New to cpap and overwhelmed!!!!

[Jewels109]

Hi I have recently been diagnosed with sleep apnea and I'm really unsure about how I feel. Let me give a little hindsight info. Jan 11, 2013 I went for a sleep study and they said my follow up appt was feb 19th I said oh ok.... Al while worrying and not sleeping etc. they called me 2/10 and said I needed another sleep titration study now so I had it done on the 11th. Then a home medical equipment company called me and said they ordered my cpap and I was like what? They said my dr ordered it for me and I haven't even talked to my dr at this time. I get a call this morning from my sleep lab saying they moved my appt to 3/22/13 to see how my cpap is working. What do I need besides the machine hose and mask? Do I need a hose holder? Anything in specific? I'm really nervous as I'm a 28 year old female and have only been married a year!!!! So frustrating ughhhhhhhkkkkkk...... Also will I lose weight using this machine? I'm really nervous about all this.... They are told me the machine I was getting was the RESMED S9 does anyone know anything about that? Please let me know your thoughts bc I'm always tired and emotional and trying to lose weight but it never seems to work!!!! Thanks in advance

[archangle]

Welcome. You've come to the right place to find out about CPAP.

You've also come to the right place to keep from being screwed by the DME (CPAP seller). You need to study up BEFORE your first visit to the DME. Otherwise, you're a sheep headed for the slaughter.

Many unscrupulous DMEs will try to sell you the cheapest machine they can get by with. You can usually get a much better machine for the same price because of the way insurance works. You usually have multiple "in network" DMEs with your insurance. If one won't treat you right, try another. It's like a pharmacy, your doctor doesn't get to pick your supplier.

Do not believe anything the DME tells you without checking it out. In particular, they will lie to you and tell you the machine they want to sell you is fully data capable when it isn't.

You need to find out which ResMed S9 machine they're trying to sell you. If it's an S9 Escape or Escape Auto, refuse it. If it's an S9 Elite, that's OK, and an S9 AutoSet is excellent. Figure this out before you have your appointment to get your machine. When you go pick it up, look next to the power button and it will have the name.

The Elite and AutoSet record every breath all night long and can be checked to see how your treatment is working. It's a little like a mini sleep study for free every night. If anything is wrong, you and your doctor will have a lot of info on what's happening. With the Escape, it only records the hours you used the machine.

Check the "useful links" in my signature line below.

[khauser]

In addition to the excellent advice archangle gave I would add that you need to make sure the DME and doctor are all on the same page. I *think* you might be getting a temporary machine to hold you while they complete the titration. It's more than a little likely that you're going to end up with a BiPap or better machine, which this initial machine probably is NOT. If I were in your place I would be concerned that they are selling you a machine prematurely. I'd want to (in this rare instance) be sure this was a rental and that once the sleep studies were done you would have options.

Assuming you live in the US, don't let the DME bully you in to anything. Many will say things like "This is all the insurance will pay for", or other forms of basically "you have no choice". What they really mean is "this is how I can make the most money from you".

If we knew a little more about the kind of insurance you have we might be able to save you serious money, ESPECIALLY if you have any sort of deductible.

[melindy]

I feel exactly the same way!!

I went to my titration last night and came home with a machine today. I'm confused and overwhelmed too. I think I have the machine in my signature now- I'm not totally sure. Is this a good machine?

I'm confused because from what I've read here it sounds like it is common to rent the machine until my actual machine comes in...I have talked to the DME people yet. Do I still have time to change anything? I liked the mask I used last night- it's a new one and they didn't have it in stock to send me home with it so they are supposed to call me very soon about that.

I'm so confused on how fast everything moved, I was never even told that I had sleep apnea.

[khauser]

Hi melindy and welcome!

Yes, it often moves fast, and when patients aren't properly informed it makes it much harder for them to be an active part of their care. This (if you can't tell) annoys me considerably, since I fully believe I am my best advocate.

It's hard to tell exactly which machine you have using the graphics. We prefer the text mode for that reason.

So far I can tell you have a Respironics (good) System 1 xPAP (where I am not sure what the 'x' is). On the bottom of your machine (careful if there's water in the chamber!) is the model number. Let us know what that is and we can tell you much more.

