Not sure if CPAP is working --- newbie

CollegeGirl · Post by **CollegeGirl** » Sun Mar 11, 2007 1:33 pm

What I did was tell my doctor CPAP wasn't working for me, and have RX me an Auto. Then I took in my old CPAP to the DME and gave them the RX and they switched it out for an auto. It had been months, though, not just 30 days - so I don't know if that makes a difference or not.

JimW · Post by **JimW** » Sun Mar 11, 2007 2:22 pm

If your machine is being rented, you should be able to return it at no penalty, since you've had it for a little less than one month. Were I in your shoes, I'd want to verify this with another DME to make sure that they are willing to pick up where the other left off, and that they're willing to supply you with a data-capable machine.

I was originally given the Compact, as well; with heated humidifier and Mirage Swift mask, the amount billed to (and payed by) insurance was $1049.47, or about $150 more than today's price for these items from our host. When I was changed over to Autoset Vantage APAP, the additional cost billed (and paid) was $225, about the same price difference between the two machines if purchased through our host. I've listed this just by means of comparison; the $1500 your current DME quoted you does seem high.

If you're going to try to make a change, it's best to do it soon. The longer you wait, the less likely that another DME is going to want to take over as your supplier, as their profit will lessen significantly with each passing month before the change.

peacefrog · Post by **peacefrog** » Sun Mar 11, 2007 3:19 pm

thanks again for all the advice. I just sent off an email to my DME to see what can be done. I guess I'll await a response and go from there.

Linda3032 · Post by **Linda3032** » Sun Mar 11, 2007 5:34 pm

Good for you. Now, your DME may or may not be absolutely honest with you. But you definitely should want to pursue getting a better machine. If the DME tells you something that sounds fishy, run it past us and/or your insurance company.

Like I said earlier, some DMEs are great to work with, but some aren't. Just because they don't have a better machine in stock, doesn't mean they can't get one. Stick to your guns.

Good Luck

peacefrog · Post by **peacefrog** » Mon Mar 12, 2007 8:51 pm

Linda3032 wrote:If the DME tells you something that sounds fishy, run it past us and/or your insurance company.

ok got a response today... tell me what you think.

Got your message regarding CPAP. Normally, your physician orders the CPAP that they feel is appropriate for you. In your case, CPAP @ 10 cm with an in-line heated humidifier. The units you mentioned need to be ordered by the physician, and are more expensive than the current unit because they have more features / technology. To a lot of insurance companies a CPAP unit is a CPAP unit (read least costly alternative) and they pay only for a basic model, unless specified by the physician and / or the patient pays the difference between the base unit and the upgraded unit. You 're talking approx. min. $500.00 to $850.00 above the unit you now have. To be able to download /view data, etc. unless you have the necessary software to do so you would not gain any advantage, plus you would not know how to interpret the data. Some people do not notice a huge change or difference in their sleep..........depends somewhat on the severity of the problem, etc. Might be worth discussing it with your physician for his input. If you have other questions please let me know and I will do what I can in that regard.

JimW · Post by **JimW** » Mon Mar 12, 2007 9:17 pm

peacefrog wrote:ok got a response today... tell me what you think.

... To a lot of insurance companies a CPAP unit is a CPAP unit (read least costly alternative) and they pay only for a basic model, unless specified by the physician and / or the patient pays the difference between the base unit and the upgraded unit. You 're talking approx. min. $500.00 to $850.00 above the unit you now have. ...

Many insurance companies only reimburse for a basic model; that reimbursement is quite often, however, high enough to more than cover the cost to the DME of the more costly models. If the DME supplies you with a data-capable model, they may have to eat the additional cost to them, and they don't like to do that.

Their price estimate sounds very inflated. When the Compact didn't work out for me, I was given a Vantage Autoset; this meant going from the bottom of ResMed's line to the top of their non-BiPap line. The additional charge to my insurance company, which they paid, was $225. I'm fairly certain that my DME did not lose any money by doing this.

You may want to check with your insurance company and find out if there would be any problems with changing to a different DME. If there would be no drawbacks to you for doing this, you might contact another DME to find out their take on the situation. You could also let your current DME know that you're shopping, and find out if they change their response.

Checking with your physician, as they suggested, is likely a good idea. If you're able to get a script with a different model specified, it certainly would not hurt your cause.
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blarg · Post by **blarg** » Mon Mar 12, 2007 9:20 pm

Well, you could have your doctor Rx you an Auto, just know that you can get one online for exactly how much they just quoted you. And of course they're stuck up about you not being able to understand what the software says.

Linda3032 · Post by **Linda3032** » Mon Mar 12, 2007 9:44 pm

That kinda sounds typical of the DME stories we hear around here.

I would tell them I want at least a Resmed Elite (that's a straight cpap with LCD readout), or you will go to another DME.

