new cpap user, picking dme, asking for s9/apap? help?

[bradb]

Hi everyone! I just have to say, I love this forum and the helpful, knowledgeable, experienced, and caring people that are here! Wow! I had no idea what I was missing.

I am a new xPAP user and just had my sleep study the first week of January, 2011 (was on a 2-month waiting list at the place my insurance would cover). Didn't know if I had OSA but my partner had told me I do stop breathing and gasp, and that my snoring is just atrocious. So I went in after doing a tiny bit of reading and told them that I hoped I wouldn't have to come back for another one since I am a poor college student and I don't know how much longer I'd have insurance, lol. Thankfully it ended up being a split study and they did both the observation and the titration. They had told me (after dozens of calls to different departments and back and forth from the insurance, physician patient billing, a 'financial counselor,' the sleep center, etc) that they'd be billing $5000, and my insurance negotiated discount was 35%, and that my deductible was $1000 and coinsurance after that of 20%, just for the polysomnography, and then the fees for the interpretation and consultation of treatment as well as the machine/DME itself and supplies. All I have to say is: thank GOD for me loading up my $3000 FSA and insurance because I feel like this would be impossible otherwise!!!

So cut to last week, I finally get to the consult with the actual doctor (sure, the sleep lab tech told me 'wow, you definitely have the apneas!'), and he tells me I have an AHI of 50.7, and anything over 30 is severe! Eep. He told me that the pressure that seemed to work the best in the titration study was 10 cm/H2O. And then scared me with all of the blood pressure stuff (mine's bad), heart probs (runs in my family), falling asleep driving (wait, you mean that doesn't happen to everyone on a weekly basis?), memory issues (wait, what was I saying), etc. He told me we're going straight to CPAP therapy and actually scared me a bit when he told me that he was worried having me go another 3-4 days without one. Anyway, that was Friday afternoon, and here it is Monday morning, and it's MLK Day and my insurance is closed so I won't be surprised if the person at the sleep doctor office is closed and won't be phoning in my script, let alone the DME providers which are probably also closed...

Anyway, I did a lot of research and found a very helpful set of posts telling me that I need to find out from my insurance if they pay by HCPCS codes (I think) and what they pay, if they specify the machines, all the fees, if they let me buy, etc etc. I know I'm leaving my job sometime in the next month or two so I want to buy if I can (not that that matters to the insurance), but if they only allow renting I guess I will have to just buy one OOP and see if they pay anything at all. I found out that I want something that is data-capable for efficacy and AHI info, I already knew I need the humidifier, and I really like all of the features and look and software capabilities of the ResMed S9 AutoSet with H5i (and I guess, ClimateLine, though I hear you have to tape it up or it can crack). Dr didn't say anything specific about APAP but he was nice so I bet he'd put it on the script if I asked, or I could just find another DME provider if they give me flak about APAP vs CPAP, since I have read on many sites/posts that they are the same treatment and codes and stuff.

My question is, I don't know how to go into this DME thing and ask for the ResMed S9 AutoSet... I'm afraid they're going to try to give me a $300 plastic pile of poop. Which I guess if I can't get exactly what I want, the world won't end, but considering how astronomically expensive this entire process has been, I should at least get therapy that (1) will be more likely to find success and (2) that I enjoy and like to use, and really those two things go hand in hand from what I have read. So I really want to get the S9 and I really want to go APAP instead of CPAP, because I won't be able to upgrade later if I don't have insurance anymore (transitioning to full time student w/part time job), and I am on a weight loss journey which I know will likely affect my pressure.

Thank you all for any advice you have in seeking out a good DME. I have a big list from my insurance to call but I am just afraid of them being put off by a customer coming up and knowing "I want this, this, and this." and not sure how they will respond to that. Again any advice is helpful I appreciate y'all!

Brad

[cflame1]

If you end up going OOP... make sure that you check online. Usually the prices online for OOP purchase are better than the price dealing with a DME OOP.

[wlhyatt]

I know the feeling.

My original visit to my family doctor was on November 3. He reffered me to a sleep doctor (luckily the only fully certified one in the area, there are others, but this one is the only one who is fully certified), and I had an appointment on November 22. He talked with me for a good hour and then said let's set you up with a sleep study. The sleep lab is across the floor in a big medical complex from where his office is, so we just walked over there. They set me up for a sleep study on December 3. I went in for the sleep study and got wired up and fell asleep. They came in at some point and put the mask on me and let me go back to sleep. Once the machine was on I slept like a rock for 2-3 hours. I felt great after I woke up but I wound up sleeping the rest of the day. So I waited for them to call me back, and it happened 2 weeks later. So I knew the kind of rest I could get, then I knew the rest I was getting and it was almost depressing. I got their call back and they wrote a prescription and sent it to the DME of my choice. Once the DME got the prescription they took 2 weeks (!) to get the machine in. I got my machine on December 30, 2010, and got to use it for a couple of days before going to work. At first I couldn't tell a difference, but then I went back to work and I could tell all the difference in the world.

