My DME Says She's Trying to "Help Me"

OldLincoln · Post by **OldLincoln** » Mon May 05, 2008 7:01 pm

I'm in a bit of a quandry with the offer I got today from my DME. My existing ResMed CPAP will be purchased in 3 more insurance payments. My doc agreed I have a real medical need for the APAP and I was rushing the DME to get it before I went on Medicare 5/1. I had called the billing dept of SleepMed and they said when I got the APAP they would sell me the CPAP or if it came in July I would own it anyway.

Today my DME calls and says the insurance refused to buy another xPAP since this one is still on rental. The offer is to trade in the CPAP for the APAP and I would own it outright in July - just continue the rental period as if I had it all along. Now I'm wondering if the insurance company would start renting the APAP in July and I'd own the CPAP while the APAP would be rented until it was paid off.

Pros:
* Doing it her way is certainly fair for the insurance company who has been terrific for many years.
* It is a bird in the hand and I don't know what all could go wrong in July now that Medicare is in the mix.
* I pushed them pretty hard because I don't want a fight with Medicare and to now change my position would make my motives suspect.
* I feel like I would be greedy to try to get 2 machines when I only need one if it works.
* I would have to wait at least to mid July to get it if all went right and my CPAP is causing me a lot of pain and could be harming me.

Cons:
* I could have 2 machines if it went right... Mmmm my precious!
* I would have a back up CPAP (which I think is harming me now)

OK, unless you have some truth I don't know about I will take the deal. The apt is Thursday so hurry with your wisdom.

roster · Post by **roster** » Mon May 05, 2008 7:06 pm

OldLincoln wrote:.........
* I would have a back up CPAP (which I think is harming me now)

.......

Just curious as to what you mean by that?

OldLincoln · Post by **OldLincoln** » Mon May 05, 2008 7:20 pm

Rooster, As time has gone on my bloating issue has worsened and now my gut hurts much of the day almost every day. When I started my CPAP was set at 2 points lower and the problem was minimal. I would not think 2 points would normally make a difference, but here I am.

Others have reported improvement to elimination of the problem going to APAP. If it doesn't work for me I may have to give it up and talk to the pulmonary doc about the O2 nose hose to keep my levels up.

sleepycarol · Post by **sleepycarol** » Mon May 05, 2008 7:59 pm

I would call the insurance company and ask them if you wait till July would they still pay for an apap. It could be that even if your cpap is paid off you will be unable to get them to pay for an apap. By going on and doing the exchange now means that you will have your apap regardless.

You can pick up a good used cpap or apap from cpapauction for a backup.

Just check with the insurance carrier about your coverage -- they are the ones to check with.

Goofproof · Post by **Goofproof** » Mon May 05, 2008 8:29 pm

Being on a O2 hose won't stop apnea, only pressure in the airway can open the airway. O2 would only help if you can breath it. Jim

OldLincoln · Post by **OldLincoln** » Mon May 05, 2008 8:53 pm

Sleepy... that's the part of the deal that is selling me. We traid machines and I own it in July. The insurance co stops paying and I don't start.

Jim... That is why I am trying to work out the xPAP. My dad has a lung thing and uses the O2 and it works for him and he snores and grunts etc like a mule, has for over 40 years. He has a oximeter and when it drops below 90 he gases up. Sleeps with it half the time. I figure if I can't continue on xPAP that's better than nothing. My O2 averaged 75 on my first sleepover so it's at the top of my list.

Slinky · Post by **Slinky** » Mon May 05, 2008 9:25 pm

Durable medical equipment is billed by HCPCS code. All CPAPs from bare-bones compliance data only thru fully data capablel CPAPs to AND INCLUDING autoPAPs are considered CPAPs, HCPCS code E0601. So the insurance sees it as your asking them to purchase TWO CPAPs. Ain't a gonna happen. You've got a great DME supplier. Take the deal and RUN! They will be giving you a brand new autoPAP and receiving a used straight CPAP for just that one 10 or 13 month or whatever "capped rental" reimbursement fee.

jsmythe · Post by **jsmythe** » Mon May 05, 2008 9:55 pm

Most insurance companys will only pay for a new machine every 5 years. I got my apap about a month ago, with only 5 months remaining on the machine. It was an even trade. My co-pay went from $24 to $37. Now, in 4 months, it will be mine. I doubt that you will get two machines from them (ins. comp.)

Snoredog · Post by **Snoredog** » Tue May 06, 2008 3:25 am

Send back the Resmed, get a Devillbiss!!

Read for yourself it is getting pretty good reviews, lots of 5 out of 5's in first go around:

https://www.cpap.com/cpap-machine/devil ... chine.html

I hear the software that is coming out is supposed to be pretty good also.

CarrieS · Post by **CarrieS** » Tue May 06, 2008 10:17 am

I dont knwo about your insurance but theres no way mine would cover both and if I hadnt of swapped within the 6 month period I wouldve been stuck for 5 years with assistance on a new machine. My DME traded my CPAP for my APAP and it was still mine after the 6 months of insurance payments but I couldnt have both they wont buy 2 machines in one year.

OldLincoln · Post by **OldLincoln** » Tue May 06, 2008 2:09 pm

Thanks all... I will take the deal Thursday.

She will have me sign a waiver on the HC150 as she was told by Respironics that "they cannot guarantee that the HC150 will not affect the Auto sensing properties of the APAP." If it screws up the alogarithm replacing it is out of my pocket. The pricing on both are about the same so I believe she has my interest at heart. All your statements have me convinced they will get along just fine.

The equipment is the Respironics M Auto w/ AFLEX and the Fisher and Paykel HC150 humidifier. Then I need to buy a card reader and software.

Again, thanks for your input on this.

Earle

Slinky · Post by **Slinky** » Tue May 06, 2008 2:31 pm

GOOD setup! Talk about falling into a pile of poop and coming up smelling like a rose!!! Its a great deal! Congratulations!

oceanpearl · Post by **oceanpearl** » Wed May 07, 2008 10:39 am

jsmythe wrote:Most insurance companys will only pay for a new machine every 5 years. I got my apap about a month ago, with only 5 months remaining on the machine. It was an even trade. My co-pay went from $24 to $37. Now, in 4 months, it will be mine. I doubt that you will get two machines from them (ins. comp.)

That is not totally correct. If your sleep doctor writes a letter of "medical Necessity" the insurance company will honor it if you are changing from CPAP to BIPAP or AUTO.

jasper · Post by **jasper** » Wed May 07, 2008 1:11 pm

That's correct ocean. I got a letter, Rx etc. and the ins co paid for a new APAP when the original CPAP Plus was only a year old. Even bought the APAP from cpap.com and insurance came through. It can be done if you have the documentation lined up. I consider the M-Plus to be my backup.

roster · Post by **roster** » Wed May 07, 2008 3:03 pm

OldLincoln wrote:....

Others have reported improvement to elimination of the problem going to APAP. .........

This makes no sense to me. If you have your cpap pressure set correctly it is probably set at level of 90% or higher. So if you get an apap and set it correctly, it will run at a level lower than your cpap setting 10% or less of the night. How will this help?

By the way, I have tried cpap, apap, A-Flex and C-Flex and I still have the gas at night.

My DME Says She's Trying to "Help Me"

My DME Says She's Trying to "Help Me"

Re: My DME Says She's Trying to "Help Me"