Well I know the response from some of you will be "don't do it", but I have my first appointment with my DME (Lincare) tomorrow afternoon. I intend to request a REMstar Auto w/C-flex and heated humidifier. I have Tricare Prime insurance and am told I have to go through a DME to get reimbursed for my equipment (they pay for 80% of allowable costs and I pay for remaining 20%). I have to first rent the equipment and show compliance before I can purchase (this may give me some time to wait for the new REMstar M-series machine).
What I am unsure of is which mask(s) to request. I used a pretty basic nasal mask during my Titration Study and don't know the brand. I am sort of leaning towards trying out an Activa mask as I tend to change positions a lot (startout on my back, but usually switch to both right and left sides). I also read on this forum that the Respironics Comfort series is pretty good.
Is this a good place to start, or should I be looking at other options like the Swift, Breeze, Aura, or Comfort Curve? I also am worried about what to do when I am congested and can't breath through my nose. Should I request a full face mask from my DME, since they are more expensive, and use my own money for the regular nasal masks?
Any suggestions on how to deal with my DME on these issues would be appreciated.
Advice for 1st Visit to DME
14 posts
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SleepDaddy
- Posts: 63
- Joined: Wed Dec 14, 2005 8:06 pm
- Location: Cape Cod
Advice for 1st Visit to DME
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born to be mild
- Posts: 11
- Joined: Sat Dec 17, 2005 10:07 am
First visit
My first visit was some three weeks ago, so I'm reasonably qualified here.
The BEST THING BY FAR is to read through the posts and see what works and what doesn't for different people. That alone will provide a level of comfort when you're discussing things with your DME.
Unfortunately I hadn't come across this site when I went to my initial appointment. The specialist at my DME (Apria) was very kind and helpful -- BUT DUE TO MY IGNORANCE, I let her get me "fitted" with something that was unacceptable after the first night.
I put quotes around "fitted," because it wasn't really a fitting; it was more of an upright "try-on" session. She didn't measure anything (such as you'd find from the detailed CPAP.com fitting site.) Instead, we went through the 15 or so masks that she had available. I sat in the chair and tried them all on. DUH, it never occurred to me that something that "fits" when you're sitting upright in a chair, might feel quite different when you're lying down when your head on your pillow.
LEARNING POINT #1: Bring your own pillow to the DME. If they don't have a place for you to lie down, you can at least put your pillow on the table, and with a mask on, put your head in a place close to what you'd do at home. In my situation, I tried all 15 masks, and ASSUMED that "snug" was good... and ended up with the Respironics ComfortFull medium. (That cost me a hundred dollars when two days later I ordered a much better solution, but on my own dime.) For example, the human body can get used to many things, but you probably won't get used to a mask that smashs into the bridge of your nose. In my case, it was blisters after the first night.
LEARNING POINT #2: What works for "many" may be completely wrong for you. Disregard a DME's statement, "I've been doing this for a long time, and many people of your size like this mask." Absolutely meaningless. Again, my DME specialist was kind and took plenty of time with me, but in the end, my "choice" was based on what she said worked for lots of folks. I have to assume the ComfortFull works for somebody, otherwise they wouldn't sell it. However, that being said, it brings me to...
LEARNING POINT #3: You CAN get some general advice from what works for others. If you check out http://cpap-supply.com/product_categories.asp, and click on "headgear", you'll notice a customer rating for every mask they sell. Guess what: high-rated masks there receive excellent write-ups on this board (e.g., Swift, Activa). If I had checked that site out, I would have seen that the ComfortFull had "two red spots" (a negative review by customers) and probably would have selected something else.
Final learning point for me? If you haven't picked it up already, it was that the mask is everything. I ended up with a reasonably good, quiet machine (see below). If I had bee provided with an APAP, or BPAP, who knows, that might be even better. But IMHO (backed up my hundreds of posts here) the "best" machine is worthless if your mask is uncomfortable to the point that you want to remove it after an hour or so.
Best of luck!
The BEST THING BY FAR is to read through the posts and see what works and what doesn't for different people. That alone will provide a level of comfort when you're discussing things with your DME.
Unfortunately I hadn't come across this site when I went to my initial appointment. The specialist at my DME (Apria) was very kind and helpful -- BUT DUE TO MY IGNORANCE, I let her get me "fitted" with something that was unacceptable after the first night.
