Difficulty getting ResMed

wireless · Post by **wireless** » Fri Jul 11, 2008 2:32 pm

The companies around here are trying to push me into getting the Respironics BiPAP M Series (probably the non-Auto type too) instead of the ResMed VPAP Auto that I want. They don't have the one I want in stock and try to tell me that they are all the same, that the Respironics is so great, that I'm not allowed to have Auto settings (at least, they won't program them in for me) if the doc didn't order it, that they or my doc needs the Smart Card and can't do the ResMed format, etc. I think there is no reason why I can't and shouldn't get the type I want, right? And once they program in the BiPAP non-auto settings I can just put the same in the Auto settings? And just print out the data for doc. I called ResMed and they haven't called back yet, they are supposed to try to find where I can get one of these, but I have my doubts about any being available around here. This is a pain, and I'm surprised it's so hard to get a ResMed. I don't mind buying from an online company, if they would do the same insurance deal, most of the online places don't seem to do the billing or rent-to-own. I'm nervous that I may not be able to get one without the doc approving the fact that it's Auto and/or ResMed (since it's "VPAP" not "BiPAP"), but it seems unreasonable if I'm not allowed to get this type. Just wondering if anyone has comments.

Insomniyak · Post by **Insomniyak** » Fri Jul 11, 2008 2:51 pm

Look for a different DME in your area if have that option with your insurance. DMEs pay alot less for Respironics than for Resmeds, so right there, they get to keep more of the Maximum Allowable Pay-out from your insurance co. Add to that it is cheaper for them to acquire and sell you somthing with less bells and whistles.

Make sure your doc puts down the features you need on the script (Data compliant, BiPaP, and auto if they will go for it) and that way the DME will have to give you those features.

If they do not want to sell you the brand you want, look elsewhere.

My DME had both in stock and they were willing to sell me either, and I did look at them side by side, BUT they had alot more Respironics in stock and my doc had said that in his opinion they are pushed due to market share, and flooding the market.

My only thing with the Resmed was that it looks like a Fisher Price toy.

FoxNewsFan · Post by **FoxNewsFan** » Fri Jul 11, 2008 3:05 pm

It's too bad that you didn't lurk on here for a while before starting the whole process. There are many very knowledgable people who will give you great advice. I couldn't see where you live but my DME has decided to sell only ResMeds because he's tired of the other brands breaking down.

E-mail John at cpap.com He will give you excellent advice.

Ed

wireless · Post by **wireless** » Fri Jul 11, 2008 3:13 pm

I've talked with 4 different DME's. Yes I know they want the profit margins associated with the Respironics. I don't think cpap.com would help since I am not willing to buy from a place that doesn't do rent-to-own under my insurance. Well, hopefully the ResMed company will come up with something helpful.

jnk · Post by **jnk** » Fri Jul 11, 2008 3:16 pm

Insomniyak, you made me laugh out loud. You are exactly right. It does look like a Fisher-Price toy! I hadn't noticed that before!

wireless, for what it's worth, I just bought a mask from cpap.com (the hosts of this forum, I understand), and they e-mailed me some kind of official-looking form for attempting to get reimbursement from insurance for what I paid. I don't know if that arrangement would work out for your insurance situation, but I bet the machine is cheaper online than from a DME, and it may be worth looking into. And I think all the online companies want from you is a copy of your prescription for PAP therapy in order for it to be "legal" for them to send you a machine. I don't think the scrip has to say "auto" or anything, it just has to be for some form of PAP therapy.

My sleep doc wrote, at my request, "patient may also use auto bilevel" on the prescription. He warned me that insurance often won't pay for auto bilevel, though.

Hope that helps.

jnk

ww · Post by ww » Fri Jul 11, 2008 4:19 pm

I don't know which brand is better in a bi-pap. Personally, I would NOT accept one that was not an AUTO bi-pap. There is a lot to analyze and there are a FEW people on here that have a bi-pap and can tell you the pros and cons. I would be patient and wait for their assessment as you will be stuck with this machine for at least 5 years!!!
The costs (retail advertised price) can be seen and compared on cpap.com, but you will have to send them and e-mail or call them to find what the real cost is. Since you didn't do all this preparation before you were ready to buy, take a couple of days and do it now. Call your insurance company and find out how they will reimburse on an internet purchased bi-pap and which DME's they will let you use at the least co-pay. It is NOT unusual for the co-pays and your out of pocket expenses to be MORE than an internet purchase machine and a lot less if your insurance company pays for a big chunk of your cost there.

Snoredog · Post by **Snoredog** » Fri Jul 11, 2008 4:22 pm

got a script for CPAP, try cpap.com they can probably get you anything you want. Just because they don't advertise something doesn't mean they cannot get it.

you will soon learn that the majority of DME's are lying bunch of individuals.

Slinky · Post by **Slinky** » Fri Jul 11, 2008 4:38 pm

IF a local DME supplier has to pay more for a Resmed than for a Respironics it is BECAUSE they've been buying in bulk from Respironics and not buying Resmeds or buying them in much smaller quantities.

It sounds like in your case, the local DME's you've visited have been doing the bulk or all of their business w/Respironics and thus don't get a "bulk" price from Resmed. That's their problem. Either they want your business and provide you w/the Resmed or they don't want it enough to provide the Resmed.

Stick to your guns. Be DIPLOMATIC, be TACTFUL, but be FIRM. You will be living w/this baby every night for AT LEAST the next 5 years.

