S8 AutoSet II died while travelling - saga of replacement

[davecpap]

Went on business trip to Manhattan.. Unpack my CPAP machine, won't turn on.. the start button is faintly lit green, light on humidifier turns on - no other signs of life.

It was a rough night, first time since summer of 2010 I went without CPAP. In the morning I called Lincare, the DME I used. They stopped taking my insurance (Cigna with Carecentrix as DME billing intermediary) in January - I hadn't received any new supplies yet in 2015 so I didn't know. I ask if I can get a new machine anyways and pay cash, they say my sleep study is too old and that they need a new RX even though they have my old one on file. The closest Lincare location was an hour away in New Jersey anyways, I would have had to rent a car to get there.

I call Cigna, Carecentrix, looked online and on this forum - no DMEs in Manhattan. I could only find mention of a single sleep lab in Manhattan. Most are in the Bronx, Long Island, New Jersey. I didn't have time to rent a car and leave the office during my trip to venture into NJ or the Bronx, so I went to this sleep lab on 55th and paid cash for a new Airsense 10 Autoset (either that or an S9 Escape Auto - no thanks). They reluctantly let me buy it with just a new RX faxed by my doctor, they too felt my 2008 study was too old. They only wanted a new one for 'audit' purposes, they expressed no concern that the machine might not meet my needs - I told them I was doing well on the S8 Autoset. In the end I got a new machine less than 24 hours after my old one broke, but there was a fair bit of legwork and $900 cash after taxes involved.

Sucks I have this nice insurance I couldn't use, but I never expected to be so far geographically from an in-network DME and I never thought a new sleep study would be a prerequisite. Cigna, Carecentrix, the DMEs couldn't site a specific rule about how old was too old, they just all agreed 2008 was too old.

Anyone travel with two machines just in case? My backup machine was at home. I tried to have the backup machine sent same day air - UPS can send it on a commercial passenger flight for a reasonable cost, but that requires having a cargo account and a 'known shipper' ID because 9/11. I have a known traveler ID number from TSA, not good enough It didn't make any sense. Do they not screen shipping cargo in the cargo hold??

I really don't want to go through sleep studies just so I can have a recent study to fulfill audit requirements in the off chance my machine dies. My OSA is mild/moderate my AHI is always <1 and often 0. Sleep doctor has never expressed any concerns about needing another one. If he writes an RX for a new machine, why isn't that enough? I don't have high blood pressure (perhaps thanks to CPAP), but what if the pharmacy denied refilling your blood pressure meds despite a valid RX because they wanted proof a doctor had checked it 'recently'' (and can't define recently)?? Why are they second guessing the doctor who wrote RX?

[Krelvin]

If you are not going through insurance, an RX from your doctor (ANY doctor) should be enough to purchase a machine. The DME shouldn't care as they are not dealing with insurance requirements.

It is the insurance company that wants you to have a current sleep study as I recently went through after my machine needed to be replace (I replaced an M-Series from 2008 but my Last Sleep Study was in 2006)

[davecpap]

If you are not going through insurance, an RX from your doctor (ANY doctor) should be enough to purchase a machine. The DME shouldn't care as they are not dealing with insurance requirements.

Yeah this was definitely not the case. Two out of network DMEs wouldn't take my CASH (no insurance involved) because no recent sleep study - maybe the front office staff didn't understand the origin of the recent sleep study requirement.

Worse, Cigna/Carecentrix didn't know their own requirements about what constitutes a recent study - I still don't know how often I should have one so I can get a new machine in the future.

[jjhall]

Maybe get a copy of the current-dated prescription from your doctor first, walk in with the script in hand, and ask for a new machine. If they ask when the study was, just tell them it doesn't matter, here is the prescription. Unless insurance is involved it is frankly none of the DME's business when your sleep study was, only that you have a current and valid prescription.

[HoseCrusher]

Dave, I've got a "guy" that hangs out on W 40th St and 5th Ave (Bryant park area). He sells xPAP units out of the trunk of his car and can get you a "good deal..."

This would be a good exercise for a law student. What exact "law" gives the guidelines for "recent" when it comes to sleep studies. What a crock of crap.

[Player]

Another way would have been to buy a used one for a few hundred off Craigs List, and then go through your insurance when you get back home.

[Sleeprider]

I submitted my 2008 Rx to CPAP.com and it's been good for everything I need. I have gotten my primary physician to give me a current prescription (that I wrote) and should be good for quite a while. A DME has no business saying you need a sleep study. Their job is to fulfill a prescription. It that prescription has no expiration, an update is none of their business. They may need to call a prescribing physician for confirmation, but they cannot tell you your Rx is too old.

[davecpap]

Another way would have been to buy a used one for a few hundred off Craigs List, and then go through your insurance when you get back home.

The day this all went down, there was only one listed on http://newyork.craigslist.org and when I called the place wasn't even local, it was in Denver. Of course now there are two for sale

[archangle]

If you are not going through insurance, an RX from your doctor (ANY doctor) should be enough to purchase a machine. The DME shouldn't care as they are not dealing with insurance requirements.

Yeah this was definitely not the case. Two out of network DMEs wouldn't take my CASH (no insurance involved) because no recent sleep study - maybe the front office staff didn't understand the origin of the recent sleep study requirement.

Worse, Cigna/Carecentrix didn't know their own requirements about what constitutes a recent study - I still don't know how often I should have one so I can get a new machine in the future.

Formally report the DME's to the state medical board. Refusing to fill a valid prescription is probably illegal. Imagine the uproar if a pharmacy decided they didn't want to fill a valid prescription for insulin.

[RandyJ]

The prescription I have for cpap machine from Dr is dated 2011 but says "Length of need = 99 years" ... I wonder if that is binding or if there are other laws that require DME to go by date on script and not length of need?

[chunkyfrog]

IMO, such a scrip should be good for 99 years.
Even a forged prescription should be of little consequence, as cpap machines are NOT narcotics!