CPAP machine may be dying

[Eideard]

Sitting at the computer after waking up coughing, chest congested. Think my machine is dying. 7 years old. Think it's ResMed oldie - but, my wife is still sleeping and I don't want to wake her turning on lights to see what the critter is...Feel like I just smoked a cigarette and I haven’t done that in 52 years.

Anyway - it's heated humidifier, removable tank, prescription is fairly high pressure. I've loved using it from Day 1. It's a leased machine from Lincare. I'm at altitude BTW = 6500'.

Now, I want to buy a new machine. I'm a cranky old geek with Humana's Medicare Advantage coverage. I've asked them casually in the past and they'll pick up 80% of cost.

I'll be perfectly happy with something comparable - though may as well go for quieter - last doc's visit he told me machines also aid exhalation, nowadays.

Questions, your experience, whatever?

1. I do everything online. Anyone you suggest to shop for a new machine?

2. New staff at local Lincare - are their prices competitive? Everyone I knew there has moved on. Their website doesn't tell me what they carry. I’ll be carrying my old machine in for them to check, this morning.

3. Perfectly happy staying with ResMed or going to Respironics. Don't know other brands I've seen online. Suggestions?

4. Have an email question in to Humana - didn't want to call, right now. Don't want to wake up my wife. Bad enough she had to deal with me coughing and sputtering out of bed! Anyone know if they have set vendors/network/whatever? Are these questions moot?

Need I deal with network? Vendor who does paperwork would be great - BUT - is it much of a hassle to sort the payback with Humana vs. Vendor who just eventually bills my share to me?

Thanks...

[Julie]

Hi - I'm not in the U.S. so may not understand this properly, but ... have you been paying a rental fee for 7 yrs for your machine? Have you figured out what how much you've payed out in that time?

If you go to Cpap.com and look at new machines (starting perhaps with mine, which is very inexpensive as they go) you may realize that buying outright (and you should ask your insce. co. if they'll cover it on receipt of your paperwork) may be far cheaper... and it does sound like you probably need a new machine - most insce. co's cover a new one every 5 yrs, with mask and accessories a lot more often.

If you join as a member here, you can then go to the User Ctl. Panel (under main logo) and fill out your profile with the make, model and specifics of your equipment so we'll all see it automatically when you post - please use text instead of icons, makes it much easier to identify.

[-tim]

Most new machines can cope with altitude.

The new ones should be much quieter but some of them have annoying hums or purrs or exhale noises... that seem to vary per machine.

I put up a review of the Remed vs Respironics a few weeks ago. The S9 is mostly a better machine but it cost more. I have one of both in the APAP models.

The new features are heated hoses. Some people love them. I'm don't know, I've never tried a non heated one.

Newer machines have exhale relief so they drop the pressure at exhale. I'm not sure you will find it a useful feature after years of an older machine but if you had a top of the line machine back then, yours might have that feature turned on and you might want the same.

There are CPAP (they do just one pressure maybe with a ramp), APAP (they start up with a ramp - maybe and then adjust), then there the the BIPAP with have pressures for inhale and exhale.

Newer machine will sometimes record lots of data which can help you a great deal.

There is a profile option where you can let others know which machine you have. There might be some help to ID your machine there too since lots of them look alike.

And remember to empty the water before turning it over to read the label!

[Tino2You]

HI Eideard,

If you want to stay in the ResMed l;ine, the S9 AutoSet and the S9 Elite will be the ones you will want to look at. The former allows you to set a range of pressures. The machine will operate within that range as required by your obstructions )mine is set 9 to 15..when I sleep on my side I don't need as much pressure to keep my airway open. The Elite is a straight CPAP machine, one pressure (much what you have now). Both machine record all efficacy data. You can download your data to your PC and monitor how your therapy is progressing.
-tino

[hyperlexis]

First, you probably need a consumer fraud/elder law attorney to chat with you about you being defrauded into paying to lease a CPAP for seven years. (How much did you spend on said scheme, btw?).

Second re machines, you will likely need a new Rx, and your pressure needs may have changed. I'd recommend an Automatic machine with full data capabilities, regardless of whether you need a CPAP or bi-Pap type machine. Medicare/Humana will pay one flat fee for whatever CPAP machine you get, so you should demand the most current technology available.

The current cadillac machines are the Resmed S9 series and the Respironics REMstar 60 series machines. Either come in full auto ("S9 Autoset" and "REMStar Auto A-Flex 560") or standard CPAP, or Bi-Pap versions. But at least the auto machines can work in full automatic or fixed CPAP if needed.

Both the S9 and Remstar 60 series models can use heated tubing to reduce rainout.

The DeVilbiss Intellipap Auto is also very good, a bit cheaper, but lacks 'waveform' tracking and heated tubing (not important for some people).

The Devilbiss and Respironics machines are made in the USA and the Resmeds are imported.

