New: Should I skip the DME

[itznuthin]

Two weeks ago I used a CPAP in my second night at the sleep clinic. I had previously been diagnosed with sleep apnea. I had 33 "incidents" per hour and 44 during REM sleep. My number was 9 for the pressure. I was OK on the CPAP but I want to make sure I get a good quality machine that I'll keep using. I still haven't heard from my DME after two weeks of attempts to get on their schedule. But I have been reading this board.

I am thinking of skipping the DME and ordering via the internet a:
REMStar Auto C-Flex CPAP with heated humidifyer
Respironics ComfortGel nasal mask (I used a similar mask at clinic)
Software to monitor everything.

The cost is about #1,000. My insurance company said they will pay 80% up to $1,000 but I suspect there will be a catch somewhere and I'll only get partial reimbursement (I'm sure they won't cover the software).

Here is my question. Am I crazy to go and spend that kind of money instead of going through a DME. I've done a lot of homework and this machine appears to be one of the best. I've also read where if you use an auto CPAP's and heated humidifyer you will stick with the program more than with a regular CPAP.

I know there is no perfect answer but I would like some opinions. I don't feel like messing with the DME's. I wondering how high my risk is of this machine not working for me.

[NightHawkeye]

Here is my question. Am I crazy to go and spend that kind of money instead of going through a DME. I've done a lot of homework and this machine appears to be one of the best. I've also read where if you use an auto CPAP's and heated humidifyer you will stick with the program more than with a regular CPAP.

I know there is no perfect answer but I would like some opinions. I don't feel like messing with the DME's. I wondering how high my risk is of this machine not working for me.

Alright, an opportunity to give an opinion .

IMHO, it comes down to just two things:
1) How soon do you want treatment?
2) What is your time worth?

I am often amazed at how many obstacles folks must navigate around to go through local DME's with such very long waits sometimes and such lousy service. When I got my prescription and decided on the equipment I wanted I ordered it from CPAP.com and got it the very next day. I had checked with my insurance and was informed that they would cover 60% of it. I had a hunch they'd cover more since I'd already met my deductible for the year though. In fact they ended up covering 100%. I have no idea how your insurance might work though, but that was my experience.

So, how's that for an opinion?

BTW, almost forgot, the risk of the Remstar-auto not working for you is very small. Doesn't mean that another machine won't work better for you though. Not many folks get to test drive machines ahead of time though, but it sure would be nice if we could. Mostly what happens, as you may have read already is that folks get stuck with a different machine to start out with and later upgrade to the Remstar-auto or another APAP.

Regards,
Bill (who has no interest in CPAP.com, other than as a satisfied customer)

[pratzert]

I'd say it depends on WHO your DME is, or who you have to use according to your insuracne company.

A VERY FEW have had a decent experience, but the VAST majority of people seem to have had an absolute nightmare of a time dealing with their DME.

Apria is one that is mentioned over and over again as being the worst one.

I have CIGNA and have to use Apria.

I tried for two weeks, every day, to get the machine my Doc prescribed with no luck.

I ended up ordering from cpap.com and saving my sanity. PLUS, I can still get a partial reimbursement from insuracne even if it is a a lower rate since I am going "Out of Network."

It was worth it to me, and many other people to avoid the "EVIL DME".

Tim

[Midnight Son]

My stats are almost identical to yours. I started with the DME, then decided to procure my machine directly. I ended up getting a low end machne (Remstar plus) initially from the DME and ultimately puchased an Auto-Cflex direct from CPAP.com. Call yor insurance directly and determine if they will cover or not. My insurance required DME to cover 50%, but it was cheaper for me to pay CPAP.com prices.

My sleep doc however encouraged me to use the auto in CPAP-CFlex mode. He felt if I tolerated this treatment well he preferred to have the machine in a constant pressure setting than using the algorithms to adjust pressure. The auto unit allows four modes of operation and he agreed it was the best machine to purchase.

Midnight Son

[Sleepy Dog Lover]

I will give only 1 advantage of using a DME, the ability to try on and test a variety of masks to see which one works best for you. I was able to try any mask that I wanted when I went to the DME, and test it under pressure. Since insurance was paying for the mask and the DME, it was cheaper than buying masks until I found one that I liked.

[Wulfman]

itznuthin,

I don't think you'll find a "catch" in having your insurance provider reimburse you on this one. Follow your instincts.....stay away from the DME. Buy your equipment from CPAP.COM and then create an invoice for the exact amount of the items you bought (they MAY want proof of what you bought and you don't want to overcharge them) and then submit YOUR bill to them. They will consider you as "in-network" and reimburse you the 80%.
This is what I did and I've NEVER been sorry.
They probably won't reimburse you for the software and reader, but that cost will be well worth it by being able to monitor your therapy.
You've selected an excellent machine and should be happy with it.

Best wishes,

Den

[Guest]

Apria (here anyway) does not let you try on masks. You can look at what they have but I was told I could not try any on. Advantage... 0.

I'm sure some DME's are fine, and you may not know how yours is to deal with until you do deal with them, but so far I have not been happy. For what I paid for the mask I couldn't try on, I could've bought two online. And thats paying the DME 50% (my insurance covers half thru the DME) and paying 100% online.

Last night was the first night with the unit (Remstar Plus... no Cflex, and Swift mask), and the swift is so noisy that I had to order a different one today online. And so it begins...

-David

[quote="Sleepy Dog Lover"]I will give only 1 advantage of using a DME, the ability to try on and test a variety of masks to see which one works best for you. I was able to try any mask that I wanted when I went to the DME, and test it under pressure. Since insurance was paying for the mask and the DME, it was cheaper than buying masks until I found one that I liked.