Long story short, be patient, It is worth it. I know it is depressing waiting but the difference is amazing. I got lucky and got the right mask on the first try and have been 100% compliant from the first day, and after 2.5 weeks I have a nightly AHI between .1 and .4.

[bap40]

I asked my doc to write the machine prescription for the EXACT machine I wanted and I got it. He had no problem doing that for me but if your doc and sleep study are all one business it might not be that easy BUT ANY Doctor can write a prescription for the machine. In my case the sleep doctor was Not going to give me what I wanted since it would end up costing them more but my family doctor had no problem giving me a script for what I wanted. I ended up going to another DME also since the one connected with the diagnosing section had nothing but not so nice people especially since I didn't want the machine THEY wanted me to have.

[KatieW]

I can tell from reading your post, that you've really done your homework!

You mentioned the office "phoning in your RX". It would be best to have the written RX in your hands, so you can shop around. Also get a copy of your sleep/titration study.

I paid out of pocket for my S9 AutoSet, because my insurance has a very high deductible. I purchased from cpap.com (the host of this site), you can email or fax them a copy of your RX, or download a form for your doctor to complete, and it doesn't have to be your sleep doc.

I haven't had any problems with my cpap or climateline hose.

[Georgio]

My mother and I have had great success with this machine for the past 2 years (I would not hesitate to buy this unit):

http://www.cpapauction.com/auction-list ... -used.html

Good luck with your therapy.

[Janknitz]

Ask your doctor to give you a written RX specifying the exact machine you want and "mask of patient's choice" and have him write DAW (Dispense as Written) on it. That should make any DME know that it's not going to be able to futz around with you (it should, but it won't). In any case, you won't have to play games like "you need to qualify for that machine" or "your prescription is not for that machine".

Good luck, sleep well.

[jbn3boys]

I I got lucky and got the right mask on the first try and have been 100% compliant from the first day, and after 2.5 weeks I have a nightly AHI between .1 and .4.

You are now the envy of MANY people on this forum! While I have been 100% compliant since say one, I have NEVER had AHIs that low, ever! I've been below 3.0 only 4 times in nearly 5 months.

bradb, I'm going to be a voice for the minority here and say that you don't HAVE to get the S9. You DO want to get a fully data-capable machine, but the S9 is not the only one. I had done some research here also, before I got my machine, and was convinced I needed the S9. I called around the some of my local DMEs, and none of them had the S9. The last one I talked to (because I decided to go with them, not because they were the last choice) actually talked to me for a bit about the differences between the S9 and the PR System One (which he carried). Because he had been the only one who took the time to actually TALK to me, and because this same DME had been so wonderful with my mom as she was on hospice during the end of her battle with cancer, I decided to go with this DME, and subsequently the PR System One. I can say that I have had NO regrets at all! I know that the S9 seems to be the "be all end all" of machines, the one that everyone either has or wants. But to me, I am very happy with my PR S1. As long as you get the software for whatever machine you get, you should be happy.

I also had my pcp write my script for an "auto cpap" machine. Come to find out, my DME only carries auto machines. If the script is written for a cpap pressure, they use the auto machine in the cpap mode, but they still give you an auto machine. I really do love my DME!

[rested gal]

I can tell from reading your post, that you've really done your homework!

He sure has, hasn't he?!
Welcome to the forum, Brad.

ANY Doctor can write a prescription for the machine.

Right. It doesn't have to be a prescription from a doctor certified in "sleep medicine." A family practitioner can write the Rx.

Ask your doctor to give you a written RX specifying the exact machine you want and "mask of patient's choice" and have him write DAW (Dispense as Written) on it.

Good advice from Jan.

I'd have the doctor write out the prescription this way (if the doctor is willing to write it for an autopap:)

ResMed S9 Autoset CPAP @ 9 - 15 cm H2O
heated humidifier of patient's choice
heated or non-heated tube - patient's choice
mask of patient's choice


If the doctor insists on the prescription being for "CPAP" treatment (not autotitrating treatment) an autopap Rx will still provide exactly the kind of treatment the doctor wants you to have. He could write it this way:

ResMed S9 Autoset CPAP -- set for CPAP operating mode @ 10 cm H2O
heated humidifier of patient's choice
heated or non-heated tube - patient's choice
mask of patient's choice


OK, here I go... here's why I'd have a doctor write out all those "patient's choice" things:

The mask is obvious -- to let you choose what mask you want, rather than having to accept whatever mask the DME wants to give you.

heated humidifier of patient's choice:
If a person gets a separate heated humidifier instead of the "integrated" humidifier the DME would normally provide with the machine, you'll have a much more versatile humidifier.

