Newbie trying to get equipped

[hankbrandenburg]

I recently finished my sleep study and the Dr. sent my prescription directly to a provider that want to rent me a machine they have already picked out. While my insurance covers some of it I will still be liable for some initial fee and a recurring monthly fee while using the machine. I have no problem paying as needed but it bothers me on two fronts: (1) they already have a machine picked out for me without meeting me or discussing it, and (2) the idea of paying an on-going rental for something that perhaps I could purchase outright.

Soooo, am I off base here? I am thinking that with my own prescription in hand I could pick out and purchase my own machine. Does this make sense? Any feedback is welcome; I am very new to this.

I've scanned the newbie post area but didn't see anything.

[Janknitz]

Take a careful look at "What you need to know before you meet your DME" by clicking on the link in my signature.

Most important:
1. You should INSIST on a data capable machine with EFFICACY data.
2. You should not sign anything or agree to anything without first understanding how your insurance covers and pays for the equipment.

If you are on Medicare, you have no choice but a 13 month "capped rental". At the end of that time period, the machine is yours. Medicare pays by billing codes (HCPC's codes), so you are eligible for ANY CPAP or APAP machine--they all have the same billing code E0601. Make sure that you get the machine you want. The fanciest best top of the line APAP will cost you not a penny more than the cheapest, junkiest, old brick with no efficacy data.

If you are not on Medicare, be sure you call your insurance company before ever talking to the DME. DME's will lie and try to redirect you to maximize their own profit over your comfort and success.

[rested gal]

Jan's excellent What you need to know before you meet your DME is probably one of the single most important things you can read when prescribed "CPAP."

To help you sort out the names of machines, here's a link to my list of machines that record "full data" (AHI and leak info) and those that don't -- updated February 2011:
You'll want a machine that can record leak and AHI info. The ones in blue do that; the ones in red do not:
viewtopic.php?p=307168#p307168

Of the brands most commonly given out by DMEs, don't accept any machine that has the word Plus or the word Escape in its name...IF you're interested in monitoring (for AHI and Leak data) how your therapy is going.

[Kahfree]

Take a careful look at "What you need to know before you meet your DME" by clicking on the link in my signature.

Most important:
1. You should INSIST on a data capable machine with EFFICACY data.
2. You should not sign anything or agree to anything without first understanding how your insurance covers and pays for the equipment.

If you are on Medicare, you have no choice but a 13 month "capped rental". At the end of that time period, the machine is yours. Medicare pays by billing codes (HCPC's codes), so you are eligible for ANY CPAP or APAP machine--they all have the same billing code E0601. Make sure that you get the machine you want. The fanciest best top of the line APAP will cost you not a penny more than the cheapest, junkiest, old brick with no efficacy data.

If you are not on Medicare, be sure you call your insurance company before ever talking to the DME. DME's will lie and try to redirect you to maximize their own profit over your comfort and success.

I have a question too....

When I got my machine in January it was right from the DME who works along side the doctors. I was given the F&P Premo Icon, which is not a cheep model, the heated hose, etc, all those things. The total price, with mask was $1,295 of which I put down $300.00 and was told that I was paying on a "rent to own" type thing and that in 9 months it would be paid off. All I pay goes to the deductible for my insurance. (I had not met it on January 10th for the new year) Did I pay too much? Am I currently paying too much? Am I better off turning it back in and buying a machine of my own? I would lose the $300 I assume, so off the top I am already adding $300 to the sale price of a machine I would own.

Curious if I got ripped off.

[Pugsy]

I was given the F&P Premo Icon, which is not a cheep model, the heated hose, etc, all those things. The total price, with mask was $1,295 of which I put down $300.00 and was told that I was paying on a "rent to own" type thing and that in 9 months it would be paid off. All I pay goes to the deductible for my insurance. (I had not met it on January 10th for the new year) Did I pay too much? Am I currently paying too much? Am I better off turning it back in and buying a machine of my own? I would lose the $300 I assume, so off the top I am already adding $300 to the sale price of a machine I would own.

https://www.cpap.com/productpage/fisher ... chine.html

$795 at our host, haven't looked anywhere else.
Add in the price of the mask. It is close, plus there is that "service" that some DME's do provide.

Weren't you wondering about getting a different type of machine?? May have been someone else.

Close one on the money thing especially if this satisfies the deductible and you will benefit greatly from having the deductible met.

[Wulfman...]

