Very Confused Newbie (updated with Sleep Study results)

[rachelp]

Please bear with me because I have no idea what I'm talking about and I'm hoping some of you fine folks can give me advice.
I was diagnosed with severe sleep apnea on 7/1. That's all I know. My doctor didn't tell me anything else besides she would have the DME people they work with
call me. It's been 2.5 weeks and no one has called.

My medical insurance has a $2500 deductible before they pay for DME so basically I'll be buying out of pocket. My question is.. Do I need to speak to the DME people or can I just order a pap once I know if I need cpap, auto, bipap? Is it common to self-titrate or is that something the DME people do? I'm so lost and I have two calls into the doctor and one into the DME people and nobody calling me back. I just want to get on the path to better sleep.

[Sonya]

I'm a newbie too and the lack of feedback from the DME and Sleep Doc are my biggest peeves. You go and do the study and get told you're gonna die if you don't get this machine. But then they take weeks to get back to you. HUH!!?? It's so exasperating in a time when you need information and support. I'm sorry.

It took a little over 3 weeks for my DME to set up an appointment. I was totally overwhelmed with choices. One thing you might want to do is read up here about the different kinds of machines and what masks work and don't work for people. It will give you a place to start and some information so you don't get steered to a machine without data capability or the wrong mask for your sleeping style.

As for the out of pocket vs going through the DME, I'll leave that to the vets here who have much more experience than I do. I'm still a renter.

[Pugsy]

You can purchase a machine on your own and save quite a bit of money if all you are needing is regular cpap/apap machine and not one of the higher end machines.

You would need a copy of the RX to buy online or you could go the private party purchase route if you wished.
Forum member STL Mark has a couple of the latest ResMed machines that are brand new.
viewtopic.php?f=1&t=106397&p=1013487#p1013487
Unless you have special pressure needs you probably would do well with the AirSense 10 AutoSet.
Special pressure needs being pressures in the upper teens or 20s or a special machine for central apneas.

Do you have a copy of your sleep study results? If not, get them.
Have you had the sleep study where you wear the mask and the machine is used to determine pressure needs?

The only real advantage to using a DME might be mask swapping potential depending on their mask swapping policy. Sometimes finding the right mask can be a PITA unless you get lucky and find the right one straight away.

You might want to read this
https://maskarrayed.wordpress.com/what- ... me-part-i/
and this
https://maskarrayed.wordpress.com/

Also...check to find out how your insurance would be doing the machine purchase...rent to own for so many months or straight out purchase. If rent to own for very many months it will likely start a new deductible Jan 1 which will likely impact out of pocket costs.

Cpap.com has a wide variety of machines. You might check them out. They would require a copy of the RX though. They also have a variety of masks but will require a RX for a complete mask package.
There are ways to get masks without a RX though.

Also...even if you bought your machine elsewhere the DME could still be a supplier of masks.

[SewTired]

Cancel the order and get it through on online dealer. You will be paying far less. Your doctor can fax the prescription (you want a copy for yourself). In addition, get a copy of your sleep study (not just a summary) for your records. You may need that some day.

As I haven't ordered a machine (just masks) from an online retailer, ill let someone else chime in on that. Btw, the online retailer will set your machine to the pressures in the prescription, so you don't need to concern yourself about setting it up.

[rachelp]

Thanks for the input! Sonya you are so right the wait is unreal. Don't tell me I have a deadly disease then drag around getting me a machine!
I'm definitely going to order online. Even though my insurance covers it, it really doesn't if I have to pay all of it up to $2500.

I didn't know the online retailer can set up the machines! cpap.com does that?

[Pugsy]

Yes, cpap.com will/can set the machine to the pressure that is written on the RX.
If they forget it isn't a big deal though. You can do it yourself if you know how to get to the setup menu and the pressure to set it at. Not difficult at all. In fact it would be a good idea for you to know how even if you don't need to set the pressure because several features that you might want to use are accessed in that same setup menu.

[SewTired]

You can get the clinicians manual, but folks can also talk you through it either on the board or in a PM.

You can ask your insurance company if they will do out-of-network. You will still have to pay, but you could apply part of the cost of your machine to your deductible should you use more of it this year. I used to do that with Bc/BS for various things. Doesn't work with Medicare.

[M'ohms]

Another thing to ask your insurance company is "what is the negotiated rate for a machine in-network?" This should be the cost to you (using insurance) even though you have to pay it all yourself. Treatment is expensive and you can be whittling down your deductible by going through insurance. Remember, you also have to buy replacement supplies too on a regular basis. By using your insurance, which you are paying for, you can ignore the DME's inflated charges because you will be paying you insurance's rates.

Compare your insurance negotiated rate (through DME purchase) to an online purchase to see which will be more cost affective for you. The answer is not always clear-cut.

[rachelp]

Another thing to ask your insurance company is "what is the negotiated rate for a machine in-network?" This should be the cost to you (using insurance) even though you have to pay it all yourself. Treatment is expensive and you can be whittling down your deductible by going through insurance. Remember, you also have to buy replacement supplies too on a regular basis. By using your insurance, which you are paying for, you can ignore the DME's inflated charges because you will be paying you insurance's rates.

Compare your insurance negotiated rate (through DME purchase) to an online purchase to see which will be more cost affective for you. The answer is not always clear-cut.

