Newbie needs C-PAP Rx HELP!

[Bluebonnet_Gal]

On advice received in this forum, I obtained a copy of the Prescription my ENT sent to my DME. I hope to be getting my equipment from my DME this week. They are in the process of insurance verification.

I want to thank everyone for the wonderful advice and I want to thank RG for the link and the info on full data machines. If I did this right, the Rx from my ENT should appear below. It appears very generic to me. He did tell me verbally that he wants me on a machine that automatically adjusts and he asked me to come in for a follow-up after I've been on the machine for 6 weeks so we can review the data and see how it's going.



As far as I can tell, my Doc didn't specify a brand or anything, so I have been doing some research of cost of the machines on the list provided by RG. I know I want an auto adjusting machine that provides full data if possible. My insurance stated that I would be renting a machine and the cost would be subject to my deductible (which I have met this year). After deductible, insurance will pay 80%. They called my DME (before we had the Rx) for an estimate of my cost. They stated I would purchase a humidifier, mask, hose, filter, etc and only rent the machine and the estimated first monthly full cost is around $650. After that, I would pay $125/month rental for 10 months (I guess then 2 months off before starting the monthly billing again?). Since I start with a new Ded in Jan, I will be paying the full out of pocket $125/mo until I reach my $1,000 Ded.

This all sounds rather costly to me. It appears I might be able to purchase the machine, (out of pocket if my insurance will not contribute to purchase) for less $ in the long run. This is something I will discuss with my DME and my insurance when I finally get to go in and pick up my equipment.

Having said all that, just to get an idea of the cost of the machine, I researched cpapsupplyusa online. I see the machines listed in RG's list as Autotitrating and recording full data range in price from $435.00 for the DeVilbiss IntelliPAP Auto CPAP to $789.00 for Respironics REMStar M Series AUTO CPAP with A-Flex and SmartCard. I'm not including the price of the humidifier because I know my insurance will pay for purchase of the humidifier (80% if before the end of this year). I would like to have at least a 1st pick and 2nd pick in mind going in to the DME.

My question, of the following machines, which do you guys recommend? Anyone have any problems with a particular machine or highly recommend one?

Respironics REMstar Auto M series -- with or without "A-Flex."
ResMed S8 Autoset Vantage and Autoset II
Puritan Bennett GoodKnight 420E
Covidien/Puritan Bennett Sandman Auto
DeVilbiss IntelliPAP Autoadjust

Some machines have A-Flex and some have C-Flex. What is the difference? What do you guys recommend?

Also, does anyone see anything on my Rx worth pointing out? All I get out of it is he wants me to use a Autotitrating C-PAP and the diagnosis for this Rx is Sleep Apnea. I don't understand why he put "X 2 weeks" and I don't understand what appears to be "tnal" after "Auto"

Any and all input is welcome and appreciated!

[cflame1]

I'm actually going to recommend whatever version of the auto that your DME comes out with.

My reason? Your insurance will pay for that humidifier... it's a purchase as they can't be returned. So unless you get lucky enough to get the FP 150 humidifier then you should keep with the same manufacturer/model as what they bring you.

[sleepycarol]

I would check with the doctor as I read your script I think it may read

cpap auto trial
2x weeks

dx sleep apnea

If that is the case then you would have a 2 week trial on an apap, but not necessarily receive that machine as your final xpap.

Call and get it clarified before going to the DME (which typically have a hard time reading the scripts correctly).

[Bluebonnet_Gal]

So unless you get lucky enough to get the FP 150 humidifier then you should keep with the same manufacturer/model as what they bring you.

cflame, what's special about the FP 150 humidfier and what machine do they go on?

[Slinky]

Yup, that's the way I read the script too: its just for a 2 week trial on an APAP, we (and the DME) evidently have to assume set wide open w/a pressure range of 4 cms to 20 cms.

How the h*ll this dimwit expects you to see him for a follow-up after you've been on the machine for 6 weeks when he hasn't provided for more than 2 weeks use is beyond me.

Or maybe he ASSUMES the DME will do a download when you return the APAP in 2 weeks and FAX him the data and tell him what pressure your bottom of the line straight CPAP should be set at for the next 4 weeks until you see him again so he can FAX over that script.

I'd be inclined to contact this sleep "doctor" to point out the script is for only a two week trial w/no pressure settings included and ask about what he anticipates you should use or do those 4 weeks between return of the auto and when he wants to see you again. And at this point I would also tell him exactly what equipment I want.

... My insurance stated that I would be renting a machine and the cost would be subject to my deductible (which I have met this year). After deductible, insurance will pay 80%. They called my DME (before we had the Rx) for an estimate of my cost. They stated I would purchase a humidifier, mask, hose, filter, etc and only rent the machine and the estimated first monthly full cost is around $650. After that, I would pay $125/month rental for 10 months (I guess then 2 months off before starting the monthly billing again?). Since I start with a new Ded in Jan, I will be paying the full out of pocket $125/mo until I reach my $1,000 Ded. ...

