This Noob's been ripped off - need advice.

[DonR22]

I have been having a terrible time with my CPAP machine. I've only now come to realize that I've been ripped off. I was told by the DME who I was sent to by my doctor that the ResMed C-Series Tango was an excellent CPAP machine that would be just what I need for the relatively high pressure (18) that I need. I've now come to realize that this machine is absolute bottom of the line and the DME has charged my insurance company $5,500 just for the ResMEd Tango (and another $900 for the mask and tube) and they want me to pay $2,500+ for the 40% that my insurance company doesn't cover - all for a device with a street price of $300! I could use some advice on how to deal with the situation as I'm feeling overwhelmed. All advice gratefully appreciated.

[Muse-Inc]

Aw, DonR22, I'm sorry. Boy you really were ripped off! My copay was $890 for a machine I couda bought for about $350 at the time...I was clueless at the time. Welcome aboard! I have no suggestion but wanted to welcome you. I'm sure several veterans will post some suggestions soon, keep cking.

[cflame1]

how long have you had it? Any chance you can return it and go elsewhere?

[DonR22]

I've had it for just over 4 weeks - but I've only really used it for 2 weeks as I was out of town for Thanksgiving holiday and a business conference for two of the weeks. The unit has 19 hours on it.

[sthnreb]

I would call them immediately and tell them to come get it. At those rates, it's cheaper to just buy your own, online. A lot depends on what insurance you have, they may pay for one online. When I had employment insurance, it was limited to $2500 for sleep apnea. Two sleep lab test got most of that. The DME insisted the insurance would pay it even after I told them there was a limit. When the insurance ran out, I got online looking. I discovered they had supplied me with a discontinued model. They wanted me to pay $3500 for it so I told them to come get it and collect from the insurance company as it was listed on the contract. I purchased one from cpap.com for about $1600 with a humidifier, mask and all. Less than half their asking price. (That's a whole other story in itself) They eventually came and got the machine. Now, I just started Medicare this December and I called up a DME to supply me with a Bipap machine. I did not know what to expect as far as pay and copay and all. I've saw some horror stories on here concerning that. Well, my DME said I would have to pay a $300 upgrade fee for the auto titrating machine as medicare only paid for a basic machine. I looked around and was told the "M" series was not being manufactured anymore and would be discontinued when the stock ran out. My DME didn't say that, but online I read it from another company. I inquired about the PR System One and my new DME said they thought it wasn't as good as the M series. Also new and not tested. Eventually, they said they would order me one if that was what I wanted and also said they would waiver the $300 upgrade for either machine. I ended up with the M series at no cost to me. So, they probably do bill a lot and get a big profit. He did say you can get a mask every 3 months and headgear every 6 months. However, they give you the whole thing and don't separate them, every 3 months. So, I feel good about my new DME so far. Hope yours works out.....but get started correcting it immediately.

[GumbyCT]

My advice - do the only thing you can right now -

EDUCATE yourself -

become your own advocate.

Read, search, then read some more.

Think about how & why they got over on you - cuz you didn't know.

Then search for an Honest DME.

Good Luck

[Goofproof]

When you go to a DME provider, bring your own pen to sign the contract. Make sure the pen is filled with disappearing ink.

Call your INS company, and see what your options are. If and when you take it back, get a signed receipt for the returned equiptment. Make sure they don't sign the receipt with a pen with disappearing ink in it.

Before you buy anything anymore do the homework, that's time well spent. Jim

[KatieW]

Welcome to the forum. I hope you can still return the machine, and start over. Here are 2 recent threads addressing some of your issues. There is also good information in the CPAP Wicki at the top of the page, on a variety of cpap subjects.

viewtopic.php?f=1&t=47590&st=0&sk=t&sd=a

viewtopic.php?f=1&t=47553&p=430061#p430061

And if you don't already have it, get a copy of your RX, so you can go to another DME, or buy or on-line. You should also get a copy of your sleep study/titration report for your personal medical records.

Good luck to you.

[rested gal]

the relatively high pressure (18) that I need.

I've had it for just over 4 weeks

In light of your prescribed pressure of 18, which is very high and the fact you've had the machine for a month even if two weeks were all that you used it so far, I've got another plan in mind.

I'd immediately contact the doctor who prescribed "CPAP @ 18." I'd tell him I'm having a tremendous amount of difficulty exhaling while using CPAP. I would not talk about the rip-off price, or the basic-ness of the machine, or about seeing less prices on the internet. I'd not mention the internet at all.