If you are renting, and wanting to get a new DME, you might have to clear that with your insurance company.

I hate it when DME "gives" patients the low end machines and expects them to be grateful -- while the DME pockets the same amount of money as a good machine.

DreamStalker · Post by **DreamStalker** » Mon Mar 12, 2007 9:47 pm

Yep ... sounds like the DME is hosing 'ya.

See if your doc can help as others have already suggested, if not, your stuck with us ... but not worry cuz there are a lot of great folks here to help you out.

peacefrog · Post by **peacefrog** » Mon Mar 12, 2007 10:27 pm

DreamStalker wrote:Yep ... sounds like the DME is hosing 'ya.

yeah, i'm kind of getting that feeling. I think I'll call my insurance tomorrow and get their take on it. Do you guys think it would be to my advantage to let this guy know at this point that I know his prices are over the top or just to let it go until I have something else lined up? Also do good DME's exist? Am I going to be able to get a better price with one of them, or just through going online.

So I'm kind of getting the opinion that I should talk w/ my insurance, other DME's, and my doctor?

Any tips on how to find a good DME in my area? I know there were some people on here from Oklahoma City or Tulsa that may be able to help w/ this.

Linda3032 · Post by **Linda3032** » Mon Mar 12, 2007 10:40 pm

I know it's frustrating for you - as it was for all of us. So tired we can't think straight and let the DME get the best of us.

1. I would call the DME first. Tell him that I want a better machine, and that I am prepared to return their machine (since it's a rental), and go elsewhere if they won't come up with one I want. And see what he says.

2. If he doesn't agree to upgrade, then I would call my insurance company and find out if I can go to another DME.

3. Depending on what the insurance company says, then I would call the Mom and Pop place in OK City (that a couple of forum members like), and ask them if you can get a good machine through them.

4. And depending on all the answers, I might have to call my doctor to help with a new prescription if needed.

Make sure you get a copy of your prescription. Worse case scenario, you have to purchase on out of pocket from cpap.com. It might not cost all that much more than your co-pay now.

Good Luck.

PS: I will see if I can find the info regarding the OK City DME. If I find it, I will edit this post.

Yes, I think it's Pathways Respiratory.

DreamStalker · Post by **DreamStalker** » Tue Mar 13, 2007 5:33 am

Yep ... Linda has a good strategy going for you. Hang in there, remember it is your health and your treatment ... settle for nothing less.

NightHawkeye · Post by **NightHawkeye** » Tue Mar 13, 2007 6:06 am

peacefrog wrote:Got your message regarding CPAP. Normally, your physician orders the CPAP that they feel is appropriate for you. In your case, CPAP @ 10 cm with an in-line heated humidifier. The units you mentioned need to be ordered by the physician, and are more expensive than the current unit because they have more features / technology. To a lot of insurance companies a CPAP unit is a CPAP unit (read least costly alternative) and they pay only for a basic model, unless specified by the physician and / or the patient pays the difference between the base unit and the upgraded unit. You 're talking approx. min. $500.00 to $850.00 above the unit you now have. To be able to download /view data, etc. unless you have the necessary software to do so you would not gain any advantage, plus you would not know how to interpret the data. Some people do not notice a huge change or difference in their sleep..........depends somewhat on the severity of the problem, etc. Might be worth discussing it with your physician for his input. If you have other questions please let me know and I will do what I can in that regard.

Peacefrog,

It looks to me like your DME is being pretty straightforward with you. (They're slanting things to be sure, but avoiding blatant lies like some folks report hearing.) I interpret this to mean that they are willing to upgrade your machine if your physician writes a prescription for one with more capability.

So . . ., why not just call the doc's office and tell them your therapy is not working. Rather than asking for another appointment, report that you have learned a lot about CPAP machines recently and you believe you would benefit from having a different CPAP machine, one which can help you (and your doc) resolve your current problems. Tell them them that the ResMed Autoset Vantage or the Respironics Remstar-auto M-series with data monitoring capability offers you a way to understand and get past these current difficulties. Then, simply tell them you'll be glad to come by and pick the prescription up (or have them fax the prescription to you -- not the DME!)

Just my $0.02. Calling the doc's office should be a lot less frustrating than dealing with the DME. After all, your physician should have your best interests at heart. If not, then now's as good a time as any to find out.

Regards,
Bill

Linda3032 · Post by **Linda3032** » Tue Mar 13, 2007 9:44 am

What Bill said makes alot of sense too.

peacefrog · Post by **peacefrog** » Tue Mar 13, 2007 11:13 am

thanks again guys. I emailed my insurance company today to try and get their thoughts on the matter. I don't know if I'll have time today to call my doc or any other DME's. I guess I'll email my current DME once I hear back from the insurance company.