I put quotes around "fitted," because it wasn't really a fitting; it was more of an upright "try-on" session. She didn't measure anything (such as you'd find from the detailed CPAP.com fitting site.) Instead, we went through the 15 or so masks that she had available. I sat in the chair and tried them all on. DUH, it never occurred to me that something that "fits" when you're sitting upright in a chair, might feel quite different when you're lying down when your head on your pillow.
LEARNING POINT #1: Bring your own pillow to the DME. If they don't have a place for you to lie down, you can at least put your pillow on the table, and with a mask on, put your head in a place close to what you'd do at home. In my situation, I tried all 15 masks, and ASSUMED that "snug" was good... and ended up with the Respironics ComfortFull medium. (That cost me a hundred dollars when two days later I ordered a much better solution, but on my own dime.) For example, the human body can get used to many things, but you probably won't get used to a mask that smashs into the bridge of your nose. In my case, it was blisters after the first night.
LEARNING POINT #2: What works for "many" may be completely wrong for you. Disregard a DME's statement, "I've been doing this for a long time, and many people of your size like this mask." Absolutely meaningless. Again, my DME specialist was kind and took plenty of time with me, but in the end, my "choice" was based on what she said worked for lots of folks. I have to assume the ComfortFull works for somebody, otherwise they wouldn't sell it. However, that being said, it brings me to...
LEARNING POINT #3: You CAN get some general advice from what works for others. If you check out http://cpap-supply.com/product_categories.asp, and click on "headgear", you'll notice a customer rating for every mask they sell. Guess what: high-rated masks there receive excellent write-ups on this board (e.g., Swift, Activa). If I had checked that site out, I would have seen that the ComfortFull had "two red spots" (a negative review by customers) and probably would have selected something else.
Final learning point for me? If you haven't picked it up already, it was that the mask is everything. I ended up with a reasonably good, quiet machine (see below). If I had bee provided with an APAP, or BPAP, who knows, that might be even better. But IMHO (backed up my hundreds of posts here) the "best" machine is worthless if your mask is uncomfortable to the point that you want to remove it after an hour or so.
Best of luck!
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SleepDaddy
- Posts: 63
- Joined: Wed Dec 14, 2005 8:06 pm
- Location: Cape Cod
Born to be Mild:
Thanks for taking the time to provide such excellent and thoughtful advice. I have read through more posts than I can remember and find your advice very useful.
I definitely am taking "mask is everything" advice to heart. I get the impression, that most xPAP users go through quite a bit of trial and error to find a mask that works for them. I am interested in knowing if there is a good place to start the mask fitting process (e.g., start with a particular type or brand of mask that works for many users). It just seems like there is such a dizzying array of mask options, that it is hard to know where to start.
Thanks for taking the time to provide such excellent and thoughtful advice. I have read through more posts than I can remember and find your advice very useful.
I definitely am taking "mask is everything" advice to heart. I get the impression, that most xPAP users go through quite a bit of trial and error to find a mask that works for them. I am interested in knowing if there is a good place to start the mask fitting process (e.g., start with a particular type or brand of mask that works for many users). It just seems like there is such a dizzying array of mask options, that it is hard to know where to start.
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Guest
Send me an email at kram29@comcast.net and I will tell you something about Tricare Prime that may allow you to get your equipment for free.
Make the subject "Tricare" so I will know it is from you and I won't delete it.
Craig
Make the subject "Tricare" so I will know it is from you and I won't delete it.
Craig
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rested gal
- Posts: 12881
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
born to be mild, I loved your post! Excellent, excellent advice!!
Sleepdaddy, I personally would skip any mask with "Comfort" in its name. Best ones to try, imho, are:
ResMed Activa - nasal mask - covers nose. Straps can be worn amazingly loose for a great seal.
Puritan Bennett DreamFit - nasal mask - covers nose. (Do not confuse this name with the PB DreamSeal.)
ResMed Swift - nasal pillows mask - sits at and slightly in the nares (the nostril openings.) If you get this one, be sure you make the DME give you ALL THREE SIZES of nasal pillows that the manufacturer puts in the box with every Swift.
ResMed Ultra Mirage Ff - full face mask - covers nose and mouth. Even if a person doesn't need a full face mask, it's good to have one stashed back, ready for any night when congestion or a cold makes it necessary to breathe through the mouth.
Puritan Bennett Breeze with nasal pillows - one of my longtime favorites, but only if I sleep on my sides. Not so good for back-sleepers. If you get this one, get nasal pillows that you, and the person fitting you, think would be "too big".