You'd be able to use the separate humidifier with any brand/model of machine. In the future should you happen want to get a different brand of machine to use for travel, as a backup machine, or as a second machine in another room of the house, you would not have to buy yet another integrated humidifier to go with the different brand of machine. Your original "separate humidifier" would work fine with the "other brand" second machine. But if you accept an integrated humidifier right from the get-go, that integrated humidifier won't work with "another brand" of machine. You'd have to buy another "integrated humidifier for the other brand machine.

For a separate heated humidifier, I'd suggest getting a Fisher & Paykel HC 150 heated humidifier. It comes with a short (sturdy, not flimsy) connector hose to connect the humidifier to the CPAP machine.
______________

heated or non-heated tube - patient's choice
If rainout becomes a problem and something as simple as a fleece hose cover for the main air hose didn't take care of it, I'd then buy a "separate" heated hose (or a Repti heat cable to use with a standard hose) and avoid possible disappointment with the durability (or lack thereof) of the S9's integrated climateline hose.

Again, going "separate" for a heated hose will give you a hose than can be used with any brand/model machine -- with the S9 as well as with any other brand of machine you might purchase in the future.

__________________

All that said in favor of separate humidifier and separate heated hose, there are a few good things to be said for accepting "integrated" equipment:

Integrated equipment is what the DME is used to giving out. Less standing one's ground to have to do. "No, I don't want the integrated ResMed humidifier, I want the F&P HC 150 humidifier -- the prescription said 'heated humidification, my choice' and that's the humidifier I choose."

Accepting what the DME wants to give you as a heated humidifier is the easier route. Should you ever change to another brand of machine in the future, you can always buy the separate F&P HC 150 humidifier then, if you want to. Or buy another integrated humidifier for the second machine.

Another plus for accepting "integrated" equipment... if you have the integrated humidifier for the S9, the matching machine/humidifier will look spiffier on your nightstand.

Footprint-wise, the amount of space a separate F&P humidifier takes up compared to an integrated humidifier that is attached to the side of a CPAP machine is practically the same. And... if a person has a nightstand with an shelf below, it's often possible to set the separate F&P humidifier down on the shelf with its little connector hose running up to the machine, and have only the S9 CPAP (autopap, whatever) up on the table. Giving more room on the top surface of the nightstand.

Some would say that an integrated machine/humidifier is handier to pack for travel. It is, but with not enough savings in space to be a factor for me. When I've packed for trips, my separate F&P humidifier and its little hose takes up very little extra room beyond what any brand of machine's integrated humidifier would anyway.

LINKS to discussions about the Aussie heated hose or Repti heat cable - to prevent rainout
viewtopic.php?t=5305

[chunkyfrog]

Welcome, bradb, and in case you don't know already, Resmed has TWO S9 auto's--the Escape auto and the fully data capable Autoset.
You do NOT want anything that says escape on it--their cost difference is only about $50. Please do not let them fool you--as some will. best wishes. Frog

[bradb]

Aww, thank you all for the responses and well wishes and great info. I love this forum!!!!

So I have a mixed bag to report:

Today, it was MLK Day, so my insurance company (United Healthcare) was closed.. boo. But that ended up being fine because I found enough data around here that UHC pays on HCPCs (E0601). After I called about a half-dozen DME suppliers I had found everything I had read on here to be true... they don't like you to ask questions, they DON'T like data-capable machines, and they absolutely do lie and say crazy things. I work in insurance, so I know when they say things like "well, the insurance companies don't *like* to pay for extra things" that they are either being lazy or just lying--either the insurance company pays for it or doesn't, though that doesn't stop them from supplying the machine I am requesting! But anyway, of the five or six places I called, two were clueless, one was rude, one told me that he'd have to call me back and never did, and several of them were very salesperson-y, and when I started to ask questions they would try INCREDIBLY hard to divert my attention or avert answering, and when I'd press them for specifics they would seem very put out or too busy to talk to me. These DME places.. ugh. They would really talk to me like I'm stupid or crazy, and then when they'd get a whiff that I was a bit of an informed consumer, they would be very put off and try to take the superiority route. One lady even commented that "well, you can't believe everything you read on the internet." Oh really - and I should believe what YOU tell me, lady?!

