Switching to an Auto Adjusting Machine - No help from DME

[ozij]

[This a respons to Guest, not to Wulfman]

But do that only after you've done some browsing on this forum to and found out how most people were treated by their local DMEs.

An informed decision is always a wise decision.

And so is Den's suggestion to buy two (or more!)machines for the price of one.

O.

Edited to clarify what I was responding to - didn't see Den's post before I sent mine.

[Slinky]

Same day turn around should something break? That sure was NOT my experince!!!

[rested gal]

62Chev--buy and patronize your local authorized DME who gives physical service and same-day turnaround should something break, etc.

Translation:

"gives physical service" = "Here's your mask. You can have another equally ill-fitting one in three months."

"same-day turnaround" = "Your appointment will be for same day next week."

"etc." = "We promise...whatever problem you have, a friendly (or not) person will be here to tell you to keep trying."

[Panhandler]

...patronize your local authorized DME who gives physical service and same-day turnaround should something break....

...if you can find such a creature.

(emphasis added)

[RosemaryB]

62Chev--buy and patronize your local authorized DME who gives physical service and same-day turnaround should something break, etc.

I thought my machine WAS broken and called my local authorized DME. Since it was no longer under the rental agreement, they said they could not help me, I'd have to contact Respironics, the machine's manufacturer. The machine is still under warranty. It was less than 6 months old. Luckily it was some other minor problem, not my machine.

Believe it or not, this is the best of the crop of DME's locally. But it's a myth that they will quickly and easily service your machine. Sales hype, bait and switch and all that.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, DME

[Bookbear]

... I realized that the CPAP of Oz hiding behind medical scrubs/lab coat and a fancy certificate on their sleep center office wall is nothing more than a medical equipment sales person doing their best to maximize profits for the sleep center … the success of my OSA treatment was only secondary if that.

Pay no attention to that man behind the sleep lab!

Thank Hypnos for this forum!

[WNJ]

62chev,

My experience was much like yours: Straight CPAP was uncomfortable and the service I got from my DME was terrible.

Consider doing what I did:

1) Get a copy of your prescription. (Mine just said “CPAP 13cm.”)

2) Fax it to cpap.com

3) Order whatever machine you want, fast service, no hassles. (I ordered a REMStar Auto.)

If you have insurance which will cover CPAP, talk to them first to see what you have to do to have them pay for an on-line purchase. In my case, my co-pay was a percentage of the total cost. Since my REMStar Auto was less than half the price the DME wanted for the most basic machine, I saved money and so did my insurance company.

After some trial, I settled on a setting of 10cm to 14 cm. I spend about 70 percent of my nights at 10 cm (with a huge improvement in comfort) and my AHI is far lower than the sleep lab attained with straight CPAP.

Wayne

[62chev]

62chev,

My experience was much like yours: Straight CPAP was uncomfortable and the service I got from my DME was terrible.

Consider doing what I did:

1) Get a copy of your prescription. (Mine just said “CPAP 13cm.”)

2) Fax it to cpap.com

3) Order whatever machine you want, fast service, no hassles. (I ordered a REMStar Auto.)

If you have insurance which will cover CPAP, talk to them first to see what you have to do to have them pay for an on-line purchase. In my case, my co-pay was a percentage of the total cost. Since my REMStar Auto was less than half the price the DME wanted for the most basic machine, I saved money and so did my insurance company.

After some trial, I settled on a setting of 10cm to 14 cm. I spend about 70 percent of my nights at 10 cm (with a huge improvement in comfort) and my AHI is far lower than the sleep lab attained with straight CPAP.

Wayne

Thank you all for the great advice. I was shocked to see all the informative responses.

I called my sleep lab and asked for a copy of my prescription. They were not sure if they could give it to me since they had 'called' it in to the DME (by the way the DME is owned by the same parent company as the sleep lab). He said I may have to file a records request, I said just let me know what I have to do (give up my first born, whatever, I just want a copy of my prescription).

I had emailed one of the online vendors about their prescription policy prior to posting here and they confirmed what people stated here, that a CPAP prescription will work for an Auto machine.

