New guy w/ questions & Dr. refused APAP - CPAP Only

[Silence]

Hello all,

I am new to all of this, but I've been reading information on this site for the past two weeks. I just had my sleep study done on Friday and the follow up with the results done today. My doctor wrote me a prescription for CPAP at 10 cm and refused to consider any other options. I've spoken to some of the DMEs in the area and it seems that the machine they start with is the M Series Pro C-Flex. If I've read correctly, this machine has full data capability. I am a little surprised that the pressure was set to 10 when I had marginally fewer interruptions at 9 and 11 cm (I have a copy of the data). The doctor also claimed that the Autopap machines were four times more expensive, but the pricing at Cpap.com does not support this statement. I have not got any pricing from the DMEs yet, but I wonder if I'd be better going out of network (50% co-pay) to Cpap.com as it sounds as though local in-network (10% co-pay) DME prices are significantly higher. This doctor also said that my insurance would likely reject a purchase from an online DME. Has this been anyone's experience? Should I just go with the M series Pro and 10 cm or should I seek a second doctor and a second opinion with the delays that would entail. Also, I'd like to get a travel/back up machine as well. From what I've read I am partial to the Intellipap Auto, but prescription won't even allow me to buy one fully out of pocket. I assume that in the second hand market no prescription will be necessary?

Thanks,
Silence

[BeanMeScot]

The Pro is at least a good machine. You won't go badly wrong with it but I prefer having my APAP, myself. It provides future versatility. The doctor should realize that any APAP can be used as a CPAP and why does he care how much it costs? It isn't coming out of his pocket.

I wish I had just bought mine myself outright. After the insurance lying to me and then my company changing insurance in Jan and the DME not crediting me for the amount I actually paid on the machine, I could have bought a couple of machines with the money I have paid .

[Pugsy]

I bought my M series auto CPAP with humidifier from an individual. Zero hours of use. I figured up my insurance "rental" co pays for the rental period plus the humidifier purchase which is done up front and that copay, and my out of pocket was $22 more than it would have been to get a straight CPAP from the DME. Duh....no brainer on that one. The doctor wrote CPAP and CPAP was what I was going to get through DME. I didn't even try to argue the point with the doctor. Not worth the hassle.

You just have to do the math according to how your insurance company does things. Check with them directly about coverage for online purchase. Cpap.com will supply necessary insurance claim form. I wouldn't believe the doctor, he is the one that told you that auto CPAP units cost 4 times as much and we all know that isn't true.

I wouldn't waste time trying to find another doctor to write for APAP. Confirm with the insurance company itself if online purchase is reimburse at whatever rate for out of network. Do the math in regards to exactly how much the M series Pro will cost out of pocket through DME. You might be surprised and what you find. Decide just how important the auto feature capability is to you. It may not even be needed but then again it might. Explore all your options and put a pencil to it.

[jdm2857]

If you are paying you can get an APAP with a prescription for CPAP. At least that's what the online suppliers will do.

If you are going to a DME and insurance is paying, you won't get an APAP without a prescription for one.

[Babette]

Get another doctor. Any doctor that REFUSES you simple requests is an a** and needs replacing.

My doc not only wrote me for an Auto, when I found out my Auto script was blocking me from buying a straight cpap on http://www.cpapauction.com, he wrote me a new script so I could buy a cheap backup machine. BTW, keep an eye there. Sometimes you can find great buys. Now sometimes you get screwed, just like Ebay, but sometimes you don't.

It's not hard to get another doctor. Lots of them out there. They all want your boat payment.

Cheers,
B.

[6PtStar]

If you have a copy of your script and it says cpap you can use it to buy an auto at cpap.com or on cpapauction. com. A lot less trouble than fighting the system. Most insurance companys pay the same for a cpap and an auto, the DME just makes a little less profit. With data off the "M" Pro you can still tweek your therapy it just takes more trial and error and time and just bit more dificult.

Jerry

[BleepingBeauty]

I've spoken to some of the DMEs in the area and it seems that the machine they start with is the M Series Pro C-Flex. If I've read correctly, this machine has full data capability.

The way I understand it, the M Series "Pro" is NOT fully data-capable. The M Series "Pro 2" IS fully data-capable. Others will undoubtedly correct me if I'm wrong.

You definitely want a fully data-capable machine. Don't let the DME (or your doctor, whose knowledge about machines appears to be seriously lacking) tell you that a machine that records compliance data IS data-capable. It's not. Compliance data (the amount of time you use the machine) is required by the insurance company so they can see that you're utilizing the machine they're paying for. Every machine provides compliance data. But compliance data is NOT efficacy data and is useless to you (or your doctor) in determining how well your treatment is going.

As far as buying a machine outright, I believe you can purchase either a CPAP or an APAP from an online dealer (such as our forum host, https://www.cpap.com) with a prescription that says "CPAP" on it. Anything more sophisticated (BiPAP or ASV, for instance) requires a prescription for that type of machine. Buying elsewhere (CraigsList, for instance) allows you to purchase whatever you want, with no prescription needed. Caveat emptor applies, of course.

Otherwise, http://www.cpapauction.com has some great deals on machines, some of them brand new. (You DO need a prescription to purchase there.)

[6PtStar]

I've spoken to some of the DMEs in the area and it seems that the machine they start with is the M Series Pro C-Flex. If I've read correctly, this machine has full data capability.