Huh? Yep, the accessories, including humidifier are usually outright purchases. And, yep, the xPAP is often some form of capped rental, i.e. rented for some many months, then considered paid in full and reverts to your sole ownership. Get it yet this month and the accessories are paid for, plus that first month's rent less 20%.
Wanna know what "I" would do? Pick up the goodies this month, next month return the xPAP, keep the other goodies, buy the xPAP I wanted out of pocket from cpap.com (before the first of the year), send a copy of the paid in full statement from cpap.com to your insurance company along w/th a bill for that amount to be paid to you. Whether your insurance reimburses you or not, you still come out ahead financially.

[sleepycarol]

In dealing with DME's there are good ones and then there are those that are verrrrry bad.

I live in a rural community (20,000 population and we are the biggest city for the surrounding counties as well). You are limited in your choices unless you want to drive a minimum of 1 1/2 hours one way. I know the DME I use only carries one nasal pillow mask -- the Optilife. If you want a nasal pillow mask that is your ONLY choice -- and they will not order others as I asked. Limited brands to choose from machines to masks to other supplies. On the insurance I am on now I have to use this provider if I want to make claims -- no other options are available unless I want to go "out of network" and have benefits cut accordingly.

You may end up getting a machine other than the one you wanted -- a Resmed instead of a Remstar, etc. ASK questions, ASK questions, ASK questions.

[cflame1]

cflame, what's special about the FP 150 humidfier and what machine do they go on?

The FP 150... will go on ANY machine.

[Bluebonnet_Gal]

I'd be inclined to contact this sleep "doctor" to point out the script is for only a two week trial w/no pressure settings included and ask about what he anticipates you should use or do those 4 weeks between return of the auto and when he wants to see you again.

My doctor is an ENT. My family practitioner recommended I see my ENT for the sleep study. He first said he wants to see me again in 4 weeks, then he said 6 weeks. I will definitely have to make some phone calls tomorrow to clear things up.

[sleepycarol]

If you have decided on a machine ask the doctor if he would write the script specifically for that machine. Then I think your DME will have to accommodate.

I have the M series Auto with c-flex. I hadn't heard about the A-flex and think it might just have came out about the time I received my machine. I get along just fine with the c-flex and don't "know" any better so am content for now.

Slinky has good things to say about the Resmed Autos. Some of the other posters use the other various brands. If you do your homework before getting your machine you should be okay. If you can swing it cpap.com has reasonable prices -- but email them for quotes prior to ordering as they do give price reductions on some of the machines.

Good luck and keep coming back.

[plr66]

Wanna know what "I" would do? Pick up the goodies this month, next month return the xPAP, keep the other goodies, buy the xPAP I wanted out of pocket from cpap.com (before the first of the year), send a copy of the paid in full statement from cpap.com to your insurance company along w/th a bill for that amount to be paid to you. Whether your insurance reimburses you or not, you still come out ahead financially.

FWIW, and having gone through a nearly identical scenario several months ago, I agree completely with Slinky on this. That insurance-required rental rackett just forces you to continue through the next re-setting of your deductible at the first of the year, which means you will very likely spend more and extend the time in which you will have to endure endless hassles with both DME and insurance company.

[Bluebonnet_Gal]

Wanna know what "I" would do? Pick up the goodies this month, next month return the xPAP, keep the other goodies, buy the xPAP I wanted out of pocket from cpap.com (before the first of the year), send a copy of the paid in full statement from cpap.com to your insurance company along w/th a bill for that amount to be paid to you. Whether your insurance reimburses you or not, you still come out ahead financially.

Once again, thanks for all the help and GREAT INFO!

I will likely do as Slinky suggested. Cpap.com has a WEALTH of info including reviews and comparison charts. I will put together a "top 3" list before going to my DME. If all goes well (or at least reasonably well) within the first couple of weeks, I will order that machine from cpap.com and try to get my insurance company to reimburse me.

[ozij]

Smokin gun stage center:



Enter rested gal, stage right.

I know my ENT wants me on an AutoPAP and I'm pretty sure he wants one that records full data. He mentioned those things when I last went in. I'm supposed to spend about 6 weeks on the AutoPAP, then come in for an appointment to see how it's going.

That's probably going to be just a "trial" on autopap. Using it for the 6 weeks so the doctor can later see (from the data recorded on the machine's "Smart Card") what will be a good single pressure to prescribe for you. Then the DME generally takes away the autopap and gives you a less expensive straight cpap machine, set for the pressure the doctor prescribes. That's when you'll have to be alert and on your toes so that the cpap machine the DME replaces the autopap with is a cpap machine that can record full data.