Fight or give in?

[goldmantx]

Ok, long time lurker, first time poster.
A little about me - I have had sleep apnea for at least 16 years now and I mostly let it go untreated for 13 of those years bc of many failed attempts and my stupidity for not realizing the long term effects this would have on my health and mind.
I read an article a little over 3 years ago that scared the $hit out of me and got my butt in gear to get his treated. My main issue when I tried many years ago was that the mask would end up anywhere but on my face and I would do that in my semi-sleep state. When I tried again, I had problems with mouth breathing and couldn't get that solved so gave up again.
When I got the scare, I decided to take a different tack and not go through an ENT but a Sleep Dr (Pulmonologist).
I started on my current quest a little over 3 years ago and have been 96% compliant with my current non-data capable machine and Swift LT mask(except for the occasional camping trip, my machine has been my companion). Has it solved all my problems, no. Not completely.
I still feel tired and never feel well rested but I do feel it when I fall asleep without my mask/machine on, so I know it is helping. Have been back to the Dr. several times and we have done a follow up sleep study and my pressure hasn't changed at all (11 btw). I have sever OSA and he tells me at 11, they reduce the apneas to almost none. He has suggested I try provigil but it gave me headaches and I didn't like the feeling when on it.
I am now eligible to get a new machine (at my expense of course) and have decided that getting a fully data capable machine will provide me with clues that might help me in figuring out why this is helping me more.
We decided on the Resmed S9, so he wrote a scrip and this is where my struggle begins.
He did not specify the S9 Autoset, so they would give me the S9 elite. I am working on losing weight and tryign to get healthier in general so I know my stats will change. I was trying to future proof bc I am paying for most of the machine as a result of a high deductible. I have asked the DR. to rewrite the scrip to specify the Autoset but he doesn't think I need it. I agree, I don;t need the Autoset now but again, trying to future proof. Oh, yeah the price is the same for both machines through my DME.
So do I keep pushing the Dr. to get the Autoset or just get the Elite and hope I don;t need those capabilities later on?

Thanks in advance!

[archangle]

Do you have insurance? If so, find out what DMEs are in network for your plan, and ask another DME if they want your business.

If not, order from cpap.com, our beloved host for this bulletin board. Or shop other local DMEs.

The S9 Elite is an excellent manual CPAP, though. AutoSet is worth the small extra cost.

[Xney]

An Elite is fine for CPAP. You may want to shell out for an Auto even if you have to pay the difference - it just gives you more options. Not a lot more $$

[xenablue]

Fight - you can use the auto as a straight CPAP, but still have the option (for your future possibilities).

Cheers,
xena

[2 B Sleeping Soundly]

fight, Fight, FIGHT!

“One of the most difficult things everyone has to learn is that for your entire life you must keep fighting and adjusting if you hope to survive. No matter who you are or what your position is you must keep fighting for whatever it is you desire to achieve.”
George Allen (1918-1990); American Football Coach

[grillhead]

If the price is the same for both machines then by all means fight to get the Autoset. You said

He did not specify the S9 Autoset, so they would give me the S9 elite.

Are you assuming they would give you the Elite or is that what they told you?

[chunkyfrog]

My husband's apnea is largely positional--nearly all his events occur in the supine position.
He would have never been compliant with straight CPAP--the pressure took his breath away.
Now he only gets higher pressure when he actually needs it--and is compliant and comfortable.
I bought my Autoset after using my Elite (also a good machine) for 8 months.
Either one will give you efficacy data, including waveform.
Many APAP owners use the machine in CPAP mode, because of comfort--but they don't HAVE to.
My Autoset only cost me $853 from cpap.com,
and it revealed the fact that I had been over-titrated by the sleep lab by 2-4 cm.

[goldmantx]

Wow, thanks for all the quick replies!

@archangle - I have insurance and I am going through the DME and largely they have been trying to help me. And to clarify, I have a $1500 deductible and I have only paid $431 of that this year so far. So apparently the machine cost for either one is $753 with a new mask and hoses and humidifier.
What they won't do is give me the Autoset without it being explicitly written on the prescription by my Dr. I have called the office several times (it costs me $50 every time I go in to see him) and I am not sure if the message that he is receiving is clear enough. I stopped n today to talk to the women who is in charge of ordering the machines. I explained the situation and she (hopefully) understood. He told her I didn't need the Auto but I am not sure that he understands it can be used as a straight CPAP.

@grillhead - No, no assumptions. The DME told me they have to have the prescription for the Autoset or else they had to give me the Elite.



It's more my Dr. I need to convince. If I have to go see him in person to have the discussion, is it worth the $50 to fight for the Autoset (that's the main question I guess).
The reason I am fighting to get this machine is that I suspect I have some major leakage issues or position apnea problems that were not seen in my sleep study (who can sleep on anything but your back with the 100 wires and electrode taped to every orifice of your body anyways!)

[archangle]

@archangle - I have insurance and I am going through the DME and largely they have been trying to help me. And to clarify, I have a $1500 deductible and I have only paid $431 of that this year so far. So apparently the machine cost for either one is $753 with a new mask and hoses and humidifier.
What they won't do is give me the Autoset without it being explicitly written on the prescription by my Dr. I have called the office several times (it costs me $50 every time I go in to see him) and I am not sure if the message that he is receiving is clear enough. I stopped n today to talk to the women who is in charge of ordering the machines. I explained the situation and she (hopefully) understood. He told her I didn't need the Auto but I am not sure that he understands it can be used as a straight CPAP.

Call the insurance and find out what local DMEs are in network. That gives you more negotiating power.

If the prescription says S9 CPAP, they can issue the AutoSet, they just have to set it to the manual pressure the doctor specified. A different DME might be willing to do it just to get your business.

[Lizistired]

Call the sleep lab and get copies of your complete reports with condensed graphs and your prescription. Make a copy to keep for yourself. Then go shop for a DME that will give you an Autoset.
OR, do a forum search for member "mcdover" and see if he has a slightly used one and buy it out of pocket.

[goldmantx]

@archangle
I have a listing of all the DME's. I think it is an issue with the insurance company as they are very willing to sell me the Autoset but I think I was told that it has to meet the minimum specifications on the prescription, so if they dont specify, then they have to issue the Elite.

Thanks for all the advice. I have sent mcdover a PM.

[archangle]

@archangle
I have a listing of all the DME's. I think it is an issue with the insurance company as they are very willing to sell me the Autoset but I think I was told that it has to meet the minimum specifications on the prescription, so if they dont specify, then they have to issue the Elite.

The insurance company doesn't care. They see "CPAP" and set the price at $753 or whatever for ANY CPAP. It's the DME who is trying to save money or is being stupid and bureaucratic. It may not be the local office doing this, but it IS the DME. Unless the prescription specifies S9 Elite, the AutoSet will legally meet the prescription.

[Xney]

CPAP and APAP machines are almost always considered the same thing by insurance - same insurance code.

It's not a deal-breaker to have a CPAP, but an APAP might come in handy some day with the ability to go to auto mode.