New Guy with a request.

[Mike Grasso]

Hello all,

Finally went and had a sleep study done and the Doc has it, he will be writing the recommendation for my HMO.
I checked with the HMO and found out the preferred DME.
I spoke to the Therapist and she was pretty adamant that they will ask for a ResMed S9 Escape.
Her statement to me was that the Elite was useless, no one needs the info it records and the Doctor's don't read them.
She then added that the Autoset was good for less than 1% of CPAP patients.

As you can tell, I think she's a tool. So, does anyone have a write up that my Doc can use to elorborate on why I would need an Autoset or Elite?
I want to get the DME to let me upgrade (at my own expense) but I don't know if they'd let me.

Any help would be appreciated.

Mike

[chunkyfrog]

If your sleep study revealed apnea that is worse at some sleep positions than in other positions,
then autopap would be the best therapy choice. Full data helps compliance--especially for nerds like us.
Find out what your co-pay would be--you may be ahead going online if it's too high.
I paid for my Autoset completely out of pocket after 9 months on straight cpap.
It was worth every penny.

[BlackSpinner]

Tell him to write that the patient needs access to efficacy data AHI, leak rates .
Any medical person , including your dentist can write a prescription so if your regular doctor is under your thumb you can dictate the exact model and "mask of patient's choice"

There is probably $20 difference at their cost between the elite and escape.

[Mike Grasso]

Thanks!

If you do have a written "prior authorization" for those, maybe I can get the wording...

Mike

[BlackSpinner]

Thanks!

If you do have a written "prior authorization" for those, maybe I can get the wording...

Mike

Yuo have an HMO which means it works different from regular insurance that get billed by a code which is the same for all of them. So you need to contact the HMO for details.

[Xney]

Something tells me that DME has a poor success rate for their patients. But maybe a high success rate in getting gear through their place to make their money.

[Tino2You]

There is probably $20 difference at their cost between the elite and escape.

That is the consumer price, I bet the profit margin between the escape and the elite is much more than the 20 dollars.
-tino