Newbie -- need advice on machine choice

[SnoozyWoozyCat]

I went for my sleep study last week at a local hospital. I just spoke with the PA from my doctor's office and came away a bit frustrated and confused. Apparently the split night study I had was successful in diagnosing my sleep apnea but was not successful in getting a good level for my CPAP machine. I was only able to sleep a little over an hour with the CPAP. I think this is because I normally go to bed so late (1:00 a.m.) and on the night of the study with the help of Lunesta, I was asleep by 10:30 p.m. and they woke me up at I think 4:30 a.m. to put the mask on and it took me a bit to get back to sleep. Anyway, the end result is that they want me to go back in for a 2nd night using the CPAP. Aarrghh!

Using this forum, I have done some research (thanks to all of you for your informed responses to questions). I want to make sure I get the best machine I can but feel a little as if my doctor's office might be pushing certain machines on me . I expressed an interest in an Auto-pap machine and the PA indicated that these were much more expensive and that my insurance would not cover an Auto-pap. I believe my insurance will cover what ever the doctor prescribes but the PA seemed very set on a CPAP and said either way, I had to go through another night's study to get the CPAP levels correct. And she indicated that many people don't tolerate "bi-pap" well and end up going back to CPAP. I said I thought APAP was different than bi-pap and the PA indicated they are the same and that bi-pap was only used in certain cases. She indicated if I was dead set on an APAP machine, there wouldn't be a loaner to try for a few months so I may as well go the CPAP-pap route. I have read on various forums that many times a patient can go home with an auto-pap machine and use if for a few nights and the correct pressures can be found but this option was not offered to me. I don't mean to be uncooperative and I really do like the doctor but I feel like I'm getting a bit strong-armed. Should I just back off and let the professionals do their thing, or am I correct in questioning the path I am being taken down? Thanks for your help.

[Pugsy]

Do the math. Look at the online prices of the commonly given machines CPAP vs APAP. The difference is far from huge. The APAP can always be used in CPAP mode. Yes some people do better on CPAP after maybe trying APAP but they will at least know which suits them the best. There are times when APAP is a better choice.

It is best for you to check with your insurance company yourself and not rely on what someone else tells you.
Be sure and ask about deductibles. Do they do a "rent to own" thing over several months? Will the deductible start over in January? Look at your co-pays versus online prices and possibility getting the APAP you may want.
Which DME does your insurance company want to work with? Check with them to see which machines they want to give out. They may or may not even offer data capable straight CPAP.

No way would I sit back and let the "pros" dictate my life without my input. You have to do your homework too.

[GumbyCT]

You never mentioned who you have insurance with that can make a BIG difference in sleep medicine, since it is insurance driven.

And she indicated that many people don't tolerate "bi-pap" well and end up going back to CPAP.

I don't believe a bipap is harder to tolerate at all, in-fact it is much easier but usu. twice the price.

I really don't understand why there are so many control freaks in this sleep money mill.

[Guest]

I did call my insurance company (BCBS of Texas) and at first they told me that I would rent the machine until I had hit the price of the machine at which point I would own it. But I was astute enough to ask if I had already hit my out of pocket max for the year, wouldn't it make more sense to buy the machine outright this year? Otherwise, I would have to start all over again in January. The insurance rep had to put me on hold and ask a supervisor if I could do this. She indicated it would be OK to do. However, had I not asked, this solution would not have been offered. She didn't say anything about which DME I was required to use. I was under the impression I could use any provider as long as the procedure code was a covered expense under the plan. I'm assuming extras like humidifiers, software and readercards are not covered expenses under insurance plans -- correct?

Who knew there would be so much to research! I get the impression my doctor wants me to purchase from a certain provider. Is it OK to buy online? What happens if the machine malfunctions? Isn't it more difficult to get repaired if purchased out of state?

[jnk]

If I may quote Slinky's words from another thread:

viewtopic/t45994/viewtopic.php?f=1&t=45 ... 06#p412306

1] Call your insurance company and ask them what local DME CPAP providers they are contracted with. Hopefully you will have the option of more than one as that gives you more bargaining/negotiating room to get the equipment you want (w/in reason, of course). You should also ask about any annual deductable, what the annual deducatable fiscal year is, any copays, outright purchase of the xPAP (any CPAP is an xPAP) or some form of capped rental (rent to own).

