Frazzled newbie CPAP questions

[wildboar]

It's 4:20 on a Friday and I've been dealing with this all week and all day today. Looks like a CPAP won't be ordered for me this week, either.

I dealt with this too, the doctors office disappeared for a week while they had the flu. Added like 2 weeks from the time they told me I needed a machine to them actually sending the script to the DME. In the meantime I called the DME enough times and got friendly with them, tried to get them to push the doctor's office to get it done, but we didn't realize they were out sick. In the end the DME felt sorry for me and gave me whatever machine I wanted.

The "rental" through United Healthcare was basically the same price as buying from online. At the end of the so called rental period you own all the equipment. If you are already on the way to meeting your deductible it shouldn't cost too much. Load up on masks and hoses and everything else as the months pass once you've met your deductible.

Frazzled is a good word. I remember it felt like I was running on 1/2 brainpower by the time I finally got in to do my mask fitting.

Just figure out what you want and tell the DME exactly what it is. Don't settle. The DME told me all the machines on their end cost the same under contract with United Healthcare so it shouldn't matter to them.

[Tracy1968]

I just called the DME 45 miles away and they said they can't tell me what monthly rental would be. They'd have to call the insurance company first and that can't be done until I have my doctor's office fax them the prescription (meaning, I can't find the cost of anything unless I agree to go with that DME beforehand).

Maybe it's better that it's the end of the day on Friday. I can't deal with this anymore this week. I can't stop crying.

I've had sleep issues for years. But I've been off of work due to severe exhaustion since late October. I can't work. Most days I can't function well enough to drive a few miles. I'm too exhausted to read or even watch TV. I'm so tired I'm having dizzy spells. I'm single and have no close family or anyone to help me. Not looking for sympathy. Just explaining why it sounds like I'm falling apart right now.

I appreciate all of the help. Not crabbing at anyone here. I'm not running on all cylinders. I'll try again on Monday.

Thank you ALL so much again.

PS: sc0ttt thank you for that visual/chart. My zombie mind is at least able to process that. Thanks.

[M'ohms]

I just went 'round and 'round with DME/UHC concerning an oxygen concentrator. Just because the doc faxes a script over to one DME, it doesn't obligate you to do business with them. Once the DME has the necessary paperwork to give you the financial details that you need, you can go elsewhere. I had my doc fax my most recent script to 3 different DMEs before I settled on one. You are entitled to have a copy of your script. Sit on the doctor's desk until you get it!

As far as UHC is concerned, I have always called them prior to getting equipment, and I have an APAP, BiPAP, ASV, and now an oxygen concentrator. In all cases, UHC told me they didn't care if I wanted to rent or outright purchase. In each case, I purchased the equipment. Very straightforward and no hidden "anythings". In the past two weeks, I have probably called UHC a dozen or more times. Stick with it, you will find out exactly what you want to know prior to signing on the dotted line.

BTW, like Scott, it was cheaper for me to buy through insurance. Good luck!

[SleepyEyes21]

I appreciate all the help, but 'm absolutely in a puddle of tears here and about to throw up. I didn't realize everything is billed separately.

I'm trying to deal with one DME 45 miles away (the one that told me about the AirSense 10) and playing phone tag with one 24 miles away that only responded via voice mail by saying they only offer Phillips. I called back and again got voice mail and asked if she could please provide me with model numbers based on what I'll need.

The doctor's office still hasn't sent me the a copy of the prescription and said the DME will need to talk to them directly before anything is ordered. The doc's office is acting annoyed that I'm requesting additional info, just wants me to give them the name of a nearby DME and have them order what's best.

It's 4:20 on a Friday and I've been dealing with this all week and all day today. Looks like a CPAP won't be ordered for me this week, either.

I no longer want to deal with any of this. I don't mind putting a huge mask over my face and trying to sleep. That's the least of my worries. The rest of this is too overwhelming. I'm so exhausted, have serious brain fog and feel like I'm trying to solve complex math problems.