A mask that most DMEs probably have never heard of, much less have, is the best one of all, imho:
Aeiomed's "Headrest with nasal seal" (nasal pillows mask). This one used to be called the "Aura". Most of us still call it that.
Sleepdaddy, you're thinking right. Of the masks you think you might want to get, let your insurance pick up the most expensive one. Buy your other masks online yourself. No prescription is needed at all to buy masks from an online store. When you compare prices on the internet, be sure to figure in whether the store charges shipping. Many offer free shipping on orders over a certain amount.
Here's a link to a lot of mask discussion topics:
LINKS to MASKS - nasal mask, nasal pillows, nasal prongs
Sleepdaddy, I personally would skip any mask with "Comfort" in its name. Best ones to try, imho, are:
ResMed Activa - nasal mask - covers nose. Straps can be worn amazingly loose for a great seal.
Puritan Bennett DreamFit - nasal mask - covers nose. (Do not confuse this name with the PB DreamSeal.)
ResMed Swift - nasal pillows mask - sits at and slightly in the nares (the nostril openings.) If you get this one, be sure you make the DME give you ALL THREE SIZES of nasal pillows that the manufacturer puts in the box with every Swift.
ResMed Ultra Mirage Ff - full face mask - covers nose and mouth. Even if a person doesn't need a full face mask, it's good to have one stashed back, ready for any night when congestion or a cold makes it necessary to breathe through the mouth.
Puritan Bennett Breeze with nasal pillows - one of my longtime favorites, but only if I sleep on my sides. Not so good for back-sleepers. If you get this one, get nasal pillows that you, and the person fitting you, think would be "too big".
A mask that most DMEs probably have never heard of, much less have, is the best one of all, imho:
Aeiomed's "Headrest with nasal seal" (nasal pillows mask). This one used to be called the "Aura". Most of us still call it that.
Sleepdaddy, you're thinking right. Of the masks you think you might want to get, let your insurance pick up the most expensive one. Buy your other masks online yourself. No prescription is needed at all to buy masks from an online store. When you compare prices on the internet, be sure to figure in whether the store charges shipping. Many offer free shipping on orders over a certain amount.
Here's a link to a lot of mask discussion topics:
LINKS to MASKS - nasal mask, nasal pillows, nasal prongs
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SleepDaddy
- Posts: 63
- Joined: Wed Dec 14, 2005 8:06 pm
- Location: Cape Cod
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Jan in Colo.
- Posts: 128
- Joined: Tue Sep 13, 2005 11:54 pm
- Location: Colorado
SleepDaddy...
All DME's don't carry all brands either. My DME only carried DeVilbiss and Puritan Bennett. So I pushed for the best machine I could get in the Puritan Bennett line, since this is the board I get my information from and nobody here uses DeVilbiss (might be a great brand, just can't get info or help on it in this forum). Point being, you may have to be flexible on exactly which brand machine you get.
And you are definitely doing the right thing getting info here about masks. My DME didn't even show me the Swift...she said she hasn't found ANYONE who likes it. Well, Duh....there certainly is a high percentage of happy users on this forum....must be good for SOMEBODY.....
So keep up the good work! You'll do just fine at the DME when you go in already armed with information...
Jan in Colo.
All DME's don't carry all brands either. My DME only carried DeVilbiss and Puritan Bennett. So I pushed for the best machine I could get in the Puritan Bennett line, since this is the board I get my information from and nobody here uses DeVilbiss (might be a great brand, just can't get info or help on it in this forum). Point being, you may have to be flexible on exactly which brand machine you get.
And you are definitely doing the right thing getting info here about masks. My DME didn't even show me the Swift...she said she hasn't found ANYONE who likes it. Well, Duh....there certainly is a high percentage of happy users on this forum....must be good for SOMEBODY.....
So keep up the good work! You'll do just fine at the DME when you go in already armed with information...
Jan in Colo.
Sleepdaddy,
You might also want to look in your local phone directory and see if there are other DME suppliers around. I went to the DME my physician had me go to and I ended up "renting" for the first month a Resmed machine. Not saying it was a not a good machine, but one I wasn't happy with. I later found out about another supplier in the area that only supplies Respironics machines (should have gone there first but who knows when you are new to this).
If you have an idea what you may want, call the suppliers in your area and ask them what brand of machines and masks they will supply. At least you'll have a better idea on what options are available to you. Obviously, you may need to choose a supplier who accepts your insurance (I ended up purchasing my own on-line).