2] INSIST on and ONLY ACCEPT a fully data capable xPAP. For the most part this means a Resmed S8 Elite w/EPR, Resmed S8 Elite II w/EPR, Respironics M Series Pro w/C-Flex, Philipps-Respironics SystemOne Pro w/C-Flex. DO NOT ACCEPT ANY Resmed w/Compact or Escape in the name NOR ANY Respironcs or PR SystemOne w/Plus in the name. Just because a device has a data card does NOT mean that it is fully data capable!!!

3] FAX a WRITTEN request to the sleep lab doctor for a copy of 1] the doctor's dictated results (1-2 pages each) and the full scored data summary report w/condensed graphs (5+ pages each) from both your in-lab sleep evaulation PSG "and" your in-lab CPAP titration PSG "as well as" a copy of your equipment order (prescription) as you wish to shop your local DME options yourself. Also request that this information be FAXed to your family doctor. Ask this sleep lab doctor WHO is responsible for going over your sleep studies with you and discussing their results and your needs as you want to set up an appointment for a consultation w/whoever it is.

4] Be sure to ask any local DME provider you talk to just how lenient their mask exchange policy as THE MASK is THE KEY to successful xPAP therapy once they have determined your proper pressure needs. Unless you insurance is only contracted w/one local DME provider you are NOT obligated to accept equipment from the first local DME provider you talk to.

5] Be aware that
a] most all insurance companies reimburse for equipment by insurance (HCPCS) code and NOT by brand or model. The insurances contract w/the local DME suppliers for a set price for each specific HCPCS code. ALL CPAPs from bare bone compliance data capable only thru fully data capapble thru fully data capable auto titrating PAPs are HCPCS code e0601. The bare bone modles cost the local DME providers the least and the fully data capable auto titrating PAPs (APAPs) cost them the most so naturally they prefer to pawn off a bare bone compliance data only CPAPs on unsuspecting new patients if they can get away w/it.
b] Resmed, Respironics and Fisher & Paykel all will provide FREE to the local DME providers most any of their mask models that patients have tried and been unsuccessful with IF the local DME provider will fill out a form and return mask and form to the manufaction W/IN 30 DAYS.
c] most insurances require some form of rental period for the PAP device but usually pay for the rest of the equipment, humidifier, mask, hose, etc. up front when you receive your equipment.

[SnoozyWoozyCat]

JNK -- thanks for posting Slinky's excellent information! I just love the internet -- it's such a great way to get information! I have printed this off and will use it tomorrow when I make my phone calls!

[Pugsy]

Humidifiers are normally a covered expense if the Rx is written to include "heated humidifier". Software and card readers are not normally a covered expense. The data cards are usually included with the cost of the machine, they don't cost much anyway.

Warranty coverage can be a concern. Check with online supplier before purchase to make sure their policy.
BC of Texas? Our forum hosts at cpap.com is based in Houston I think it is. Check with them. Your insurance may reimburse for online purchases. Again, best to check with them as to exactly what rate and if. Do the math, sometimes it means less out of pocket to buy a machine online. Nothing is stopping you from still using a DME for masks if you wish. I have a DME for masks and I didn't buy my machine from them.

[Celticherself]

Hi,
I got my machine from a fancy sleep clinic in the Dallas area. The first machine they assigned to me DIDN'T let me exhale. The second one they they assigned me is the one I have now, an Escape II. I'm now waking each morning with nasty migraine headaches. The first six months, I did very well. But I don't know HOW to increase my pressure by even one bump on this machine. My first two masks were junk and cut my face. I didn't get good masks until I went (on my own) to a nearby free standing CPAP Store (with no connections to any clinic or doctor.)

I have an appointment tomorrow morning with the sleep doctor's assistant. I've heard that my doctor is on the board or financially connected to the sleep study clinic that sold me my mask and machine. I'm not going to mention this to the assistant, because I don't know for sure that it's true, but the pieces fit now.

I still owe a couple hundred dollars on the machine, the "10 month rental" fees for this Escape II machine were over 3K and that is the honest truth. My health insurance did pay a lot and I paid a lot too. I'm out of money now, earning half of what I used to make.

My migraines cause vomiting, tremors, sweating and insane pain. I can't believe that doctors take advantage of patient's desperation and then DON'T get them the best machines possible. I have a boss who is NOT SYMPATHETIC at all about migraines, and I can lose my job over the many absences I have, then of course lose my health insurance. Then the doctor can lose me as a patient-- whose therapy failed.

Can anyone online give me advice about what clinics to look for in order to get the best care? I'm trying hard to keep my job and you would be helping me keep my job and my husband right now.

ANY ADVICE WILL BE TREASURED AND CAREFULLY READ!!

THANKS, Celticherself.