Then halfway through the day I get a call, thinking it was one of the DME places I had contacted, and it was another one.. a local mom and pop type of place that my sleep doctor had apparently referred me to. I told them I really wanted the S9 (didn't beat around the bush), needed the H5i, and I wanted the Elite or Autoset preferably. Well, they only had the Escape but they do order the Elites, and they tried the whole "well auto pap is a different therapy and these sleep doctors are VERY particular so yeah, we won't be doing that" and I sort of just tabled the discussion when they told me they'd be willing to give me the S9 Escape now, and then when they order next, they will let me get a different one and return the Escape with no restocking fee. That's a great bonus, they will take back a used machine? Sure, I'll take the Escape for now. (The guy later made comments about 30 days, and believe you me, I will be watching the calendar on this one.) The only negative part is that they insisted their contract with UHC meant they could bill be for the "upgrade" to the Elite or Autoset. I don't know if that's true. But on the other hand, he said it would be $100, which I guess isn't that bad. Also, he found out that UHC is willing to purchase the machine and implied it was due to my severity, so I didn't even have to worry about the renting conversation. Woohoo!

He made me take home a standard (non-slimline) tube and told me that if I get rainout, they can get the ClimateLine for me. He said that "almost no one" has to get a heated tube.. not sure I believe that. He also told me that he gets "about 1 customer a year that asks for a data-capable machine like you are" and that's why he only had the Escape.. riiight. Considering in the 2-hour nap I had with it I already had rainout, I will be going back to either exchange the tube or buy another one that's a ClimateLine. I also upgraded to the Mirage Gel Nasal mask, which is seriously amazing and a way better feel and fit than other masks I tried. And they charged me $30.

So, I walked out with an Escape (no data, and not autoset), when I said I wouldn't, I am going to have to pay some upgrade fees for the machine/mask/tubing, and I didn't get the heated tubing... but, I have a CPAP *tonight*, and I can exchange/upgrade it with no restocking fee, and they're willing to at least give me the Elite, though I am still going to insist for the Autoset (especially if they are willing to upgrade to the Elite, why wouldn't they?). Again a mixed bag but at least I am starting therapy and I found a DME that wasn't rude, pushy, or going to ignore me (which, apparently, is tough to find!). And, I am really stoked about this, I am purchasing not renting. So all I'll have to worry about are my 3- and 6-month supplies, down the road. And for that I have the internet!

Thank you again for all of the help and guidance. I am not going to give up and keep this Escape... I want data capability, and I want an autoset.

Oh! And a funny thing. I brought my laptop in the DME place with me, and I had this forum up, UHC's benefits info, and the manuals downloaded etc etc just in case I needed to refer to them with any questions during the discussion... didn't end up having to, but he commented on it. When I said I wanted the data-capable Elite, he said two things: that I wouldn't be able to get the software because it's not sold to consumers, so I'd "have to get a bootleg copy" with a smirk on his face and looked at my laptop. I just smiled and said "Yeah, I know." Lol!

[rested gal]

I love the way you tell your story, Brad.

You've got the right attitude and determination. And you've done your research to a T.

From what I've read here on the board, Mom and Pop DMEs are often the best. Usually more cooperative than the big chains about trying to please the customer.

[bradb]

Thank you Rested Gal. You are so nice.

As a note, I had my first night with the CPAP last night and I don't recall waking up or anything... I do have a bit of a sinus headache today though so I think I'm gonna loosen my mask tonight, and I washed all of my tubing and mask and humidifier tub just in case it was some type of chemical residue that did it. And I had a "clop clop" sound that kept me up for a while with rainout so I called to ask for a heated tubing and after insisting that I didn't have the humidity too high and that I couldn't put the CPAP in a warmer place etc, the guy said to try it for a week with humidity off (passive) and I said "Well, I saw on the internet where I can order my own heated tube. Should I do that?" And his response was asking me what time I could come pick it up - LOL. I think these people are just sales guys and they couldn't care less about giving better treatment.

Going to give it a few days (the guy seemed annoyed w/me) and then try to call back again to get them to order the Elite or preferably the Autoset.

[bradb]

I just wanted to update that eventually I got my S9 Elite (gotta update my sig) and Climate Line, and he wouldn't budge on not giving me the AutoSet without a script that said so (even though I know that is wrong)... I insisted so many times that I just gave up because I didn't want to push my luck and I just got tired of fighting. Overall even the best DME I could find was still basically an a-hole. Sigh.

But I have the Elite, I guess. And last night, it recorded an AHI of 2.8. Not bad!

[Janknitz]

Brad,

All that great research and homework, and they STILL snookered you out of $100 with what is most likely an illegal charge. They just wear people down. You are knowledgeable and assertive. Think of what they must get away with when less sophisticated people walk in their door. Makes my blood BOIL!!!!!!

In any case, at least you are happy with the machine and getting good results. I'm glad you're getting something for your money.