[Sleepy Dog Lover]

I feel lucky then. Apria was 1 of my choices for a DME, and I chose not to use them, mostly because of the problems that I have read on here. I had 1 other choice, a local DME, and I went to them. I tried on about 10 different masks, and I got a Remstar Plus with Cflex. When I called, they told me that I would have to pay $400 for a cpap with cflex, but when I went for my appointment, the RT brought out a FP 231 for me, and I asked for a respironics machine. He brought out the plus with cflex and there was no additional charge. I'm also lucky that my insurance paid 100%. Of course, I really wanted an Auto, but I would have had to pay megabucks for that. Its crazy that you can't try on the masks as most of the masks leaked for me.

[quote="Anonymous"]Apria (here anyway) does not let you try on masks. You can look at what they have but I was told I could not try any on. Advantage... 0.

I'm sure some DME's are fine, and you may not know how yours is to deal with until you do deal with them, but so far I have not been happy. For what I paid for the mask I couldn't try on, I could've bought two online. And thats paying the DME 50% (my insurance covers half thru the DME) and paying 100% online.

Last night was the first night with the unit (Remstar Plus... no Cflex, and Swift mask), and the swift is so noisy that I had to order a different one today online. And so it begins...

-David

[Guest]

New: Should I skip the DME?

Yes.

[Ric]

I am thinking of skipping the DME and ordering via the internet a:
- REMStar Auto C-Flex CPAP with heated humidifier
- Respironics ComfortGel nasal mask (I used a similar mask at clinic)
- Software to monitor everything.

I approve. EXCELLENT choice.
(I haven't tried the mask, no opinion)
Add an Australian heated hose if you experience "rainout".
Card Reader from 2Factors.

Have you tried the "billmyinsurance.com" option? They don't work with all insurance providers, (mine for example, UHC). Might be worth a try. You could have the best of both worlds, (your choice of equip, insurance pays, no run-around with bizarre tales of how you will go to jail for even THINKING about using an APAP, etc, and fast shippng), assuming it all connects. And no wait.

As for trying on the masks, I didn't find it that useful, except to pick the correct size. But I ended up with a Swift® and size wasn't an issue. If they would let you sleep with a mask overnight, THAT would be useful. But I haven't heard of anybody doing that.

That's my 2¢
(keep the change)

[rested gal]

Absolutely, yes, iznuthin. And you've chosen a very good machine.

Only thing I'd change about what you're planning to get is... I'd get a ResMed Activa mask instead of the Respironics Comfort Gel mask. The Comfort Gel might have felt nice for a few hours during your titration at the sleep clinic, but hour after hour, night after night, you stand a much better chance of leakproof comfort and less chance of ending up with a sore on the bridge of the nose if you choose the Activa.

While you're getting shipping paid for on the order over $100, I'd get a second mask too. It helps a LOT to have two masks to rotate between in case one mask begins to bother the same pressure points on your face all the time.

I'd suggest the Respironics ComfortLite 2 for your second mask -- with nasal pillows (Med and Large) and the "Simple Cushion" (Med and Large) as the second option to get with that mask.

That's my two cents, anyway. But it's your money and your face, so use your best guess about a mask.

[Guest]

YES

especially if your dme is like mine. I figured out with what they were charging my insurance "the usual and customary" fees for the equipment... that I in the end was the one really paying for the equipment by the time I paid my co-payment. In other words, my co-payment=cost of equipment brought on-line.

So, yes it makes since to skip the DME. Might want check and see if you can get your insurance to reimburse you directly.

REMstar Auto is a good machine choice. And Rested Gal has suggested some good mask choices. The active was actually my first mask, and I go back to it quite a lot.

One mask to diffantly stay away from is the Comfort Curve. It is JUNK. If you get it to not leak, the second you lie down it will leak.

If fact, I have several masks, and I sort go back and forth to each of them, with the exception of the Comfort Curve. I gave up on it LONG ago.

[dllfo]

Quick one...Apria sold me the auto Bipap and I love it. But no smart card.
I read the owner's manual and it says it should have one in it.

Where is mine? Does Respironics sell them without the smart cards? Should
I call Apria and ask them about it?

I asked their rep and he said this model didn't come with it. I didn't know
any better, so I said ok.

If Tricare paid for it, I want it. How important is it?

If the sealed box says it has one in the kit, and when we opened the auto
bipap box, the smart card is not in it?????? Any ideas?
Thanks......

[NightHawkeye]

Quick one...Apria sold me the auto Bipap and I love it. But no smart card.
I read the owner's manual and it says it should have one in it.

Where is mine?

That's easy. Your DME stole it from you.
Just my opinion though. Of course, I'm sure their explanation could be very interesting.

Does Respironics sell them without the smart cards?

Why would they? Especially if the manual says it should be there.

Should I call Apria and ask them about it?

Absolutely, Think of it as sport. You could have a lot of fun with it. You know, just give them a little rope and see if they can hang themselves.

I asked their rep and he said this model didn't come with it. I didn't know any better, so I said ok.

. . . sigh . . .

If Tricare paid for it, I want it. How important is it?

You can buy Smart Cards for $10 from CPAP.com.

I think that Rested Gal made a good recommendation for you though. What is the name on the top of your machine? It should say BiPAP-auto in big letter on the top left side.

Regards,
Bill

[pratzert]

The DME's have no problems STEALING the manuals for your machine right out of your box, I'm sure they have no second thoughts about STEALING the Smart Card too.

It's probably being auctioned off on ebay right now !