I got it!!! DME/Insurance giving me an IntelliPap

[lanndi]

As recommended by FatiguedMe, I'm starting a new thread. Click here to review history:
viewtopic.php?f=1&t=42432&view=unread#unread

This is my last post under topic "I'm about to have one of those conversations with my DME"

Argghh!!

OK, I get it now about dealing with DME's. Here I am, fairly educated by you guys, aware that this is going to be an issue, and still I can't get what I want.

How do you get past the argument "your insurance will only cover these machines?"

At this point, it looks like I'm going to get an Intellipap c-pap w/ SmartCode. That was not one I done much research on. At least it appears to be data capable! Is it any good?

Because I want to feel better, I've decided I'm going to go ahead and take this machine, while I continue my battles. I figure I may have to wait until I meet w/ sleep doc in Aug to get a Rx for what I really want.

So I would love any input on this machine and other steps to get what I want.

[Wulfman]

Which one?
It's my impression that the plain CPAP only reports compliance data. However, I believe the Auto (second link) collects more data. I know some of the forum members are using the Auto and maybe they can comment further.

https://www.cpap.com/productpage-bundle ... undle.html

https://www.cpap.com/productpage-bundle ... undle.html


Den

[lanndi]

From Pugsy on my other thread:

lanndi wrote:
How do you get past the argument "your insurance will only cover these machines?"

Your insurance will pay for whatever your doctor prescribes. To confirm it go directly to your insurance carrier.
If your prescription allows leeway in your personal choice then that is also what the doctor prescribes. DMEs bill by equipment code. The code is the same for all machines so they want you to take the least expensive model so they make more money. Typical DME BS.

Check with your insurance company as to how much out of pocket expense you would incur if you bought it and submitted for reimbursement. I put a pencil to mine and I had a 20 % copay no matter who supplied it. Over the 13 month rental copays and humidifier costs, it was a wash for me.

Intellipap seems to be a very good brand so nothing wrong with that part of it. Your DME is being a tightwad. Intellipap offers other models including auto units and software capabilities which was more in the lines of what I believe you were wanting.

Get a copy of your actual prescription. Exactly what does it say?

Based on you great folks, I sent the language to my allergist (who is one who ordered test) to prescribe what I wanted:
1] AutoPAP with integrated humidifier and usage data capablity
2] Pressure ____ cms
3] Efficacy & usage data access
4] Nasal mask of patient's choice

However, an APAP needs a pressure range. Since my doc is not a sleep doc, she did not feel qualified to set that when the anonymous sleep doc who wrote my report gave a specific pressure. Also, my insurance "does not provide APAPS" without an AHI of 15 or more (mine is 13.7).

My insurance co will pay nothing if I buy it myself -- but I'm going to talk with our benefits person to double check that info.

[lanndi]

It

Wulfman on Mon Jun 08, 2009 10:03 am
Which one?
It's my impression that the plain CPAP only reports compliance data. However, I believe the Auto (second link) collects more data. I know some of the forum members are using the Auto and maybe they can comment further

I'm pretty sure it is the IntelliPAP Standard CPAP with the SmartCode. I was told I can go on line to see my data.

[Pugsy]

Why will your insurance provider not reimburse if you purchase elsewhere as long as you have the proper insurance form filled out? Even Medicare allows for reimbursement as long as proper completed insurance forms are submitted.
Cpap.com furnishes insurance forms. I got one with my software purchase even though it is not really needed because I know software is not covered.

[Hawthorne]

I think just the "autoadjust" in the Intellipap gives detailed data.

If you get an Intellipap, with that wording "Autopap" you should get a data capable machine.

From other threads on the forum, I think DMEs have balked at giving an Autopap if a pressure range rather than a single pressure is not prescribed. If you know your titrated pressure, you can get you doctor to specify a range starting maybe 1 cm below that titrated pressure and few cms above it. (i.e. in your case 12.5 cm - 17 cm). If you list your maximum pressure above the 15 cm insurance cutoff, you MAY just get an auto. Worth a try!

[Wulfman]

Here's another link. This one includes the software.

https://www.cpap.com/productpage-bundle ... ement.html

Be sure to also "do the math" before signing anything. Depending on what a local DME would charge your insurance and what your co-pay would be, it's highly probable that you could buy one of these machines out-of-pocket and be money ahead. And, then you wouldn't be at the mercy of the DME for "whatever".

Many insurance providers WILL reimburse their insured members for out-of-pocket purchases up to xx%. Mine reimbursed me for 80% after I made out an invoice from ME (billing party) to THEM (party being billed).