Whatever you do, YOU are the patient and YOU need to be a part of the decision on a new machine. Be sure that when you decide on a machine, that your MD writes the make and model of the machine on the Rx. That is key. Otherwise you will be at the mercy of the DME who could decide to give you the cheapest, least capable machine in their inventory. Not that cheapest is always bad, but why get something less capable when your insurer pays the same flat fee for any CPAP, no matter the model. Taking a cheaper machine in that case just benefits the DMEs bottom line.

[Pugsy]

What is the full model name for the machine that you have used for the past 7 years?
Is it a regular cpap/apap machine or is it one of the higher end machines used to treat people with problems with centrals?
Leasing a regular cpap/apap machine for 7 years is unusual but might not be unusual for one of those really high end ASV type of machines.
Before you go shopping for any machine you need to know exactly what type of machine you have been using.

[purple]

You might start with your sleep doctor. He might suggest you do another overnight titration. If the sleep doc mentioned a different pressure on exhale he might be thinking you would benefit from a Bi-Level machine.

While a Bi-Level is twice what the others are, if it is what you need. you will enormously benefit as well.

Of course I, myself, do not have the money to do those things.

[-tim]

The Devilbiss and Respironics machines are made in the USA and the Resmeds are imported.

The Resmed has more USA made parts than the Respironics from what I can tell and some are assembled in Australia and some in Singapore. The Respironics is "assembled" in the USA according to its manufacture.

[hyperlexis]

The Devilbiss and Respironics machines are made in the USA and the Resmeds are imported.

The Resmed has more USA made parts than the Respironics from what I can tell and some are assembled in Australia and some in Singapore. The Respironics is "assembled" in the USA according to its manufacture.

How do you know this? What majority of parts in Resmed xPAP machines are actually Made in the USA? It would be interesting to know this. Resmed does not seem to promote this anywhere on their website, from what I have seen. All Australian technology or from New Zealand (or now Singapore, apparently) from what I can tell. The bottom of the S9 states "Made in Australia," (Or now, Singapore) which under labeling laws means all or virtually all of the parts of the machine is made in Australia(/Singapore). Otherwise it would state "Assembled in Australia". Splitting hairs but an important distinction.

Do the Resmed machines comply with the Buy American Act (+50% US parts)? (My new Respironics FullLife mask had a sticker on the bag stating it did, [and the Amara mask I am replacing states "made in America" on the package]).

The Respironics machines are assembled in the USA with US and imported parts by American workers in Pennsylvania. That I do know. And Devilbiss is US made as well. The Respironics 50 series and below stated 'Made in USA' on the unit, while my 60 series states 'Assembled in USA,' which legally means built with mixed US+foreign parts. Respironics couldn't tell me what the exact percentage was, however....

Would be interesting to learn exactly what comes from where with these machines. Or if they actually share components.....

[Eideard]

OK - up and at 'em, this morning.

CPAP machine is Remstar Pro with C-flex from Respironics.

Taxpayers get to complain about lease - tab picked up by Medicare.

I really don't want new overnight study. Been happy with results for 7 years. Saw sleep doctor about 6 months ago and he saw nothing out of line. Just want to use existing prescription on new machine.

Current Medicare Advantage plan will pick up 85% of purchase price. My concerns are ease of programming it myself - if I buy mail order. Ease of handling paperwork if I deal with firm that doesn't handle Medicare related paperwork for me.

If the software is halfway decent, I don't have problems. Longtime geek - online since 1983.

[Pugsy]

If you want to stay within the Respironics line...
The PR System One 60 series Pro Cpap with CFlex is comparable to your existing machine. It is a full data machine and software is available. Right now EncoreBasic or Encore Pro 2.5 or higher. Model number 460.
The APAP model would be the PR System One 60 series Auto CPAP. Full data machine and model number 560.
The 60 series being the heated hose capable machines.
There are also models 450 and 550 of the same above machine but they don't have the heated hose thing.
The heated hose is a nice feature...not a deal breaker but it is a definite plus.

ResMed line...S9 is the newest model line
The S9 Elite would be comparable to your old machine...straight cpap but full data and comes with heated hose already.
The S9 AutoSet would be the APAP model. Full data.
Software available...SleepyHead and ResScan.

Both APAP models can be used in cpap mode though.
Check out my signature line for PR S1 software options. Right now SleepyHead won't work with the 60 series model but will work with the 50 series. You can see some examples of both in my thread.
For ResScan samples you can watch the video. http://montfordhouse.com/cpap/resscan_tutorial/

If you buy online from cpap.com they will furnish you with necessary paperwork to submit to insurance for reimbursement. I would make sure that your insurance would accept such paperwork though.
If you buy online and insurance will accept online supplier costs...the PR System One machines are substantially lower and your co pay would be lower.
Medicare advantage plans may or may not accept charges made by an online supplier though. So check to make sure.
From the wording on my plan it appears that they would but would just consider them to fall under the out of network thing. I have never tried it though.

