Can I avoid local DMEs and go online?

[zgeggy2k]

Hello everyone,

I am new to this forum (just registered a couple of minutes ago, but have been reading up on it for hours), and obviously all of this is fairly new to me.

A little bit of history from me:
I'm in my mid 30s, 160 lbs and 5'10.
I did a first sleep study end of 2006 (PSG) and they conducted a "split night" study, except they didn't wake me up in the middle of the night to try CPAP because (they told me the following morning) "it didn't feel like you needed it". The result was "mild OSA", no followup.
Then fast forward to december 2009 (less than a month ago), I did a second PSG and this time they did wake me in the middle to try CPAP.
This study shows a huge improvement in sleep (first half of the night shows a very fragmented sleep pattern, which gets 100 times better with CPAP support). Result "mild to moderate OSA".

So, my doctor wrote a prescription for me to get a "machine of my choice with datacard capability and modem", "mask of choice", chinstrap, filters, etc...

Now I'm spending time hunting for a good DME to get all this equipment from, and I've spent hours and hours browsing the internet (including this site) to come to the conclusion that... most DMEs are really really bad!

So here's are the questions:
- is there a good DME in the San Jose, CA area? i.e. someone who's not just interested in their $$ bottom line, but genuinely interested in helping patients get the care they need, the most comfortable way

...and since I don't have much hope for the first question above, here's a follow up:
- can I simply bypass Brick&Mortar DMEs altogether and buy my equipment online?

I'm sure the answer isn't simple... it probably is "it depends" or "yes, but here's what you're up against".

What do I need the DME for, that I wouldn't get from an online supplier? This is what I gathered:
1) the DME may be "in-network" (I have Anthem/BlueCross PPO - they cover 80% for in network and 50% for Out of Network supplies) and therefore have better coverage.
My understanding is that they mark up prices so much, that it actually ends up being more expensive than going online, even if they are in-network

2) the DME works with you to find the right mask/machine
I hear that most DMEs don't actually do that and try to sell you "what they want to sell you" (more $$ for them), sometimes charging your insurance company twice if you return a mask to get another one. As far as the machine, it looks like I already have a good idea what I'd like (Resmed S8 AutoSet II CPAP), but being a total newbie, all I looked at was online reviews, low noise, auto adjust pressure (it seems smarter than having a fixed pressure, as your need may vary based on what you ate/drank, body position, etc), data card, recording of events/flow limitation/etc.
If I already know what I want, it seems like, for the machine itself, online is the better $$ deal. Now for the masks, that's a lot harder to try online.

3) the DME works with you to analyze results
Is that even true? Is there follow up and analysis of data? Do you become your DME "patient" and do they really review your data with you?
I'd rather skip the middleman, download the data myself, and possibly send it to my sleep doctor. I feel like I can get educated enough to learn about how to interpret the data well enough to know if I should escalate to my doctor. Do I need this middle-man reviewing my data?

4) the DME reminds you about supplies
Well, from what I read, they're not too good about that. Second, isn't that equivalent to having a reminder in your calendar that says "order more filters" etc?

5) the DME teaches you how to use the machine
That's when they know what they're talking about - but more seriously, it doesn't seem like rocket science. Is it really useful? I usually find that the internet is much less biased and more useful for these kinds of things.


So what I'm really trying to avoid is to go through a DME nightmare (like many have gone through in these forums unfortunately). I feel I can be educated enough to make my own decisions and put my treatment into my own hands, as I don't feel like anyone else cares as much about my own health as I do. I am ready to pay more $$ to have more independence and flexibility.

Is it doable? What do you guys think?

Many thanks in advance. Looking forward to getting my hands on my first machine and starting collecting data (and hopefully getting better!).

Cheers,

-- Greg

[Julie]

You absolutely can go wherever you want to buy your equipment, and if you can afford it, you'll be light years ahead of things by doing it online. We can help you through almost anything in terms of explaining how it all works, as for that matter could the online sellers like Çpap.com, and you'll then be in charge of your therapy, not at the mercy of others. Your insurance co. should also be quite happy to pay for your machine, masks and accessories (though of course do check with them) but not the software or card reader. If your script is written for a 'Cpap' that's good, it also allows you to get an Apap machine, but for compilcated legal reasons, it doesn't work the other way round, so be sure you have that written for Cpap. Oh and BTW, I've never, ever heard of a DME 'working' with anyone re their results. They report only compliance figs to your MD or insurance co. but that is all. And also BTW, their submission code for Apap, Cpap and or any data capable machine is exactly the same but they routinely try to tell you only the bottom line machines are covered!

[foxhunter]

Easier than you think. Try cpap.com, the originators of this forum. Selection is wide, prices are fair and you can buy a return guarantee should you not feel comfortable with the mask.
you will of course need the prescription but that should be no big deal.
As a start you can price an item at a local dme supplier then check it against cpap.co . I think you may be pleasantly surprised. I have used them.
Good Hunting.