Hi Tracy - I don't think it's a definite that things will be billed separately; I think Jan just wants you to be aware that DME's can do this, so its best to know ahead of time so YOU can choose which way to go to get your machine. I feel your frustration and aggravation with this process - it can be so intimidating I think you are actually on a 'solid path' here in terms of learning ahead of time, about machine options, etc. - I found that this is more than half the battle!

There are other options you may want to consider to get a CPAP machine. You can look through machines offered at secondwind.com - I'm fairly sure they take credit cards, if this works for you. You can also try to find a low cost machine on Craigslist in your area; one of our members (I think Grayghost?) may be able to help you find an excellent bargain there. Also, ask any of the DME's (or DME's in your area) if they have used machines for sale; you don't have to stick with only the DME's your insurance gave you if, if you decide to pay privately.

I remember being in a very similar situation as you when I first started, so REST when you can and use this time to learn as much as you can about machines, etc. Take time to weigh out your options as far as costs, preferences, etc. We area all here to help and support you - welcome to the group

[kaiasgram]

I had no choice but to private pay for my equipment because my insurance at the time did not cover any DME. It was painful and I went into debt for it, but the time and psychological energy I've saved not having to deal with some of the nightmare stories I read about here -- well, I think maybe private pay was a blessing in disguise. No hassling with insurance or DME, no surprise costs, no wireless monitoring and compliance tracking, it was my machine and my therapy right from the start and I believe that is part of why I was able to make it work for me. So if it's a close call between private pay and going through insurance, give private pay serious consideration.

I missed a good couple of months of work by the time I was diagnosed so I have some understanding of what you're describing that you're going through. I'm self employed in a solo practice so that time off work was devastating on many levels. Hang in there, take the weekend off and relax as much as possible. You really will get this all settled. There is hope.

[palerider]

The 37208 is the Airsense Autoset and has full data. ... Did you transpose the model number in your post?.... Keep in mind the machine is available online at $883 in the For Her model 37209.

The AirSense 10 Autoset with HumidAir is the SKU #37208. The "For Her" model carries a SKU# 37210.

just for the sake of accuracy, Tracy1968 had it right.

37028;Resmed;AirSenseTM 10 AutoSet

37036;Resmed;AirSense 10 AutoSet for Her
37034;Resmed;AirSense 10 AutoSet for Her
37039;Resmed;AirSense 10 AutoSet for Her

the ones you two mentioned are combo packs.

37208;Resmed;AirSense 10 AutoSet tri-pack
37209;Resmed;AirSense 10 AutoSet for Her co-pack
37210;Resmed;AirSense 10 AutoSet for Her tri-pack

source, resmeds FAA listing.

[chunkyfrog]

And the Airsense 10 cpap is NOT the same thing! Very little useful data, and no auto feature.
All auto cpaps can be run in cpap mode, but not the other way around.

[Sleeprider]

Thanks PR. What are the Tri Packs, Co packs?

At least all the machines the DME is talking about are good ones.

[palerider]

Thanks PR. What are the Tri Packs, Co packs?

At least all the machines the DME is talking about are good ones.

my guess is that it's a double, or triple pack, it's an ordering code, like a s9 autoset is a 36005, but a 36015 is a autoset with a humidifier and a 36025 is an autoset with a humidifier and climateline. but even if the box says 36025, there's still a 36005 inside.

[Tracy1968]

I finally got a copy of my prescription from my pulmanologist's office. I'm back to going ten rounds with DMEs today. I had my version of sc0ttt's spreadsheet all ready to go. I only have three DMEs to choose from and none of them are close by. One (that offers a 37028; Resmed; AirSense 10 AutoSet) is closed for the holiday (?)

One DME is telling me they cannot quote me actual prices or give me a break down on any equipment until they process my prescription and place the order for pick up. I said, "That would be like buying a car blindly and then finding out the cost three months later." She had no response to that.

When I asked additional pricing questions and if hoses, masks, etc are separate, the rep said, "It depends on your insurance." I told her my insurance covers CPAP rentals, pays 80% after deductible is met (and it has been met) and told her I have a copy of my prescription and could provide all info to her. She said, "Well you'd have to talk to an RT." I asked what an RT was. She laughed and said, "Respiratory Therapist." Like how stupid am I to not know the lingo. I asked if I could talk to a RT and she said, "She's not here today, and if you call back she can't tell you any more than I did." ???