Both of the above brands of machines are excellent. I happen to own both. Minors pros and cons for either.
Both do a great job. Algorithms are different but end result is effective way of treating OSA.

My personal preference is for APAP machine. Nice to have APAP mode available even if it isn't needed.
It's like having 2 machines in one and sometimes that APAP mode comes in real handy.

[-tim]

The Devilbiss and Respironics machines are made in the USA and the Resmeds are imported.

The Resmed has more USA made parts than the Respironics from what I can tell and some are assembled in Australia and some in Singapore. The Respironics is "assembled" in the USA according to its manufacture.

How do you know this? What majority of parts in Resmed xPAP machines are actually Made in the USA? It would be interesting to know this. Resmed does not seem to promote this anywhere on their website, from what I have seen. All Australian technology or from New Zealand (or now Singapore, apparently) from what I can tell. The bottom of the S9 states "Made in Australia," (Or now, Singapore) which under labeling laws means all or virtually all of the parts of the machine is made in Australia(/Singapore). Otherwise it would state "Assembled in Australia". Splitting hairs but an important distinction.

Do the Resmed machines comply with the Buy American Act (+50% US parts)? (My new Respironics FullLife mask had a sticker on the bag stating it did, [and the Amara mask I am replacing states "made in America" on the package]).

The Respironics machines are assembled in the USA with US and imported parts by American workers in Pennsylvania. That I do know. And Devilbiss is US made as well. The Respironics 50 series and below stated 'Made in USA' on the unit, while my 60 series states 'Assembled in USA,' which legally means built with mixed US+foreign parts. Respironics couldn't tell me what the exact percentage was, however....

Would be interesting to learn exactly what comes from where with these machines. Or if they actually share components.....

I know this because I used to buy electronics parts and I've seen inside the machines. Many of the complex parts in the Resmed are made in the USA as are many of its connectors but most of the rest come from China. Assembled in the US can mean the larger of a two sub assemblies of foreign parts is also assembled in the USA. We make things that meet the "Made in the USA" legal requirements here in Melbourne. When you start sourcing parts for DOD projects you can find it's nearly impossible to buy what you need but that is why there are waivers. "Made in Australia" has different requirements than "Made in the USA" and part of that can involve where it was designed and other parts of the R&D and production and marketing. Per component, the resistors and capacitors outnumber everything else by a significant majority and I expect every single one of them in all the machines was made in China. The power bricks are all made in China and they have more electrical components by weight than the blowers.

Masks and things requiring very high quality control mostly haven't moved over to Asia yet but its starting.

[wilsonintexas]

TE TO KICK IN HERE, WITH INCORRECT INFORMAITON... BUT

IfYOU ARE ON MEDICARE, YOU MAY HAVE TO GO THROUGH THE DME, and probabluy can not buy online. I am pretty sure Medicare required the DME in the loop.....

Does not change the discussion onw which machine , only where you get it from.

ALSO

I was helping my mother with her midicare... the "normal" mediacre plan for most equipent is to rent if monthly for a year.... after that it is yorus. I ended up with a hospital bed, and wheel chanre after my mover moved in with me, we got them perscribed... rented them of the year with a very small co-pay for 11 months, and then they were ours.

[pats]

Current Medicare Advantage plan will pick up 80% of purchase price. My concerns are ease of programming it myself - if I buy mail order. Ease of handling paperwork if I deal with firm that doesn't handle Medicare related paperwork for me.

If the software is halfway decent, I don't have problems. Longtime geek - online since 1983.

I got my APAP from cpap.com. I made sure I had an electronic copy of the provider manual before the machine arrived, but cpap.com included the paper copy of the provider manual with the machine. I checked the settiings, and it was already programmed to match my prescription, with reasonable defaults for everything not specified in the prescription.

Even the provider menus are designed to be usable by non-geeks with minimal training.

I picked one of the machines that is compatible with SleepyHead, which is open source, C++. I liked the idea that if it did not do what I wanted, I could make my own changes.

The main issue for you is your Medicare Advantage plan- will they reimburse 80% if you buy on-line, or only if you buy through an in-network DME?

[Pugsy]

I forgot to provide link for the provider manuals.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual
See bottom of the page for instructions on how to request them.

Medicare Advantage plan...may or may not reimburse. They are not always going to mimic what Medicare actually does.
This is why I say check with them directly to see if they will accept an online supplier's receipt and universal insurance form and base reimbursement off that paperwork.
Some insurance will and some won't. Medicare Advantage plans vary greatly between plans. Some may allow out of network suppliers and some may not. Online suppliers are going to be out of network for sure.

Also bear in mind..if your plan does mimic Medicare and only allows the rent to own option and only through a regular participating DME...that come January the part B deductible will have to be met again. So more out of pocket come January. Do the math to see which way is less out of pocket expense...going with an online supplier or going with a regular DME and the copays involved.