Help!

Lyn · Post by **Lyn** » Fri Sep 16, 2005 5:40 pm

NOzsnAZ,

Below is the response I received from billmyinsurance.com yesterday when I asked them about BCBS.

"What we have found is that in most cases we are
considered "In Network" with most Blue Cross Blue
Shield plans. We will not be certain until coverage
is verified, however. If you would like for us to
verify coverage and contact you, please submit your
information using the following link:
https://www.billmyinsurance.com/copay-quote.php"

Lyn

NOzsnAZ · Post by **NOzsnAZ** » Mon Sep 19, 2005 12:24 pm

Thanks Lyn. I'm very tempted to use Billmyinsurance.com but I'd kinda like to have someone out to "fit" me on my first time. I also feel a little bit more comfortable knowing that the DME is listed right on BCBS's website as an "In network provider" since they are paying for a large portion.

Now my updates on the wonderful DMEs!

The first DME (provided by my doctor) called me and wanted to set up a time to come out and "set me up". I said I have some questions about the equipment and got "Well, most of the equipment is pretty much the same BUT you will be getting a CPAP from one of the best companies in the business!" I asked what the equipment was SPECIFICALLY and was told it was a REMstar Plus.

I said that I was looking to get a 420E, which didn't go over well and after a bit she said "Well, yes we carry the 420G. No problem AND you'll get the "built in" heated humidifier too!" I said "No. The 420 E!" Now she's even less happy and says: "Well, we could special order that for you but there will be an "upgrade" charge since your insurance company will only pay for a straight CPAP and that unit is an Auto-titrating unit BUT I'll have to check with my manager and get back to you.

I ask about the Ultra Mirage FF mask and get more resistance and a "recommedation" that I try the P-K Flexifit mask instead.

(Since this was my first experience with a DME, I just said "OK. Call me back after you talk to your manager) I still haven't heard from her.

DMEs 1 - NOzsnAZ 0

NOzsnAZ · Post by **NOzsnAZ** » Mon Sep 19, 2005 12:38 pm

Now I call a friend of a friend who works at my ins. provider and I am told that they do not have a specification for CPAP versus Auto CPAP (which just verified rested gal's comment from earlier). He says that they have one code for CPAP equipment purchase and that the $$ amt they pay the DME is a flat $1,300...

NOzsnAZ · Post by **NOzsnAZ** » Mon Sep 19, 2005 12:53 pm

I go through 3 more DMEs and get similar responses. Some with some creative arguments against the 420E such as "The machine is not weighted and lots of people are finding that when they roll over in bed, they are pulling the unit off the nightstand and ruining it" or "the unit is designed poorly and lots of people are finding that when they try to refill the humidifier, they are pouring the water into the unit and damaging it." Another argument is that my prescription needs to stipulate a "range of pressures" not a specific pressure to get an Auto-CPAP.

I'm also getting the "your insurance only covers "basic" CPAP units and the 420E is an "upgrade" which will come out of your pocket/ will not be covered.

DMEs 4 - NOzsnAZ 0

I finally get a guy who simply answers the phone "This is Mike". I tell him I'm trying to reach a specific DME and he says "That's me." I tell him I'm looking for CPAP equipment and he mentions some brand I've never heard of. I ask him if he has the equipment in his garage and he laughs and says "No. I actually have an office." I tell him that I'm looking for the 420E and he pulls it up on his computer and says that it shouldn't be a problem but needs to know about my insurance. I tell him my provider info and he says no problem - I assumed that would be the case since he's listed on their website. I also mention that I'd like the Ultra Mirage mask but I'm not sure what size relative to the medium Comfort Full the doctor prescribed and he said I'll get a few sizes and I'll just send back the ones you don't get.

I'm waiting to hear back from him...

Wulfman · Post by **Wulfman** » Mon Sep 19, 2005 1:06 pm

You've got it backwards. It's DMEs 0 - NOzsnAZ 4

Den

NOzsnAZ · Post by **NOzsnAZ** » Mon Sep 19, 2005 1:22 pm

Thanks for the "perspective" Wulfman!

It's just hard to feel like you're coming out ahead when you are facing such resistance and it seems like the light at the end of the tunnel is so far away (getting the equipment). I just want some sleep.

As a first timer with CPAP, would any of you recommend just getting the equipment online? Is it that hard to set up properly and to understand how to program/operate or to be "fitted" with a mask?

Not ONE DME has mentioned any OPTIONS for renting/buying the equipment....

NOzsnAZ · Post by **NOzsnAZ** » Mon Sep 19, 2005 1:36 pm

BTW - I've been told that the Ultra Mirage FF LARGE is equivalent to the Comfort Full MEDIUM. Can anyone confirm this?

Bigboy · Post by **Bigboy** » Mon Sep 19, 2005 1:37 pm

Don't let your foot up off of their necks!! You deserve to be treated properly by any vendor. You wouldn't take that crap at KMart, so don't even think of letting them get away with anything.

I've got 9 years on my machine and wanted a new unit. No sleep complaints, just wanted a new machine, since mine's been to three countries, camping (great for inflating air mattresses )and inumerable hotel rooms. WELL, you'd think I asked my pri-physician to build one himself!:shock: I had to go through a new sleep study, which revealed the same thing as the old study...even the same pressure. Then on 3 separate occasions I was hearded like a cow down the DME chute. Not being a particularly well behaved cow, I resisted and finally got what I wanted...what a struggle. I see from the un-scientific age poll in another thread that the vast majority of us are in the 45-55 yr range and aparently we're an ornery bunch. Screw 'em, I say, keep pushing 'til you get the answers you want, need and deserve. <end rant>

Wulfman · Post by **Wulfman** » Mon Sep 19, 2005 1:45 pm

NOzsnAZ,

Well, I'm pretty partial to buying from CPAP.COM, or you could try BILLYINSURANCE.COM if that will work. We were all "first-timers" at one point (for me it was April of this year) and have tried to learn from our successes and mistakes. We TRY to share these experiences with other new users so they won't be led astray by the (evil) DME's and uninformed sleep doctors.
That light at the end of the tunnel won't be a train if you don't weaken to those who keep trying to give you something other than what you want. This is YOUR life and it's going to be your therapy for quite some time to come....get what YOU want!

