Need help with telling DME what I want/need

[whome]

hello lovely people!! I've done lots of reading and you really seem to be the nicest group of people on the internet.

I had my sleep study 2 weeks ago, and I have an appt to see the DME on Wednesday (it's connected to the center that I had my sleep study at). I'm lucky enough to be able to pay out of pocket and to be able to afford anything I want, so I want to make sure I get what's right. When she made the appointment, the girl told me the exact amount down to the number of cents, so I'm a bit confused, since that implies she's chosen for me.

So far, I've worked out that I need to ask for an APAP (in case my condition changes), fully data capable (so I can see what's going on), with a humidifier and heated tubes.

Long list of questions:

Is that right? Do I need heated tubes in Texas?
The doctor's note says he's prescribing CPAP. Will I still be able to get APAP?
I have a mac - is the software still compatible?
I know masks are important, but I think I was fine with the one at the sleep study. Is there anything else I should be thinking about?

My data in case it's helpful

During the diagnostic portion: Apnea index 6.5/hour, AHI 45.7/hour, RDI 90.5/hour. Lowest oxygen 82%
He recommended 16cm for treatment, and at that rate my stats were: AHI 0/hour, RDI 5.8/hour, lowest oxygen 97%
They also put me on BiPAP at 18/14 which reduced the RDI to zero, but my oxygen went from 98.5% mean to 97.5% mean, which I presume is why he didn't prescribe that.

Thank you for all the information on this forum - I can see the beginning of a path through the forest

[sc0ttt]

Is that right? Do I need heated tubes in Texas?

Condensation will happen with humid air inside the tube, and cold air outside the tube; so it depends how cold your bedroom gets and how humid your therapy air is.

The doctor's note says he's prescribing CPAP. Will I still be able to get APAP?

Probably not, but the DME may be willing to call your doctor for an amendment to the prescription over the phone. Call them and ask them to before you go.

I know masks are important, but I think I was fine with the one at the sleep study. Is there anything else I should be thinking about?

If you have a good vendor they may show you some you like even better - but otherwise no.

[palerider]

you could just buy one from cpap.com... at least check the prices on the resmed s9 autoset (36005) and the pr sys1 560 online before you go, so you know if the local people are ripping you off

[Guest]

I had my sleep study 2 weeks ago, and I have an appt to see the DME on Wednesday (it's connected to the center that I had my sleep study at). I'm lucky enough to be able to pay out of pocket and to be able to afford anything I want, so I want to make sure I get what's right. When she made the appointment, the girl told me the exact amount down to the number of cents, so I'm a bit confused, since that implies she's chosen for m

I would avoid any DME tied to a sleep center and likewise avoid any sleep center tied to a DME. They just will not care about you.

So either find another DME or buy from cpap dot com. You will need a copy of your sleep study (your own copy) - your doctor (primary or otherwise) can write a script - you can get the wording needed here at the forum.

A (good) local DME can be helpful to someone just starting out - esp. with mask exchanges and fittings.

I doubt the reason your not getting a bipap is your O2 level but more likely the cost (to the DME). A Bipap will be much easier to exhale out and if your doc writes a script for a bipap that is what you will get, esp. since you have no insurance hoops to jump thru.

Of course to get what you want will require patience and determination. But you can get all the help you need right here.

[Janknitz]

Please read my blogposts for "What you Need to Know BEFORE you meet your DME".

Your situation is a little different because you're paying out of pocket, but that makes you a sitting duck. Make sure you especially read this post: http://maskarrayed.wordpress.com/2011/0 ... in-common/

I wholeheartedly agree with Palerider--know the online prices before you agree to buy ANYTHING from a DME. You will likely be charged 300 to 400% MORE from a DME--and a real boon to them because they don't have to spend money or time billing your insurer. Is it worth it, to have them help you set it up? NO. It's not rocket science. A reputable online company like cpap.com will set up the machine to your prescription and offer good phone support.

The mask is a different story--it helps to be able to try on several masks and find the best mask for YOU (not for their profit margin). So you may want to buy one from a DME with a good return policy until you find "THE" mask for you. After that you can order them online.

[tortoisegirl]

I agree to price out buying the machine & humidifier & hose & filters online (likely much much cheaper), and to consider buying the first mask from a DME with a good mask swap policy. Ideally at least 30 days where you can swap out the mask for free, or just paying the difference if the new one costs more, often where you still get to keep the old mask as they would just trash it anyways. A DME's list price on machines is several times higher than what they typically end up getting paid by insurance (and a percentage of which the patient pays as a copay).