The way I understand it, the M Series "Pro" is NOT fully data-capable. The M Series "Pro 2" IS fully data-capable. Others will undoubtedly correct me if I am wrong

Yep, you are wrong, Sorry!! The Classic (Tank) Pro is not data capable but the Classic Pro 2 is but the "M" Pro is data capable!!

Jerry

[ozij]

The Pro vs. Pro 2 distinction is only true for the older model.
The M Series Pro is fully data capable.
https://www.cpap.com/cpap-machine/Respi ... -CPAP.html

[kteague]

Hi. I have the M Series Pro. I am fine with straight cpap, as long as I have my data. Actually, most patients are given non data cpaps as the norm, so you're already a step above that. Couple things... why do you say the prescription won't allow you to purchase a machine out of pocket? You should be able to use the same prescription for multiple purchases. If you buy used at resale sites online such as cpapauction.com you still need a prescription, but not from Craigslist. As far as insurance reimbursement, you'd need to talk with your insurer as to their policy. Your doctor should be willing to provide you your prescription. If you just want to avoid a confrontation, you can ask them for a prescription to use in case you have a problem while traveling, or to purchase an second machine online for travel purposes.

As far as your doctor's concern with the cost, if it doesn't matter to you it shouldn't matter to him. He may feel an auto is not his preferred mode of treatment and an unnecessary expense, but who the cost matters to is the buyer and the (DME) provider. The provider will be reimbursed the same amount for either machine so their profit margin is less as they will have paid more to obtain an autopap.

Best wishes as you sort thru this.

Kathy

[DBoone]

I can verify that a prescription for CPAP can get you an APAP through CPAP.com. I recently made that purchase using my CPAP script and there were no problems at all.

I now own two machines. The first was compliance only data and supplied by DME. The second is the M series Auto and is fully data capable. I much prefer the new one. Data from the first night showed that I was at the wrong pressure.

Do everything you can to get the APAP of your choice. The DMEs, (some) Doctors, and insurance companies will often count on you being non-confrontational.

[bonjour]

A CPAP and an APAP have the same billing code, that is what the insurance company pays against. There may be an issue between out of network and in-network to your insurance company, check your coverage.

Call and ask your insurance company, see what they say.

I suspect that you will have to purchase the data module yourself either way

Fred

[Slinky]

The M Series Pro is fully data capable. APAPs and CPAPs are the same insurance (HCPCS) code (e0601). YOU are the one paying for the xPAP whether thru insurance or out of pocket makes no difference. If you refuse to accept a straight CPAP the local DME supplier doesn't get the sale. Do you know the exact wording of your equipment order (prescription)?? Unless your doctor was a real pr....., er, jerk .... that CPAP script is good for an APAP as well. Call your insurance company and ask them what local DME suppliers they are contracted with. Hopefully you have more than just the one as that gives you more bargaining/negotiating room. One of your local DME suppliers should want your business bad enough to provide a fully data capable APAP if you diplomatically but firmly stick to your guns and insist on one or no sale.

Actually, if you intend to self-purchase a backup/travel CPAP you are better off w/a rather generic script that the local DME suppliers try to insist means only a CPAP and not an APAP 'cause if you want to buy a CPAP online and have a script specific for an APAP you won't be able to buy a straight CPAP. A CPAP is NOT an APAP but an APAP is a CPAP.

[Silence]

Hello again,

Thank you all for the input. I kept calling local DMEs until I found one who only carried the S8 AutoSet II CPAP Machine and accepted my insurance. They said they stopped carrying straight CPAP machines because they saw better compliance with the APAP machines. They said they made this move about a month ago even though it cuts in to their profit margin. (However, I think their margins must still be pretty good comparing online price to the prices they charge.) This isn't the machine I had in mind, but it is auto and has full data recording so I think I'll be fine with with. My co-pay for the machine, humidifier, and mask came about to about $250 and I'll be able to start my therapy tonight. I still need to get the card reader and software though. Besides, I can try another model when I buy a backup/travel machine out-of-pocket.

One final thought on my doctor. As I mentioned before she refused to change the prescription (which read CPAPAE601) . Her rational was that she was heeding the President's call to eliminate frivolous and excessive health care costs. When I pointed out that the price difference on-line was almost negligible she said that didn't matter because my insurance would not accept the online DME. She also said that APAP was only for folks with very high pressure i.e. 25 - 30. (I thought these machines don't even go that high). At this point I told her I wanted APAP listed as a clear option on the prescription and if she was unwilling to adjust the prescription I'd continue my treatment elsewhere. I can't comment on her skill as a sleep doctor, but she told me several things that were untrue and I didn't like her unwillingness to work with me. I'll have to find a new sleep center and a new doctor to continue my treatment with.

Thanks again for the help guys and I'll keep reading and learning here.

Silence

[gasparama]

I have the C-flex Pro because the dr. said he didn't like the autos. However, he may have been in cahoots with the DME. Because I have 2 insurance policies and because the local DME gives me free masks and free parts replacements, I purchased from them. However, it you do want to go through CPAP.com, they will send you the machine of your choice, and by turning in your receipt to your insurance company, you can probably get at least a partial refund. Of course, this depends on your particular policy. I spoke with a CPAP.com representative and even though she thought that for the most part I was better off dealing with my local, she did explain about using their receipts for insurance claims. I am going to use their cpapauction.com site to order a travel or backup machine. Good luck to you!