I don't know if it is possible to return a machine if you're not happy with it, but I would certainly TRY to, and be quite vocal about it too, since you weren't consulted in the first place. But as I said, Respironics and the System 1 line is a good start. If it isn't the very basic CPAP without data, you've got a decent system.

[Jewels109]

According to lincare (the DME) they said the dr ordered the cpap and that I will use it on the setting she ordered until my follow up appt march 22 (was moved today so she can monitor my therapy) the DME company said that its like a rent to own thing where I pay monthly until x amounts of months then its mine.... My insurance is blue cross blue shield PPO and I just called them and asked how often ins. Would pay for replacement parts and she said that if its medically necessary it would be covered. I didn't know what to say so I said ok I also asked if any machine was covered and she said I need to call in with a cpt code and she could tell me..... I am trying so hard to get this and understand bc ill be danged if I get taken advantage of as a 28 year old female. What else do I need to do?

[khauser]

You're off to a good start. I don't see a problem with the rent to own concept at this point. Also, since you are PPO you probably do NOT have a deductible (you may have a co-pay). Those of us with deductibles or large co-pays often do the math and find out that buying the unit online is cheaper even though it won't get reimbursed by the insurer. I don't think that will be the case for you.

Actually it is a GOOD thing that you are getting a system while the rest of your study takes place ... I'm giving kudos to your team on that mark. But don't be afraid to ask questions of them, and between now and your next study read up on the forum!

[melindy]

Hi melindy and welcome!

Yes, it often moves fast, and when patients aren't properly informed it makes it much harder for them to be an active part of their care. This (if you can't tell) annoys me considerably, since I fully believe I am my best advocate.

It's hard to tell exactly which machine you have using the graphics. We prefer the text mode for that reason.

So far I can tell you have a Respironics (good) System 1 xPAP (where I am not sure what the 'x' is). On the bottom of your machine (careful if there's water in the chamber!) is the model number. Let us know what that is and we can tell you much more.

I don't know if it is possible to return a machine if you're not happy with it, but I would certainly TRY to, and be quite vocal about it too, since you weren't consulted in the first place. But as I said, Respironics and the System 1 line is a good start. If it isn't the very basic CPAP without data, you've got a decent system.

Thanks, I didn't realize it was hard to tell with the image, I changed it. I double checked and I'm 99% sure it's the right now.

I've been having migraines for a year now- non stop so I'm really hoping this will change my life in a good way. SO I'm bound and determined to do everything I can to do things right.

[Guest]

Jewels109, please don't worry. I'm coming up on one month (have my follow-up with the sleep doc on Wednesday). When I was diagnosed with moderate SA (my AHI from the sleep study was 33 with a dip to 68% o2 sate), I was very upset about being told I needed a CPAP. I was angry at myself and angry at my body. I have always been a very healthy person (one surgery in my life) and I was angry at my body for letting me down. I can tell you that in a relatively short period of time I worked through much of the angst. Part of this is that I have had NO issues with adjusting to the CPAP. I still wake up once or twice at night and I really don't notice that I am wearing the mask. And I am just beginning to realize how much better I feel.

Hang in there!

[Pugsy]

The cpt code is diagnosis code.
The billing code for the machine is a different code. CPAP/APAP machines all use the same billing code. E0601
The higher end machines have a different billing code. Most likely this is the one you will get.
http://maskarrayed.wordpress.com/what-y ... me-part-i/

Read this to get familiar with which machines offer full data.
http://maskarrayed.wordpress.com/

If you want to be able to follow your therapy progress and results...get a machine that offers full data so you can make sure leaks aren't a problem and everything else is going well.
The machines that only offer hours of use data...can't tell you even if leaks are well controlled.
In the S9 model line ...avoid any model with Escape anywhere in the name.

[Jewels109]

The cpt code is diagnosis code.
The billing code for the machine is a different code. CPAP/APAP machines all use the same billing code. E0601
The higher end machines have a different billing code. Most likely this is the one you will get.
http://maskarrayed.wordpress.com/what-y ... me-part-i/

Read this to get familiar with which machines offer full data.
http://maskarrayed.wordpress.com/

If you want to be able to follow your therapy progress and results...get a machine that offers full data so you can make sure leaks aren't a problem and everything else is going well.
The machines that only offer hours of use data...can't tell you even if leaks are well controlled.
In the S9 model line ...avoid any model with Escape anywhere in the name.

