Does the patient haveany say in what machine they get ?

sloizeaux · Post by **sloizeaux** » Thu Oct 05, 2006 11:16 am

I have to get my equipment through CIGNA Apria, the sleep lab doctor prescribed a specific machine and mask. Does any one know if I have any say in the matter of what machine I get ? And how should I approach it - throgh my doctor, or CIGNA.

I have been prescribed a: Remstar Pro M Series and a comfort gel mask

Wulfman · Post by **Wulfman** » Thu Oct 05, 2006 11:40 am

Well, there should be nothing wrong with the machine they're planning to give you, but I would think you should have some say in the matter. It is going to be YOUR therapy......probably for the rest of your life.
What did you have in mind? Different model or different brand?
Is Apria the ONLY DME that CIGNA will let you use? Most insurance providers have a list of "in-network" DMEs that a patient can choose from.
In any case, be sure to get your prescription from the doctor and hang on to it. Another option is to purchase out-of-pocket (and check with CIGNA to see if they will re-imburse you at the in-network rate).

Best wishes,

Den

Guest45 · Post by **Guest45** » Thu Oct 05, 2006 11:45 am

you should get the EXACT machine your doctor prescribed--just make sure he checks "no substitutions" on the Rx...

He or she obviously prescribed it for a reason.

KansasRT · Post by **KansasRT** » Thu Oct 05, 2006 12:04 pm

If your DR wrote for a specific machine, you would have to get a different script from your DR. (If you wanted something different) Make sure that he writes for what you want and specifies no substitutions.

Snoredog · Post by **Snoredog** » Thu Oct 05, 2006 12:07 pm

if your doctor prescribed a "Remstar Pro M series machine" the DME should NOT substitute another Remstar machine such as a cheaper Plus or series 100 machine. It is my understanding that Apria has its own cheaper Remstar OEM for them.

The only exception would be if they screwed up and gave you a Remstar M series Auto.

I would suggest going to http://www.respironics.com and learning about the various machines, cpap.com is another good place.

The M series Pro (one your doctor prescribed) is a good machine it also records detailed sleep data to the SmartCard so if you add EncorePro software on your own you can get detailed reports from it. The larger older Pro model didn't record detail data unless it had "Pro2" silkscreened on the top.

The M series is the newer smaller units:
http://www.respironics.com/

rested gal · Post by **rested gal** » Thu Oct 05, 2006 12:11 pm

The Respironics REMstar Pro M series machine is a very good straight CPAP machine, imho. It will have C-Flex with it, and it records more data onto its SmartCard than just "compliance" (hours of use.)

My own personal preference would be for an autopap. Also called "auto-titrating" or "self-titrating" CPAP. And I'd want a Respironics autopap since that brand is the only one that can give some relief from pressure (C-Flex) when exhaling AND when being operated in auto mode. The autopap made by resmed...the Vantage...cannot use its "EPR" exhalation pressure relief when it's operating in auto mode.

So... one of these machines would be the one I'd try to get if I wanted autopap capability along with exhalation pressure relief:

Respironics REMstar Auto with C-Flex (must have a sticker on top of the machine that says "C-Flex")

Respironics REMstar Auto "M" series (all of the M autos have C-Flex)

Respironics BiPAP Auto with Bi-flex (can operate as both a bi-level machine for wonderful exhalation relief AND, at the same time, as an autopap varying the pressure as needed throughout the night.)

Any of those machines could be set to operate as straight CPAP (like the Pro) if it turned out that straight cpap single pressure suited you better.

If I couldn't get one of those three machines that can use auto mode with exhalation relief, then the REMstar Pro M series machine straight cpap machine they have in mind for you, sloizeaux, is a very good one.

Encore Pro software works with all of them (including the M Pro) to give full data from the SmartCard...if you choose to buy software on your own.

As for your question, "Does the patient have any say in what machine they get?" well, that just depends. If you have to go through a DME and use insurance, it would depend mainly on your doctor being willing to write a prescription for the exact machine you want. Some doctors are knee-jerk "No" to autopap. Even if the doctor is willing to prescribe exactly the machine you want, it could also depend on whether the doctor and you were willing to fight for that exact machine if the DME balked at filling the order.

If you are willing to spend your own money for your own machine and not bother with the hassle of trying to convince the doctor, the DME, or the insurance company to let you have the machine you want, then the current prescription you have from your doctor would allow you to buy either the REMstar Auto with C-flex or the REMstar Auto M series machine from the online store cpap.com.

As long as a doctor's prescription has the word "CPAP" on it, you can buy an autopap from cpap.com. The Rx doesn't have to say "autopap", since an autopap IS a CPAP machine. The Rx doesn't even have to mention a range of pressure for the machine to be set for, since autopaps come from the factory already pre-set for a range of 4-20 cm H2O. That range encompasses any single pressure the Rx for "cpap" would have on it.

If you wanted the Respironics BiPAP Auto, though, the Rx would have to say BiPAP or "bi-level cpap", instead of "CPAP".

Good luck!

P.S. The mask will be the real key to getting good treatment -- much more so than what machine you choose. Try as many masks as you can at the DME. Take your pillow and a blanket along. Try the masks out while laying down on the floor, if need be (that's why to take a blanket along!) and with a machine hooked up using your full prescribed pressure. Don't settle for a couple of minutes being "fitted" with a mask while you're sitting up. You definitely should have plenty of say-so in what mask you get!

rested gal · Post by **rested gal** » Thu Oct 05, 2006 12:24 pm

Here's some very good reading for anyone just starting on the journey to good "cpap" treatment:

Mile High Sleeper's great information resource for cpap users.

That link goes to: http://www.smart-sleep-apnea.blogspot.com

Offerocker · Post by **Offerocker** » Thu Oct 05, 2006 1:25 pm

Snoredog wrote:if your doctor prescribed a "Remstar Pro M series machine" the DME should NOT substitute another Remstar machine ......

My first reaction was, only due to personal experience: NO

However, my prescription, although written for apap cflex didn't even get me a PRO2 w/cflex.

Have your prescribing physician write it up just as Snoredog suggested!! (adjusting for make of course)

I bought what I wanted (APAP c-flex), out-of-pocket from cpap.com
My sleep lab Dr. asked me why I did that......
And he asked me why I was on oxygen....he's a pulmonary dr. who didn't give me good news. Now you know why I'm "Offerocker"!!!

This place -->*<--- right here has been my most reliable source of solid information. I know, no docs here, but so MANY expert, experienced cpap users that DO take the TIME to EXPLAIN AND HELP.

I have to add that the Activa mask has made a world of difference in my compliance in the past week; am a side-sleeper. Not a pretty mask, like the CL2, but stays put on me. Most of us have tried a "few" masks before hitting one we like ''best", then finally that "best yet"...etc.

Mask