Good luck and there is some great advice given by other posters - I wish I had their knack at putting ideas into words so well.
You might also want to look in your local phone directory and see if there are other DME suppliers around. I went to the DME my physician had me go to and I ended up "renting" for the first month a Resmed machine. Not saying it was a not a good machine, but one I wasn't happy with. I later found out about another supplier in the area that only supplies Respironics machines (should have gone there first but who knows when you are new to this).
If you have an idea what you may want, call the suppliers in your area and ask them what brand of machines and masks they will supply. At least you'll have a better idea on what options are available to you. Obviously, you may need to choose a supplier who accepts your insurance (I ended up purchasing my own on-line).
Good luck and there is some great advice given by other posters - I wish I had their knack at putting ideas into words so well.
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SleepDaddy
- Posts: 63
- Joined: Wed Dec 14, 2005 8:06 pm
- Location: Cape Cod
Jan in Colo.
Thanks, I am anxious to get this process going and just hope I get one of those DMEs that is easy to work with (I can hope can't I).
PEELS
I checked around and was told that Lincare is the best DME in my area (Northern Virginia). I gave them a call to check on what equipment they have and they indicated that they prefer ResMed, although they could "order" Respironics equipment if I really wanted it.
The individual I spoke to on the phone indicates that their experience with the REMstar APAP has not been very good and that they had to return quite a few machines for repairs. They indicated that they recommend the ResMed S8 Vantage APAP for their customers. Since both machines appear to be the same price on cpap.com, I don't see what advantage Lincare would get by pointing me towards one machine over the other. Anyway, I'm interested to see how the visit goes tomorrow. I intend to ask for a REMstar Auto w/C-flex and a heated humidifier. I have Tricare for my insurance, so I think I will have to rent the machine for some period of time before I can purchase it.
Thanks for all the great advice!
Thanks, I am anxious to get this process going and just hope I get one of those DMEs that is easy to work with (I can hope can't I).
PEELS
I checked around and was told that Lincare is the best DME in my area (Northern Virginia). I gave them a call to check on what equipment they have and they indicated that they prefer ResMed, although they could "order" Respironics equipment if I really wanted it.
The individual I spoke to on the phone indicates that their experience with the REMstar APAP has not been very good and that they had to return quite a few machines for repairs. They indicated that they recommend the ResMed S8 Vantage APAP for their customers. Since both machines appear to be the same price on cpap.com, I don't see what advantage Lincare would get by pointing me towards one machine over the other. Anyway, I'm interested to see how the visit goes tomorrow. I intend to ask for a REMstar Auto w/C-flex and a heated humidifier. I have Tricare for my insurance, so I think I will have to rent the machine for some period of time before I can purchase it.
Thanks for all the great advice!
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SleepDaddy, from what I've read on this forum, anything Rested Gal says you can take to the bank .
Here is a little bit of what I do with Tricare Standard (yes, Prime is a little different).
(this is from a prior post) = I'm on Tricare Standard, and buy my own CPAP equipment - including my original Remstar Auto. In fact I did it over the internet because my local (rural Arkansas) DME was inflexible and ignorant (sorry to have to say that). Then I send my paid invoice and copy of my prescription to Tricare and they reimburse me, minus my 25%. Can you do that with Prime? If so, you can buy it cheaper and save on your co-pay."
Your 80% going thru a DME is going to be alot higher than if you buy it yourself and pay 80%
Be sure to check with Tricare first to make sure you can do this. If you have any questions of me, just contact me via PM or post here.
Good Luck,
Linda
Here is a little bit of what I do with Tricare Standard (yes, Prime is a little different).
(this is from a prior post) = I'm on Tricare Standard, and buy my own CPAP equipment - including my original Remstar Auto. In fact I did it over the internet because my local (rural Arkansas) DME was inflexible and ignorant (sorry to have to say that). Then I send my paid invoice and copy of my prescription to Tricare and they reimburse me, minus my 25%. Can you do that with Prime? If so, you can buy it cheaper and save on your co-pay."
Your 80% going thru a DME is going to be alot higher than if you buy it yourself and pay 80%
Be sure to check with Tricare first to make sure you can do this. If you have any questions of me, just contact me via PM or post here.
Good Luck,
Linda
_________________
| Machine: DreamStation Auto CPAP Machine |
| Humidifier: DreamStation Heated Humidifier |
| Additional Comments: Compliant since April 2003. (De-cap-itated Aura). |
Follow up to my message above:
Tricare Standard never required that I rent for a month or any other length of time - I bought mine outright (another money saver by not rent).