My P.A. called me back, I'm sure I raised a 'stink' by asking for my prescription etc. I told her the reasons I wanted a APAP machine. She was very receptive. I told her I'm sure you love these internet 'informed' patients, again she was very nice and said she encouraged patients to learn as much as they can.

I told her I could not tolerate the constant pressure of the CPAP and wanted to try an auto machine. I told her that I saw several responses on the online forum where people didn't tolerate a CPAP and loved an autopap. I told her a CPAP will not do me any good if it is so uncomfortable I only wear it a few hours a night - which I'm sure I would eventually give up on.

I told her I had even gone to my family practice Doc because I was sure I had an ear infection since one of them hurt so bad since I started using the CPAP machine. He said my ears were clear and I should talk to them about lowering the pressure on my CPAP.

I told her one of the sleep lab techs told me that they did not encourage the apap machines since the pressure can go too high. She (the P.A.) did say there is some concern with apap machines that they don't cause some type of apnea (central ? can't remember exactly). I assume setting the upper limit helps prevent this??

She said the things I brought up (thanks forum contributors ) were very reasonable and she had no problem prescribing an Apap machine. She even asked me the specific brand and model I wanted so she could prescribe it accordingly. wow.

She said she did encourage me to use a local DME in case I have issues with the machine, but she also said don't be afraid to try a different DME.

Based on a prior post, it sounds like service from a local DME may not amount to much anyway. One thing that was nice, when I switched from a nose mask to a pillow mask it was nice to go into the DME and try one before buying it.

By the way, I asked her to prescribe the Respironics Auto-Cpap with A-flex. Thanks to this forum for pointing me in that direction. It sounds like a very flexible machine (can run in all modes) and provides data reporting.

Oh, I also told the P.A. that I was nerdy enough to want to get the additional data reporting capabilities of this machine. She laughed.

I have to say she restored my faith that there are still some people out there working in the patients best interest, but I was surprised at the run around you can get if not prepared.

Again, thank you to the users of this forum for preparing me for the 'battle'.

I found a package deal on the Remstar Auto-cpap with A-flex on directhomemedical.com with the encoreviewer software, heated humidifier for $759, I can only imagine what my DME's price will be (I'm guessing close to $2,000).

I will check with my insurance provider BCBS and see if they will pay for an online purchase. The funny thing is, (I'm guessing) they will pay 80% for a local DME (i.e. $2,000 x 80% or $1,600) but will refuse to pay 80% for an online purchase (i.e. $759 x 80% or $607). Will be interesting.

Someone did ask what my pressure was set at - it was 8 on my CPAP, my P.A. said she was going to set my APAP at a range of 6 to 12.

Am I correct to assume the masks I purchased for my Resmed (the comfort gell for nose only and a pillow mask) will be compatible with the Remstar?

Thanks again for all the help. Hopefully within a week I will have a machine and enjoying a good nights sleep!

Bless you all.

[Wulfman]

62chev,

You need to ask your insurance provider the right question(s) about reimbursement.

You need to ask them if they will reimburse YOU for an out-of-pocket purchase. If they will do that, then, you need to purchase the equipment and put it on your credit card. Then, you would need to bill your insurance provider with YOU as the billing party and them as the party being billed. You should be able to use the invoice that the online supplier sends you as an example of how to create your own invoice to your insurance provider......all of the correct insurance codes will be on it. You then send YOUR invoice to the insurance provider along with a copy of the one from the online provider as proof that you're not screwing your insurance. They should then send you a check for about 80% (sometimes more) of the invoice....less the software which is usually not covered for reimbursement.

This is what I did with my insurance provider.

Den

[rested gal]

Glad to hear you got such a good reception from your P.A. about what you want to do, chev! She sounds like a "good'un."

[RosemaryB]

Based on a prior post, it sounds like service from a local DME may not amount to much anyway. One thing that was nice, when I switched from a nose mask to a pillow mask it was nice to go into the DME and try one before buying it.

I do go to a local DME for this reason. I had to fight them to get the machine I wanted, but they eventually got it. Then they said to contact the mfgr when I thought my machine was broken, too. Not good on the machine stuff. Not good at all.

