Advice on CPAP upgrade (S8 Escape II to S9 Elite)

[anonymoe]

Like so many other newbies on this forum, I'd like to thank everyone here for all the great information.

I was diagnosed last month with severe sleep apnea (75.5 AHI). My DME supplied me with a ResMed S8 Escape II and Quattro FX mask and I've spent the last 8 days learning what it's like to live with CPAP. I've never had a problem going to sleep, and the adjustment to CPAP has been going well. I find that I get a good seal when I go to sleep with the Quattro FX and have been feeling very rested most days. In 8 days I'm up to 63 hours of usage. I suspect that makes me compliant. I have woken up a few times each morning with slight leaks but can usually adjust the mask slightly to take care of the problems.

This morning though I think the leaks were worse. I suspect I went to sleep with the mask a little looser and it slipped as I tossed and turned. I overslept an hour and woke up thinking like "what happened?" By afternoon I was running on fumes.

This morning I decided what I really need is data capable equipment. On screen display of AHI and leak rate will help give me the peace of mind that I'm not sabotaging my treatment while unconscious and that my AHI is minimized. Without independent verification, I'm not sure if my apneas are really going away or how much leaking I'm not realizing is happening. As a software guy, getting access to reporting and data with the software is very appealing.

I called my DME and asked them about upgrading to the S9 Elite. The DME implied that I could go to the S8 Elite without much additional cost but that my insurance wouldn't cover the entire cost of the S9 and there would be a $300 upcharge including the heated hose. My question is, is this what I should expect from my DME/insurance company? I am willing to pay the difference, financially that won't be a burden, but I want to check with the community to see if this raises any red flags. Also, does anyone have any recommendations comparing the S8 Elite II and S9 Elite and whether the newer model is worth the out-of-pocket upcharge? Getting access to AHI and leak rate information on-screen without schlepping the card to the computer seems like a pretty big difference.

Another question, I see a lot of folks recommend the Autotitration devices. While my sleep doctor didn't prescribe an APAP, should I be requesting a S9 AutoSet instead? My pressure setting is currently 11, and after a week I'm not aware of any problems, under what conditions does one usually use an APAP instead of CPAP?

Thanks in advance for any advice. The journey to CPAP has been interesting. The silver lining is I've maxed out my high-deductible health insurance plan in early February, free health care for the rest of the year! Whoo whoo!

[Pugsy]

Take a look at what another member here Janknitz has compiled in her very informational blog about insurances and upcharges. I don't think would mind if I point you there since she has it in her signature. She explains it in great detail. If you have questions just post them and I bet she will be around and answer them.

http://maskarrayed.wordpress.com/dont-p ... -upcharge/

Regarding the Auto units. They are essentially 2 machines in one. It can be set in straight CPAP mode and it can be set with variations in pressures in the APAP mode. Some people do very well on CPAP, some people do better with APAP. Nice thing about the APAP is if for some reason a person wants to question their therapy it is easy to set a range and see what happens. Also sometimes a person might need one lower pressure most of the night and maybe a bit higher pressure for just short time. Using an auto will enable a person to possibly use the lower more comfortable number for the majority of the night and only need the higher pressure short term. So in general possibly more comfortable. They aren't for everyone though, but with the AutoSet S9 a person can always go back to straight CPAP.

Don't forget the software. Ask around if you can't find it.

[dtsm]

Generally speaking, most folks would recommend unit with at least these two features:

1. full data capability
2. auto adjusting [apap] and not just a straight cpap

I've got S8 autoset II which has both of above. This is no longer made but can be found via on-line sites. If S9 auto is an option for you, go for it! https://www.cpap.com/cpap-machine/resme ... chine.html

[Pugsy]

Forgot to add, get the S9 either Elite or Auto if software reports matter to you.
The SD card for software is easily read with card reader or computer SD reader.

The S8 Elite or Auto uses a completely different card reader that is next to impossible to locate.

The software works with either.

[sleeplessinaz]

If I were you I'd get the S9 AutoSet ---you can run it in straight CPAP mode if you want to. The Auto set is great and you can set it for a range of pressures---get the top of the line if you are going to have to pay that much extra for it!!!

Carrie

[Janknitz]

Before you go to "Don't pay that upcharge" on my blog, be sure to read "What you need to know before you meet your DME"

You need to first understand what HCPC's codes are (billing codes) and how to find out if your insurance company pays by billing codes (in most cases the answer is YES, but you need to call and find out for sure). While you're on the phone with your insurer, ask them if a DME is allowed to charge you an "upcharge" for an item when it has the same HCPCs code as a less expensive item. In most cases, the answer will be NO.

More than likely (unless you have an HMO type of insurance), your insurer has one allowable amount for HCPC's code E0601, which covers the dumbest brick of a dataless CPAP that the DME stuck you with in the first place (the Escape) and the fanciest most expensive APAP (the ResMed Autoset). And in most cases, it is ILLEGAL for the DME to charge you more for one E0601 machine over another. If not illegal, it more often than not violates the contract they have with your insurance company.

If you want to feel sorry for the DME that will have to take back a now used Escape to trade it out for a more expensive Elite or Autoset, remember they saw you coming with a big fat SUCKER sign on your head when you walked in and got the Escape and they are trying to take advantage of you AGAIN by charging you for the better machine they should have given you in the first place.

