Another newbie ? about online DME's

[kkb]

Just a little background....went for a split night sleep study on 10/19..technician said definitely sleep apnea. I wore "headgear with pillows" (don't know brand I wore unfortunately) but did really well with it. Slept the remainder of the night with mask on and woke up feeling surprisingly well. Tech said I had 2 hours of REM sleep with mask on whereas I had zero without mask.

I've been reading, reading, reading on this forum about DME's and how most of them are just in it for the money, etc. and how I can buy online for so much cheaper. I've placed several calls to my insurance company (BCBS/GA) and unfortunately, I have a $2000 deductible, so the first $2000 is coming out of my own pocket, then after that 80/20 coverage. Of course it would make sense for me to buy online since I'm paying for it either way - with or without my insurance.

I've been seeing where apparently the Resmed S9 autoset is the top of the line machine and fully data capable, etc....if that's the machine that I buy, how do I learn how to use it without going to a DME? Or will I figure it out on my own? Also, how do I know which mask will work for me if I buy online? Or is that where the mask return policy comes in especially handy in case it doesn't work out so well? Or should i go to a DME and get them to fit me for a mask, but then buy it online? That would be a terrible thing to do to a DME I think...use their time helping me and then not buy from them.

Does nobody else have this problem or am i making a mountain out of a molehill?

Also, what about buying APAP off of Craiglist? Does anyone have any experience with that?

[Pugsy]

First....Sleep Study costs? Will they go toward your deductible or do you have a separate deductible for supplies?
If it goes toward deductible obviously will impact any other 80/20 charges.

You can buy off craigslist. I have done it but extreme caution is advised. It is easy to get burned. Best thing is local so you can see the machine. Often sellers don't really have a clue what they have. I have seen 15 year old machines listed as almost new with low hours and I wouldn't have one if they gave it to me much less pay more than retail costs of a brand new latest model. They seem to think value is related to original inflated DME cost.

Online purchases can possibly save you some money. Do the math. Also remember January is just around the corner and lots of insurance companies do a monthly "rent to own" the cpap equipment and January starts a new deductible.

The machine I use is APAP..full data...software easily available. Priced from our host here at cpap.com with humidifier for $635. ResMed machines are also very popular. Similar equipped ResMed APAP and humidifier is around $1100 to 1200... I forget exact amount. Software easily available.

Both are excellent machines.

DME would come in handy for quick mask exchange. I have DME for this only. I purchased my machines privately.
Out of pocket cost was a wash and I got what I wanted, when I wanted and without usual DME hassle. So a no brainer for me.

Do the math... sleep study costs part of the deductible or not? If monthly rent to own...January is a new deductible so don't forget about that. Also some DMEs are good and give you a good full data machine from the start. Others go the cheapo base model and fight kicking and screaming about giving you what you want. How much is that potential hassle worth to you?

[Emilia]

Go over the list of fully data capable machines on Janknitz's blog.... and also read her post on one's first meeting with a DME. Priceless info there! http://maskarrayed.wordpress.com/

I bought out of pocket because my BCBS/FL HMO would not cover a data capable apap at all....they only wanted to give me a brick. I went with the DeVilbiss IntelliPap with SmartFlex and have not been disappointed. We have a growing group of IP users now on the forum, and all seem to be quite happy with them. You can purchase a unit with the humidifier included for around $450. Our host site sells them as does secondwindcpap.com where I bought mine a little over a year ago.

You must do the math and find out what is covered and what your costs will be now and come January. Sounds to me, though, that buying online will be the best way to go. You probably can still use your BCBS for supplies. Mine still covers my mask, replacement mask parts, filters, and hoses even though I bought my own machine. Ask questions of them....get the full details of your policy.

[kkb]

When I called BCBS/GA...the person i spoke with wasnt' understanding my question or maybe I wasn't explaining it clearly. I asked her if they paid by HCPC code and she said that it would depend on what the DME set me up with what they would pay. And I said, no, that's not what I'm asking. I tried to explain to her that I wanted to know if it mattered WHICH machine I got...if the same amount of money was going to be applied towards my deductible...she kept saying that it depended on what kind of machine the DME set me up with and there was no way for her to tell me what the pre-approved amount was without knowing what machine the DME set me up with.

One of the DME's that my Doc referred me to called me back today and she said that they rent machines. I personally don't see "renting" a machine for 13 months if I'm paying for it..I'd rather just buy it outright. I found what I think is a pretty sweet deal on a ResMed S9 Autoset on Craigslist. The seller said it had been used 3 times.

One other thing...when I talked to my insurance co, they said that whatever I have applied to my deductible in the last 3 months of 2011 will also go towards my 2012 deductible, so that's a little bit of good news

[LSAT]

Many insurance companies require that you rent for 13 months and then you own the machine, The thought being the if you are not in compliance after 30-90 days they can stop payment on the rental. If they bought it upfront and you didn't use the machine they are stuck for the entire purchase.

kkb...You made a comment in your first post that said..."most DMEs are only in it for the money". Do you know of ANY business that is not in it for the money? Without profit there is no business.