I'd ask the doctor, "Is there such a thing as a CPAP machine that gives two separate pressures? One for breathing in, and a lower pressure for breathing out? I just can't breathe out against the pressure with this one. I keep waking up all night trying to force breathing out."

If the doctor has any sleep medicine sense at all, he will understand that means you have "failed CPAP" and need a bilevel machine. It's important with some insurance companies that a person "fail CPAP" in a month's trial, before the insurance company will ok reimbursement for a bilevel machine.

By the way, VPAP is ResMed's trademark name for their bilevel machine. BiPAP is Respironics trademark name for their bilevel machine, although the word "bipap" is often used as a generic way of referring to any manufacturer's bilevel machine. Either the ResMed VPAP or the Respironics BiPAP would fill a prescription for "bilevel" (or "bipap.")

So, you have an extremely good chance of getting yourself switched to a bilevel machine, which, for many people, is MUCH more comfortable to use than a straight CPAP at a pressure like 18.

Once you get that bilevel prescription in you hand, you can decide whether you want to go back to the DME that gave you that bottom-of-the-line Tango, to make the swap to a bilevel machine....or.... (this is what I'd do) choose a different DME to give your business to. Check with your insurance company first for the names of other DMEs in your area that they would let you use.

Do be sure to get a copy of your prescription (hopefully a new one for "bilevel") and a copy of your sleep study report, as KatieW said. A new DME store, if you decide to change DMEs, will need both of those things.

In the unlikely event that the doctor will not write you a new prescription for "bilevel" (if he doesn't, he's a sadist, imho) and you don't want to pursue that, then I'd at least ask the doctor to rewrite the current prescription for the name of a specific model of CPAP -- ResMed S8 Elite II with EPR @ 18 cm H20. Take that Rx, and the Tango, back to the DME to have them swap one CPAP for another. That is, if you want to still use them as your DME (I wouldn't. ) I'd give them their beloved Tango back, say adios, and go to another DME with that specific Rx for the Elite II machine. Or, I'd buy it online.

You might want to crunch the numbers with a new DME and see if you'd come out better in the long run just buying the Elite II online (or a bilevel machine online if you get a bilevel Rx) instead of using a bricks and mortar DME.

Since you're in your first month of machine rental, ANY DME would love to have you as their customer. They'll be looking at 11 months of insurance rental reimbursement....almost as good as having had you as a customer from the start, for 12 months rental. But as each month goes by, you become less and less "desirable" to take on. Less rental money rolling in.

So now's the time to:

1. Check with your insurance company for names of all the DMEs they do business with in your area.

2. Beg ("I can't breathe out!" ) the doctor for a prescription for a bilevel machine. If he won't give you that (he should!) then at least an Rx spelling out the name of the specific CPAP machine you want -- ResMed S8 Elite II with EPR at your pressure of 18. EPR is "expiratory pressure relief" -- gives a 1 to 3 cm drop in pressure when you breathe out.

3. Decide what DME store you want to do your business with.

[sthnreb]

There are some great responses on this subject. You can always trust Rested Gal to lead you in the right direction. Cpap.com has a search for DME's in your area and will list them. Guess you do have to be sure your insurance accepts their terms. sleep-apnea-services-locator.php 18 is high for cpap. Mine is 12/8 for bipap, the 12 matching your 18. My actual sleep lab reports I couldn't tolerate the cpap so they recommended the bipap. I have just gotten my lab report (2) after 8 years. I needed them for Medicare and there was no charge at the hospital, I should have got them a long time ago. My Medicare DME requested this information along with an updated Rx. When he wanted me pay $300 upgrade for the Auto, I did go back by my doctors office and asked them to write a specific model, the PR One Auto DS750HS on the Rx so there would be no doubt about the machine. No problem at all and she also added mask on it. Didn't know you had to have a Rx for mask too. If, and I doubt, you have trouble with your doctor, there are also others that will listen. It may cost an office visit but with sleep report in hand, it should be no problem. BTW, 18 is not relatively high if the cpap just goes to 20, it is high! The bipap does go to 25. I've never understood why they expect someone to exhale at the same pressure as inhale, especially 18 cm. You did good coming to this forum, now do what you have to do and quickly. You are responsible for your health. Follow Rested Gal's plan.

