Newbie Confused About Where to Get My Equipment

[keverino]

Thanks so much for the great site and the yellow light bulb/FAQs!

Had my first sleep study week before last and have AHI of 59.9. Saw the doc last Thursday and he says talk to this DME "today" and get the CPAP "today or tomorrow at the latest". Also, the doc seemed willing to prescribe APAP but recommended we start with CPAP. Well - I hadn't read this site first, so I didn't realize I should probably push for APAP.

Well, turns out my lousy Aetna insurance doesn't cover Pulmon Solutions (who were ready to hook me up ASAP), only covers Apria which is far away and can't see me for another week! Plus, the doc's office was closed on Friday so I didn't even get to talk to anyone until today.

My question: I am strongly considering avoiding insurance and paying everything out of pocket (likely via cpap.com) so that I can be sure to get the equipment I need and avoid the dreaded insurance hassles. But, I didn't get a copy of the prescription from the doc. Will the doc's office be cool with me calling them to fax me the prescription? Will they be willing to change it to APAP from CPAP (since the doc seemed amenable and I have no contraindications)? And how dangerous is it for me to wait until I can do all this and then order the equipment from cpap.com?

I went ahead and scheduled an appt with Apria for Thursday, so I'll probably see what they have to offer. I'm also tempted to go back to the very nice people at Pulmo Solutions (they told me they'd sell directly to me at their "internet" rate) but after reading this a bit afraid of DME salesmanship.

I realize this is kinda rambling but hey, I'm sleepy!

many thanks!

[Wulfman]

You're entitled to have your prescription (original if at all possible) since it's good "forever". If you have your prescription, you can get whatever you want from CPAP.COM.....CPAP, APAP, etc.
Check with your insurance provider and see if they will reimburse you for purchasing out-of-pocket. Tell them it'll save everybody a LOT of money.
If you order from CPAP.COM, you'll have your equipment within a couple of days (depending on shipping speed). I've seen posts where people have waited weeks for the specific equipment THEY want. Hard telling what the DME will give you that's been sitting on their shelves.

Best wishes,

Den

[rested gal]

My question: I am strongly considering avoiding insurance and paying everything out of pocket (likely via cpap.com) so that I can be sure to get the equipment I need and avoid the dreaded insurance hassles. But, I didn't get a copy of the prescription from the doc. Will the doc's office be cool with me calling them to fax me the prescription?

The doctor's office should be willing to fax you your Rx. Can't imagine that they'd give you any problem about sending that to you...especially if you don't ask for any changes to it.

Will they be willing to change it to APAP from CPAP (since the doc seemed amenable and I have no contraindications)?

The smoothest, quickest, easiest way (imho) is to not ask that the Rx be changed from cpap to autopap. Simply ask the doctor's office to send your existing Rx. The one that says "cpap" on it.

Here's why. If you deal with a local DME, then yes, you'd need the prescription changed to "autopap." But you said you are considering just buying what you want online. You can order an autopap from cpap.com as long as the Rx has the word "cpap." Doesn't even need to state a pressure or pressure range if you're ordering an autopap. (The Rx would need to state a pressure if ordering a straight cpap machine.) You'll receive the setup instructions with any machine you buy from cpap.com.

An autopap machine is considered to be a "cpap" machine. It's an auto-titrating cpap machine. It comes pre-set for a pressure range of 4 - 20 cm H20. That's why all that cpap.com requires, in order for you to buy an autopap from them, is that the Rx has, at the very least, the word "cpap" on it. The pre-set range that autopaps already have would encompass any single "straight" pressure that is usually on an Rx.

You won't need an Rx to buy masks, humidifier, or any other accessories from cpap.com. The only thing that requires an Rx is the machine itself.

And how dangerous is it for me to wait until I can do all this and then order the equipment from cpap.com?

Well, I'm not a doctor, but...personally I'd not go rushing to the DME. I'd order exactly what I wanted from cpap.com. If I was very concerned about getting it as fast as possible, I'd ask for overnight delivery. But personally, I wouldn't feel that's necessary. No matter how bad it looked on the sleep study, I'd take that very seriously and would plan to be absolutely compliant, but....I'd also figure, "I've been sleeping this way for years; it's bad and I'm going to do something about it, but I'll use an extra few days to get exactly what I want to use for treatment." But that's just me.