[.mike]

I have bought a couple machines from craigslist.org and you do need to know how to set the machine and know what your buying. Often the seller don't know what they have. Usually they are willing to take pictures or read model numbers from the machine. The used market is very different than retail. I set myself a 100 or 200 limit and tell the seller that they should keep my name and number and if they can't get the price they want, call me back. I have the same problem as you, my deductible is 500 so I don't even turn it in.

[Emilia]

Be sure it is truly an S9 AutoSET that is for sale on CL. ResMed also makes an S9 Auto ESCAPE which is not data capable.... only gives compliance hours. You definitely need to invoke Buyer Beware when purchasing off CL, but some forum members have scored amazing deals that way. Just do the homework, ask for picture or model number, ask how many hours it has on it. If possible, ask to meet the seller at a public location so you can SEE it before purchasing.

[purple]

If your sleep study recommends a standard xpap instead of a machine that has really good high end exhalation relief, or a Ventilator, you might consider: PR System One REMstar Auto CPAP Machine with A-Flex

From our host: https://www.cpap.com/cpap-machine/respi ... -flex.html

A few weeks ago, our host site cpap.com would sell it for about $650.00 with humidifier. Click on the price link on the page. cpap.com has a deal with Philips Respironics for a discount price, rumor is that Resmed, (who build the S9 Autoset) will not offer discounts to cpap.com.

If you do buy from cpap.com, then call them on the phone to place the order to make sure you get all the discounts available.

While Insurance companies, like Medicare actually do a 'rent to own' for 13 months, a DME will usually not do that from an ordinary user, and I suspect, if you ask your insurance company, they will probably accept the receipt for the straight purchase.

My DME will accept $1300.00 dollars for any machine available, which is nearly the price of the S9 Autoset from an internet source. Having a DME is useful in that they should also provide advice, and to make it easy to try several different masks.

I can not say that the System One Remstar Auto CPAP with Aflex is better than the S9 Autoset as I have never used the S9 Autoset, some say that there is not a dime's worth of difference between the two machines. I almost bought the S9 Autoset instead of the PR even though my sleep doc prefers the Respironics machines.

Actually if the deductible is to be applied to your Sleep Study, you have probably already spent your two grand, and you might try the' brick and mortar' DME because of the cost savings. Beware that both manufacturers use similar terms in describing several completely different machines, some of which do not have the full data reporting capability, or an Auto Feature. Be focused on accepting only the S9 Autoset or the PR machine I just mentioned.

[gasp]

[quote="kkb"]I've been seeing where apparently the Resmed S9 autoset is the top of the line machine and fully data capable, etc....if that's the machine that I buy, how do I learn how to use it without going to a DME? Or will I figure it out on my own? Also, how do I know which mask will work for me if I buy online? Or is that where the mask return policy comes in especially handy in case it doesn't work out so well? Or should i go to a DME and get them to fit me for a mask, but then buy it online? That would be a terrible thing to do to a DME I think...use their time helping me and then not buy from them.{/quote]

To settle your ethical dilemma you could get the selected mask from the DME and then if you like the mask when you need a replacement buy it online. I use our forum hosts online store cpap.com.

[purple]

How to set machine. When you choose which machine, then come back here and someone can suggest the correct manual for it, altho the manual may be in the box for a new machine as well. Assuming you are comfortable doing computer type things. Well it is pressing buttons, but I know some older individuals who would never be willing to try and set their machine on their own.

Would your sleep clinic help you pick a mask? Many here say their Sleep Clinic was not very helpful at all, the sleep clinic which diagnosed me was willing to be helpful, and their people were very helpful.

While I think you still have the thirty days to return your masks to an online DME (at least some of them) it is inconvenient to to ship it back and wait, whereas a local brick and mortar might be a place you can drive to, and some are even more generous with sending one over with a person if it is an emergency, or shipping one before you return the first. While a lot of folks here have had bad experiences with DME, some DME's have been quite nice to me.

An RT can sometimes help you with how to control leaks, determine some little odds and ends, like humidity and such. That is the RT employed by the DME should be available to help you with that, as you can tell, a lot of them are not available.

[MidnightOwl]

While I think you still have the thirty days to return your masks to an online DME (at least some of them) it is inconvenient to to ship it back and wait,

At cpap.com you cannot do this unless you purchase expensive "mask insurance" first - at about 50 percent of the cost of the mask. I don't know about other online providers. The
ability to change masks (if your brick and mortar DME provides it) is an argument for going that way if you are a new user who doesn't yet know what mask will work. The mask used by the sleep lab for the study should be a part of the report if that mask worked well.

It's also worth keeping in mind that even if an insurance company does reimburse for online purchases it may do it very slowly.