[anonymoe]

Thanks for all the advice, here's my update:

After the original discussion with my DME I had told them just to order the S9 Elite and I would pay the difference. After reading things here I decided I really wanted the Autoset, so I called my Doctor's office. They seemed clueless, and stuck by the "we don't handle equipment, contact your DME" line. The insurance company (a high deductible anthem plan/HSA) seemed to indicate the DME could charge additional amounts for upgraded equipment. That's fine, at this point, I'm willing to pay out of pocket for peace of mind that I'm getting the data I need to monitor my own treatment.

I called the DME and asked about the AutoSet. I was told "they cost 4 times as much and you don't need one"... surely they don't think I'm too stupid to notice the $50-70 price difference between the S9 Elite and S9 Autoset at online retailers... I'd gladly pay that difference.

But in the end, the DME tech who placed my order for the S9 Elite never called me back. Three days later, I'm torn between just letting the S9 Elite get in or insisting they re-order the S9 Autoset. Either way seems like a big improvement over the brain dead S8 Escape II. I definitely want to go with the S9, using a standard smart card rather than having to buy a special reader is attractive.

[avi123]

Thanks for all the advice, here's my update:

After the original discussion with my DME I had told them just to order the S9 Elite and I would pay the difference. After reading things here I decided I really wanted the Autoset, so I called my Doctor's office. They seemed clueless, and stuck by the "we don't handle equipment, contact your DME" line. The insurance company (a high deductible anthem plan/HSA) seemed to indicate the DME could charge additional amounts for upgraded equipment. That's fine, at this point, I'm willing to pay out of pocket for peace of mind that I'm getting the data I need to monitor my own treatment.

I called the DME and asked about the AutoSet. I was told "they cost 4 times as much and you don't need one"... surely they don't think I'm too stupid to notice the $50-70 price difference between the S9 Elite and S9 Autoset at online retailers... I'd gladly pay that difference.

But in the end, the DME tech who placed my order for the S9 Elite never called me back. Three days later, I'm torn between just letting the S9 Elite get in or insisting they re-order the S9 Autoset. Either way seems like a big improvement over the brain dead S8 Escape II. I definitely want to go with the S9, using a standard smart card rather than having to buy a special reader is attractive.

Hi, I am under Medicare rental. My DME first gave me the S8 Escape II. After a month I asked for a better data capable machine. They offered me a swap to the S9 Elite with no additional charge. I am happy with it b/c I don't need the S9 AutoSet which I could also get. My required pressure of 5 to 8 cmm H20 don't justify the complicated S9 AutoSet. Besides, I think that the AutoSet is dangerous if a naive newbie starts playing with setting the pressures on it. Most of the posters in this forum are in such a predicament.

Check this on Google:


Is CPAP Pressure Dangerous?

[scrapper]

avi123 wrote: Besides, I think that the AutoSet is dangerous if a naive newbie starts playing with setting the pressures on it. Most of the posters in this forum are in such a predicament.

Many, many members disagree with avi123's statement that the AutoSet is dangerous. Please see a recent thread where everyone was extremely clear on the subject:

viewtopic.php?f=1&t=60788&st=0&sk=t&sd=a

The S9 AutoSet II is a wonderful machine.....I have used both the S8 & the S9 AutoSet II. Both are excellent machines, the S9 AutoSet II with climate hose being my preference!

[Pugsy]

I think that the AutoSet is dangerous if a naive newbie starts playing with setting the pressures on it. Most of the posters in this forum are in such a predicament.
Check this on Google:
Is CPAP Pressure Dangerous?

Okay, for grins I googled it. First thing to pop up was from a supply house forum and second thing was from eHow.com. They talked about cpap, not apap. They said it FORCED air into the lungs. It is not a ventilator, it is an airway stint. Geez...

APAP's are NOT dangerous. I have used one for nearly 2 years and with my doctor's blessing because of my needs.
They are often used for titrations at home. Do we have to go through all this stuff again with your putting forth erroneous information? We will just come behind you and refute it. Keep it up and no one will pay any attention to anything you say because statements like this are so far off the mark.

[jabman]

I have been using the S9 Autoset now for almost 8 months with no problems, I love it.
I do not use it in the Autoset mode but in cpap mode, But as I have been loosing weight it is nice to know that if I feel the need to change my pressure I can. Thanks to reading on this site I know enough to not make big changes in the pressure should I need to change it.
I think that the Autoset would be a good investment for you but more importantly is a model that is data capable and I believe the S9 elite is.

[NancyAZ]

I just traded my S9 Elite for a S9 Autoset. The Elite is a great machine and I am sure that many people here are pleased with it. I just felt that the Autoset was a better choice for me. During my titration I never once moved from my back and I also never entered REM sleep. Before CPAP I only snored it I slept on my back. Therefore, after researching, I felt that I didn't need the same pressure all of the time. The Autoset allows for that. If you can get the S9 Autoset, go for it. Tonight is the first night I will sleep using mine and I can't wait to try it. Good luck!

Nancy

[scrapper]

I think that the AutoSet is dangerous if a naive newbie starts playing with setting the pressures on it. Most of the posters in this forum are in such a predicament.
Check this on Google:
Is CPAP Pressure Dangerous?

Keep it up and no one will pay any attention to anything you say because statements like this are so far off the mark.

Now this is the truth!