I got my Vantage back!!!

drummergirl410 · Post by **drummergirl410** » Thu Aug 09, 2007 1:13 pm

I'm sure most of yo have read my posts in which I was ranting about the sitchuation I've had with my DME. Thankfully, this battle may be over... far from me to say it's the end of the war.

My RT called me pretty early this morning, after being informed of the emergency call I put in to my DME the night before. Perhaps it's just her personality but she still didn't seem to want to listen to me or for that matter believe that I had an actual problem. I leveled with her though and told her that the s8 Compact they left me with would NOT do the job and that if left at that, my compliance was going to be down the tubes (no pun intended ). I told her that the s8 Elite might work better for me because it does have the EPR function. She had never even heard of the machine, which really surprised me. She told me that she would talk with the doctor and see what could be done.

She called back maybe a little more than an hour later and was much nicer this time. She did say that the s8 Compact was what my insurance would pay for, but if I were willing to pay the difference, I could get either the Elite or the Vantage. She also told me the EPR on the Elite only makes a difference if your pressure is highter than 10, which mine was not. She claimed to ahve gotten this info off the clinical info on the Resmed site. We talked it over and I very quickly agreed to take the Vantage and pay an extra $150 for the next two months for a total of $300 out-of-pocket. It's a small price for me to have a machine that I liked and that works!

However, they still don't seem to be convinced that I require the auto feature. Right now the machine is set at my "perscribed" pressure of 7 with an EPR adjustment of 2, chosen on my own. The ramp time is now on 20 minutes. I did not use ramp before, so that's new too. I was shown how to change the EPR setting in case I felt like I needed to, which was much more than what she showed me last visit. What gets me is I had very little to no aerophalgia on the trial setting of 5/20. This surprised the RT because my presures were "for the most part higher than 7 on that machine". OK, so if the Auto setting TOTALLY cleared up the apneas, and it did.. I had no apneas and very few hypopneas... then I don't understand how I can only require a pressure of 7? I can understand them wanting to narrow the range a bit. 5/20 is as wide open as you can get. But why can't I just stay in auto mode with a range of 5/10 perhaps? that gives the machine some playable room to respond but is still a narrow enough window to work in.

I think a lot of it may have had to do with the quality of the machine. The Vantage when in auto mode "adjusts the pressure breath by breath for maximun comfort", quoted straight off of the Resmed website. I think this ability is what allowed me to be so comfortable on the machine and remain 100% compliant for the whole trial.

I'm going to give the new setting a try. I'll give it a night or two, maybe adjust the EPR and try again for a couple more nights and hope that takes care of the aerophalgia, which was my chief complaint. If this doesn't work I am going to insist that the doc. put me back in auto mode. I am paying for this feature, and if it makes me comfortable and aides in compliance, why in the heck should I not be allowed to use it?

Another advantage is that I do have full data again. I talked with the RT and told her that my interest in that isn't to self-medicate and I wasn't going to go bananas over the slightest change. However, I was glad that the doc. now has access to the data so that he can better inform me on how to plan out my therapy. An endocronologist wouldn't be able to accurately manage the therapy of a diabetic without some info on their insolin intake, etc. Why should this be any different? There are no Ronco CPAP's... you can't just "set it and forget it'! You can't determine a pressure and then just close the book on it!

Anyways, I'm much more pleased now than before! Onward to tonight!

geoDoug · Post by **geoDoug** » Thu Aug 09, 2007 1:31 pm

The insulin example is the best argument I've ever heard for a fully data-compliant machine. Why diagnose a person with diabetes, hand them a bunch of syringes, and then tell them to guess when they should give themselves a shot? That's essentially what a machine that only gathers compliance information is doing.

The other example I use: I take my blood pressure every morning and enter that info into Excel to keep track of the trend.

Doug.

Guest · Post by **Guest** » Thu Aug 09, 2007 1:39 pm

There are no Ronco CPAP's... you can't just "set it and forget it'!

Love that! I'm going to tell my doctor that one! I bought my own auto because my insurance doesn't cover DME of any type. I told him when I became a new patient that I had apnea and was on CPAP - he has never asked me a single question or scheduled any tests. I don't think he is aware of what apnea even is!

drummergirl410 · Post by **drummergirl410** » Thu Aug 09, 2007 1:42 pm

Thanks! That one just kind of came to me when I was thinking of comparisons to make between data/no data machines. Weird how somethng you've seen or heard years and years ago suddenly just "pops" into your mind at the most opportune time!

Guest · Post by **Guest** » Thu Aug 09, 2007 1:42 pm

I would be wary of agreeing to pay $300 for the machine.

I have forgotten if you ever said what you will pay in copay. But add that to the $300 and you may really not be getting any insurance benefit at all.

Call your insurance and check with them yourself. DMEs are notorious for trying to collect extra money for APAP. The difference that the DME pays for that machine I assure you is not $300.

$695 vs $825 on cpap.com and that comes with a hose and all the manuals.

Hopefully your total out of pocket is much less than $825 or the DME won

Guest · Post by **Guest** » Thu Aug 09, 2007 1:48 pm

Sorry, that last one was me, not logged in I guess.

Wulfman... · Post by **Wulfman...** » Thu Aug 09, 2007 2:16 pm

Anonymous wrote:I would be wary of agreeing to pay $300 for the machine.