Another DME told me they only offer the Resmed S9 and even as a rental, it'll cost me $700 for the first month and $100 for every month after and that's not including hoses or masks. She said the machine purchase price is $1800. Whoa. When I tried to look up the same model on CPAP.com (where it looks like most Resmeds are $800 or so) and asked the rep for the model ID number, she could only provide "IPXI" and I see no such model.

Am I being jerked around or is this all normal?

I don't have $800+ for an outright purchase, but even so, I called United Healthcare. They said if I purchase a machine from CPAP.com it will be billed as out of network. But here's the thing: Out of network requires meeting an additional $1,000 deductible and after that they only pay 60%. Sounds like out-of-network isn't an option. United Healthcare said even if I go with the Resmed S10 (from the other DME), they may deny it and approve another model instead because they may feel it's not the most cost-effective machine for my issue. AAAAAAAAAAAAUGH!

I'm as confused as I was a week ago (CPAP, APAP, BIPAP, auto, wireless monitoring, efficacy data etc - I have no clue what any of it means or does). I still haven't the first clue about what I'm supposed to be renting or buying or what any of this is going to cost me. Funny thing? I'm not a moron. I do tech support for a living. And I'm the kind of person who goes on Amazon.com, searches for items, only looks at items that have a high 4+ star rating and then I start narrowing down by price and then purchase based on seller rating. With CPAP, I feel like I'm blindly making a seriously expensive purchase while someone is holding a gun to my head.

So ... here we go into week two after getting a CPAP prescription and still no closer to ordering one. *sigh*

If someone can dumb this down even further for me (again, zombie-brain + having no idea what I'm doing): Just have the doc's office fax the prescription to the DME that has the 37028; Resmed; AirSense 10 AutoSet, and then have them call insurance and THEN tell me what it's going to cost? I mean, I'm not locked into doing business with them even if they order the machine, right? And is such a high amount ($700) for a first month's rental normal?

[Sleeprider]

Tracy, a permanent rental is not much of a deal. Why don't you send a private message to GrayGhost4 on this forum and ask if he has a machine that might work for you. It should be less than your deductible and copay, and you'd own it. Then, use the DME for a mask if you want. In addition to machine rental, any of your DMEs will charge you separately for a humidifier (even if it is integrated), filters, hose, face mask, frame, headset etc. The billed amounts can be pretty outrageous, but the insurance only allows costs similar to what you see on CPAP.com.

Someone posted this on another forum. It's shocking the price billed. Note that everything is itemized, and even though the CPAP here (Airsense 10 Autoset) has an integrated humidifier and comes with a hose and filters, all are charged separately...even the humidifier water chamber. Look at the price of the full face mask and separate head gear.

[Janknitz]

Yes, you ARE being jerked around and yes, this IS normal.

Welcome to the club. Nearly everyone gets treated this way. I laugh when people think they are going to solve the health care cost crisis by requiring us all to be more careful consumers--we can't even learn the real cost of anything because of this crazy system.

The reason nobody can tell you how much it will cost you out of pocket is that every insurer has a different contract with the DME and it's all dependent upon what the insurer will cover for your particular plan.

You might try calling your insurer back and asking what the "allowable" costs are for any CPAP unit (they will have one price that covers all, whether it's the dumbest brick or the best and newest model) rental, for purchase of a humidifier, hose (regular or climateline), filters, and mask (there may be a difference in reimbursement between a full face mask and a nasal mask). From there you can calculate your 20%. Most insurers will share this info with you, but some consider it "proprietary" And it may vary from DME to DME depending on how they negotiated their contracts with preferred providers, just to confuse things more.

And no matter what the DME charges, the MOST that they will get (as long as you use the in network provider) will be what the insurance deems to be the "allowable" amount--you pay 20% of that no matter how much the DME wants to charge you. Be sure you read my blog post "Don't Pay that Upcharge!"

Now, your job is to decide which make and model machine you want, what type of hose (regular or climateline) and what mask to start with. Be sure you have the EXACT model number of the machine--don't say "Resmed Auto", say "Resmed model XXX".