Have your sleep doctor write the prescription for both a CPAP and Heated Humidifier. I also had mine include "nasal pillows" just in case Tricare wanted to debate reimbursement for my mask.
And my prescription was written as "CPAP with pressure 7cm" and I bought a Remstar Auto. Tricare never questioned it - because a Remstar Auto can also be used as a CPAP.
Tricare Standard never required that I rent for a month or any other length of time - I bought mine outright (another money saver by not rent).
Have your sleep doctor write the prescription for both a CPAP and Heated Humidifier. I also had mine include "nasal pillows" just in case Tricare wanted to debate reimbursement for my mask.
And my prescription was written as "CPAP with pressure 7cm" and I bought a Remstar Auto. Tricare never questioned it - because a Remstar Auto can also be used as a CPAP.
_________________
| Machine: DreamStation Auto CPAP Machine |
| Humidifier: DreamStation Heated Humidifier |
| Additional Comments: Compliant since April 2003. (De-cap-itated Aura). |
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SleepDaddy
- Posts: 63
- Joined: Wed Dec 14, 2005 8:06 pm
- Location: Cape Cod
Linda3032:
It is usually pretty easy to figure out who the experts are on these forums, and agree that Rested Gal is one of 'em.
Thanks for the Tricare advice. I contacted Tricare and was told I had to go through a DME to be able to be reimbursed for a CPAP machine. However, I have learned over the years that Tricare often gives out different info depending on who you ask. Accordingly, I am going to try a few more time to see if I can get the answer I really want, which is that I can purchase the exact equipment I want online a submit the paperwork directly to Tricare for reimbursement. It remains to be seen how successful I will be.
It is usually pretty easy to figure out who the experts are on these forums, and agree that Rested Gal is one of 'em.
Thanks for the Tricare advice. I contacted Tricare and was told I had to go through a DME to be able to be reimbursed for a CPAP machine. However, I have learned over the years that Tricare often gives out different info depending on who you ask. Accordingly, I am going to try a few more time to see if I can get the answer I really want, which is that I can purchase the exact equipment I want online a submit the paperwork directly to Tricare for reimbursement. It remains to be seen how successful I will be.
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When you call Tricare, don't talk to the "claims people". Make sure you talk to your "Northern Area Benefit Representative" (your rep is different from my Southern one).
The Rep will probably refer you to the DME (durable medical equipment) info person. That's the person to talk to. In fact, when I first spoke to mine, she even emailed me confirmation of our conversation - just in case I had problems from the claims dept.
I think your Northern Rep phone number is 1-877-874-2273, and be sure to ask for someone in the DME dept.
Again, Prime might have different rules from Standard. I love standard, I can pick my own doctors, and even go to a specialist without a referral. It's worth the extra 5% to not go through the hassle.
Linda
The Rep will probably refer you to the DME (durable medical equipment) info person. That's the person to talk to. In fact, when I first spoke to mine, she even emailed me confirmation of our conversation - just in case I had problems from the claims dept.
I think your Northern Rep phone number is 1-877-874-2273, and be sure to ask for someone in the DME dept.
Again, Prime might have different rules from Standard. I love standard, I can pick my own doctors, and even go to a specialist without a referral. It's worth the extra 5% to not go through the hassle.
Linda
_________________
| Machine: DreamStation Auto CPAP Machine |
| Humidifier: DreamStation Heated Humidifier |
| Additional Comments: Compliant since April 2003. (De-cap-itated Aura). |
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SleepDaddy
- Posts: 63
- Joined: Wed Dec 14, 2005 8:06 pm
- Location: Cape Cod
Linda3032:
I called Tricare claims first time around. I will take you advice and call the Area Benefit Representative and try and get to DME department. I sure wish there were more "Tricare experienced" xPAP users on this forum. It seems like word of mouth is the only way to get reliable information on xPAP equipment reimbursement. I would definitely be clueless without this forum.
Thanks again for your willingness to share your experience.
I called Tricare claims first time around. I will take you advice and call the Area Benefit Representative and try and get to DME department. I sure wish there were more "Tricare experienced" xPAP users on this forum. It seems like word of mouth is the only way to get reliable information on xPAP equipment reimbursement. I would definitely be clueless without this forum.
Thanks again for your willingness to share your experience.
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14 posts
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