Which Respirionics Should I Get

[spocpm]

Hello, new guy here.

I just came back from the doctor's office and was prescribed a CPAP machine. The DME, which is right next door to the doctor's office was going to give me the Respironics DS100 w/humidifier. I would have to pay a copay of $150.00 for this machine. They seem to suggest that a full data machine is not really necessary.

From what I read in the forum, many suggest that I should get a full data machine and that the Respironics M Series with AFLEX and humidifier is a good choice. The DME told me that I would have to pay about $300 extra, out of pocket, for this model. Is this worth it??

Any advice would be appreciated. Thanks

[DreamStalker]

Don't ever step in that DME office again.

They are not interested in your health nearly as much as making a few extra dollars off you.

The insurance code for the DS100 is the same as for the AFLEX machine so they are trying to rp you off for an extra $300.

Get the original Rx from your docs office ... it should be good for life and it is yours by law.

Shop around til you find what you want.

Welcome to the forum ... you are one lucky PAPer.

[LinkC]

DS makes some good points. Copay of $150 plus $300 to get data??

For $450 you can BUY your own basic machine and for very little more go full data.

Get your 'script in hand and RUN away from that DME!

To answer your question, tho, my DME initially gave me a Plus CPAP (basic). I arranged to get an "auto" script and I love my M Series Auto. Full data, APAP or CPAP, A-FLEX.
Get the best machine your Insurance Co can afford!

[spocpm]

Thanks for your replies. I am glad I found this forum.

[Guest]

Spoc - before you "run" and join the ranks of the brick-and-mortar DME-haters....can you PLEASE go back to this DME and FLAT-OUT ask WHY you need to pay an extra $300 for the A-Flex unit? Ask to see where it is in your insurance's guidelines that this is spelled out. Ask them why they can't supply you with one under code E0601.

Do this:

1) Call your insurance provider and ask them how much they reimburse for code E0601.
2) Take that information to your DME and tell them that you would like the A-Flex unit under E0601.

Can SOMEONE on this forum post up what the DME actually said in response to being confronted with this information? E0601 is E00601.

Thanks.

[spocpm]

The DME told me that they either didn't have or there wasn't a code for the A-Flex unit - I forget exactly what they said. I'm am going to try calling another place tomorrow. By all the responses, it seems that this current DME is not being straight up with me. If this second place doesn't work out, I will try asking the first DME about the reimbursement code. If I do, I will post their response.

[jules]

Are you in a HMO?

[ww]

Hello, new guy here.

I just came back from the doctor's office and was prescribed a CPAP machine. The DME, which is right next door to the doctor's office was going to give me the Respironics DS100 w/humidifier. I would have to pay a copay of $150.00 for this machine. They seem to suggest that a full data machine is not really necessary.

From what I read in the forum, many suggest that I should get a full data machine and that the Respironics M Series with AFLEX and humidifier is a good choice. The DME told me that I would have to pay about $300 extra, out of pocket, for this model. Is this worth it??

Any advice would be appreciated. Thanks

I wrote this up for someone else, but since your DME wants you to pay $450 as co-pay for a data capable machine, you may be interested to know that you can buy if with a humidifier for almost that exact same price without any insurance:

"A similar machine is also available from Respironice that includes Aflex , but it is a noisier machine. They still have a software bug that skips a day or two every week or two and have had some problems with their humidifier leaking. It is an auto cpap that is data capable p/n DS510HS and includes humidifier and aflex. Private Pay price is $596.00. The Pro version is data capable but not auto and is the DS400HS with cflex, it is the same thing without the auto and private pay is $555, so is really a poor choice for either you or the doctor. The Plus (DS200HS) is NOT data capable (reports only hours used) and should not be taken under any circumstances! The private pay price is $485 and is a poor choice for you or the doctor as neither of you will ever know whether your therapy is working properly."

Don't accept a non data capable machine as the DME (or another one) should get you a data capable machine for the same co-pay as the non-data capable machine and in return your doctor can actually tell if you are getting the therapy you need without putting you through another expensive sleep test! With an auto, you can determine this every night!!!

[DreamStalker]

The DME told me that they either didn't have or there wasn't a code for the A-Flex unit - I forget exactly what they said. I'm am going to try calling another place tomorrow. By all the responses, it seems that this current DME is not being straight up with me. If this second place doesn't work out, I will try asking the first DME about the reimbursement code. If I do, I will post their response.

They are not only crooks but they are liars too because if they don't have it they can order it and the code is exactly the same as for the DS100. They are lying crooks just like the Guest (sin) poster (who is just a DME ashamed to register as a member).

CPAP/APAP MACHINE INSURANCE (HCPCS) CODE
E0601 Continuous airway pressure (CPAP/APAP) device

[carbonman]

Spoc - before you "run" and join the ranks of the brick-and-mortar DME-haters....can you PLEASE go back to this DME and FLAT-OUT ask WHY you need to pay an extra $300 for the A-Flex unit? Ask to see where it is in your insurance's guidelines that this is spelled out. Ask them why they can't supply you with one under code E0601.

Do this:

1) Call your insurance provider and ask them how much they reimburse for code E0601.
2) Take that information to your DME and tell them that you would like the A-Flex unit under E0601.

Can SOMEONE on this forum post up what the DME actually said in response to being confronted with this information? E0601 is E00601.

Thanks.

Why should these low-lifes be given another chance?

They need to be driven out a business for the lying bastards they are.

Sorry for my french, but it just makes me sick to hear these stories over and over.

[spocpm]

Are you in a HMO?

I have Aetna PPO. I have already met my deductible with my sleep study. So If I got the basic machine, I only need to pay the co-pay of . But from what I am reading here, it looks like I should get something better.

I didn't realize that this would be such a hard process. I called several DME's around me and neither accepted my insurance. I am still trying to look for some other places that I can go to.

[jules]

Just an HMO with an in house DME doesn't probably care what the insurance codes are.

The DME is probably basing what they say on how well your insurance reimburses them (and that will vary from insurer to insurer).

Can you get your doctor to rewrite the Rx to be machine specific?

What would be the copay for an out of network DME?

[DNAClone]

I also have Aetna PPO & although there are many different plans I used a local Aetna Participating DME in NY. I did not pay a dime for my Remstar Auto M Series with A Flex, C Flex & heatred hum.
The DME already provided me with an LT Swift and Mirage Quattro at my request, once again fully covered by Aetna.
You can call DMEs and tell them your insurance and state that you have a prescription for an APAP and ask if they can provide you with Model X. That's what I did and i am very happy. Had I not provided them with two choices of Auto machines (Autoset II and above), who knows what htey would have given me?

[cpapqueen1]

Lincare is an in-network AETNA provider. My neighbor just got an intellipap auto. Has all the data that the M-series has, no card to worry about and easy do your own uploading.

[spocpm]

Lincare is an in-network AETNA provider. My neighbor just got an intellipap auto. Has all the data that the M-series has, no card to worry about and easy do your own uploading.

Thanks, I have a Lincare not too far away. I will try them.

What a pain this whole process has been. I called my insurance company and the rep had no idea what code EO601 was.

Anyone have any experience with Apria? They take my insurance and quoted me a copay of about $120 (my portion of the 10 month rental fee) for a respironics m series with aflex and humidifier.

I called my doctor and the office is willing to give me a prescription for the machine that I want. So hopefully, either Lincare or Apria will work out.

Thanks again to everyone for their input. If I hadn't come across this forum, I would be sitting here with a basic machine the DME wanted to give me and not have a clue.