RANT - I want my CPAP! Plus advice needed!

[Heart Jumping]

Before reading this rant, please understand I first requested a sleep study almost 6 months ago, it literally took me 6 months before I got it, and that's only after paying for it in full out of my own pocket, because 5 days before it was finally happening my blood sucking insurance company turned it down. And that's not boring you with all the other insanity that took place along the way. I literally feel as though I diagnosed myself and that without endless determination would have never even been diagnosed.

Today the company that the doctor ordered my CPAP through calls me and needs a $700 payment that my insurance company won't cover. No problem so far but...the person calling me is from the "billing department" and has no idea what machine I'll be getting, even though she wants my money and even though I've emphasized based on feedback here that I want the Resmed 10 Autoset. But tells me she's sure I can "discuss it with the scheduling department when they call me". She also can't tell me how long the wait for delivery and education will be. But I'm supposed to give her my money. RANT - I am so f*cking done with the non-stop insanity of dealing with the medical industry! If past events inform the present that means I could give them my money, then the next person will tell me I'm getting a different cpap and of course won't have any clue about the previous promise, and I'll be told it will be 4 weeks before they can schedule the in-home delivery and training. In the mean time I've been diagnosed with severe apnea 2 weeks ago after a 6-month wait, and still don't have a CPAP machine.

Questions:

1. I did a search on "cpap suppliers" and was surprised not to find many hits, though I'm sure it's been discussed many times. If I can't get actual facts from the CPAP supplier mentioned above by the end of the day I want to call the doctor and have her write a prescription and have a supplier of my choice send me the CPAP. I'm in the US, what are my options? I want someone that stocks them and can next day air them, I'll probably pay and then make the claim myself so I don't have to wait. I liked the information provided on the Easy Breath website, if anyone has any opinions on them. I am NOT looking for the rock bottom lowest price as much as I am someone with good service.

2. Do people get backup CPAP's? What happens if your CPAP breaks? I want to plan now for that - are there suppliers that offer guaranteed 24-hour replacements?

3. Is there any reason to believe that I actually need someone to deliver this thing and give me in-home training? My guess is that in 3 days I'll know more about it than the person delivering it.

4. Now for the big question, how do I decide what mask? In the sleep study test I wore a nose mask and seemed to do OK with it. Would it be a good idea to start with two different types?

5. I hope as long as I have a CPAP prescription I can buy as many different masks as I want without needing prescriptions for each.

6. I also see options for hose types. Comments on that welcome.

7. Other than CPAP and masks, what else do I need? What supplies should I stock?

Thanks

[chunkyfrog]

Never, never, NEVER give anyone money until you have WRITTEN confirmation of what you are getting.
I would also not pay except at the scene/time of the transfer of equipment.
Something smells very fishy.

[Heart Jumping]

Never, never, NEVER give anyone money until you have WRITTEN confirmation of what you are getting.
I would also not pay except at the scene/time of the transfer of equipment.
Something smells very fishy.

Thanks, I think it's another messed up company where NOTHING is designed around the customer. The hospital/doctor refers someone to them and most people just go along and don't question. Either way they aren't getting a cent from me without sending me an invoice showing WHAT I am paying for.

[LSAT]

If you are paying that much I would suggest that you purchase it on your own at cpap.com. Keep your insurance out of it. The costs will be similar.

[Sheriff Buford]

Call cpap.com. Heck... the $700 may pay for the Resmed autoset. Get the Resmed P10 mask. Ask abot their return policy. You can normally get insurance for a small charge and be able to return the mask for a different one within 30 days. You know before then if you can manage the mask. The mask search is a journey. I went thru 6 or 7 before I found mine. A mask should not leak and feel comfortable. You need to keep your mouth closed with the P10 type mask. Cpap.com are good, reliable folks. They will help you.

Sheriff

[Heart Jumping]

If you are paying that much I would suggest that you purchase it on your own at cpap.com. Keep your insurance out of it. The costs will be similar.

My intention is to purchase it and then submit a claim myself and see what if any part gets reimbursed. I could be wrong but I think the main reason to submit is that even if they don't reimburse it will apply to my deductible and max out of pocket expenses, so the next time there is a claim it will be paid for.

[Pugsy]

Check out cpap.com...they are good people and they pay the bills for this forum.
I think this is the machine you are wanting.
https://www.cpap.com/productpage/resmed ... idair.html

For masks...check them out for masks too. Some come with free return insurance which means if you hate it you can send it back and get your money back as long as they get it back within 30 days.
Some of the masks don't have free return insurance but instead you pay a small price for the ability to return it....but there are enough really good masks with free return insurance that you will have many to maybe try.

