Oh, Wise Ones, I have ?'s

[SnoozeButton]

I succeeded in getting my DME to exchange my M Series Plus for an M Series Auto, but was told that I might not be able to keep it, something about my sleep study might show that I don't have the need for it????? But my doctor did approve it and faxed them a script for it. Does this make sense or is this another DME lie?

Also, I think my DME's *%$*% RT disabled the mask leak and AHI read out so that I can't see it on the screen. It doesn't show as an option on the screen does this mean it is disabled or since the machine is new will it not show until I actually use the machine? All I'm able to see on the screen is the basic compliance information.

If I get into the clinician's menu (with someone's help) and enable it will the DME be able to tell that I enabled it when they read the Smart Card? Of course all I was given was the User Manual.

Another question. My pressure is supposed to be 8 and the RT said the machine is set to be 6 - 15. Is this correct for that machine? I know I need to study up on this machine some more - so much for a newbie to learn!

[AuntieNae]

I'll try to help ..

The Plus machine can only record compliance data .. to show you are using it .. nothing else. It is also set to one constant pressure.

There is a way to get into the set up menu, I have seen better explanations than this .. but if you turn off the machine, and turn it back on, hold the top two buttons .. and it will unlock the set up .. hopefully someone can add to this for you.

Going from the Plus to the Auto, I had the same problem. The DME said I could have the Auto for 30 days yet I had a Dr. prescription for it. I recorded and printed out 1 week of data for my Doctor and dropped it off at his office. I told him what the DME said and he said he would confirm I needed the Auto. So far, so good .. as I reach that 30 day mark now.

Hoping someone else adds to this but it is my understanding that there is 1 insurance billing code for the CPAP machines. As in, they get paid the same regardless if you get the Plus or the Auto. So, it is the DME's benefit to give out the less expensive Plus machine.

[DreamStalker]

I succeeded in getting my DME to exchange my M Series Plus for an M Series Auto, but was told that I might not be able to keep it, something about my sleep study might show that I don't have the need for it????? But my doctor did approve it and faxed them a script for it. Does this make sense or is this another DME lie?

Also, I think my DME's *%$*% RT disabled the mask leak and AHI read out so that I can't see it on the screen. It doesn't show as an option on the screen does this mean it is disabled or since the machine is new will it not show until I actually use the machine? All I'm able to see on the screen is the basic compliance information.

If I get into the clinician's menu (with someone's help) and enable it will the DME be able to tell that I enabled it when they read the Smart Card? Of course all I was given was the User Manual.

Another question. My pressure is supposed to be 8 and the RT said the machine is set to be 6 - 15. Is this correct for that machine? I know I need to study up on this machine some more - so much for a newbie to learn!

They lie as most do most of the time to most of the people and mostly for profit.

Are you sure you have an auto, maybe they lied to you and just told you that they gave you an auto.

If it is indeed an auto, I would use the 6 to 15 for a week or two and see what efficacy numbers you are getting before going and changing settings.

[Wulfman]

I succeeded in getting my DME to exchange my M Series Plus for an M Series Auto, but was told that I might not be able to keep it, something about my sleep study might show that I don't have the need for it????? But my doctor did approve it and faxed them a script for it. Does this make sense or is this another DME lie?

Also, I think my DME's *%$*% RT disabled the mask leak and AHI read out so that I can't see it on the screen. It doesn't show as an option on the screen does this mean it is disabled or since the machine is new will it not show until I actually use the machine? All I'm able to see on the screen is the basic compliance information.

If I get into the clinician's menu (with someone's help) and enable it will the DME be able to tell that I enabled it when they read the Smart Card? Of course all I was given was the User Manual.

Another question. My pressure is supposed to be 8 and the RT said the machine is set to be 6 - 15. Is this correct for that machine? I know I need to study up on this machine some more - so much for a newbie to learn!