[sleepywolverine]

Just wanted to say welcome! I think Rested Gal gave some great advice- I'm pretty new myself, but from what I've read so far- I think what she's saying will definitely work. Good luck!

[PaJoe]

I agree you got ripped off and admit I can not help you with that. However, even though I am new to these forums I have been using cpap for maybe 10 years and my setting is about 17 cm. I remember at first I would wake up every half hour or so, had a lot of trouble with my masks but would just keep putting it back on. These days if I wake up at night I will lift the mask to see if it is still working, as I can not feel the 17 cm. after I have it on a couple minutes. I hate using the ramp because it makes it more difficult to breath. I always tell people to keep the humidity set as high as possible, set it just below the point where you get water in the hose - if you get water in the hose it will wake you also

I have not found a local DME yet that I feel comfortable dealing with, and I get extremely frustrated at how they rip off both insurance and patients by overcharging for everything - that is I why I am here. My old Resmed S6 has developed fan bearing noise and I need to replace it. I found a generic cpap prescription example on line and asked my doctor to fill one out like it so I can buy my new cpap on line. It will be cheaper even without insurance. I had been buying masks on line without prescription for a long time I use the Aclaim 2 HC401A which comes complete for about $41.00 on cpap.com but they require a prescription. The local DME will charge me twice, once for the headgear and once for the mask even though the kit comes with everything. I contacted Fisher & Paykel to confirm it was meant to be sold as a complete kit but they said they have no control over how the DME will sell them. I argued with the DME and they told me I did not know what I was talking about, the headgear is not included in the price. I also found most people working at the DME really only know what they read about cpap useage, non were actual users. You will learn more from reading forums such as these than what you get at the local DME.

Many of us have gotten "ripped off", but maybe not as much as you. It may be part of the learning process.


Good luck,


joe

[DoninOrlando]

Don,
WOW. The prices your DME is charging is outrageous. No wonder insurance costs so much. I thought I was ripped off when I started. I have crappy insurance and although they paid for a good portion of the sleep study, they pay absolutley 0 for the sleep doctor himself and 0 for equipment. The sleep dr is the one who orderd my sleep study and prescribed all my equip. Even he could not figure that one out. Why pay for the study when they are not going to pay for equip if the study shows the need. Anyhow, I paid for all equip out of pocket. My local DME he suggested charged me $700 for a Remstar M series Pro, with integrated humidifier, and included the Swift LT mask, hose, and some extra filters. When I went on cpap.com and saw I could have gotten the machine for hundreds less, I thought I was ripped off. Now I just feel they had to make something to pay their overhead and techs. At least it was decent equip and they let me try several masks.
Best of luck to you. You have already received some good suggestions above. Hang in there and good luck with their therapy. If you are successful with your therapy, it will have been worth whatever you end up paying.
Don

[sthnreb]

These days if I wake up at night I will lift the mask to see if it is still working, as I can not feel the 17 cm. after I have it on a couple minutes. I hate using the ramp because it makes it more difficult to breath.

You are absolutely right. I've used bipap for about 8 years and if the mask fits right, you don't "feel" the air. The more I read about other DME's, the better I like mine. No problems so far and they give you the mask and headgear so they say every 3 months, not 6. I believe a new machine is every 5 years. Either way, they have a 2 yrs manufacturers warranty and the DME will keep it going until you can get a new one if necessary. With Respironics, they supply a "refurbished" machine. I believe everyone when they search the Internet on their first machine feel like they were ripped off after checking it out. And they probably were in the majority of cases, including yours. It's all a learning curve and this is a good start.

[Slinky]

You weren't just ripped off. You were raped!!! Repeatedly! Don't waste time. Get things cleared w/the doctor about failing CPAP as RestedGal suggested and then TAKE THAT TANGO BACK!!!! Just be sure to use it until you take it back so that you are establishing attempted compliance. I'm not sure the Tango is even capable of compliance proof. There must be SOME way to determine how many hours are on it. And your receipt for it SHOULd have shown if there were any hours already on it when you got it.

RestedGal is more cool-headed than I am. I'd have been on that DME provider's doorstep the MINUTE I realized how badly I'd been raped and insisted on a receipt as proof I returned it. They'll probably include a phrase similar to "patient refused therapy" on the receipt.

Good luck!!! There HAS to be a way to reveal these gross overcharges by this DME provider to the doctors, insurances and public!!!