Positive DME/Doc News

[There]

Because it's a novel concept and should be shared:

My relatively new sleep doc did not even blink when I asked him to write me a scrip for a new CPAP so I could get one that uses software and lets me track data myself. In fact, he even wrote it for APAP to make sure (pardon me while I get back up off the floor where I fainted). His only comment was that he'd only write one letter to the insurance company if they refused to pay, since he was positive mine wouldn't cover APAP without a fight. Compared to the condescending attitude of my last sleep doc, this was a miracle.

Follow that up with the DME he referred me to. His staff contacted them right after my appointment and they had called me back in an hour from the time I got home. The guy I spoke with offered to research which machines had the specs I wanted. He stated up front that they were ResMed friendly but would look into other brands, too. He also suggested options for if my insurance didn't cover it, including helping me find one used or online. But here's the clincher, he THEN said that, no matter how I bought it, they would still see me to help me get it setup. A DME offering to setup equipment that didn't come from their supply? WOW.

He called me back two days later with results. I picked a machine based on what he told me but also based on what I've read here *grin*. He's now verifying what kind of coverage I can get on a Resmed S8 Elite. I'll have to buy the AutoScan software and card reader direct here, but, really - how easy has this been?

I keep wondering what the catch will be

Tina

[Guest]

The Resmed S8 Elite is not an apap.

[GoofyUT]

The auto-titrating model in ResMed's S8 line is the S8 AutoSet Vantage. The S8 Elite is their premium CPAP, one step below the Vantage. Both the Vantage and the Elite collect and display the same data though: Efficacy data including Pressure (95%), leak in L/s, AHI, AI and HI with daily, weekly, monthly, six monthly and yearly averages, and Usage data including Total hours used, sessions used per total sessions, usage last session. All of this data is available for inspection right on the LCD screen every morning (BEFORE NOON or the machine resets) without ANY SOFTWARE or computer. I'd skip the AutoScan 5.7 software if I were you. It apparently doesn't work well, and doesn't deliver any more info than the LCD screen will (except for some summary data) except for a detail charting of the last 5 nights.

Hope this helps.

Chuck

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, CPAP, AHI

[Ric]

Another thing you might want to consider before you commit your life to the machine of your dreams, have you weighed the benefits of "exhalation relief"? In the Resmed line it's called EPR, Respironics calls it C-Flex. I find it VERY useful for not having to work so hard all night to press against the incoming pressure, just to exhale. The good news is that both Respironics and ResMed have that feature. The bad news is that on the Resmed model, even if the machine has both features (as in the S8 Vantage) you can't use the EPR and the AUTO mode at the same time. Go figure.

Your sleep doc is good news, he sounds very supportive. Wish there were more like him in the industry.

I keep wondering what the catch will be .

*COUGH*
(sorry)

I am concerned that your DME has pulled a switcheroo, if indeed he is trying to set you up with a Resmed Elite. That is a lesser device, a straight CPAP, although it does have EPR. The Elite is not "evil", it's just not what you bargained for and it's not an APAP, as you seemed to believe you were getting. Correct me if I'm wrong, this has a familiar smell about it. I have visions of your cheerful DME fellow pointing to "EPR" and saying "AUTO", and doing a little dance. Wrong answer. But if true, time to pull your own switcheroo, find another DME. Life is too short to sleep with wrong equipment.

-Ric

[There]

Oh, thanks for the warnings - everyone here always look out for everyone! But I know it's a CPAP not an APAP. In fact, I'm the one who chose the model independent of the DME. My insurance won't cover an APAP at all, so I'm trying to get the lesser machine with coverage first. If that fails, then I'll just spring for the APAP myself.

And I honestly haven't found too huge a difference in having my CFLEX on or off on my current machine or during the sleep studies. I guess I just have strong lungs from all those years struggling to breathe. But it's good to know that the EPR doesn't work at the same time the AUTO function is on. Nothing mentioned that anywhere in the specs I read.

It's VERY nice to know that all the info is available in the morning off the LCD screen, I just don't know how devoted I would be to journaling it every morning. Plus, then, being a nerd, I'd still have to go enter it into Excel and make charts and graphs for interpretation, so the software may be worth it to me despite its bad reputation (I read the thread where people were talking about constant disk access, yuck). We're at a good point financially right now and can afford this kind of expense, so why not take advantage of it on something related to my health instead of going to blow it on new shoes or something cool from Target?