Them saying that you may not "need" it may be referring to the fact that your titrated pressure is relatively low (8 cm.).
However, since they make more profit from cheaper, lower-end machine.....and that your insurance will pay the same amount......whether it's a cheap or expensive machine......that would be another reason for them to try to keep you from getting the Auto.

The "Show AHI/Leak" feature needs to be turned ON in the Setup menu to see the data.

You'll be able to see more when you get into the settings.

Den


Menu for M Series Auto

1. Hold down the <- -> buttons while plugging in the power on the back, wait for 2 beeps, release buttons.
2. Press the + key. <- -> buttons move to next field, -/+ keys decrement/increment
3. Check the following field(s):

-Therapy Mode = (CPAP/Auto)

-Auto:Max = (default=20.0cm)

-Auto:Min = (default=4.0cm)

-C-Flex Setting = 2 (options are off, 1, 2 or 3)

-AutoRamp Time = (options are 05 to 45 min)

-AutoRamp Pressure = cm (4cm->AutoMin)

-Mask Alert Feature = On (On/Off)

-Auto Off Feature = Off (On/off)

-Split Night Time = Off (off, 120, 180, 240)

-Show AHI/Leak Feature = On (On/Off)

Press On/Off button to exit.




==========Resetting LCD Display Data====================

To reset LCD Therapy data (does NOT erase any data from SmartCard):

1. Hold down the (<-) (->) buttons while plugging in the power on the back,
wait for 2 beeps or 5 seconds, release buttons.
2. Press the (->) key and navigate to Therapy screen.
3. Press and HOLD down the (-) minus key for 5 seconds and/or until therapy data is reset to Zero.
4. Press the (->) key to scroll back to main menu, press (+) key to enter Setup or
On/Off button to exit.

[Slinky]

Yep, when the DME does a download of the data they can see what pressures you've been playing with. At least they can w/the Resmeds so no reason to think that they can't w/the Respironics' as well.

[Paul56]

But my doctor did approve it and faxed them a script for it. Does this make sense or is this another DME lie?

Your Doc is the higher authority. If you can convince the Doc to write a prescription for an Auto then that is the machine you get. DMEs are not authorized to change prescriptions.

If I get into the clinician's menu (with someone's help) and enable it will the DME be able to tell that I enabled it when they read the Smart Card? Of course all I was given was the User Manual.

Very likely they can but don't sweat it. This is your therapy so don't take crap from the DME when all you are trying to do is help yourself.

Another question. My pressure is supposed to be 8 and the RT said the machine is set to be 6 - 15. Is this correct for that machine? I know I need to study up on this machine some more - so much for a newbie to learn!

Given your titration was 8 that seems like a reasonable range to start with. Collect your data for at least a week before messing with the settings. My own titration was also 8 so I started with a similar range on my Auto.

[SnoozeButton]

Thanks for the info. So are you saying that I can set it and then reset it back to the way it was before and no one will be the wiser? If so, that is what I will do.

Is there really a way they can get the machine back from me if the doctor approved it and the insurance covers it? Or is that just a nasty DME scare tactic ? What would their grounds be for getting it back? How would they determine whether it was beneficial to my treatment or not and then if all my other bases are covered how would they be able to get it back from me?

[DreamStalker]

Thanks for the info. So are you saying that I can set it and then reset it back to the way it was before and no one will be the wiser? If so, that is what I will do.

You will be wiser and correct, they most likely will not.

Is there really a way they can get the machine back from me if the doctor approved it and the insurance covers it? Or is that just a nasty DME scare tactic ? What would their grounds be for getting it back? How would they determine whether it was beneficial to my treatment or not and then if all my other bases are covered how would they be able to get it back from me?

If you are renting, I suppose they could take it back. But they certainly cannot make you take something you don't want or exchange it for something you don't want. If it is rented and they take it back, not sweat it as you can then get the APAP of your choice.

