Newbie intro and a question about "DME" and equipment

[danielan]

Hi,

My name is Dan.

I've pretty much always had sleep apnea (as did my father). My mom would complain about both of us stopping breathing in the middle of the night. Later my wife would also comment periodically that it sort of "creeped her out" when I'd stop breathing at night, but that it was at least a nice break from my insanely loud snoring (I sleep in the basement and the kids could hear me in their rooms upstairs and at the other end of the house).

Anyway, a few months ago, I was at the doctor for a routine physical, and she had a display about sleep apnea on her wall. So I asked her if it was the sort of thing that you should get looked at only if you bothered you (which I had always assumed was the case), or if you should get it taken care of if you have it. I wasn't really having any "symptoms" as far as I knew (although from reviewing this site, I guess I was after all). I had read the signs at the TSA checkpoints about CPAP and Googled it once to find out what it was, but I knew nothing more about it. So anyway, she says that it can cause heart problems if untreated (!), so I should get it looked into. Off I go for an evaluation, then a sleep study where I got to dress up like Darth Vader. Halfway through that night the nurse wakes me up and puts a mask on me that blows air in my mouth - she indicates that this might be a sign that I have sleep apnea . A few days later I get a call from the "Sleep Doctor" who affirmed that I had sleep apnea and sets up a meeting with a "Home Health Care Company", I think you call these DMEs. (I also get a bill for $3k for the sleep study - I wish I had known about that before the test, but anyway...)

So, I went and got a CPAP - a pretty nice ResMed Escape II and a comfortable well fitting mask (Quatro). They seem really nice and helpful at the DME.

I've always been able to sleep through anything, so getting used to it hasn't been much of a problem so far aside from some "rain outs" and 1 overfilling of my humidifier (help! help! I'm drowning! ).

This pretty much catches you up. So, on to my question: Can I swap out my machine for a machine that collects data other then just usage data? YES

My understanding of the agreement with the DME is that I am "renting to own" this device. That I purchased many of the pieces (mask, humidifier, tube, etc) upfront, but the machine itself is being purchased over the rental period of 10 months. With that in mind, shouldn't I be able to return the current machine and swap it for another different one? Yes, but there might be some time limits If this is a "rental" and not a purchase or a lease it seems like I should be able to do this.

I think I'd like the Elite II. It will fit my current humidifier/hose/mask and I think it has data collection of the variety that I'd like (if I am going to wear this, I'd like to know that it is actually working - so I'd like data about apneas, leakage, etc.)

Have any of you done this? Yes Is it possible? Yes Will it cause insurance headaches? Will there be a bunch more out of pocket expenses if I do this? Should I forget about this and just order a cheap logging pulse oxymeter - since that is really what I probably care about in the end? etc.

I have a meeting with my "Sleep Doctor" here in a couple weeks, so I have to get my usage pulled anyway. I was thinking about driving down to get my machine read, instead of mailing the data card in, and asking if I could do this.

If they won't do this, can I just end my relationship with them and find another DME who will rent me the meter I want? Or will that cause problems too?

Thanks for any advice you can provide!
Dan

Update: New search terms have turned up some answers (in green above)

[pdean44]

I am knew at this as well but when my doctor gave me my precription they also gave me a list of dme's and had one they said that worked on site. I had the choice of which one i could use regardless. I would imagine that even if they don't make it widely known as long as you had a prescription you should be able to go to the dme of your choice. I would make sure the dme is one that is sanctioned by any insurance you may or may not have.

Good luck on your journey sounds like you have a good handle on things.

[NEW YORKER]

Trust me, I am no expert but one would think you still have time to exchange it. I was'nt aware of data capable machines and I got stuck with one that only shows compliance. I also think that if you dished out 3k for the sleep study then I hope you got the RX for the machine? If not, make sure you get it, so in the furture you wont have to deal with the DME and be able to order it through other means, like CPAP.COM? Good luck to ya Dan....

[Slinky]

Here is the problem:

The local DME provider got away w/foisting a bottom of the line, excellent therapy but nothing but compliance (usage) data capable device on you. It would have been a brand new, unused, device. They've "rented" it to you for x amount of months. It is now a used device.

Now you want, and justifiably so, a fully data capable device that provides the same excellent therapy as well as the efficacy data, i.e. Leak, Pressure, AHI, AI, etc. That means an entirely new device midway thru the 10 month contract.

The problem is - your insurance is contracted w/them to pay them x amount of dollars for 10 months and then they have paid all they are going to pay for your PAP device. At the end of the 10 months the device becomes your sole property.

Do you see the problem here?

That's not to say that it can't and hasn't been done. I have read of a VERY few instances where someone was able to get an entirely new, fully data capable, device at the end of the "rental" period. BUT - they are the EXCEPTION. And in that case, I'm not sure that the original device was new, but rather a used device. Or - the fully data capable device provided at the end of the rental period was a used or refurbished device. Usually such swaps have to be made w/in the first 30 days.

This is something you will have to try to work out w/your DME provider, your insurance and perhaps enlist the aid of your sleep doctor.

GOOD LUCK!

[ccm]

I had a similar situation - got stuck with a basic machine that only recorded compliance info. Was having some physical and emotional issues with the situation. After doing lots of research and reading on this forum, I decided I wanted/needed a data capable machine. Was also some communication issues with my DME who didn't seem to know a lot about CPAP equipment. Went to my pulmonologist, got a new prescription for a fully data capable machine. Called insurance company to see what their policy was - because I had only had my machine for a month, there were no problems. Visited 4 new DMEs until I found one that seemed knowledgeable and helpful. Took the old machine back and got written confirmation of the return. Took new script to new DME.