So what do I need to tell the insurance company when I call to make sure that specific machine is covered if its not the cpt code? I thought I was on the right track and now I feel I'm lost in the woods again.....

[Pugsy]

CPT code is diagnosis and the most commonly used code for plain ordinary OSA dictates the machine that gets prescribed.
Several minor variances but normally 327.23
http://www.icd9data.com/2012/Volume1/32 ... 327.23.htm

With this diagnosis code you get a regular E0601 machine code being allowed.
You couldn't get a higher end machine that treats centrals with this diagnosis...but you wouldn't want one anyway.

Diagnosis codes have to sort of match the equipment being requested.

E0601 is a HCPCS code and this is the code that insurance companies use to decide what they will pay for..
Most insurance companies use this code and not machine brand and model because there are just so many of them out there and they don't want to have to learn about every little brand/model.
E0601 code covers all cpap/apap model machines....from the bricks with no data to the top of the line APAP machines.
DMEs typically supply the most basic model no efficacy data machines because they are cheaper...Insurance pays the same for a S9 Escape as it does the S9 AutoSet. Some DMEs have seen the light and they actually dispense the full data machines.

What I would do first would be not worry about insurance at the moment. Instead just call the DME supplier who has the machine and ask them to confirm exactly which model S9 machine they are prepare to supply. They may be one of the DMEs that actually dispense full data machines because it helps them help you to be able to see the data.
If they say S9 Elite...that's a full data machine...and would be acceptable. It offers a straight fixed pressure called cpap mode.
If they say S9 AutoSet...that's also a full data machine...it's a step above the Elite because it offers APAP mode with adjustable pressures as well as fixed cpap mode...so 2 modes of operation.. like having 2 machines in one.
APAP mode isn't for everyone...but there are situations where it is nice to have. Like maybe if you need a higher pressure part of the night (on your back sleeping or maybe REM stage sleep which sometimes those events might need more pressure) and the other parts of the night you can get by with a lower setting. Some people don't do well with varying pressures though...but it's nice to have it available if it is needed or wanted.

The S9 models to avoid...S9 Escape and the S9 Escape Auto...if DME tells you either has full data...they are lying.
The plain Escape only gathers hours of use. The Escape Auto gathers only a general AHI and 90% pressure...it doesn't offer even leak data and gee...leak data is kinda important...if you have a big bad prolonged leak and don't know it then your therapy could be in the toilet because all the pressure is going out the leak and not down your airway and you wouldn't even have a clue what is going on. Might be so bad that you are still having a truck load of apnea events happen and still feel crappy.
So I usually tell people to push the leak data thing...that's something the DME can't pooh pooh off.
If you were diabetic would you just blindly give yourself insulin without checking your blood sugar levels? Heck no.

If the DME absolutely refuses to supply a full data machine...say thank you very much but since I want so and so I will take my business elsewhere.... Often they will back peddle and say "okay".
But if they don't then call your insurance company and find out who else in your area you can use and start calling them and just ask which machine they normally will supply.

[raptor5150]

What Pugsy said I was given a s9 escape from the DME, then i found this place I went back and talked to my Doc and the DME and ended up with an autoset. I told them if I was going to have to use this for atleast 5 years before insurance would allow a new machine I wanted the best one for me. I also asked how the non data machine would help them help me if i have problems, I have a large deductable and cant afford sleep studies anytime there is a problem. It's what is best for you, not them.

[archangle]

Quite a few people have been unhappy with lincare. Find out who your other local "in network" DMEs are before you pick up the machine. That way you have more leverage.

Lincare should be able to tell you the model of S9 machine you have ahead of time. Probably Escape, Elite, AutoSet or Escape Auto.

When you get there, look next to the power button. If it says "Escape or Escape Auto," I recommend you walk out and try elsewhere. DO not let them scam you by giving you a bad machine and promising to replace it later. Promises tend to vanish with any DME.

Getting a good fully data capable machine is critical.

Good luck.