S9 Autoset prescription - example?

[yardbird]

Trying to anticipate resistance from DME and *possibly* insurance in my attempt to get an S9 Autoset.

Anyone got an example of how their script was written? I have an idea as to how it should be written but thought if there were any examples from folks who successfully got an S9 Autoset, it might be helpful.

I'm shooting for an S9 Autoset, H5i humidifier and I'm kind of "up in the air" about the Climateline hose.

Did anyone have to justify this specific machine to their insurance company? If so, what features did you cite that other machines don't have?

I am 100% covered for DME, so if these all get billed under the standard codes, I can't see the insurance company creating hassles, but.... ya never know.

I know the S9 Autoset is E0601
The H5i is E0562 ?
What code is the climateline tubing? I'm guessing A4604
And if they balk at the Climateline, does the slim tubing simply go out as "Tubing" code A7037? I know it comes with the S9, but I also believe they'll bill separately for it because I KNOW they want to charge me an "upgrade charge" for the S9 Autoset (which I won't be paying). If DME #1 gives me a hard time, I have DME #2 as a backup.

[Pugsy]

To avoid hassles if your doctor will order what you want, just have him write

ResMed S9 Autoset with H5i Heated humidifier and heated hose.
Mask of patients choice.

Dispense as written..checked....so no substitutions are allowed.
Keep it simple and clear cut.

[yardbird]

Thanks, Pugsy.

I just got a mask so that won't be on there, but the S9 Autoset is my goal

[Dazzles]

Please let us know how this goes. I'm shooting for the same machine!

~Dazzles

[Pugsy]

Adding mask option covers the bases for mask purchases in the future off of the new RX.

Without it there is the possibility of needing RX for mask in the future. Mask of patient's choice also opens the door for any brand or type of mask.

[yardbird]

Pugsy,

Understood regarding the mask, but my sleep doc is really great and has already said he'll write a script for whatever I need. I also have a mask script on file with our host so I can get one in a pinch whenever I need one.

Also, IF I got with this "convenient" DME, I'm going to get on a schedule of replacement parts and supplies and they actually request script from doc. My request to the DOCTOR's office is that I be advised of any request from the DME prior to a script being issued and they have no problem with that.

We'll see. I've been doing this on my own for several years because I hated having to work with sleezy DMEs. Hopefully I'll get hooked up with a good one. I am encouraged because the sleep doc is awesome.

[Pugsy]

It is good that you have a doctor willing to give you what you want easily.

I will leave RX wording as is for any new members who may happen to see this thread. It might be of help to someone else to have an explanation as to why such wording might be useful in regards to RX and mask.
Just in case someone else's doctor isn't so agreeable.

[SMenasco]

I suggest you also ask your doctor to write in the pressure settings, for example, "8 cmH2O - 16 cmH2O". This, along with the other recommendations, will cover all bases.

[apneawho]

My husband and I asked our doctor to write Autopap pressure 5-20 with humidifier, mask of patient choice, filters and tubing. His script or order says good for 99 years which means for lifetime. He was fine with this. We adjusted our pressure ranges ourselves with the help of members here. He is fine with that also.
The first DME we went to tried to pull the up-charge trick. Insurance didn't care what cpap machine was issued based on the E0601. We stood our ground and asked for referral to another DME who readily dispensed the S9 Auto that we wanted without any questions asked. Don't accept anything less than what you want based on your research.
We both have the climate line and love it. I would recommend getting it.

[yardbird]

Just an update:
CAlled DME #1 again just to be clear. Got that used car lot, sleazy salesman feeling that made me head off on my own 12 years ago.

Called DME #2: "Yes, we have that machine." ... "With your insurance it is 100% covered and we don't charge an upgrade fee. It's bad for our whole business when places do that when they KNOW they aren't supposed to."

So... called doctor's office. They are faxing over a script for the Resmed S9 Autoset with heated hose and heated humidifier. 8cm - 12cm and also sending a copy of the sleep study and a demographic sheet.

So.... forward progress I hope. Still remains to be seen if this will go smoothly

[Slinky]

Hey, there ARE good local DME providers out there (especially when they are aware you walked away from another DME provider) just as you've found there are good sleep doctors out there.

[yardbird]

Hey, there ARE good local DME providers out there (especially when they are aware you walked away from another DME provider) just as you've found there are good sleep doctors out there.

I had heard stories that there were good ones. I thought they were just fairy tales.
I like my sleep doc, but he gets at least a few mixed reviews. Our relationship so far has obviously just started, but I have hope. heheheh.... He'd like to see me in a year. Ok. When I called his office, they responded immediately and hopefully got it right. I hate to say it but the doctor's office, at this point, is simply a means for me to obtain prescriptions for equipment. I do expect the doctor to help me if I need help, but I'm guessing that anyone who has been on CPAP for over 12 years probably doesn't need a lot of help from the doc. I could be wrong.

Right now it seems I may have found a good DME..... no... a REALLY good DME. One with whom I can comfortably have a long term relationship. Right now it seems that the docs office generates the scripts for equipment and the doc may not even be involved at that level.

There's still a question of what my insurance may want since I just got switched over to this insurance when I got laid off in March. They have no record of me using CPAP equipment. It's at least a possibility that they may request a new sleep study (even though the doctor said I don't need one) or they may have some other hoops to jump through. It's all still up in the air.

We shall see what we shall see.

[yardbird]

DME called back. My insurance apparently won't replace a machine unless it's not working. The only machine I ever got on insurance was my first one. A Solo LX I received in Feb. , 2000. I had to call the doctor's office and ask if they could right a script that says replacement CPAP as current machine is overheating and shutting down and fax that over to the DME.

I can deliver the old Solo LX to them if they need it. It overheats eventually and shuts down. Not sure what other hoops I may encounter, but that's the latest progress.

Ain't this fun?

[apneawho]

Isn't it amazing you can pay your insurance premiums and yet have no benefit to replace an 11 yr old machine?

[yardbird]

Can't say I'm surprised. Used to be that doctors would order lots of unnecessary tests and probably did the same with equipment. I have a real problem with insurance companies dictating my health care, but...... it costs both the insurance company and the patients if they don't have some kind of policies in place to prevent waste. So in that sense, I'll ride along for now. This is a relatively new insurance carrier for me. We had to switch over to my wife's insurance when I got laid off from my university job back in March. It's good insurance, but we're new to them and they're new to us so there's bound to be some bumps here and there.

I also found out I have to wait until mid-January to get a machine because there's a "pre-existing condition clause" in the insurance. I wasn't even aware those were still legal. I can stay on my "borrowed" machine until mid-January and I guess we'll see what happens at that time.