Am I stuck with my machine

[nervusldy]

Newbie here who found this forum too late.
I went for a sleep study the end of December and the first part of January 2011 I received a call from a DME saying that a prescription for a cpap machine had been sent to them for me. On January 7th I went to the DME and was given a machine and told how to operate it. My DME told me that my pressure setting was 7 so my sleep apnea wasn't too bad. A week later I found this group and found out that I had been given a "dud" machine that didn't read all the data. I called my DME and he told me that my machine DID read data and I took it back to him to show me. All my machine tells is that I am in compliance. (That seems to be all anyone is concerned about.) I told him I wanted a machine that read all the data and I was told this machine was the one I was supposed to get. Then I heard from my family doctor that I had severe OSA. She told me to keep using the machine and to come see her in a few weeks.
When I went to see my family doctor, she was shocked when she saw my sleep diary that showed that I only slept 2-4 hours a night. She said she could see how tired I was. I told here that I sleep a couple hours and then nap most of the day. Maybe in the afternoon I can function for a little while. She called the RT at the sleep lab and he said that I could either go to see the doctor who read my sleep study or I could have another sleep study done. The RT and my family doctor decided that I should go to see the doctor who read my sleep study, but I couldn't get an appointment until April 5th. I told the RT and my doctor that I wanted a cpap machine where I could monitor what was going on, but got blown off by both of them. I don't want to have another sleep study if I don't absolutely have to.
My first thought is to just pack up the machine and take it back to the DME and try to find one that will give me the machine that I want, but I have Medicare and a supplemental policy and since they have already paid on the machine I have I don't know what it would cost me out of pocket if I went somewhere else, or if I even could.
I would hate to give up my machine because I am finally starting to have a glimmer of hope that things are getting better. I go to see my family doctor again on March 15th and I will see what she says and I will definitely get a copy of my sleep study.
Is it too late to get a data capable machine?

[Pugsy]

Is it too late to get a data capable machine?

No but it would take more than what anyone apparently wants to do. It is hard after 30 days. Though with Medicare they normally do a 13 month capped rental. You should be able to turn it in and get another but you will need to keep the humidifier most likely since those are usually purchase out right. DME will squawk. Get a copy of your Rx and see if the doctor actually said the model name of the machine or did he say cpap with heated humidifier.... I bet there was no model listed. You will need to dig in your heels and likely find another DME that offers data capable machines.

Where in Missouri are you? PM me if you wish.

Amount of pressure needed is unrelated to the severity of OSA. Some members with "severe" need less than your 7 and some with "mild" OSA need 15. Pressure needs only relate to the amount of pressure needed to keep airway open and not collapsing. Not the number of events a person has.

[sleepycarol]

I am from Central Missouri, so if I can offer some suggestions feel free to pm me as well.

I would use that you are still tired and that the therapy doesn't seem to be working the way it should to get an apap so that you can titrate yourself (with the doctor's help hopefully) over a few weeks to get a more accurate picture of what pressure you actually require. Be prepared to fight for what you want as it won't be easy. I have heard some on the forum say that thirty days is the "magic number." I don't know how try that is. I was able to trade my Plus machine in for an apap -- but I was only two weeks in and the script was written for a "smart" cpap and that doesn't qualify as a "smart" cpap and the script had a range of pressure written on it.

I know our locally owned DME is really bad about pawning off the cheapest machines they can to increase their profit margin. I had the RT argue with me that the machine I was originally given was what my script called for. At the time I was so ticked off, I figured she was scamming me -- but in hind sight I wonder if she was just that dumb.

Good Luck and hope you get a different machine.

[Pugsy]

It can be hard after 30 days because the billing has already been sent in and DMEs don't want to have to redo the paperwork. Some may actually have a time limit for purchases but for rentals, that is a whole different story.
Typically the humidifier is billed out in total but the cpap machine for Medicare people is a 13 month rental capped after 13 months, you own it.

There is nothing stopping a person from returning the rental unit and taking their business elsewhere. A person needs to have Plan B in place already so no down time. If it were me I would check with other DME's about which machine they would deliver. In other words, I have a RX for a cpap machine with heated humidity and at so and so pressure, what machine would you give me? Even Auto units can be set in CPAP mode but the DME's will sometimes dig in their heels about APAP. I would state a model that I would accept and not go into the data capable stuff since DME will say that compliance only is data capable.

[Janknitz]

I have Medicare and a supplemental policy and since they have already paid on the machine I have I don't know what it would cost me out of pocket if I went somewhere else, or if I even could.

If you have TRADITIONAL Medicare (Parts A and B), then Medicare has not "already paid" for your machine. Medicare does NOT purchase CPAP machines--they require a "capped rental" meaning that you must rent the machine for 13 months, afterwhich the machine belongs to you. Medicare purchases the humidifier and the other supplies, but NOT the machine.

If you have Medicare Part C (Also called Medicare Advantage), often an HMO, then you may be out of luck--In that case it depends on your Advantage provider. But it doesn't sound like you do, since you describe Medicare and a "supplemental".

So here's how Medicare works. Depending on your state, Medicare allows X dollars per month for the rental of an E0601 PAP machine. E0601 is the billing code (HCPC's code) for any and ALL CPAP/APAP machines, but NOT BiPAP's, ASV's, etc. By "any and ALL", I mean the dumbest brick like you've been given, and the best, top of the line, all bells and whistles CPAP or APAP machine. So Medicare doesn't give a HOOT which machine you get.

