Newly diagnosed, equipment questions

[~Q~]

I just finished my initial sleep study yesterday and the Dr told me I had Moderate - Severe OSA based on her preliminary look at my study results. The Dr. didn't have the exact numbers when she met with me the morning after the study, saying the results were preliminary and the exact numbers would take a few hours to calculate. The Dr. went over the various treatment options and recommended CPAP (no surprise there).

I'm scheduled for another night at the sleep clinic to do the testing again on a CPAP machine. I'm taking it this is called the titration test? The Dr. said during this test, they would determine weather a CPAP for bi-level machine were best for me.

My question is this. When it comes time to get setup with the xPAP, how much of a choice do they give you in selecting?

I know absolutely nothing about the equipment other than what I've gleaned over the last week or so from this site. From what I've read, it seems an APAP machine is the best option for a person needing CPAP given the flexibility of the machine.

Can I just go in and say I want a S9 AutoSet CPAP Machine, for example?

Thanks!

[Pugsy]

Couple things to read so that you are better informed as to what your options are.
http://maskarrayed.wordpress.com/what-y ... me-part-i/
http://maskarrayed.wordpress.com/

Check with your insurance company to get a list of what DMEs work with your insurance network (if you have to stay in network). The call them up and ask them what brands they supply and what they usually dispense.
For cpap/apap machines there are several brands and models.
If you end up needing a Bipap (bilevel pressure machine) which is Respironics market name...ResMed's is called VPAP you don't have to worry about getting brick in those models because the PR S1 BiPaP and the S9 Vpap are both full data machines.
Different DMEs will normally supply the brand they got the best wholesale price on and they will try to tell you that you don't have a choice but you do...you can go elsewhere.

Don't know your insurance situation but check out what your co pay is....sometimes you end up paying less buying directly online when you add up monthly rental copays for however your insurance does thing.

So find out exactly what their policy is...direct from them...don't count on the DME for this.

So start your reading and ask your questions here so that you are alerted to what to expect and how much leverage you will have. Some DMEs are real hard asses about it and some are great and will work with you to get you what you want.

[~Q~]

Excellent links. Thanks for the great info!

Q

[hyperlexis]

Prepare yourself for a possible mess -- it may or may not go according to plan. (Plus there are always good alternatives to the S9 if they won't supply it).

1.) Whatever doctors or DME people you deal with, double and triple check they are 'participating providers' before doing anything at all -- call them and re-check them by checking the insurance company's web site. PRINT out the page on the website proving they are participating providers in 2013. You may need the proof later on.

2.) You can ask your M.D. for whatever equipment you want, but you may not get it in the end. My original 'participating provider' DME said they would get me a PR60, per my internist MD's prescription, but then they later refused. Yep, totally refused to do it. They said they usually give out DeVilbiss Intellipap Autos (which are still really great machines, but currently lack heated hoses which I wanted...) and so would not get me the more costly PR60. So, I had to hunt around for another participating DME who would get me the PR60, -- which I did. (Lower profit margin to the DME by giving me a PR60 compared to the Intellipap..... go figure. Welcome to U.S. healthcare.)

3.) Demand to know from your insurer what the total cost they will pay for renting and then buying off the machine will be. That way you can (sort of) calculate what you will eventually end up paying in total co-payments. This will not be easy. You will need diagnosis CPT codes and equipment codes. The doctor and DME should give them to you. Ideally, the DME will call your insurer and will calculate everything for you. But some do not....

Good luck!

[~Q~]

Why are these DME's so difficult to work with? Seems to me that they should give you what you want so long as the equipment falls into the same technology as prescribed.

Perhaps I'll call my sleep clinic before my next appointment and find out where they send you for equipment so I can do a little "recon" before I get in.

Thanks!

[StuUnderPressure]

Perhaps I'll call my sleep clinic before my next appointment and find out where they send you for equipment so I can do a little "recon" before I get in.

You DON'T have to go where they SEND you!

If you have private insurance or Medicare, all you need to do is find out who their providers are. And then, YOU pick from 1 of those.

If you are paying for it 100% on your own, you have even more choices.

Now, you may find that where they send you turns out to be a great DME.
But, if not, go elsewhere.

That is why you must always get the ORIGINAL of the prescription in your hands.
Don't let them fax it to some DME.
Tell them, you will bring it to the DME you choose.

[synaptium]

Just to repeat what others have said. You dont have to deal with the nuances of some DME's.

I dont know if you funding it yourself but if you have then as they in China, you own the knife and the yam.

[MS Gray Man]

Another good question for your list of DME's - especially if this is a first machine so that you don't have a spare machine around is how they handle equipment malfunctions.

Example, Quest Healthcare here does a *cough* great job of making an appointment for you maybe four days after your machine stops working to have the RT "check" your machine. Now, at that point they will give a loaner or replace if it's a rental... but the four days in the middle sort of suck. Which for me was a great motivator to acquire a spare machine...

If you have a DME in your area that takes their role more seriously, that can be a good thing...

If not, just be aware of what their approach is.