All they need is a copy of your RX and they will even help you get it...and you only need one RX for any mask you want. Usually..the RX says so and so machine with humidifier and mask of patient's choice.

Whether or not your insurance will reimburse or apply costs to your deductible...that's up to your insurance company. Some will and some won't for online purchases...you probably should verify that first.

[Heart Jumping]

Thanks for the referrals to cpap.com, was not aware the forum was tied to a specific online shop, I'm checking them out now.

[OkyDoky]

Talk with your insurance company on reimbursement. Many will not cover online or if they do it is out of network with higher copay. Your insurance will tell you who is in network for you. No matter how you end up getting your equipment you do need to get a copy of your Rx and Sleep Study.

[Heart Jumping]

Talk with your insurance company on reimbursement. Many will not cover online or if they do it is out of network with higher copay. Your insurance will tell you who is in network for you. No matter how you end up getting your equipment you do need to get a copy of your Rx and Sleep Study.

I'm assuming the best path to follow is to just get a copy of the RX myself? What does your typical CPAP RX look like? i.e. does it just say "CPAP machine"? Does it list a company? I'm about to call the doctors office, is there anything specific I need to ask for on it, or do they all look the same?

[Krelvin]

Talk with your insurance company on reimbursement. Many will not cover online or if they do it is out of network with higher copay. Your insurance will tell you who is in network for you. No matter how you end up getting your equipment you do need to get a copy of your Rx and Sleep Study.

I'm assuming the best path to follow is to just get a copy of the RX myself? What does your typical CPAP RX look like? i.e. does it just say "CPAP machine"? Does it list a company? I'm about to call the doctors office, is there anything specific I need to ask for on it, or do they all look the same?

you might look at:
https://www.cpap.com/cpap-faq/Prescriptions.html as to what needs to be on the RX.

[Janknitz]

Be sure to read "What you need to know BEFORE you meet your DME" in my signature below. It's a little out of date, but most of the info is still good

1. Ask your doctor to write the Rx for exactly the machine and MODEL you want.
2. Get the precription in YOUR hand.
3. Call your insurance company and ask:
a. Whether they pay by hcpc code (read my blog for explanation)
b. What DME's are "in network"
c. Will they reimburse you for online purchases?
d. Do they purchase or require a "rent to own" and for how long? Pay attention that it's November and you could get stuck for a second deductible come January. Be sure to factor that into your out of pocket costs!

4. Calculate your out of pocket costs using insurance. You don't need to contact the DME for this--they are only allowed to charge you the cost that your insurer has negotiated with them. Don't let them charge you more. Don't authorize payment until you have seen the Explanation of Benefits from your insurance company and you know the amount they will charge you is accurate (HA!).

5. Compare the DME out of pocket costs to purchasing it yourself online. Be sure to factor in deductible(s) and co-payments, and the aggravation of dealing with a DME.

6. If you have a choice of DME's start calling around to see who can provide what your prescription calls for. Don't let them bait and switch. If you've done your homework, you'll be ready for their stupid DME games--don't fall for that. Be sure to understand their mask return policy before choosing a DME.

7. Ask for the mask you had in your sleep study. If it worrked well for you, that's a good place to start.

Good luck!

[OkyDoky]

Include what is noted above, also be sure and with the model include heated humidifier and heated hose.
My Rx also has
Pressure Settings
Diagnosis
length of need: 99=Lifetime
Mask of patient choice.

[schrader]

Weird DME you are dealing with there. I am fortunate to have a local DME in network with a great tech.
Latest equipment and talked to me about my preferences about a mask.
I called all the DME's in the area and went with the one I felt comfortable with.
Hand carried my prescription over to them from the doctors office.
Couple days later I am good to go. We did not talk about trying a bunch of different masks though.
She asked me what I do before I go to bed, and picked out the smallest mask that would work for me.
I am happy with the setup and have good numbers.

[Cardsfan]

I'll answer #7.
Basic Supplies needed:
Distilled water for the humidifier- 1 gallon 89 cents, lasts about a month for me.
Baby wipes- non alcohol, not antibacterial, no lotion- wipe the mask off with.
A gentle soap- common ones are Johnson Baby shampoo, Ivory, Dawn dish soap (the blue one) (no antibacterial cleaners, no alcohol) - to wash the equipment.

Comfort items:
http://www.padacheek.com after you settle on a mask, these pads and liners improve the comfort of wearing a mask.

http://www.snugglehose.com for those who drape the long hose over our headboard. It stops the "click click noise" when the hose moves across the headboard. Plus, it makes the hose more comfortable against the skin. The one with a zipper is easier to use.