Another thing to ask your insurance company is "what is the negotiated rate for a machine in-network?" This should be the cost to you (using insurance) even though you have to pay it all yourself. Treatment is expensive and you can be whittling down your deductible by going through insurance. Remember, you also have to buy replacement supplies too on a regular basis. By using your insurance, which you are paying for, you can ignore the DME's inflated charges because you will be paying you insurance's rates.

Compare your insurance negotiated rate (through DME purchase) to an online purchase to see which will be more cost affective for you. The answer is not always clear-cut.

Thanks that's a good point. I'll ask them the negotiated rate in-network. I have been doing so much reading and research my head is spinning! I just want my machine already. The DME place is dragging around and odds are I'm not even buying one from them but we will see what the rate is before I decide.
These are really good tips guys. Thanks again.

[Sleeprider]

Get a copy of your sleep study report and recommendations, and a copy of any prescription that resulted. It is your right to have copies of this. Don't just get bounced to a DME Unless you have a complex apnea issue, the machine you need is $600 to $900 from any online supplier, and can be much less through secondwind.com or a private seller like STLmark mentioned earlier. The records are important to keep so that you can continue to fill the prescription and bet insurance reimbursement when available. You should not have been kept waiting this long, so ask for your results immediately, and let the sleep doctor's staff know you will be filling your prescription yourself due to lack of coverage.

Even if you buy this out of pocket, there will be a procedure for you to file a claim with your insurance for out of network purchases. Be sure to use it so the deductible is reduced for any unforeseen DME needs. If you don't have a titration result or pressure prescription, do not go back for a second study at additional expense. Get a prescription for auto CPAP and you can self-titrate. If you did do a titration study, did you try a mask that you liked and worked for you?

[rachelp]

Get a copy of your sleep study report and recommendations, and a copy of any prescription that resulted. It is your right to have copies of this. Don't just get bounced to a DME Unless you have a complex apnea issue, the machine you need is $600 to $900 from any online supplier, and can be much less through secondwind.com or a private seller like STLmark mentioned earlier. The records are important to keep so that you can continue to fill the prescription and bet insurance reimbursement when available. You should not have been kept waiting this long, so ask for your results immediately, and let the sleep doctor's staff know you will be filling your prescription yourself due to lack of coverage.

Even if you buy this out of pocket, there will be a procedure for you to file a claim with your insurance for out of network purchases. Be sure to use it so the deductible is reduced for any unforeseen DME needs. If you don't have a titration result or pressure prescription, do not go back for a second study at additional expense. Get a prescription for auto CPAP and you can self-titrate. If you did do a titration study, did you try a mask that you liked and worked for you?

You guys are so awesome. Thank you for this advice. I would have never known all this information! My prescription is for autoCPAP so I should be able to self-titrate. I'm on hold now to put in a notice that i want my prescription on paper.

[Janknitz]

Also you need to check to see if your sleep study counts in that deductible. If that's the case, you may be closer than you think and it MAY be worth it to buy from the DME so you don't have to pay for other things for the rest of the year. If this was December, it wouldn't be worth it, but since it's only mid-year it may be.

[rachelp]

I talked with my insurance company, the DME, the doctors office and you guys and it came out much cheaper for me to just pay out of pocket.

I got this machine from the secondhand site you guys recommend with the humidifier and module. I'll use the SH software with it. https://www.cpap.com/productpage/devilb ... chine.html

This is my first mask to try. It has the free return insurance from our sponsor in case I don't like it.
https://www.cpap.com/productpage/resmed ... dgear.html

I also picked up a snuggle hose cover, the aromatherapy kit, and some cleaning wipes. I'm ready to get my equipment in and start getting used to it.
Thank you all for the advice! I will probably be back with questions as I start using the machine.

[postitnote]

I talked with my insurance company, the DME, the doctors office and you guys and it came out much cheaper for me to just pay out of pocket.

I got this machine from the secondhand site you guys recommend with the humidifier and module. I'll use the SH software with it. https://www.cpap.com/productpage/devilb ... chine.html

This is my first mask to try. It has the free return insurance from our sponsor in case I don't like it.
https://www.cpap.com/productpage/resmed ... dgear.html

I also picked up a snuggle hose cover, the aromatherapy kit, and some cleaning wipes. I'm ready to get my equipment in and start getting used to it.
Thank you all for the advice! I will probably be back with questions as I start using the machine.

My favorite mask Next time just buy the cheap unscented baby butt wipes. Probably a lot cheaper.

[rachelp]

I talked with my insurance company, the DME, the doctors office and you guys and it came out much cheaper for me to just pay out of pocket.

I got this machine from the secondhand site you guys recommend with the humidifier and module. I'll use the SH software with it. https://www.cpap.com/productpage/devilb ... chine.html

This is my first mask to try. It has the free return insurance from our sponsor in case I don't like it.
https://www.cpap.com/productpage/resmed ... dgear.html

I also picked up a snuggle hose cover, the aromatherapy kit, and some cleaning wipes. I'm ready to get my equipment in and start getting used to it.
Thank you all for the advice! I will probably be back with questions as I start using the machine.

My favorite mask Next time just buy the cheap unscented baby butt wipes. Probably a lot cheaper.

I'll remember that wipe tip for next time! They were only a penny because a promo our sponsor is running. Any particular brand you like or any unscented baby wipe?