Just diagnosed with OSA

[mrghos]

Hello everyone! Man am I glad I found this forum! A bit of background. My dad has had OSA for the last 12 years. (at least that is when it was diagnosed). He has had a few different machines but is currently using an S9 Elite with no humidification. He loves it. At the end of May, I had a sleep study done and my overall AHI was 57.8. Supine AHI was 97.7. Non-Supine AHI was 4.5, REM Sleep AHI was 7.6. Desaturation was at 72%. Total arousals was 60.3/hour. Not good per my follow up visit. I just completed the second sleep study last friday and have an appointment on the 27th to get more information and they say to pick up a CPAP.

I really have no idea what to do next and I guess I will find that out at my next visit. Here is what I am dealing with and where I need help or advice.

My dad gave me his 2 year old S8 Escape. I know I dont have all of the information I assume I need to make a decision on equipment but if I am able to use this machine, should I do so or should I get the S9 model? Since my dad does not use the humidifier, he gave me the Hi5 unit (even tho it does not go with S8 model) I have seen some posts on here that the S8 Escape model is not the best.

What conversation do I need to have at the next meeting with respect to getting the S9 model? Do I need to say something in particular to get this model or will they just offer it to me since it is the newest model? Should I just go with the S8 for now and not spend the money on the S9? I have insurance but have a high deductible and will more than likely have to come out of pocket for some equipment. I just spoke with the lovely folks at BCBS and they told me of the contractual agreement between them and the doctors where the equipment is deeply discounted. I guess if I get a big enough discount I would get the S9.

Is there some sort of negotiation process I need to be aware of to get as much money off the unit as possible or is it a predetermined amount?

I apologize for being all over the place but I really have no idea what my next move is and I dont want to say or do the wrong thing and shoot my self in the foot with the insurance folks regarding their relationship with the doctors.

Any help or comments would be greatly appreciated.

Best,

Mrghos

[Julie]

Hi - you need your doctor (or anyone else on the planet who can write a script) to write one for an S9 Autoset that also says "fill as written" or something to that effect to keep the DME from switching on you to a lesser machine.... but not being an S9 user, let someone else here give you the exact wording... but welcome, and we can probably help you better if we know some basics, so if you click on User Ctl Panel under the logo above, then on Profile, you can fill in (text please, not 'icons') your equipment's full names, model #'s, pressure settings, ramp, etc. etc. And remember, you can always use an auto- in cpap mode, but not the reverse.

[robysue]

mrghos,

The usual process is that you get called back for a second sleep test called the titration test in order to determine what pressure you need. (Some people have a split night study on their first sleep test; the first half of the night is diagnostic and you sleep without a mask, and the second half is the titration and you sleep with the mask.)

After the titration, the doctor usually faxes the prescription to a durable medical equipment supplier, which is known around here as a DME. You meet with the DME, they order the equipment and set it up for you. The follow up appointment with the sleep doc may come before the titration, after the titration, or not at all.

Newbies are often "given" bare bones machines by a DME they have never heard of and newbies often think they have no choice in the matter. You do have a choice.

In order to get the equipment you want it helps to have a doc who will write "S9 AutoSet, fill as written". But many of us don't have docs that are accommodating. Note, however, that a generic prescription for "CPAP at n cm H2O" is enough to allow a DME to sell you an S9 AutoSet if they are willing to do so. Some enlightened DMEs will provide their customers with AutoSets as a routine matter (mine does), some will provide AutoSets to those who ask for them, and other DMEs will fight tooth and nail to convince you that you are not allowed or entitled to get such a "fancy" machine with your prescription or that your insurance company will not pay for such a "fancy" machine. Don't believe these less than honest DMEs.

Before you do anything else, you need to read and re-read JanKnitz's What you need to know before you meet your DME. You might also find my Advice for those newly diagnosed with OSA a useful place to begin your reading about your upcoming move to Hosehead Land.

[mrghos]

Thanks so much everyone! Looks like a have a bit of light reading to do before next Wednesday. I am pretty sure my DME here in Atlanta gives out the S9. Now whether it is the auto set or not, I have no idea. Am I correct in assuming that the S9 is better than the S8 Escape I received from my father?

I never knew this would require so much attention...

[Julie]

Very definitely!

[Sleep2Die4]

I am pretty sure my DME here in Atlanta gives out the S9.

Be very careful, half the S9s are bricks -> http://www.resmed.com/us/products/s9_se ... c=patients

[mrghos]

When you say they are "bricks" what does that mean? Thanks!