I have forgotten if you ever said what you will pay in copay. But add that to the $300 and you may really not be getting any insurance benefit at all.

Call your insurance and check with them yourself. DMEs are notorious for trying to collect extra money for APAP. The difference that the DME pays for that machine I assure you is not $300.

$695 vs $825 on cpap.com and that comes with a hose and all the manuals.

Hopefully your total out of pocket is much less than $825 or the DME won

I agree. There's NO reason you should have to make up any difference. As has been stated in another thread, the billing code is the very same for the basic CPAP as it is for an APAP. Be sure you "do the math" before you sign your name to anything.

She'd never heard of the Elite?

BEWARE of the evil (and stupid) DMEs.

Den

JeffH · Post by **JeffH** » Thu Aug 09, 2007 2:35 pm

That poor 'ole straight cpap machine didn't have a chance in hell of working for you. You weren't about to cut it any slack.

JeffH...LOL

amandalee · Post by **amandalee** » Thu Aug 09, 2007 3:22 pm

If I were you I'd call my insurance company and tell them what the DME is trying to do.
It sounds to me like they are still jerking you around, and you should mention it to your insurance company.

I'm glad you are at least getting a decent machine.

drummergirl410 · Post by **drummergirl410** » Thu Aug 09, 2007 3:27 pm

Thanks, guys and gals, for all your help! You have all had to put up with me ranting and raving like a lunatic for two days! Bless you!

I tried to start off last night with an open mind. I did find a couple things I liked.. but when the aerophalgia kicked in, it pretty much closed it for me! The other quirks I didn't care for were just reinforcers.

I am going to check with the insurance, just to be sure. They asked me to go ahead and put the first $150 down, and I told them I would be able to do it next week, closer to payday. They agreed. The RT had me go ahead and write out the check and agreed to hold it for m so that I would not have to drive the 30+ miles to pay it on site. (I'm calling tomorrow to ask someone to REMIND the RT and follow up at the DME to be sure that is carrried out.) I haven't signed anything, save the packing slip that they have you do, saying the equipment is in youir possession. It is not the same as the other one they have you to sign when the insurance has officially kicked in. The one today was like the one I signed upon getting the Vantage for trial. The one I sighed for the Compact, which they thought was final, was completely different. If I do get wind of the insurance company telling me anything besides what I've been told already. it will be battle #2 with the DME!

Yes, I am proud of the machine... and will gladly pay the extra cash if it realy ends up coming to that.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): DME

RiverDave · Post by **RiverDave** » Thu Aug 09, 2007 3:42 pm

drummergirl,

glad you got your machine back.

Good Luck,

geoDoug · Post by **geoDoug** » Thu Aug 09, 2007 4:02 pm

Wulfman... wrote:She'd never heard of the Elite?

Yeah, at that point I would've turn tail and run.

Doug.

drummergirl410 · Post by **drummergirl410** » Thu Aug 09, 2007 4:03 pm

Thanks so much! Ypu guys are an AWESOME support system!

socknitster · Post by **socknitster** » Thu Aug 09, 2007 5:46 pm

I'm glad to read you got the right machine back. Be sure to follow up with your insurance--what if they pay the full amount of the machine and you pay too--those greedy dme's will get double--and that would be ludicrous indeed!

If I were you, I would set it at a tight range around the titrated pressure. You will need to be able to look at your data to see what that might be, but 7-10 doesn't sound unreasonable to me. You want to have the lower pressure for most of the night but have the machine be able to go up quickly to take care of any apneas that might take place, without going so high on pressure, out of control, and wake you up, which often happens with settings like 5-20. The gap is too wide. For me, tight ranges work exeptionally well. The best of both worlds and the reason why xpap'rs on autos are more compliant--you get to spend most of the night at a comfy lower pressure, but take care of problems as they arise.

congrats and I hope you don't end up having to pay that $300, no fair at all, but if you do, it is better than being stuck with the one they tried to stick you with. Good luck,

Jen

j.a.taylor · Post by **j.a.taylor** » Thu Aug 09, 2007 6:09 pm

drummergirl,

I'm glad that you got your machine back.

And I also would suggest checking with your insurance, just to double back on the DME. If the insurance company doesn't like what they hear, they can get things fixed very quickly.

I was given a Compact by my DME, and not made aware that there were other options. Mine seems to be a pretty good machine, unlike the one you described, but after I started using it, and discovered this forum, I realized that this machine would only measure my compliance, and I already know I'm being compliant.

Plus I have a good relationship with my Primary Care Physician, I asked him to refer me to a good place for a sleep study, so he already knows that I'll be compliant. He's a good enough doctor, that I generally take his advice, and an honest enough doctor, to refer me to someone else when the problem seems out of his league.

And since I never met the Sleep Doctor who prescribed my machine (only the evening and morning RTs who assisted me), I really want to make sure that I'm working closely with my PC Physician.

So I contacted my Insurance Company, and asked them if I can upgrade. I told them that I'm taking treatment for my apnea very seriously, and I want to be able to work better with my doctor in order to have the best treatment options available to me. If they have any questions, they can feel free to call him.

They said they'd let me know in a couple of days. So I'm waiting for the results, and that will then determine the next steps.

Mask

Additional Comments: Equipment isn't correct, S9 ASV w/H5i

Mask

Additional Comments: Encore Pro, Encore Pro Analyzer

Mask

Additional Comments: Encore Pro, Encore Pro Analyzer