THIS IS IMPORTANT RE: RESPIRONCS “M” SER BIPAP

[alancalan]

I’d really appreciate some responses!! Do any of you know of a Respironics BiPap in the smaller “M” series?

I will soon become compliant with my Respironics BiPap Pro 2, for the “Empire Plan” medical insurance company. I told the DME that when it comes to the purchase, I want and need the smaller “M” series BiPap. I will be doing a lot of traveling, including 2 weeks in Italy during the very hot period of July. I am looking to lighten things up, not make them heavier.

The person from the DME said Respironics does not make an “M” series BiPap. I told her I’ve seen them and then she said they don’t have them. So, I said, can we wait until you get one before finalizing the purchase with the insurance company? The she said, in a very condescending way, “That is fraudulent. Do you want to commit a fraud?”

First, is there a Respironics “M” series BiPap and does anyone have one? I saw them on the net but I don’t know if they’ve been scrapped for some reason.

Second, once a DME gets the approval for a certain BiPap, can it be switched before or after the patient is determined to be compliant?

Third, if the DME wants to give me the non “M” series machine, can I go to the Empire Plan and ask them either to step in or would they ever allow me to refuse the non “M” and go to a different DME that will give me an “M”.

I like the people at the current DME but the attitude of this one person really was counterproductive for what is good for me. Maybe they have to reapply and they don’t want to be bothered. I just want to know if any of you have had these kinds of experiences and what was the result?

Alan

[snorestats]

First, is there a Respironics “M” series BiPap and does anyone have one? I saw them on the net but I don’t know if they’ve been scrapped for some reason.

Do you mean this one? https://www.cpap.com/productpage-bundle.php?BundleID=46

Second, once a DME gets the approval for a certain BiPap, can it be switched before or after the patient is determined to be compliant?

You can EASILY call the Dr back and see if you can get him to change the prescription requesting that exact machine. Remember, there are a couple of M series BiPaps:
M Series BIPAP Plus with BiFlex
M Series BIPAP Auto with BiFlex

Again, if you play your cards right, you should be able to get this machine. I see no reason (given the machine you are using now) that you can't get the M-Series. IN fact, I'm not sure that it's more expensive.

Regardless, you are not obligated to go with that DME. Assuming you're being reasonable here (and it looks like you are, but what you wrote here is limited), tell him you'll be happy to take your business back to another DME.

Third, if the DME wants to give me the non “M” series machine, can I go to the Empire Plan and ask them either to step in or would they ever allow me to refuse the non “M” and go to a different DME that will give me an “M”.

Just don't accept the machine. Again, call another DME and tell them what your prescription says. Ask them if they will give you the machine you want. If so, they'll get your business. Or, try to talk to someone else at your DME.

“That is fraudulent. Do you want to commit a fraud?”

Good Grief!

[Wulfman]

Or this one without the software bundle (from the sponsor of this forum):

https://www.cpap.com/productpage-bundle.php?BundleID=45

I'm SHOCKED!......a DME lied to you???

Best wishes,

Den

[alancalan]

I don't get it, unless there is a problem once you get something approved.

Do you know what the difference is between the Auto and the Plus. Right now my rental is the larger Pro. Do you know the differences between all these designations and does the fact that there is no Pro in the "M" series mean anything? Does the PRO do something special that the Auto and Plus do not do?

Alan

[alancalan]

The funny thing is, the sleep lab is connected with my internist. This is the firsr time they have used this DME. I requested them because they are close to where I live.

If they want to get recommended, they aren't being too smart!! At least this one woman isn't being too smart.

[Goofproof]

The Plus, stands for minus features, kind of reverse advertizing for no frills machine.

However, you would do better to eat a bowl of Wheaties in the morning and get the Full sized model, (The Tank), by the time you are packed up for travel the size doesn't matter much. Ask yourself, what did they leave out to cut the size and weight. The unit you have now is the same size and weight, I have three that size, the Dr. says I can carry 10 LB's, just not far. Jim

[whatrdreamsmadeof]

You should listen to Jim, he knows his stuff, I did and I love my machine, and I can only carry a max of 10 pounds too. The Tank is the best IMHO..........Ellen

[Guest]

I agree (from reading here) that the non M-Series (aka Tank) is better in a couple of ways. It seems to be a bit quieter (and that was something I got to hear first hand), and it seems better built. By the time you add the Humidifier to the M-Series, it's the same size (or bigger) than the tank... albeit probably lighter.

Regardless of which you get (tank or M), get the Auto. It will give you MUCH MORE flexibility in the future should things change. Insist on it.

[Guest]

And be sure to get a card reader with software so that you can monitor your own progress. Going without it is sort of like driving a car without gauges....you'll probably "get there"....but, you won't know how you're doing. Good gauges (software) will allow you to take charge of your own treatment....and you can do far, far better at that than anyone else.

Gerald

[Ric]

I don't get it, unless there is a problem once you get something approved.

Do you know what the difference is between the Auto and the Plus. Right now my rental is the larger Pro. Do you know the differences between all these designations and does the fact that there is no Pro in the "M" series mean anything? Does the PRO do something special that the Auto and Plus do not do?

I will contribute two thoughts to this discussion:

1. I concur with Snorestats, get your physician to write a prescription for an M-series AUTO. With that in hand you can get exactly what you need and deserve. Approach your DME and ask if they are able to fill the prescription AS WRITTEN. If not, inform your insurance provider that they are not able to fill the prescription and please provide the name of another provider that can. Don't waste another minute with the one that wants to maximize their profits at the expense of your therapy and comfort. Forget about the warm feelings you have about the DME, they are out to screw you, to a one, it's all about money. If they try to push something less than the prescription demands, ask if they are attempting to commit fraud? Are they illegally trying to rewrite the prescription? Are they misrepresenting the product line? (The M-series AUTO doesn't EXIST ????? BWAHAHAHAHAHAH!) Are they willing to be named in a malpractice lawsuit when things go wrong and the treatment doesn't work out and you fall asleep at the wheel and cause great property damage, injuries, or death, and the plaintiffs learn that the DME FAILED TO PROPERLY FILL THE PRESCRIPTION ????