I now have a DME, a new machine & a new mask. I have daily concrete evidence that this therapy is working and my attitude is SO much better.

Go for it - - - Good luck!

[Slinky]

I failed to clarify: If you have had your Escape II less that 30 days you should be able to exchange w/o much hassle by being diplomatic but firm. Even as much as 45 days - beyond that first billing period it gets stickier. So if you have had the Escape less than 30-45 days, do NOT wait until you see the sleep doctor. Take it back now and start negotiating for an exchange for find a new DME provider contracted w/your insurance.

[GumbyCT]

Went to my pulmonologist, got a new prescription for a fully data capable machine. Called insurance company to see what their policy was - because I had only had my machine for a month, there were no problems.

Could you explain that in more detail please? exactly what was written on the script? Did you get a copy? etc.

Oh and how you got YOUR "Gold Star" too.

[aroche]

Dan,
I am very glad to hear that you are starting on therapy, especially for you and your family. I am local to you and so I have a pretty good idea of the DMEs you were offered, be sure to check them out and do yourself a favor and learn all you can about CPAP and OSA before dealing with them. The DMEs here are varied and one I worked with was less than helpful or knowledgeable, PM me and I can give you more info on what I have seen locally. Odds are you are going to get a compliance data only machine from the DME since they make more money on that type of machine than with a full data system. Also, take the time to get your mask fit correctly so there are no leaks and minimal red marks.

My greatest find was CPAP.com and CPAPTalk.com. I have since returned the system I was given 4 months ago and purchased new equipment thanks to the great advice I received on this forum. You have a great start by posting here and doing all the research.

[ccm]

In response to GumbyCTs request:

When I went to my pulmonologist, I explained to her why I thought I needed a fully data capable machine (based on the reading and research from this forum - I even took "rested gal" s list of acceptable machines). She concurred and wrote "fully data capable CPAP with all necessary accessories; may need APAP capabilities; call me for further information". The DME decided to go ahead and give me an APAP so, if we need to make adjustments, we don't have to switch machines again. And, yes, I have a copy of EVERYTHING, from my first appt to the return of the old machine. Hope this helps someone else get what they need.

The star was sent to me by another poster when I finally had something good to post - I think it was "jules". I liked it so much that I copied, saved and made it my avatar! Feel free to borrow - - -

[danielan]

Here is the problem:

...

Do you see the problem here?

...

GOOD LUCK!

I see that problem, but I think it is accounted for in their business model like any other "rent to own" type organization - they are charging me and my insurance company a total of $1500 for an Escape II machine (not counting the accessories).

Thanks
Dan

[rested gal]

Welcome to the message board, Dan.

Please check your Private Messages.

[Slinky]

Keep in mind the costs of accepting and billing insurances! Insurances are THE main reason that one doctor can no longer survive in private practice w/just one nurse/receptionist like they could in the late 70s and prior. Not accepting insurance is one of the main reasons online DME suppliers can undersell the locals. In addition when accepting insurances the local DME providers have to shell out up front for their inventory - and then get their reimbursement in dribbles over several months. Online providers get their "reimbursement" for the products they sell right up front.

[Bernie]

I read this board regularly but actually never posted before. I have an experience with swapping an Escape for an Elite II about two months in to a 10 month rent-to-own period. I had read this board before my first visit with the DME, and told them when I called for the appointment, and again at the visit, that I wanted a data capable machine. When I got there they told me I that the Escape was data capable, which I knew not to be true. Then they said that they didn’t have anything else and this is all I would need. Their patients do very well with it! Anxious to get started, I took it home. After several weeks of not being sure how my therapy was working, and reading this board further, I called them back and said I wanted an Elite II. They said I “can’t have one”. That got me going, at which point they said they don’t carry the Elite II. Then I said I would return it and get one somewhere else, knowing that losing two months of rent, and buying an Elite II online, would be cheaper than they were charging. I figured I could deal with insurance later. The DME said that to get out of the contract I would have to sign a statement saying I was refusing treatment, which wasn’t true and which I didn’t want on my insurance record. Then they offered me a used Elite I, which I said I didn’t want. After more grousing, they said they’d get back to me. A week later I called them again, and they said I could come in the next day. When I did they took my Escape back and handed me a new Elite II. Here’s the most ridiculous part. No change in my contract, no additional cost, just pay the rest of the 10 months.
The data in the Elite II is helpful in anaylzing whether your treatment is working. I write it down daily, and bring it to my doctor, who looks at it and comments on it. With the data, I decided to increase my pressure setting from 8 to 9. When I told the doctor about it he asked how I figured out how to change it, and I told him I learned it online. It takes about five seconds to do it, but the DMEs want you to drive to their office, and pay for their service. The doctor suggested that I try 10, which I did, and have been there ever since. It would be better to have the Elite II now rather than waiting for your doctor visit, so as to get more out of the visit.
My advice is to be persistent with the DME, and try to take advantage of the fact that they charge the same for any type of equipment, and don’t let them stick you with the cheapest equipment so as to maximize their profit. If it doesn’t work with them, talk to your insurance company about what you need to do to get reimbursed for buying a machine directly. You’ll be paying less online, but oddly, they might give you some pushback. Just don’t let anybody tell you “you can’t have it”.
Good Luck!