Den

[bonjour]

Here are a couple of days detail charts from the APAP
viewtopic/t42458/viewtopic.php?f=1&t=42 ... 23#p372723

The CPAP sw records compliance data and costs at CPAP.com $475, the APAP $589 (pkg price with heated humisifier and data module/software). Both are the same insurance code E0601 so they are the same to the insurance company.

Fred

[lanndi]

I think I'm screwed. I think the IntelliPAP I'm getting will provide only compliance data.

And my head is spinning! There are just too many variables to keep track of!
-- Should I accept the machine they are bringing me today for now? Will I be stuck with it? Can I get sleep doc to Rx better machine in August?
-- Should I try a different DME?
-- which solution
-- try to get hold of sleep doc whom I never met and talk him into writing Rx I want? -- Still not sure if my insurance co will pay for it.
-- try to get hold of ALLERGY doc who doesn't know sleep issues enough to vary from sleep study report?
-- My ins co will NOT reimburse me for out-of-network purchases -- should I stretch my budget and buy something else? Or can I get them to pay for part of something better and then buy add ons?
-- Am I even right in presuming the autopap will be best for me?
-- should I "settle" for what current ins will pay for, but then see if I would get better options by changing insurance plans this fall?

And I know there's lots more questions spinning around -- but my head's moving to fast for me to catch them all!!

[Pugsy]

Will you be satisfied with compliance only?

I would try another DME and at least try for CPAP that will give you data capabilities. You may not "need" the auto unit but if you read my story you can see how APAP helped me get improvement fairly quickly as opposed to flying blind with no data.

I cannot imagine not being able to see some sort of data. My first choice for a DME tried to do this to me, I politely told them no thank you. Even DME #2 who I get my supplies from would have given me the data capable machine if I hadn't found the private machine offering.

From reading on various forums once you accept and sign for the machine it is even harder to get them to change unless data supports a change and ooops, you won't have any data. Talk about between a rock and a hard place.

[BeanMeScot]

If you let them leave the cheap machine, you will probably be stuck with it for 5 years unless you buy your own. The DME charges outrageous prices for things so make sure you really do understand how cheaply you can get something online vs what you will ACTUALLY pay through your insurance. The machine will often fall under your deductible and if you have as high a deductible as I do, you could have bought 2 machines by the time the insurance will pay any on yours. If you buy online, you can buy any machine you want APAP or CPAP.

You also have the right to use a different DME if this one is playing hardball. Just tell them that the machine is unaccetable and you will be contacting your insurance to find a different provider. They just might change their tune.

[BeanMeScot]

If all you can do is get the allergist to write a script with an APAP specifically but have it set with the top and bottom number = to your titrated pressure, you can find out here how to change it. Maybe he/she would agree to that.

[Wulfman]

It

Wulfman on Mon Jun 08, 2009 10:03 am
Which one?
It's my impression that the plain CPAP only reports compliance data. However, I believe the Auto (second link) collects more data. I know some of the forum members are using the Auto and maybe they can comment further

I'm pretty sure it is the IntelliPAP Standard CPAP with the SmartCode. I was told I can go on line to see my data.

Yeah......R I G H T.....

Do you have your prescription? (the physical document)
If not, you NEED to have it.

These people (should) work for YOU (you and your insurance are paying their fees). If they don't give you exactly what you want (all CPAPs and APAPs have the exact same insurance code), they've only got their own best interests at heart ($$$) and not YOURS.


Den

[GumbyCT]

If I were you - I wouldn't agree to or sign anything until I had time to make certain it was data capable (here online), period. If they won't allow time, they are trying to trick you. Changing later means they will make more excuses later.

Take a breath and take your time.

[GumbyCT]

As mentioned before you need to add up your cost for ALL of the co-pays. Then the software - if available for the machine they have. Keeping in mind that while the Intellipap may be an excellent machine, not as many here have that as have either Resmed or Respironics and will not be able to help as much.

That going on line to see your data is BS and would likely require a monthly $ub$cription that your insurance won't cover or just add to your co-pays.

Make sure any data recorded includes, leaks, apneas, hypops, snores, flow limitations, etc. Don't forget Respironics has a "Smart Card" to record hours of use. So don't be fooled bc they call it Smart Code. It too can record hours of use.

If your costs for co-pays are even close to what you can get a data capable machine from cpap.com - I would just buy from cpap.com

Your doc shouldn't care who or where you get this machine from and should support you, or you need a new doc.