Who cares? Your DME cares, because if they foist a cheap machine like the Plus onto you without any data capability, their profit margin is higher. If they have to give you a data capable machine, they do not make as much money off of you. So guess which machine they want you to have and be stuck with??? Clearly this is NOT in your best interests, and they have already indicated they are not willing to work with you to have the best machine to determine why you are having problems or how to make your therapy more effective. They are NOT your allies in this!

The good news is that (assuming traditional Medicare) you are on a rental basis, and you can stop this rental and seek a better machine from another vendor. BUT, don't run and do that without some careful research first! What you don't want to happen is to end up with NO machine!

You are early enough in your rental period that you may be able to find another vendor who is willing to forgo a few months of rental to get you as a lifetime customer who will give them a lot of repeat business for supplies. But you need to move fast, because your value to a DME is quickly diminishing.

I would suggest the following steps:
1. Get your doctor to write a specific prescription for a Philips REspironics System One Auto-Adjusting machine (since you already have the humidifier, this will save you a few hundred dollars to stick with the same brand).
2. Call around to other DME's. You'll have to be honest that you are already renting a Plus from your current DME since December, but your doctor wants you to get an APAP instead and you want to know if they can help you by providing the exact machine requested for the duration of your Medicare Rental period. If they say yes, get the name of the person who made this promise.
3. Now contact your current DME and politely but firmly tell them that your doctor has ordered the APAP and if they cannot provide it for you you would like to return the Plus because another DME has promised to provide it for you.

It's likely that the current DME will understand that you mean business and agree to provide the APAP. Do NOT let either DME charge you an extra, out of pocket fee in order to get the APAP. The APAP is an E0601 machine, and Medicare regulations PROHIBIT the DME from charging you a penny extra for any E0601 machine. If anyone suggests such an upcharge, politely point out that it is your understanding is that "balance billing"(that's what the practice of upcharging is called) is not permitted under Medicare law, but perhaps you are mistaken and you will call Medicare Fraud to ask. Be sure to smile sweetly while you say this.

Good luck!

[Pugsy]

Ditto to what Jankintz said.

Also, ANY physician or PA can write the script if they will. It doesn't have to be the sleep doctor. Regular GP or primary care physician can do it.

[Randy32]

i just wanted to point the machine and humidifier you have listed don't work with each other. are you sure you have the right machine and or right humidifier selected?

[Pugsy]

i just wanted to point the machine and humidifier you have listed don't work with each other. are you sure you have the right machine and or right humidifier selected?

I will bet she has this one

https://www.cpap.com/cpap-machine/respi ... cflex.html

PR System One Remstar Plus. Probably saw Remstar Plus in the equipment drop down choices and didn't realize that one is a much older model.

[nervusldy]

Thank you so much for your help. I will make some calls to other DMEs and see what they tell me. Then when I go to my doctor next week I will try to get her to write me a prescription for a specific machine. I think the PRO model of the machine I have would be ok as I could use my humidifier.
I am so glad that I found this forum as the professionals seem to keep you in the dark.

[BlackSpinner]

Thank you so much for your help. I will make some calls to other DMEs and see what they tell me. Then when I go to my doctor next week I will try to get her to write me a prescription for a specific machine. I think the PRO model of the machine I have would be ok as I could use my humidifier.
I am so glad that I found this forum as the professionals seem to keep you in the dark.

Suggestion:
Print off everything in duplicate about the machine and the medicare info and take that with you. Make a check list of all the features you need and do the same. There is nothing so impressive as a stack of papers. It will also allow you to check out the terms if you start fumbling due to overbearing peoples. You can point "It says right here..."

[bap40]

I did go over the sleep doctors recommendation for a plain old cpap. I went to my regular doc and explained what I wanted and he cheerfully wrote me a new script. I returned and fired the first DME and went elsewhere but I was only about 10 days into therapy.

[NancyAZ]

I received my first machine (S9 Elite) on the 26th of January and last Monday (the 28th of February) my DME exchanged machines and gave me the S9 Autoset. My doctor wrote a new prescription for the exact machine that I wanted. I have to say that my DME never questioned it. I talked to her about it before I talked to the doctor and she said that if I got a new prescription there would be no problem. My insurance company has an agreement with the DME for a 10 month capped rental. Good luck and don't give up. Insist on getting what you want. I was nervous before I did it but with the encouragement and advice from people on this forum, I managed to get what I feel is the best machine for me.

Nancy

[Janknitz]

I think the PRO model of the machine I have would be ok as I could use my humidifier.

Given that you are having problems, I'd really ask for an auto If I were you because that will give you the best information and flexibility to figure everything out. As long as you're pushing, you might as well get the best machine possible for your therapy. Remember you are going to be stuck with this machine for 5 or more YEARS.

[mayondair]

Go for the auto, you may very well save yourself some visits to the sleep lab, not a lot of difference in price, and it looks like you can use the humidifier you already have. Kathy

[jbn3boys]

I think the PRO model of the machine I have would be ok as I could use my humidifier.

Given that you are having problems, I'd really ask for an auto If I were you because that will give you the best information and flexibility to figure everything out. As long as you're pushing, you might as well get the best machine possible for your therapy. Remember you are going to be stuck with this machine for 5 or more YEARS.

You can still use your humidifier if you get a PR System One Auto.