2. If you are in doubt about the superior benefits of owning an AUTO bipap, versus any other model, spend more time on the board here reading old posts or messaging those who own one. I personally would NEVER go backwards to a straight CPAP, nor a machine that did not record and transfer detailed data. One of the most important features of an AUTO class of cpap is that as your pressure requirements change, the machine can adapt quickly, in real time, you don't even have to wake up and push a button. And your pressure requirements DO change over time due to changes in weather, barometric pressure, pollens, humidity, your state of health, what you ate for supper, how much you drank, how much you exercised, your blood pressure, your anxiety, fatigue, allergies, medications, changes in medications, changes in weight, light-dark cycles, ambient noise, nighttime arousals, sirens, dogs barking, bed-partner twitches, snoring, having to get up and go wee-wee, being happy, sad, angry, going on vacation, sleeping in strange places, having bad dreams, having good dreams, having really good dreams, having no dreams at all (and the list goes on, I'm barely getting started). And there are things that can cause your pressure requirements to change quite suddenly, like turning on your side, sleeping on your back, falling out of bed, swallowing your tongue, swallowing your uvula (and regretting it), or just stop breathing for no apparent reason.

The really nice thing about an APAP is that it can detect changes in your pressure needs and respond quickly. It won't even wake you up. And a nice side benefit is that you get a complete sleep study each and every night, no extra charge. (And YES, your DME HATES THAT !!!)

There you have it. At a penny a thought, that adds up to $0.02
(keep the change).


Good luck !

-Ric

[alancalan]

Haven't they fixed the leak problems?

2 things, maybe I'm wrong but I was thinking of leaving the humidifier home for Italy in July, as it will be hot and humid there.

Also, I believe there are better battery options for the M series and using it on a plane might be easier if it is lighter and smaller. Is that logical to anyone?

Do we really know that the pre M is better built than the M? I can see the motor might be better but I really don't know that for a fact as so many things have gotten smaller these days with no loss of quality. Are there any stats on M machines breaking down more than the pre Ms?

As far as the card reader, I don't think I have a choice as the Insurance Co, requires it. However, what can I do with it without a card reader and the ability to change settings? I don't think the Ins Co, would approve a machine with the software. I guess that can be purchased separately and I guess the instructions to change the settings can be found, even as a check on the RT who set up the machine. The rental machine that I got was set up so quickly, who knows if it is optimal. or even correct


Alan

[alancalan]

Sorry about the large type. I wanted to make the type large in the typing mode. not the viewing mode.

Ric,

The Dr. sent in a prescription for a Resmed. The DME said the Empire Plan insisted on the Respironics because they want the Card. I also expected that the insurance company wanted a cheaper machine as the Resmed's seem to be more expensive for the same functions.

So, after that prescription, unless the Dr. sent in another one, they are working off no prescription and going by what the insurance co. wanted or at least that is what they say.

[alancalan]

Ric,

I want to get as smart a machine as possible. However, it is impossible to tell which is smarter the Auto or the Plus, since they both have auto and is the Plus the auto plus more? I'm trying to read about it but it is hard to tell, at least from the Respironics website.

Alan

[Wulfman]

I want to get as smart a machine as possible.

Then that would be the "Auto" and NOT the "Plus".

Den

[Guest]

Do you have an actual copy of your original script for your Bi-PAP? The one that the DME has filled w/the RemStar Plus?

I think that what you will find is that the script is just for a bi-pap or bi-level and the pressure settings. That gives the DME the legal right to give you a bare bones bi-level PAP machine. It doesn't require them to give you a top of the line bi-level machine.

Decide what you want and ask your sleep doctor to write a script for that EXACT and SPECIFIC machine and don't let him FAX it to the DME but rather have him give the original to you which YOU will TAKE to the DME. (Make a copy, keep the original). If the DME refuses to fill that EXACT and SPECIFIC order w/the EXACT and SPECIFIC machine then take your business elsewhere.

IF you sleep doctor WON'T write a script for the EXACT and SPECIFIC machine you want ..... talk to your family doctor, provide him w/a copy of your order from teh sleep doc and explain the problem. May he will write the order for the EXACT and SPECIFIC machine you want.

I think it is safe to say that NO insurance company will pay for xPAP software and reader. However, they do pay for the data card if it cnormally omes w/the machine.

No way would I go to Italy or anywhere else, not even home, w/o a heated humidifier. I've found that I cannot "do" PAP w/o a heated humidifier. I've tried w/no humidifier and w/an unheated humidifier and its a no go for me.

Interesting that your insurance only wants to pay for a Respironics when your doctor specifically scripted a Resmed machine. Especially if your insurance company insists on the Respironics because of the data card and then your DME gives you a Respironics WITHOUT data card capabilities.

I think I would go back to square one. I would ask my sleep doc for a copy of the full data report for your sleep study and titration study, not just the dictated report. I'd also ask for a copy of the original order/script for your xPAP treatment. Then I would call my insurance company to determine just which DMEs in your area they are contracted with. AND if they insist on Respironics machines as this DME has stated (if so, ask why). Ask for clarification on your full benefits for xPAP therapy. Deductables, co-pays, etc. I would also ask if they will reimburse you if you buy direct from cpap.com or if they work w/billmyinsurance.com. (You could ask billmyinsurance.com if they work w/your insurance company as well).