They and the sleep lab may well NOT have the software and cable reader for Resmed downloads. Too bad, so sad. They'll have to be satisfied w/your bringing your device in to manually check the data via the LCD screen, OR IF you decide to purchase the software and cable reader, be satisfied w/your providng the download printout and your doing their job for them. Poor babies. My heart bleeds. NOT!

You could try talking to or asking for an appointment w/your sleep doctor or whichever doctor is writing the order and ask that they re-write the script EXPLICITLY for the Resmed S8 II VPAP Auto w/Humidaire 3i integrated humidifier. When you make it clear you do NOT HAVE your bi-level yet BECAUSE you refuse to accept less than the one you want that you are going to have to sleep w/every night for AT LEAST the next 5 years.

Medicare lists the Resmed S8 II VPAP Auto as follows (keep in mind all auto bi-levels will be this SAME HCPCS code - the STs, etc. may well be a different HCPCS code):

Billed: $239.92 - Allowed: $218.11 - Paid: $174.49 - CoPay: $43.62

Resmed S8 II VPAP Auto: E0470
Respiratory Assist Device, Bi-Level Pressure Capability, Without Backup Rate Feature, Used W

This is what Medicare will be paying for 13 months. The CoPay is what my secondary insurance will be paying for 13 months (or the 20% I would have to pay monthly if I didn't have that secondary insurance). Just so you have some idea of what you are getting into w/a bi-level.

So my local DME supplier will be receiving $2835.43 total for my Resmed S8 II VPAP Auto.

Slinky · Post by **Slinky** » Fri Jul 11, 2008 5:15 pm

And, Insomniyak! You're just jealous 'cause my bi-level is prettier than your bi-level. Better to look like a Fisher Price toy than an ugly, charred black oversized brick considering what these babies cost.!

Insomniyak · Post by **Insomniyak** » Fri Jul 11, 2008 7:44 pm

Well, Slinky, when you say your Resmed has the bells and whistles, since it looks like a Fisher-Price toy, that must mean it has the dangling bells, and the squeaky things that you squeeze to make them whistle, LOL

Slinky · Post by **Slinky** » Fri Jul 11, 2008 10:28 pm

Oooooh! You ARE feeling sassy, Insomniyak!!! Hey, it whispers sweet nothings to me in French too! Its a keeper!

hobbs · Post by **hobbs** » Fri Jul 11, 2008 10:46 pm

Slinky wrote:And, Insomniyak! You're just jealous 'cause my bi-level is prettier than your bi-level. Better to look like a Fisher Price toy than an ugly, charred black oversized brick considering what these babies cost.!

. . . and the Resmed engineers also realized that it would need a power supply and built it in. Or, maybe they considered the power supply to be replaceable like their humidifiers?

wireless · Post by **wireless** » Sat Jul 12, 2008 12:12 am

I asked my insurance company before, and they said they'd cover an Auto just the same. Yeah, maybe there will be some ResMed dealer around here. That's how I feel, I need a machine and I need that specific type, so the docs and others better just accept it. It would just suck if the doc or assistant were to make it harder for me or try to dissuade me, ah well.

Snoredog · Post by **Snoredog** » Sat Jul 12, 2008 1:43 am

Slinky wrote:
Medicare lists the Resmed S8 II VPAP Auto as follows (keep in mind all auto bi-levels will be this SAME HCPCS code - the STs, etc. may well be a different HCPCS code):

Billed: $239.92 - Allowed: $218.11 - Paid: $174.49 - CoPay: $43.62

Resmed S8 II VPAP Auto: E0470
Respiratory Assist Device, Bi-Level Pressure Capability, Without Backup Rate Feature, Used W

This is what Medicare will be paying for 13 months. The CoPay is what my secondary insurance will be paying for 13 months (or the 20% I would have to pay monthly if I didn't have that secondary insurance). Just so you have some idea of what you are getting into w/a bi-level.

So my local DME supplier will be receiving $2835.43 total for my Resmed S8 II VPAP Auto.

this is a perfect example WHY our medical costs are so high, Medicare is paying $2835.43 for a machine that once sold at cpap.com for around $1200-$1400.00. Maybe it is not the exact model but if anything the only difference is the firmware software that makes it function.

I might add when you add up your medicare premiums on top of your copay that is the true cost of that machine not the 2835.43.

While you would think that price is bad enough, they jack up the price of everything in medical care for medicare billing purposes, so it doesn't matter if you are on Medicare or not you pay the ridiculous price because of of Medicare.

Your portion as a patient is 43.62 x 13 or $567.06, you can buy almost any autopap at cpap.com for that copay alone, now add your premium on top of that, even with the copay you are taken to the cleaners.

Slinky · Post by **Slinky** » Sat Jul 12, 2008 6:19 am

Yeah, well, SnoreDog, I didn't ask for Medicare. I turned 65 and I was on Medicare like it or not. My previous primary insurance became my secondary insurance whether I liked it or not. I was given no other option except to not pay the Medicare premium and go w/o insurance. I'd have lost my previous primary insurance.

I will agree, and have said for years, INSURANCE has been the largest reason for the outrageous costs of medical care. When I was breeding and showing dogs and the insurance industry started trying to make inroads into health insurance for dogs I like to have hit the roof when some of my acquaintances would get excited about finally being able to get health insurance for their dogs and "bring down their veterinary costs"!!!!!

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