[Pugsy]

"Bricks"...what we not so affectionately call machines that don't offer us any efficacy data.
Might want to read this blog. It explains what I mean about efficacy data.
http://maskarrayed.wordpress.com/

The S8 Escape...doesn't off any useful data beyond how many hours it has been used.
The S9 Escape..same thing. No useful data beyond how many hours used. This is useful only so the DME proves to the insurance company that you are using it X numbers of hours so they will pay for the machine.

The S9 Elite and the S9 AutoSet..offers the full efficacy data describe in above link.

[Sleep2Die4]

Thank you Pugsy!

Mr. Ghost, If it were me I would not settle for anything but the S9 Autoset.

Good luck,

[Pugsy]

Mr. Ghost, If it were me I would not settle for anything but the S9 Autoset.

I agree.

To mrghos...the S8 Escape is a good machine as far as delivering pressure and such. It isn't a crap machine. ResMed builds good stuff. Our main problem with the Escape is lack of data in case someone runs into trouble and doesn't feel well..
There is nothing available on the Escape except how many hours you use it and you have a clock to tell you that.
Nothing that might explain a potential problem...like with leaks or whatever.
It would make an excellent back up machine.
If you are okay with having no data available (I wouldn't be but that is me) and/or money is really tight..it will offer excellent therapy as far as working for you.
So you could use it with its limitations (if you are okay with no data) while you evaluate your cost out of pocket to get a full data machine...if you want to go with a full data machine.

The S9 Autoset that we really prefer...is like 2 machines in one..while not everyone likes or needs APAP mode..it is nice to have if available just in case it is ever needed and the cost using insurance is usually no different than the cost for the other machines (even the Escape) because most often the same billing code is used for all of them.
Might as well get the machine with the most options..if the cost is the same when using insurance.

[chunkyfrog]

With positional apnea like yours, my husband can only use the S9 Autoset.
He was enjoying his Autoset so much I bought one out of pocket and put my S9 Elite away for emergencies.
I find my pressure is always lower than that titrated in the lab (and comfort way better). (individual mileage may differ)
The software lets you see/print so much--and it is wicked cool!

[gertrude]

Ditto what Chunky Frog said about positional apnea. Like you, I had a relatively low AHI on my side during the sleep study. The S9 autoset can adjust the pressure to respond to my needs. When I am on my back, it goes up to 8-10. On my side, it stays down around 6. I suppose it could be set at a straight 10, but the leaks are less and I have less trouble waking in the night at the lower pressures. With the trouble I have at 9-10, I can't imagine how the folks at the higher pressures adjust to them.

BTW, my titration study concluded that a pressure of 6 would be adequate. Must have been on my side much of that night! My autoset "ignores" and exceeds the titration study outcome for large portions of every night.

[mrghos]

Thanks everyone for the great information. So the S8 that I have does not record any data? My father told me that all I have to do is send the "card" to them or take it in to have the machine analyzed. Does that make sense to anyone? I am a bit anxious about all of this. I just want to make sure I don't screw up and say or do wrong thing next week at follow up meeting.
I see the S9 is about $850. Does anyone know roughly what it will cost using insurance? Keeping in mind my deductible has not been satisfied at this time? Is there a discount or "agreement" between DME and Dr. that I should know about that will reduce my out of pocket expense?
And when I got next week do I just outright ask for the S9 autoset unit or do I need to beg or sell my first born? Ha!

I really appreciate all of the feedback from everyone. It makes this adventure a little more bearable.

Best,

Mrghos

[Julie]

The S8 will record your compliance - i.e. if you use the machine every night (or as many as are needed to impress your insce. co.) for at least 4 hrs/night... but you don't need that to follow your progress (tho' your DME may sent it to your insce. co.) because you know how much it's used.

[Pugsy]

You would need to check directly with your insurance company to see what they actually "allow" as the contracted amount.
Different insurance companies and even different plans within a same company can have different allowed amounts.
Your cost is based on allowable amount and not the pie in the sky amount the DME might bill out. Excess above allowable amount is written off to let you feel that your insurance got you a good deal.
DME won't likely tell you the allowable amount because they might not know and/or don't want to go to the trouble to find out.

If deductible has not been met, nor is close to being met with the purchase of a machine then you need to do the math to see which is less costly to you....the allowable amount set by your insurance company or buying online out of pocket.

That S8...the only data that your dad's DME got off that card was how many hours he used it over however many nights needed to satisfy insurance requirements so the insurance company would pay.
Generally they look at the hours of use "Oh, you are doing great" "Have a nice day".