Any arguments for or against Remstars versus the Resmed stuff? I've had my Remstar since I started treatment, and other than it being bulky and limited in function, it has served me quite well. But the Resmed does look like it's got more features. Am I sacrificing basic quality to get them? Anyone?

You guys are the best!

Tina

[GoofyUT]

I actually believe that ResMed equipment is built of higher quality than Respironics is (donning asbestos flame suit). The most importatnt differences however are:

1) ResMed makes the data available on the LCD read-out rather than reequiring a computer, software and reader as Respironics does;

2) The ResMed algorithm is very different than the Respironics algorithm. Respironics is a testing algorithm that constantly probes potential improvements in flow by increasing pressure throughout the night in small increments, and then decreases the pressure if it doesn't find improvements. The ResMed algorithm works more pre-emptively by analyzing flow waveform and amplitude, and trying to increase pressure to head off an SDB event before it happens, thouigh one one DOIES happen, it'll sit and do nothing until the event passes, so that it can avoid increases in pressure that might either cause centrals to occur, or else might wake you. Both algorithms are tried and true and both are well accepted, but they do have different effects for different patients, on sort of an unpredictable basis. Its simply a matter of which one works best for you;

3) ResMed's EPR lasts for the entirety of the exhalation whereas Respironics C-Flex lasts only for an instant upon the start of the exhalation. Therefore, many report taht EPR provides relief much more similar to a Bi-level than does C-flex. But, its not available in auto mode ( and I haven't missed it at all).

If you got the bucks now, see if you can get the DME to sell you an S8 Vantage for the insurance + a co-pay from you (of probably no more than $10-0 or so. Alternatively, if your slep doc writes you a Certificate of Medical Necessity (CMN) for APAP, most insurances wil reimburse the DME for an APAPA (mine did). Its just that the HCPCS code for xPAP is the same for CPAP and for APAP so DMEs won't get a penny more for giving you the top of the line APAP -v- the cheapest CPAP. Same Medicare reimbursement code for them.

Hope this helps.

Chuck

[Ric]

Tina,

Just a couple more random thoughts then I'll stay out of it. I didn't read where you were interested in a heated humidifier as part of the package. That's personal preference, I use mine part of the time, some people wouldn't be without it, some don't need it at all.

As for Resmed vs. Respironics for the equivalent device, consider the Respironics Pro 2 which many of us would consider has a much better repertoire of data available, and is compatible with Derek's MyEncore (free) software. It's only $3 more without the humidifier $482 vs. $485, Resmed vs. Respironics. Or with the humidifier it's $650 vs. $545, the Respironics is actually cheaper and (IMO) more capable. Some insurance plans won't pay for the humidifier.

HOWEVER! A more interesting option would be to reconsider owning an AUTO capable machine. Many DMEs, if not most, can deliver an AUTO machine and bill the insurance using the same code as for a CPAP. An auto IS a CPAP, (and more). But they won't usually reveal that little detail because that erodes their margin of profit. The way around it is to offer to pay the difference in cost. (I had to cough up another $150, and I feel robbed, but I would still do it again, the auto is WAAAAAAY worth it). In reality a durable medical equipment provider should be able to fill the prescription AS WRITTEN without de facto rewriting the prescription just to preserve their margin of profit. For them to argue that "insurance won't pay for an AUTO" amounts to double talk. That always sounds like YOU the patient must cough up the full amount for an auto if you decline straight CPAP. NOT TRUE !!! Virtually every insurance that will pay for a CPAP will pay at least the same for an AUTO, it is usually the same billing code. To get a straight answer call your insurance directly, ask for the DME specialist, find out exactly what their reimbursement policy is. You might be surprised.

Having said that, the difference in the Resmed Elite that you are considering (without humidifier) vs. Respironics Remstar AUTO is $482 vs. $610. And the same models (with humidifier) are $650 vs. $710. (For comparison, S8 Vantage is $635/750 without/with humidifier).

Oh, and with the Remstar AUTO you are not punished for using the C-Flex (exhalation pressure relief) and the AUTO feature simultaneously. I for one am spoiled and would not be without either. But if I had to choose, I would opt for the AUTO.

OK, I'm done. Keep us posted ! .

-Ric


(Prices quoted are from the cpap.com pricelist.)