Call each DME back (sorry) and say I would like "MAKE/Model #XXXX", can you provide it?". If you read my "What to know BEFORE you meet your DME, you know more jerking is coming. "Well, we have to see the prescription" (That wasn't my question, do you have these machines in stock or available or should I check elsewhere?), "It depends on your insurance" (I've already verified that my insurance will cover it, I'm asking if you can provide it or not). "Well, we might be able to provide it at an extra charge." (My insurer has a contract with your company that prohibits balance billing-would you like to discuss it with them?). Actually, I'd probably respond by asking them if they'd like to discuss it with my insurer's FRAUD department, but that's a bit confrontational if they are the only DME who might be willing to provide what you want.

While not absolutely required, it's a whole lot easier if your prescription calls for the exact make and model machine that you want. If your doctor is amenable, then that will help. But given the difficulty you had obtaining the rx in the first place, it may not be worth the effort.

[palerider]

and asked the rep for the model ID number, she could only provide "IPXI" and I see no such model. Am I being jerked around or is this all normal?

you're certainly suffering at the hands of the ignorant. "IPX1" stands for "intrusion Protection x 1" it's an international standard for how resistant a device is to water and finger incursion. http://en.wikipedia.org/wiki/IP_Code
people who know nothing will think that's the model number because it's up at the top of the label by the word 'resmed'. the actual model number is on the bottom right of the label, following the letters REF.

here's a list of the more common basic models:

36001 S9 "Escape" (CPAP Only no data)
36002 S9 "Escape Auto" (No data apap mode)
36003 S9 "Elite" (cpap only)
36004 S9 "VPAP S"
36005 S9 "AutoSet" (advanced autoset mode)
36006 S9 "VPAP Auto"
in any event, those are total ripoff prices.

check secondwindcpap for a good price on an s9 autoset, or a prs1 560 auto model... or pm grayghost4

[Tracy1968]

Thanks again, all.

Again, I have no money (literally NO money) to buy a machine. I've been on short term disability due to the fact that it's nearly impossible to do tech support while in zombie/severe fatigue mode. Most days I can't drive. It looks like I will be forced to rent until I can get my health back, get back to work, and get the money to buy a machine.

Now, your job is to decide which make and model machine you want.

Then I'm screwed. I live in Mayberry with few options. I just want something that will help me sleep so I can stop living in this day-to-day nightmare of not being able to function. I stupidly thought the doctor's office would take care of this for me. *insert end of tantrum here*

Out of the three DMEs within 60 miles, one never answers the phone, one 45 miles away has the ResMed Air Sense 10 (37028), and the one only 20 miles from me (the same one who insisted their ResMed S9 has a model number of IPXI) just told me they cannot offer or order any other type of machine than that one. Just for kicks, I asked this person (different from yesterday's rep) for the ID Number of the Resmed S9 and he told me he'd have to open the box to see the model (!!!) and sorry, he can't do that. End of conversation. Wow.

"And no matter what the DME charges, the MOST that they will get (as long as you use the in network provider) will be what the insurance deems to be the "allowable" amount--you pay 20% of that no matter how much the DME wants to charge you."

Wow. You were right on the money. I called United Healthcare back. While they won't give me a specific "allowable cost," they told me what you said here, almost word for word.

So ... out of the lesser of the evils, I'm gonna try the place 45 miles away.

One last question and I'll stop making this board all about me (which is what it seems like -- I'm using to GIVING advice, not being whiny and needy): Has anyone here rented and then purchased their own later? I mean, is ending a rental also a nightmare in itself?

[sleepy-k]

When I first began therapy, my insurance only covered "rental" as well, but it was structured such that after 12 months it was yours. I had some oddities in that my insurance changed before the 12 months was up, but my DME at the time was fantastic, and though I was a month or two short, effectively just closed it out and it was mine.

(My insurance was also pretty good, so while I did have to rent for 12 months, the copays were pretty small.)

I'm still using the same machine 3-4 years later, although I did take a 1-2 year break from using it. (oops.)