Best wishes,

Den

Wulfman · Post by **Wulfman** » Mon Sep 19, 2005 4:37 pm

NOzsnAZ,

As far as setting up the equipment.....if you can read, you can set it up. For some, getting the right mask may be a little trickier, but there's a link to mask sizing here.

https://www.cpap.com/cpap-mask-sizing.php

You may already have an idea whether a full face mask or nasal mask may be what you want. Do some comparisons and pick one.

Good luck,

Den

guest13 · Post by **guest13** » Mon Sep 19, 2005 5:17 pm

NOzsnAZ:

Been on cpap for over 11 years! What Bigboy and wulfman are telling you is the best advice you can get in my opinion! Please heed it for your own sake! I also agree that you should definitly not take any BullS--- from these DME's etc!

My best to you and welcome!

steve,
ufo13

NOzsnAZ · Post by **NOzsnAZ** » Tue Sep 20, 2005 11:03 pm

rested gal wrote:ResMed Ultra Mirage FF full face mask - which I'd suggest instead of the (imho) far less comfortable and far more prone-to-leaks Respironics ComfortFull FF mask that the doctor plans to put on your Rx. Online, the Ultra Mirage FF mask is $139.00

Wulfman wrote:NOzsnAZ,

As far as setting up the equipment.....if you can read, you can set it up. For some, getting the right mask may be a little trickier, but there's a link to mask sizing here.

https://www.cpap.com/cpap-mask-sizing.php

Den

Ok, so having been unable to get anywhere with the local DMEs, I've gone through billmyinsurance.com and have been pleasantly surprised at how simple a process it is. HOWEVER, I'm still trying to figure out the FF mask sizing. According to cpap.com's "equivalent masks" link, the ComfortFull MEDIUM that I was fitted for at the sleep center would be equivalent to the Ultra Mirage LARGE, but when I go through the mask-sizing chart, I come up with the Ultra Mirage Medium??? What's up with that?

It seems to me that the discrepancy must come from the #5 measurement (Full face length measurement - which is eyeline to middle of chin) which in my case is 3 5/8 inches.

rested gal · Post by **rested gal** » Wed Sep 21, 2005 12:03 am

BTW - I've been told that the Ultra Mirage FF LARGE is equivalent to the Comfort Full MEDIUM. Can anyone confirm this?

Nooooooooooooo. Not so (imho!). Just the opposite!!

In my experience, the Respironics full face mask (the ComfortFull) is SMALLER than the ResMed Ultra Mirage FF (full face) mask.

I used a Respironics ComfortFull full face mask my first 6 months on autopap. It was a size "small". It ALWAYS felt too snug along the sides of my nose, as well as vertically. I have a small nose, btw. Also, when I would relax my mouth open for easy mouth breathing, my lower lip would often drop down too far below the bottom of the cushion.

After 6 months I switched to a ResMed Ultra Mirage FF full face mask, also size "small". "Small - standard". It was a much roomier feeling - did not press against the sides of my nose. It also gave my mouth room to be more open for mouth breathing while still staying within the mask...not dropping below the bottom of the cushion the way it often did with the same size ComfortFull.

I don't know if the difference in roominess holds true for other sizes, like "Large", but I do know for sure that the "Small" Ultra Mirage FF was definitely bigger all over inside than the "Small" ComfortFull.

A big plus about the ResMed Ultra Mirage FF mask is that the SHAPE of the cushion can be selected, as well as the size.

"Shallow and Standard" are terms that describe the cushion SHAPE. I can wear either shallow or standard fine - shallow is usually a bit better for me. A person who has a prominent bridge to the nose would need standard.

"Small, Medium, Large" describe the cushion SIZE.

So, with the ResMed masks, if a certain size fits you pretty well, but you have a bit of leaking up around the eyes and no amount of fiddling with the angle adjustment helps (the vertical bar that goes up to the forehead pad...changes the "tilt" of the mask on the face), then switching to the other cushion SHAPE (shallow vs standard) in the same size might be all it takes.

Cushions can be bought separately...any cushion size and shape will fit the plastic frame.

NOzsnAZ · Post by **NOzsnAZ** » Wed Sep 21, 2005 3:18 pm

You are right AGAIN rested gal! (why would anyone ever doubt you? )

My info came directly from cpap.com. I went to their "compare CPAP masks" link:

https://www.cpap.com/cpap-mask-comparison-guide.php

I scrolled down to ComfortFull Full Face Mask with Headgear - Medium and selected the "equivalent masks" link and it gave me the Ultra Mirage Full Face Mask with Headgear - Large Standard

https://www.cpap.com/cpap-mask-comparis ... 04&PAID=51

BUT when I went through their mask sizing link is said that I should be in the MEDIUM...

So, I called their help phone # and I walked the rep through the same process and the rep said that it was a mistake. There must be a glitch in their system. She asked me what my "Full Face length measurement" was (Length From the eyeline to the midpoint between the lower lip and bottom of the chin (in inches) and I said 3 1/2-3 5/8 inches and she said that the LARGE would require a length of 4 inches or more.

So it looks like a MEDIUM is the mask I want.

Thanks AGAIN rested gal!

NOzsnAZ

Help!

Getting guested again but.......