[Snoredog]

[quote="GoofyUT"]I actually believe that ResMed equipment is built of higher quality than Respironics is (donning asbestos flame suit). The most importatnt differences however are:

1) ResMed makes the data available on the LCD read-out rather than reequiring a computer, software and reader as Respironics does;

2) The ResMed algorithm is very different than the Respironics algorithm. Respironics is a testing algorithm that constantly probes potential improvements in flow by increasing pressure throughout the night in small increments, and then decreases the pressure if it doesn't find improvements. The ResMed algorithm works more pre-emptively by analyzing flow waveform and amplitude, and trying to increase pressure to head off an SDB event before it happens, thouigh one one DOIES happen, it'll sit and do nothing until the event passes, so that it can avoid increases in pressure that might either cause centrals to occur, or else might wake you. Both algorithms are tried and true and both are well accepted, but they do have different effects for different patients, on sort of an unpredictable basis. Its simply a matter of which one works best for you;

3) ResMed's EPR lasts for the entirety of the exhalation whereas Respironics C-Flex lasts only for an instant upon the start of the exhalation. Therefore, many report taht EPR provides relief much more similar to a Bi-level than does C-flex. But, its not available in auto mode ( and I haven't missed it at all).

If you got the bucks now, see if you can get the DME to sell you an S8 Vantage for the insurance + a co-pay from you (of probably no more than $10-0 or so. Alternatively, if your slep doc writes you a Certificate of Medical Necessity (CMN) for APAP, most insurances wil reimburse the DME for an APAPA (mine did). Its just that the HCPCS code for xPAP is the same for CPAP and for APAP so DMEs won't get a penny more for giving you the top of the line APAP -v- the cheapest CPAP. Same Medicare reimbursement code for them.

Hope this helps.

Chuck

[harikarishimari]

Chuck, I think you are slightly goofed up.

I actually believe that ResMed equipment is built of higher quality than Respironics is (donning asbestos flame suit).

Too vague to be taken seriously. Have you dropped one of each off a high place to see which one keeps ticking? I doubt it. (keep the flame suit, you'll need it).

1) ResMed makes the data available on the LCD read-out rather than reequiring a computer, software and reader as Respironics does;

There is so little data, a thimble would suffice.

2) The ResMed algorithm is very different than the Respironics algorithm. Respironics is a testing algorithm that constantly probes potential improvements in flow by increasing pressure throughout the night in small increments, and then decreases the pressure if it doesn't find improvements. The ResMed algorithm works more pre-emptively by analyzing flow waveform and amplitude, and trying to increase pressure to head off an SDB event before it happens, thouigh one one DOIES happen...

You've got some of the right-sounding phrases, but it doesn't quite match the written description. Feel free to read up on the issue, then come back and continue babbling. We'll give you another chance. .
Here's the document: http://lewiston.mit.edu/sleep/Autopatent.pdf

3) ResMed's EPR lasts for the entirety of the exhalation whereas Respironics C-Flex lasts only for an instant upon the start of the exhalation.

Simply wrong. C-flex lasts MANY seconds. That would be INFINITELY longer than an instant. Which means you are infinitely wrong. I have observed C-flex to last many seconds, in fact nearly the entire duration of a normal exhale. It DOES have to turn around SOMETIME, and clearly the turn-around point is based on pressure feedback, and not as you describe. But I haven't tried Resmed EPR, so I won't speak to that. I'm not convinced you have tried C-flex. You don't really seem to know how it works.

If you got the bucks now, see if you can get the DME to sell you an S8 Vantage for the insurance + a co-pay from you (of probably no more than $10-0 or so. Alternatively, if your slep doc writes you a Certificate of Medical Necessity (CMN) for APAP, most insurances wil reimburse the DME for an APAPA (mine did). Its just that the HCPCS code for xPAP is the same for CPAP and for APAP so DMEs won't get a penny more for giving you the top of the line APAP -v- the cheapest CPAP. Same Medicare reimbursement code for them.

I agree with you AND Ric about the APAP, and the co-pay idea. (even though is smacks of robbery). I'm not convinced Resmed is in any way superior. Does it bother you that the EPR and the APAP don't work concurrently on the Vantage?

Hope this helps.

Chuck

BTW, your helpful attitude IS appreciated. The flamesuit was YOUR idea. Don't blame me for "testing" it. *snicker*

-HKS

[Snoredog]

HKS wrote:

Chuck, I think you are slightly goofed up.