Generally, the insurance wants to know if you are compliant which is why most DMEs only care that you have a machine that monitors compliance ... so they can bill your insurance and they get their profit. Most insurance requires that you average 4 hours per night compliance for a period ranging from 3 months to 6 months before they agree to purchase.

So if they want it back give it to them just don't let them give you a lessor one to replace it .... you can get the machine of your choice most anywhere.

[Wulfman]

Thanks for the info. So are you saying that I can set it and then reset it back to the way it was before and no one will be the wiser? If so, that is what I will do.

Is there really a way they can get the machine back from me if the doctor approved it and the insurance covers it? Or is that just a nasty DME scare tactic ? What would their grounds be for getting it back? How would they determine whether it was beneficial to my treatment or not and then if all my other bases are covered how would they be able to get it back from me?

If the machine was a brand new one (as opposed to a used/loaner), then it should be YOURS.

If it's YOURS......you can set it to anything you want to. That might not be a prudent thing to do, but this is YOUR therapy.
I cut my original (prescribed) pressure almost in half (18 to 10) about an hour after I started testing with it.....and my sleep doctor wasn't any too happy about that......but he couldn't argue with me because I had a handful of printouts from Encore Pro which proved my therapy was working well at 10 cm. FUGM!

Den

[Slinky]

A good share of these local DME supplier's RTs never bother to get to know the capabilities of the xPAPs they provide, they just follow the Quick SetUp Guide to your doctor's script which usually is just the pressure to set or the pressure range and Ramp and/or C-Flex and everything else to Default. Access to your efficacy data via the LCD screen has to be specifically enabled and usually isn't unless your doctor includes that in your script. Sleep doctors don't work with and thus can't keep up w/all the various data capabilities of the various brands and models of xPAPs so they usually aren't even aware that they have to include an order to enable access to your efficacy data in the script.

[SnoozeButton]

Thank you all for your help. I've now enabled my machine so that I can view my AHI and Leak information. Furthermore, I decided that since my doctor wrote a script for this machine if they ask for the machine back they can have it and I will just take my script somewhere else to get the machine. There are some other in network DME's that my insurance works with so if this one doesn't want to work with me I'm sure one of the others will . Of course for my convenience I will tell them this in case they want to "rethink" things.

Maybe it's my sleep deprived mind, but I almost enjoy watching them backpeddle when I call them on their BS. It will be interesting to see if they try to say this machine needs to come back. Is there a time period in which they have to "reclaim it" or in which I have to return it? So far I've had one week with them. I can track what my insurance has paid, so if they make a payment on it is it too late at that point for the DME to "reclaim it"?

[plr66]

Is there a time period in which they have to "reclaim it" or in which I have to return it? So far I've had one week with them. I can track what my insurance has paid, so if they make a payment on it is it too late at that point for the DME to "reclaim it"?

I think it depends on what agreement you signed. If you did a month's rental and paid your part for a month and signed that---I think you have that long to just eat that amount, and arrange your next plan. I ordered my machine from cpap.com in that interinm period and got it just before returning the DME machine, so I got the most from that expenditure.

[RevnJeff]

Hoping someone else adds to this but it is my understanding that there is 1 insurance billing code for the CPAP machines. As in, they get paid the same regardless if you get the Plus or the Auto. So, it is the DME's benefit to give out the less expensive Plus machine.

Not sure how your insurance policy works, or how your DME works, but my experience is that I am responsible for whatever the insurance company doesn't cover. For example, until I meet my out of pocket maximum (which for this current year I will not), I have to pay 20% of the cost, plus whatever difference there is between what BCBS pays and the real price.

So, it's really in the DME's best interest to try and sell me a more expensive machine...they will get their money, some from BCBS, the rest from me.

As the commerical said, "You can pay me now, or you can pay me later."

Jeff

[SnoozeButton]

My insurance pays 100% of the rental and I have no deductibles.

[MurphysLaw]

My insurance pays 100% of the rental and I have no deductibles.

Whoa! Do you work for the government? A senator, perhaps?