Although you may be able to work out a deal with them to pay closer to what they would normally get from insurance, it would be much easier to buy it online. Also, the DME often charges for items separately that come together, as insurance would pay more that way, like mask & headgear, and humidifier & tank. Not good for a cash customer. Plus even if you only have a CPAP prescription, you can get an APAP from CPAP.com. There is a version of Sleepyhead (free) for Macs. You might as well get the heated tube & humidifier; both are quite adjustable so you can turn it way down if you want.

There are only two main choices for APAPs, from the two main companies, and often DMEs primarily carry only one of the brands, so it can be common to not offer the patient a choice. Look at the Resmed S9 Autoset and the Philips Respironics (PR) System One REMStar 60 Series Auto. There are some good comparison posts here. For a start, the System One is a bit cheaper and the S9 is a bit more popular here. Best wishes.

[Guest]

I agree to price out buying the machine & humidifier & hose & filters online (likely much much cheaper), and to consider buying the first mask from a DME with a good mask swap policy. Ideally at least 30 days where you can swap out the mask for free, or just paying the difference if the new one costs more, often where you still get to keep the old mask as they would just trash it anyways. A DME's list price on machines is several times higher than what they typically end up getting paid by insurance (and a percentage of which the patient pays as a copay).

Although you may be able to work out a deal with them to pay closer to what they would normally get from insurance, it would be much easier to buy it online. Also, the DME often charges for items separately that come together, as insurance would pay more that way, like mask & headgear, and humidifier & tank. Not good for a cash customer. Plus even if you only have a CPAP prescription, you can get an APAP from CPAP com. There is a version of Sleepyhead (free) for Macs. You might as well get the heated tube & humidifier; both are quite adjustable so you can turn it way down if you want.

There are only two main choices for APAPs, from the two main companies, and often DMEs primarily carry only one of the brands, so it can be common to not offer the patient a choice. Look at the Resmed S9 Autoset and the Philips Respironics (PR) System One REMStar 60 Series Auto. There are some good comparison posts here. For a start, the System One is a bit cheaper and the S9 is a bit more popular here. Best wishes.

Some excellent points made, I would just like to point out that it would be extremely unusual for a DME to sell to a cash customer for even close to what they do for "contracted" insurance patients. If the mfg finds out about sales like that they could stop distributing to that dealer, yea it is price fixing but that is what they do.

so

Although you may be able to work out a deal with them to pay closer to what they would normally get from insurance

is not likely to happen and you will likely pay more than you will online.

Do your research to be sure what you are up against as a cash customer.

Also be aware that

Also, the DME often charges for items separately that come together, as insurance would pay more that way, like mask & headgear, and humidifier & tank.

Also

DMEs primarily carry only one of the brands, so it can be common to not offer the patient a choice.

If they don't carry what you want they can order it. If they won't I wouldn't order anything from them as that will lead to other future problems. Find another DME or order online.

Finally...
Find a sleep doc that won't push towards a particular DME. Word of mouth is best but if you ask on this forum for something in your area/town, I am sure someone will have suggestions.

[bwexler]

It sounds to me like you may need a bipap. You need to get a copy of your complete sleep study and post the detail grafs here for some experts feedback. I would make this happen prior to spending a penny anywhere.

[whome]

Thank you so much for all your guidance. I was so keen to get a machine and good night's sleep I would have done anything! I have a lot more information to be armed with tomorrow.

I'm in San Antonio, should anyone be able to give me a DME recommendation.

Thank you all - I'm sure I'll be back with more questions!

[Guest]

I'm in San Antonio, should anyone be able to give me a DME recommendation.

You are in luck. I believe cpap dot com is in San Antonio. If you do a walk-in I am sure they will help you.

[Sheriff Buford]

I'm in San Antonio, should anyone be able to give me a DME recommendation.

You are in luck. I believe cpap dot com is in San Antonio. If you do a walk-in I am sure they will help you.

Cpap.com is in Stafford (a suburb of houston).

[Guest]

Cpap com is in Stafford (a suburb of houston).

Quite a difference....Thanks for the correction.

[wm_hess]

When I purchased my S9, I bought it for cash. I was able to purchase it at what Apria would charge my insurance (Kaiser). If you have insurance, you can see if they'll match what they charge your insurer. Failing that I would definitely recommend our hosts

[Guest]

I wonder why someone who has insurance would choose to pay cash?

[wm_hess]

For me, it was not time for a new machine that would be covered by insurance. I now have a data capable machine instead of the brick I had. My health is worth the cost. Plus in 2.5 years I'll get the new machine that my insurance will cover as a backup/travel