Gee HKS you took all the fun out of it

[rested gal]

Tina, it does sound like you have a very helpful guy in the DME you're using. The only thing I'd question in what he (or the doctor, or someone at the insurance company) has told you is about what you said here:

"My insurance won't cover an APAP at all, so I'm trying to get the lesser machine with coverage first."

If the insurance company said it to you, it's probably that they mean they pay different rates for only two kinds of machines: cpap and bi-level (bipap.) Autopap is not considered a "different" kind of machine to them...it's just another cpap. They're saying, we're not going to pay out more for an autopap because it doesn't have a separate billing code...it's still just a "cpap" to us.

The doctor is probably repeating what the DME says. Doctors usually aren't interested in the nuts and bolts of treatment equipment/costs/insurance issues...they leave that to the DME...when the doctor told you insurance probably won't cover an autopap. An autopap IS a cpap machine. It's an auto-titrating cpap machine and falls under the same billing code ( E0601 ) as any regular "cpap" machine. Bi-level machines have their own code with a higher reimbursement, but the billing code for just cpap encompasses auto-titrating cpaps (autopaps) too.

The insurance company couldn't care less which brand or model of "cpap" machine you are given. Insurance is going to pay the same contracted amount to the DME for "cpap" whether the DME gives you a straight single pressure cpap machine or an auto-titrating cpap machine.

More often than not, when a rare bird (no offense, Tina...that's a good thing in this case! LOL! ) walks in asking specifically for an "autopap", the DME will try to steer them away from that notion and get them to accept a straight cpap machine instead. Makes good business sense to the DME, as there is more profit on straight "cpap" -- the insurance company is going to pay only X amount of dollars regardless of which "cpap" machine you are given - straight or auto-titrating.

Some DMEs will give you the machine you want, even if its an autopap. They'll content themselves with making a little less profit - or perhaps even costing them - this time, in order to keep your business. Few people who walk through their doors are going to ask specifically for an autopap, so the DME's straight cpap sales will rock along just fine. By keeping you as a customer, they still can make a tidy profit on other insurance reimbursed sales to you...masks, filters, etc. Or, they might want you to make up the difference in what they receive from the insurance company for "cpap" and the cost of the autopap.

But no way, no shape, no how, should the DME ever try to make you think insurance would make you pay for ALL the price of an autopap or try to tell you that insurance won't cover any of the cost of an autopap. If your insurance is willing to pay the DME anything for a straight cpap, insurance will pay the exact same amount for an autopap. What the DME does about that (absorb the additional cost or ask you to pay the difference) is up to the DME.

That's where you need to crunch the numbers to see if the "difference" the DME would want you to pay out of your pocket is cheaper or more expensive than buying online.

If it were me, I'd choose a Respironics M series Auto/C-flex with heated humidifier. The C-flex feature can be turned off if you don't need it. The Auto feature can be switched to CPAP if you find a single straight pressure suits you better. You'd be getting a sophisticated small machine. You can see AHI and leak info on the LCD of the Respironics M machine...without having software.

The Encore Pro software is sooooo much better, imho, than Autoscan software. That alone would sway me away from a ResMed machine, toward either Respironics with its Encore Pro software or Puritan Bennett with its Silverlining software. Even if I didn't intend to get the software for a machine, I'd still choose a brand that didn't have to use Autoscan, in case I ever decided to get software in the future.

Mainly because of the software, I've personally preferred using Respironics and Puritan Bennett autopaps, even before ResMed announced that they were going to hit the online stores with an ultimatum...raise your prices for our products or we'll not let you have any of our stuff to sell. In effect saying, to H*** with the uninsured people who turned to online stores in order to get affordable machines and masks.

I'll not buy another ResMed product. Ever.

[RedThunder94]

yup, my dme did not say anything about me having to pay extra for an autopap, they dispensed my script exactly as written by the sleep doc, aototitrating cpap with c-flex set at 3. thank god for some of these dme's that don't try to rape people by making them pay the "difference" for an apap, too bad they are the exception, not the rule.

[Darth Vader Look]

yup, my dme did not say anything about me having to pay extra for an autopap, they dispensed my script exactly as written by the sleep doc, aototitrating cpap with c-flex set at 3.

My first DME (that my sleep doctor sent me to because he either owns part of it or gets a kickback from them) wanted me to pay extra for an APAP and couldn't see the reason for one even though the doctor specifically spelled it out on a prescription with C-flex. That is why I dumped his sorry a$$ and went to a DME that would honour the doctor's requested prescription .