My first DME experience

Mtnman · Post by **Mtnman** » Mon Jul 16, 2007 4:55 pm

I called four DME's today to let them know I wanted to use my Insurance to get my first CPAP set up. They all said I had to have a sleep study first. I told them that my doctor had me take a nite time pulse ox test and it clearly indicated that I have an issue (low O2 was 70%). Also that he said that my nasal anatomy is almost certainly the cause of my OSA. (nose broken in high school along with very narrow nasal passages). My doc wrote a prescriptin for a sleep study OR an auto titrated cpap. The DME's didn't budge, stating that without a sleep study, no CPAP. I also learned that their charge for a RemStar M series with c-flex was $1900!!! Cpap.com has them for under $600. So is it better to just order from cpap.com and pay for it myself? My deductible is $500 in network, and $1000 out of network which cpap.com would be. I'm looking at the Remstar M series with A-flex, a heated humidifier and a Nasalair II Mask.

Thanks for your input!

Babette · Post by **Babette** » Mon Jul 16, 2007 5:02 pm

First off, the machine you want is THIS:

https://www.cpap.com/productpage-advanced.php?PNum=2486

You want an APAP with AFLEX. Do not say Remstar with CFlex or you'll get a non-titrating, non data capable machine.

Just say APAP with AFLEX. It's proprietary to Respironics. No need to say Remstar. You will just confuse the monkeys and give them the opportunity to scr*w you.

Next, contact http://www.billmyinsurance.com and find out if they can work directly with your insurance.

Then call your insurance and ask them if they will accept a claim from you directly, for your purchase on https://www.cpap.com. Figure out which is easier and or better for you financially.

Now figure out how you're going to do the Mask Dance. If you don't buy the machine from them, most brick and mortar DME's aren't going to sell you a mask.

And after all that - keep yer powder dry and don't let the bay-ers et youse.

Cheers,
Barbara - Mountain Woman in WA state

Mtnman · Post by **Mtnman** » Mon Jul 16, 2007 5:12 pm

Thanks Barbara! I appreciate your input. Yes, I'm going to get (one way or another) the Remstar M with A-flex. If I'm going to spend the money, it seems liek the way to go. I also like to concept of the Nasalair II mask. I hope it works for me!

Babette · Post by **Babette** » Mon Jul 16, 2007 5:15 pm

Hope it works for you too! I've really found it great, but not everyone does like it. Keep me posted if the NAII isn't your dream mask - I might be able to take it off your hands, trade you, or put you in touch with someone for a trade.

Are you a REAL mountain man, or do you just wear the hat?

I'm up here in HBC country, http://www.fortnisqually.org

Cheers,
B.

Mtnman · Post by **Mtnman** » Mon Jul 16, 2007 5:21 pm

Yep, I'm the real thing. By day, I'm a corporate puke in Atlanta, but by night and weekend, I'm all Mountain Man. I live at 3000 feet elevetion in the north Georgia mountains, heat my home almost entirely with wood that I split, live miles from my nearest neighbor and about 45 minutes from a Walmart (now that's roughing it!), and I have to dodge bears and rattle snakes all summer.

Love my life except for this sleeping thing. I'm jazzed though that there may be an answer!

Babette · Post by **Babette** » Mon Jul 16, 2007 5:24 pm

OOOOOO!!! Now that's real! I just play one on weekends, and do the suburban hot showers and modern flush toilets during the week.

It's going to get worse before it gets better. My first six weeks after starting therapy were way worse than before I started therapy. Now it's much better, but be aware of that initial drop. Some people don't get it. Some people start feeling better immediately, then suddenly have a drop, then come back up again. It's very individual.

You have a good doctor if he/she is getting you this far. Best wishes!!!
B.

snoregirl · Post by **snoregirl** » Mon Jul 16, 2007 7:28 pm

You may find that the brick and mortar dmes and Bill my insurance hold the line on sleep study because your insurance co won't pay them without it.

You would probably pay a deductable for the sleep study and copay as well as a copay for the doc who reads the data. Then the copay on the overpriced machine... So if you don't want the sleep study and your insurance won't pay without it, you may still be money ahead to buy cash online.

You still may be money ahead if you by two or three masks and the machine online with no insurance...

jennmary · Post by **jennmary** » Mon Jul 16, 2007 7:40 pm

Are you flirting babette? lol kidding kidding.

Most insurance wont cover a CPAP without a sleep study. As my dr told me...."a lowered O2 could come from anything...maybe you twitch your finger at night and it skews the reading." yes I am serious. If insurance thinks they can get out of paying for something they will do it. And the DME knows that....so they wont even try to haggle with the insurance company.

MidnightOwl · Post by **MidnightOwl** » Tue Jul 17, 2007 12:48 am

Your insurance might pay to rent an auto machine for a couple of weeks for the purpose of getting a diagnosis. You'd still have to deal with the deductible of course. And I'm not sure that would work with a doctor who's not a specialist in sleep disorders.

Are you deductibles only for equipment or do they also cover all other medical costs. Mine is a combination deductible and I'd met it for the year before I got the CPAP luckily.

mno

blarg · Post by **blarg** » Tue Jul 17, 2007 4:59 am

If your doctor is a nice guy and you want less hassle, make an appointment to see him for a "consultation" but make it obvious that you just want him to call the DMEs and make his wishes clear. That way he gets paid, and you get your setup with minimal hassle. While he's at it, have him request a specific mask. It might be worth your copay if it's 20-40 bucks to just not have to spend hours on the phone with the DME to get nowhere.

Guest · Post by **Guest** » Tue Jul 17, 2007 6:37 am

This isn't really a DME issue, it's an insurance issue, as many others have stated already. Every insurance company that we deal with REQUIRES us to fax them a copy of the sleep study along with the RX. Missing one of those 2 items and we don't get paid.

GaCRT · Post by **GaCRT** » Tue Jul 17, 2007 8:24 am

mtnman, where in North Georgia do you live? Just curious as I live in the same area. Well I live in NorthWest Georgia mountains.

tomjax · Post by **tomjax** » Tue Jul 17, 2007 9:42 am

mtnman,
you bring back many pleasant memories,.
Back in my young and pretty days, I lived in Atlnata and tried to take off as often as I could to the N GA mountains.
It was the mid 70's and I had a VW THING. I filled it up with gas and TRIED to get lost,. Blue ridge, Hiawassee, highland and NC area.
I spent 2 years at NGC in Dahlonega. 58-60.
My accountand had a cabin I stayed at.
The last time I was up there it was totally destroyed with development.
So sad, but it sounds like you still have a nice place.

Tks for the memories]

tomjax

Babette · Post by **Babette** » Tue Jul 17, 2007 10:29 am

jennmary wrote:Are you flirting babette? lol kidding kidding.

Yes, but not seriously. I need another east coast boyfriend like I need more holes in my head... I swore after Mr. Montgomery, AL I would never do that again!!!

Blarg does not listen to my advice, clearly... Or maybe he does - since he MOVED!

LOL,
B.

My first DME experience

My first DME experience

Thanks

The real thing

mtnman