I recently finished my sleep study and the Dr. sent my prescription directly to a provider that want to rent me a machine they have already picked out. While my insurance covers some of it I will still be liable for some initial fee and a recurring monthly fee while using the machine. I have no problem paying as needed but it bothers me on two fronts: (1) they already have a machine picked out for me without meeting me or discussing it, and (2) the idea of paying an on-going rental for something that perhaps I could purchase outright.

Soooo, am I off base here? I am thinking that with my own prescription in hand I could pick out and purchase my own machine. Does this make sense? Any feedback is welcome; I am very new to this.

I've scanned the newbie post area but didn't see anything.

That's what I did. I purchased all of my equipment from CPAP dot COM......then I made out an invoice and billed my insurance provider and they reimbursed me for 80% of it (because they considered me to be "in-network"). I checked with them beforehand to see if they would do that, but even if they wouldn't have, I was prepared to purchase all of my equipment out-of-pocket so I wouldn't have to deal with a local DME.
The horror stories of users getting shafted by DMEs abound on these forum pages. Try to avoid being a "statistic".


Den

[Pugsy]

it bothers me on two fronts: (1) they already have a machine picked out for me without meeting me or discussing it, and (2) the idea of paying an on-going rental for something that perhaps I could purchase outright.

My first DME did this to me. Called me to tell me they had the order and they had ordered the machine (most basic F&P) and would let me know when it arrived. No bother to talk to me beforehand. After some discussion about the machine I told them I didn't want that one that I wanted another brand and model. They flatly refused. I fired them and got a different DME for masks and such. Bought my own machine so that I could have what I wanted.

My insurance is similar to Medicare's 13 month rental to own. My cost out of pocket for the machine was actually a little less than my co-pay each month times 13 months. So I actually saved money and got what I wanted without the hassle. Second DME told me they would have ordered what I wanted but by then I had my own machine.

[Lizistired]

[quote="hankbrandenburg" ]
Soooo, am I off base here? I am thinking that with my own prescription in hand.......[/quote]

That's the most important part. Go get your prescription and the full study reports. Shop for your own DME.
Did your Dr ask you which provider to send it to or did they just pick for you?

[hankbrandenburg]

Did your Dr ask you which provider to send it to or did they just pick for you?

Yes the Dr. just picked this DME for me. I have requested the prescription be sent directly to me and have not heard back yet. In the mean time I'm going to call my insurance company and and continue to study the vast knowledge base that is cpaptalk.

[Lizistired]

I told them I would pick it up, but that was when they asked where I wanted it faxed, so I didn't have a problem. It was the whole packet including the condensed graphs from both studies. You really want that information.
Get it and make copies before you give it to anyone. Then shop for a DME.
That's like having the bank send your loan check to the car dealer of their choice before you ever visit the lot or pick out a car.

[Slinky]

... That's like having the bank send your loan check to the car dealer of their choice before you ever visit the lot or pick out a car.

GREAT analogy, Liz!!! One to keep in mind along w/the apnea/diabetes "treatment" comparisons.

And Hank, you are way ahead of the game already. Your instincts were so right on! If only more "newbies" had your instincts when encountering the sleep medicine profession!!!

[hankbrandenburg]

Hi All,

MANY THANKS for all the advice here! I finally got a copy of my prescription and here is what is says:

CPAP at 10 cm
Medium Respironics Comfort Gel Mask
Heated Humidification & C. Flex
DX OSA (or OSH)

I'm thinking the ICOM Premo CPAP would be a good choice but I do welcome any input available. Right now CPAP.com is out of stock so I'll have some time to consider this.

[Pugsy]

Are you going to be wanting the software for that machine? If so do you have a source for the software? InfoSmart software I believe it is called. If you want more than the data on the machine screen, I would be looking to see if I could find the software.

I can't comment on the machine itself as I have never used it. A few others here do use this machine and I think I have see frustration about not being able to find software. Though they love the machine.

I think that "Smart Stick Software" showing on spec page is some sort of music thing. Not the report software. Someone please correct me if I am wrong.

Just curious, what made you interested in this machine?

[cflame1]

hank... I wouldn't recommend the ICON as you'll have problems getting software for it, plus there isn't a FLEX on it.

Recommend you stick with either Resmed, Respironics (PR S1's) or DeVilbis

[hankbrandenburg]

Thanks for the feedback, and that brings up another good question: Do any of the preferred manufacturers supply software for a mac?