if you would be so kind...

...get a copy of your Drs prescription for your cpap machine. It is good for life...

Really? I thought all Rxs expired after a certain time. Since they want me to try it for a month to get my settings right, don't they specify the Rx is only good for that period...So I would have to get a revised Rx once they decide all that stuff?

What if the dr's assistant doesn't want to send the Rx to me? I don't like getting all tough and demanding "you have to according to -----"...Being stressed out is keeping me from coming up with nicer wordings. What words of persuasion worked for you? If it comes to it, though, what goes in place of -----?

rooster, I'm with you about the drugs; thanks for spelling it out more clearly than I could have right now.

RE: insurance. The good news is there are a bunch of DMEs in my city that are contracted with my plan. And the ins. rep. said all in-network DME's are contracted at the same amount across the board. Ins. will cover purchase or rental. There don't seem to be any other requirements to having it covered. I will compare my cost using ins. vs going self-pay. But maybe I should rent it the first month, just to be on the safe side? Any pitfalls here I might be missing?

[ozij]

Rent for the first month - if the machine does its job - great. If not, rent another kind of auto for another month. The algorithms of different companies are different, and while all of them do work for the majority of people, you can't know ahead of time if you fall within a machine's minority - so renting for finding this out is better, IMO.

O.

[Wulfman]

One of the "pitfalls" I could envision is that it could be expensive to rent for a month. Typically, they charge a person (their insurance) a permanent charge for a humidifier and those usually run around $400 (or maybe more now) because the humidifier is considered non-returnable/non-reusable. If you start trialing different (brands of) machines you're going to end up owning the specific humidifier that goes with each one. For the cost of ONE humidifier, you could buy a big chunk of a new machine WITH a heated humidifier from CPAP.COM.

Another one could be that once you get caught up in the paperwork at one DME, they could try to perpetuate it for longer than you want (if you don't like dealing with them) and it could be harder to get away from them.

Considering the overpricing of the machines at the local DMEs along with any deductibles and co-pays, it could be less expensive to purchase out-of-pocket. That's why we always advise the prospective users to "DO THE MATH" before signing any documents or making commitments.

I know this has been said before, but it bears repeating......get your prescription in hand. (the physical document)


Den

[enso]

What if the dr's assistant doesn't want to send the Rx to me? I don't like getting all tough and demanding "you have to according to -----"...Being stressed out is keeping me from coming up with nicer wordings. What words of persuasion worked for you? If it comes to it, though, what goes in place of -----?

Any suggestions?

[cflame1]

Read up on HIPPA

[enso]

I have read HIPAA. (I'm in a field where I need to be familiar with it.) My understanding is while I am entitled to my health information and does not include a prescriptions written in 'dispense upon presentation of this slip of paper' form. If I am incorrect, I would gladly review the relevant cited section to learn otherwise.

[snoregirl]

Ask for the prescription. Tell them you want your prescription so YOU can decide where YOU want to do business.

That is all. NO FAXING OF PRESCRIPTIONS.

You also need a copy of your sleep study. If you have to pay a copying fee, do it. Do not be tied to a medical office deciding who YOU can do business with.

[enso]

snoregirl, that worked. I asked what was on the Rx, and didn't have any changes to suggest. They are mailing it to me, along with a copy of my sleep study (I already have a copy for myself--posted it on another thread).

I'm going to call around some DME in my medical plan and see if I can find a nice one. I got a tip about one local company, but wouldn't mind more, if you're in the Twin Cities, MN.

I'm going to try and hang onto the script and get the DME to either be happy with a copy or have another copy faxed from dr's office once I decide. I guess this is good progress, even though I don't exactly feel cheerful...