New Insurance uses a different brand of c-pap

[moosie]

Hi
Need your advise. I have had a Resmed Air Curve ASV for about 18 months. I have severe sleep apnea. It uses variable pressure. The machine works great. My new insurance uses Respironics and will only give me a Resmed if the doctor writes that it is medically necessary. Since I have no idea about this other brand could you advise me whether I should insist that the doctor prescribe the Remed or is the Respironics just as good?

[LSAT]

I don't understand....If you have a ResMed machine, why do you need a different one? Why can't you continue to use the ResMed...Besides...The insurance does not care what brand of machine you use...They pay the same amount for a machine regardless of what you get. It sounds like the supplier is giving you a line of bullshit.

[moosie]

The new insurance company contracts with a different medical supply company who does not use Resmed unless the doctor specifically says that there is a medical necessity. The new insurance provider is AvMed.

[D.H.]

Since you've had it eighteen months, you're past the compliance period; the machine is yours! Typically the machine is replaced after five years, so you have 3½ years left before this is an issue.

The maintenance items which are machine specific are the filter(s), the water tank, and the heated hose (if you're using a standard hose, it's not a machine-specific item). I suspect your insurance should cover that, since it makes more sense than providing a new machine.

[Janknitz]

Since you've had it eighteen months, you're past the compliance period; the machine is yours! Typically the machine is replaced after five years, so you have 3½ years left before this is an issue.

The maintenance items which are machine specific are the filter(s), the water tank, and the heated hose (if you're using a standard hose, it's not a machine-specific item). I suspect your insurance should cover that, since it makes more sense than providing a new machine.

That's not necessarily true. If she's on Medicare the machine is hers after 13 months and many insurers follow the Medicare "capped rental" plan, but NOT ALL. So her former insurer may have required perpetual rental. The machine may or may not be yours. It's time to talk to that DME and find out (and check your paperwork too, because you can NEVER, NEVER, NEVER, EVER, EVER trust what a DME tells you--always verify). If it was on perpetual rental, the old DME may be willing to sell it to you for the amount already paid or a little more, because they will now have a used ASV on their hands. You may have to negotiate a little.

If it is yours, then just keep it and consider (if you have low deductibles and co-pays) getting the new one so you'll always have a backup. If you don't like the new one, use the ResMed and provide that card for compliance--you may have to print out the compliance data if the new DME doesn't have ResMed software.

[moosie]

How does a Resmed compare to a Respironics c-Pap?

[Mark Sadler]

I had a Dreamstation ASV for six months and was never satisfied with the AHI score. It was all over the place. Went from 6 the lowest to 20. Kaiser in Oregon only uses philips (Dreamstation). I purchased an Aircurve 10 ASV and used the same setting as the Dreamstation and my AHI scores are between 1 and 4. For me the Resmed Aircurve ASV is Much better. Well worth the out of pocket money.
Get the doctor to give you the Aircurve!
My opinion

[Sheriff Buford]

Both machines are good machines. They have different algorithms (see!! I can use them there fancy words!! ), but both offer excellent therapy. It's like masks, some folks will swear one over the other. I have always used Resmed, but would love to give Philips a run for their money.

Sheriff

[Pugsy]

Respironics makes the DreamStation ASV which is comparable in functions to the AirCurve 10 ASV but it goes about doing its job quite a bit differently.

I wouldn't change brands...and I wouldn't let the DME force me to change brands just because they don't routinely stock ResMed machines.
The Respironics brand....the reason they want to stock it is because Respironics gives them a better wholesale contract price...they make more money off Respironics.
Insurance itself pays the same (by HCPCS billing code and not brand) so guess which brand they want to supply?

What I don't understand is why they want you to change after 18 months?
What kind of insurance do you have? Is it some sort of perpetual rental and you never own the machine?
Some Medicare Advantage plans are going to the perpetual rental....and a few of the other plans also had perpetual rentals.
Most plans though have a capped rental where after so and so months you own it and insurance payments cease and you don't worry about it until the machine dies some years from now.

If your insurance does have a perpetual rental where you have a monthly rental fee forever....get your doctor to write a RX and be very specific as to which brand and model and settings you are to use.
The setting choices on the 2 brands of ASV...not exactly the same....don't change brands mid stream. You are doing well with what you are using and no sense in upsetting things and risking not doing well.

Call up your insurance company and ask them about the perpetual rental thing or are they done paying for the machine after 18 months.
If they are done paying...there is zero reason to change just because the new DME only stocks Respironics machines because you don't need a new machine right now anyway.
Don't ever rely on information from DME as to what your insurance will do....get it straight from the insurance company.
DMEs are known to lie, mislead, cheat and/or just be incredibly stupid and not care.

[LinkC]

I've had (and used!) my S9 for 11yrs without a hiccup. And my first is in the closet, just in case.

[palerider]

I've had (and used!) my S9 for 11yrs without a hiccup. And my first is in the closet, just in case.

So, you had a pre-production model?

Considering that the first S9 was only announced to the public sometime in 2010, and the bilevel machines in may 2011.. you had yours a couple years before they were available..

What do they have coming out next?

[bwexler]

I have and own a Reperonics ASV and did just fine with it for 4 years.
I just bought a lightly used Resmed Airsense 10 ASV.
There is a dramatic difference between the two machines. I prefer the Resmed, but it is a personal preference.

As already mentioned talk to your prior insurance to determine weather you already own your machine. If you do conversation over.
If not talk to the DME who provided your Resmed and see what you can negotiate.

If all else fails have your doctor write a prescription for exactly what you want. I have done this many times.
Any doctor who would not do what I asked, would no longer be my doctor.