Heading to my 1 month review

[jdmoore99]

I'm heading back to my sleep lab to meet with the RT and go over my first month's results. This will be more than a little bit anti-climactic, since thanks to this forum I already know how it is going - my AHI has been under 2.0 every day for the past two weeks, and I manage to keep leaks under the 'red line' most nights. I even had a 0.0 AHI one night! My sleep study was 22 AHI overall, 50+ supine and 60+ in REM, so this is a huge improvement for me.

I am currently at 14cm CPAP on a machine that is nice in every way but isn't APAP capable. I have to believe that my needs are going to change over time and having the S9 AutoSet instead of the Elite will be the best long term bet. I do wake up some mornings having clearly gulped in some air, but otherwise I don't have many complaints and the Rx pressure certainly is doing the job. I just have this nagging feeling that the APAP will come in handy down the road, and I'd rather not shell out $850 to cpap.com when I have decent insurance (10% out of pocket for the DME's inflated rates). I'm encouraged that this lab's default machine was a ResMed S9 Elite for a CPAP Rx at least.

What line of argument do you think would work best? I have some mild aerophagia, but little else to complain about -currently-. I would gladly pay them for the $$$ difference between the AutoSet and the Elite out of pocket even though I know it gets billed back to insurance under the same code.

Thanks again for all of the great information that everyone contributes to this forum. You are all fantastic human beings!

Dave

[Janknitz]

Unless the sleep lab has some financial connection with the DME they shouldn't have any argument with you having an APAP rather than a CPAP "just because". The sleep lab won't get paid any more or less if you have an APAP instead. A good sleep lab should support your efforts to take an active part in your treatment including using APAP mode on occasion to make sure your pressures are optimal.

Your insurer won't care either. In most cases, the insurer pays the same regardless of which E0601 (HCPC's billing code) machine you get, and they won't shell out any additional money if you switch to an APAP. They could care less what machine you get under that billing code, but the DME will lie and tell you that the insurance won't cover the "upgrade". It's not an upgrade, and your insurer doesn't care. And believe me, they are NOT paying what the DME charges for the machines--their contracted price is much, much lower. The DME "price" is pure fantasy and the only people who pay it are hapless suckers who are uninsured and don't know enough to look online.

The DME is the one that cares--because they have to eat the difference between the cost of a CPAP and an APAP. My guess is they will make it difficult or impossible for you to switch, or try to make you pay the difference. If your sleep lab is good at patient advocacy, they can help by writing you a new script specifying APAP and writing "dispense as written" on the prescription, and stand behind your efforts to get an APAP--you don't have to justify it to them or anyone else.

Do yourself a favor and call your insurance company FIRST to make sure you understand exactly what they'll cover. A list of questions to ask is on my blog here http://maskarrayed.wordpress.com/what-y ... me-part-i/

[elena88]

I switched out my a-flex for an s 9, but my one month follow up was at 28 days not thirty, had it been thirty one, I would have been
screwed, NO exchanges after thirty days!

check your dates! count the days, if its more than thirty, go in asap with or without doc appt. to exchange the
machine.. at least return the first one on time... get that s nine, its so much easier to have an auto!

[jdmoore99]

Unless the sleep lab has some financial connection with the DME they shouldn't have any argument with you having an APAP rather than a CPAP "just because". The sleep lab won't get paid any more or less if you have an APAP instead. A good sleep lab should support your efforts to take an active part in your treatment including using APAP mode on occasion to make sure your pressures are optimal.

Thanks very much for the advice. Interestingly, the 'DME' is an in-house offshoot of the sleep lab itself. We'll see how it goes.

Dave

[Tielman]

Wow, reviews of your CPAP treatment! What a novel concept!!