They seem to be doing a good job with the masks, though. I think there is an intermediate category of DME's. They are good with the masks but want to give you a cheapie machine. Also, I'm finding out that the RT's they hire can make a difference. The first RT was ok at mask fitting (I got to try a number of my choosing, and ended up with one that worked reasonably well), but seemed very ill-informed about a lot of other things and gave me wrong information. The one I had for my 6-month visit with last week is a keeper! We talked at length about the patient use of software with the machines. He was in favor of it! We chatted about a number of things and he said he appreciated a patient who went out of their way to learn a lot about their treatment. But this is not the norm, unfortunately.

I found a package deal on the Remstar Auto-cpap with A-flex on directhomemedical.com with the encoreviewer software, heated humidifier for $759, I can only imagine what my DME's price will be (I'm guessing close to $2,000).

. If you are going to get it online, I recommend cpap.com. If you find a better price, they will often price-match. I buy all my extra masks and other equipment from them.

I will check with my insurance provider BCBS and see if they will pay for an online purchase. The funny thing is, (I'm guessing) they will pay 80% for a local DME (i.e. $2,000 x 80% or $1,600) but will refuse to pay 80% for an online purchase (i.e. $759 x 80% or $607). Will be interesting.

I have BCBS and there are two plans. One is out-of-network where you pay for it and get reimbursed. This doesn't work well for me since I always meet my deductible with the in-network part of the plan, but not the out-of-network part of the plan. Plus the "out" has a higher deductible than the "in."

If these are the same for you, I'd buy from cpap.com. If they are not, you should check with "billmyinsurance.com" which is a sister company of cpap.com and they will give you a quote as to how much you will pay out of pocket. Then you can compare how much you will pay in each case.

It's complicated, but definitely worth checking into. Good luck with whatever you decide to do. You are on the right track with the machine, that's for sure.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): humidifier, cpap.com, DME, auto

[Bookbear]

I called my sleep lab and asked for a copy of my prescription. They were not sure if they could give it to me since they had 'called' it in to the DME

By Federal law, you are entitled to a copy of your prescription, as well as any and all other medical records kept by your doctor, including results of any and all medical tests. Be persistent. They can stall you for 30 days, and make a "reasonable charge" for copying, but they must give them to you.

I found a package deal on the Remstar Auto-cpap with A-flex on directhomemedical.com with the encoreviewer software, heated humidifier for $759, I can only imagine what my DME's price will be (I'm guessing close to $2,000).

Ummm.... greed?

I will check with my insurance provider BCBS and see if they will pay for an online purchase. The funny thing is, (I'm guessing) they will pay 80% for a local DME (i.e. $2,000 x 80% or $1,600) but will refuse to pay 80% for an online purchase (i.e. $759 x 80% or $607). Will be interesting.

And we wonder why medical insurance costs are so high....

Am I correct to assume the masks I purchased for my Resmed (the comfort gell for nose only and a pillow mask) will be compatible with the Remstar?

Yeppers!

Good luck with your therapy!

[RosemaryB]

You should definitely get more than your prescription. You should get your complete sleep study and complete titration study, too. By this, I mean, the study with all the graphs, charts, not just the doctor's interpretation of those graphs and charts.

[62chev]

You should definitely get more than your prescription. You should get your complete sleep study and complete titration study, too. By this, I mean, the study with all the graphs, charts, not just the doctor's interpretation of those graphs and charts.

Thanks, I believe I will get these at my next appointment with my P.A. We pushed the appt. out a couple of months so I can get used to my machine, but she did say she would go over the results of the sleep study at that time.

Appreciate the response!

[62chev]

I have BCBS and there are two plans. One is out-of-network where you pay for it and get reimbursed. This doesn't work well for me since I always meet my deductible with the in-network part of the plan, but not the out-of-network part of the plan. Plus the "out" has a higher deductible than the "in."

If these are the same for you, I'd buy from cpap.com. If they are not, you should check with "billmyinsurance.com" which is a sister company of cpap.com and they will give you a quote as to how much you will pay out of pocket. Then you can compare how much you will pay in each case.

It's complicated, but definitely worth checking into. Good luck with whatever you decide to do. You are on the right track with the machine, that's for sure.

Thank you, I will check with BCBS and see how they will handle it and also check with both online sites you mentioned.

Again, thanks for all the help to a newbie!