I'd choose the Respironics REMstar Auto with C-flex and integrated heated humidifier -- either the new M series machine or the previous slightly larger model.

Again, personally...I'd opt for the previous larger one since I already have experience with it and liked that machine very much. I also like the Encore Pro software Respironics' machines use.

I went ahead and scheduled an appt with Apria for Thursday, so I'll probably see what they have to offer. I'm also tempted to go back to the very nice people at Pulmo Solutions (they told me they'd sell directly to me at their "internet" rate) but after reading this a bit afraid of DME salesmanship.

At pulmonarysolutions.com:

Respironics REMstar Auto with C-flex - no humidifier - $741.00
Their humidifier page didn't come up - message said they were updating their catalog.

I didn't see a picture of an "M" series machine at their site, but perhaps they have them.



At cpap.com:

Respironics REMstar Auto with C-flex - no humidifier - $609.50
with heated humidifier - $689.00
This is the one I'd get...with heated humidifier.


Respironics REMstar Auto "M" series (has C-Flex) - no humidifier $610.00
with heated humidifier - $744.90

Good luck.

[snoregirl]

I am with Rested Gal for the most part.

I also have the older Auto Remstar unit and love it.

If you can get the doc to change the script quickly fine but if not I would do as she says and get the one he wrote already and buy online cash either immediately or after your meeting with Apria. You shouldn't need to wait until Thursday to get costs from Apria (phone works). I might also then ask for APAP script to be written as soon as the doc can in case it was financially beneficial to buy from a Apria as you would need it there. Should be able to get that by Thursday. Heck he already offered and all he has to do is scribble on a pad (auto needs to have pressure range and don't forget heated humidifier, and cflex etc on that in case you want to use Apria).

You don't say what your insurance provides for. If you want to spend out of pocket you MAY be able to get some insurance coverage after the fact but many of us can't especially if your insurance requires rent to own.

But if that does turn out that you can't get insurance for an online purchase, and money is not an issue, you may want to set yourself up cash, then get that APAP script and go through Apria. They don't need to know you already have a machine you bought.
May be a fight to get APAP from Apria even with dr script but if you can hold out you can win (I did while using a used machine for treatment while I fought). I found that you just have to keep after them. Tell them over and over you want the APAP your doc prescribed. If they say no, call back again the next day. Same billing code for either machine E0601. If they tell you your insurance won't cover it, while it may be true, your insurance most likely will see E0601 and pay for it. Mine did. Then you could have them get you an M series AUTO as a travel machine with your insurance money. This is assuming you have good to great insurance and the setup costs you very little out of pocket. I paid $280 for the AUto from Apria (with copay of 20% and my annual deductable was already gone due to sleep studies. You have to run your own math to see if it is worth it. You may then need to use the insurance bought machine exclusively for a period of time for compliance purposes before insurance will buy.

[SelfSeeker]

Welcome keverino,


You got great advice.

I will also say contact your insurance about online purchases.

As for the interfaces (masks/nasal pillows etc), find a DME that is willing to let you try them on at home and exchange them after a couple of weeks if it is not a good match for you.

I agree with Rested Gal, take your time and get the machine you want.

[keverino]

Wow, so many detailed, informative responses SO QUICKLY!

THANK YOU all for your help. I am really touched. I will take the advice to get my prescrip, get the APAP Respironics REMstar Auto with C-flex AND humidifier, and get it online.

These insurance/dme battle stories really annoy me - we shouldn't have to fight to get what we need for our health!

This forum - and especially those who took time to respond to someone you don't even know - YOU ROCK!

THANK YOU SO MUCH!

[oldgearhead]

..and once in while you can find a good one at Yahoo Auction. However,
you must be very informed before going this route. The unit needs to come from a smoke free home an be a late model with low hours,

The following is an example one NOT TO BUY because its a pre 2004 model without C-Flex (look for the big blue sticker).

http://auctions.yahoo.com/i::10457985