First DME visit coming up

[xchecker]

New to CPAP and this community. Thank you for this resource!

I had my polysomnogram a few weeks ago and was told my score was 'severe' with an index score of 66. I have requested and am awaiting via mail a copy of the test results so I can dig further into the data. Like many of you I am comforted by understanding such things.

My titration test was two weeks ago and went very well. I slept well with a nasal mask but had a bit of trouble when I tried to sleep on my side. I called the doctor's office today and was told the doctor has prescribed a machine, heated humidifier, a nasal mask and 11cm of pressure to start. I asked if the prescription specified any particular equipment models and was told no. When I indicated I wanted to make sure I got a fully data-capable machine and not just a compliance data machine the assistant I spoke with had no idea what I was talking about and responded that she thought only home cpap testing equipment did that!

So moving on, my insurer is Aetna and the only in-network DME in my area in Lincare. I asked the doctor's office to forward the prescription there. It stinks to have limited choices! I am concerned that Lincare will want to upcharge me for an efficacy data machine. I called Aetna member services to see if they could help clarify but all they could tell me is that each provider has a separate contract with the insurer so I will have to find out from the DME what the cost will be!

Since I am on a high-deductible insurance plan most all these costs will be coming out of my own pocket anyway next year, but I want to make sure I am not getting ripped off, or at least ripped off as little as possible. Your advice? Call the doctor's office back and find someone who can/will amend the prescription for efficacy data? Go to the DME first and just see what they have to say? Move somewhere with more choices?

Thanks!

[Pugsy]

Know your machine models and go to the DME and see what they are wanting to dispense...maybe they will be offering a full data machine right from the start. If it isn't what you want...just don't accept it. That's what I did (and yeah....it was a Lincare office )...but they also lied to me and tried to tell me that what they were wanting to dispense was a full data and I knew it wasn't and I don't take being lied to very well.
So I just bought my machine privately to avoid the hassle.

If your insurance does the capped rental thing...you probably will be money ahead to just buy your machine online because your deductible will start all over again in January. Do the math.

In my case I ended up paying about the same buying it privately as I would have if I had used my insurance and the copays involved. I didn't save any money but I didn't lose any either. Pretty much a wash for me but I didn't have any deductible either.

[xchecker]

... If your insurance does the capped rental thing...you probably will be money ahead to just buy your machine online because your deductible will start all over again in January. Do the math.

In my case I ended up paying about the same buying it privately as I would have if I had used my insurance and the copays involved. I didn't save any money but I didn't lose any either. Pretty much a wash for me but I didn't have any deductible either.

Thanks for the quick response.

Aetna does do the rental thing and I too thought about just buying the machine, but then I lose the progress towards my deductible and out-of-pocket maximums for next year. It's hard to figure if we will hit them again next year or not - a lot of guess work at this point I'm afraid.

[Pugsy]

Well you can always go see what it is they want to sell you and how much it is going to be and then decide.
If they want to play hardball about selling you a full efficacy data machine and they are the only source in your insurance network then the decision may be made for you.

But maybe they routinely dispense full data machines....some offices do.

Unfortunately none of us have a good crystal ball when it comes to what our expenses might be next year. If the final cost isn't a whole lot more than what you could get the same machine for online then it wouldn't be so bad to have it go towards the deductible. It all depends on what that final cost will be.

[jaycee2]

I also use Lincare. I called ahead and asked about models and was told by my local office that they had the make and model I was interested in. They seemed to only dispense Resmed machines and they like the ones that send data to them daily via the wifi/cell technology that the machine has. It doesn't hurt to call them ahead of time.