[Wulfman]

Can I avoid local DMEs and go online?

ABSOLUTELY! I did. I purchased all of my equipment from https://www.cpap.com


Den

[rested gal]

Greg, what a great post you wrote! Every word you said was right on target.

If you're willing to buy your equipment out of your own pocket and have a prescription, you most certainly can buy everything you need -- machine, mask, humidifier, any accessories you want -- from an online store like cpap.com. And if you see something priced for less at another online site, cpap.com will price match.

In my six years of "cpap" treatment, I've never bought a single thing from a brick/mortar DME store. I've been in a few, helping others who had insurance get their machines and masks, but have always bought my own things online from day one.

I've often said that my nice normal blood pressure would skyrocket if I had to put up with one minute of the delays/hassles/condescension/lecturing etc. that so many on this board have reported enduring from their DMEs. Sure, there are good (and some great) DMEs out there. But there are wayyyy too many just going through the motions. Motions they really don't have much clue about, unfortunately.

My vote, if finances allow it, is buy online and continue digging into reading this message board as if you were a medical student studying for the exam of your life. It's obvious you've already gotten a big head start on educating yourself to take care of yourself just fine.

The only advantage I see in using a local DME would be if they will let you keep swapping masks without limit during your first month. The mask is the major thing that can make doing "cpap" be easy or difficult. A very supportive, helpful DME who will let you keep trying masks at home until you find just the right one for you would be a treasure to find and worth using your insurance to do business with them.

[KatieW]

Your analysis is logical and reasonable, and it sounds like your are proactive enough to handle this yourself. Many of use have bypassed the DME and bought from cpap.com. I have never regretted that decision--I talked to 2 DME's to find out what "services" they offered, and decided their services were not worth the exorbitant prices they charged for everything. You can find lots of information, support and advice here.

[zgeggy2k]

Thank you very much for the help and support, everybody! I really appreciate it.

I am more and more convinced that going online is the way to go

Now, I had a question about what Julie said:

Oh and BTW, I've never, ever heard of a DME 'working' with anyone re their results. They report only compliance figs to your MD or insurance co. but that is all.

If I do end up bypassing a DME vendor altogether, who's going to "report compliance figs" to my MD or insurance company?

It seems to me it matters mostly if people go for the "rent before you buy" scheme (which I hear ends up being horrendously expensive), so the insurance company can cut its "losses" if the patient isn't following treatment. However, if I'm purchasing the equipment, they better trust I have a good incentive to use it, so what can they do if they don't get compliance reports? I'm happy to send them reports, but I'm not sure how to do that. Should I set something up directly with my doctor and upload some data from the data card to her?

So many questions...

-- Greg

[zgeggy2k]

Thank you, rested gal!

The only advantage I see in using a local DME would be if they will let you keep swapping masks without limit during your first month. The mask is the major thing that can make doing "cpap" be easy or difficult. A very supportive, helpful DME who will let you keep trying masks at home until you find just the right one for you would be a treasure to find and worth using your insurance to do business with them.

Do DME vendors end up being helpful if you've done all your "heavy shopping" online and all you ask of them is to help you figure out the best mask for you? There may not be enough $$ for them to be willing to spend time with you trying different masks - even though that's something where I see local DMEs as being of value, and where I'd pay extra $$ for the service! (whereas the actual machine itself is the same no matter where I get it from!)

I hear DME vendors are so unhelpful that I'm wondering if going with a "I only need to figure out a good mask" proposition is really pushing my luck

-- Greg

[Wulfman]

When it came to mask selection, I did lots of researching of the models and some "self-analysis" as to what TYPE of mask I thought I would need.
I knew I was a mouth-breather. Even before my sleep study, I knew I'd need a full face mask and that's what I asked for during the titration portion of my study.
Since I knew I wanted a full face mask, I only looked at those.
There weren't many full face masks available five years ago, so I narrowed down the selection to the one I chose. I guess I did OK......I'm still using the very same one I started out with.
There have been three others I've tried since then, but they just don't compare. All that "homework" I did ahead of time paid off.


Den

[Julie]

If your insurance co. requires compliance figs (ask them) then tell them to your MD (show him a print-out of your stats). I don't think anyone cares past a certain point,and it may only matter to DME's to begin with, but do ask whoever matters - I can't really relate to your insce. co. completely because I'm in Canada. No one here has cared about my compliance .. ever? Can't remember back that far!

[mattman]

You've more or less already answered your questions and what you didn't, the replies pretty well covered.

The bottom line is this:

If you want to basically be the one handling your therapy (And it sounds like you already do) then yes - by all means buy your equipment and supplies online and do it yourself.

Obviously, since this site is owned and run by a company that sells cpaps, most of the users here shop at that site but obviously there are also many others.

I honestly think that contrary to the popular sentiment on this board that yes - most DME providers do help patients with things like mask selection, machine selection and teaches people very well how to use the machine. By nature of what it is, this site and others like it attract people looking for something they didn't get so it stands to reason that if you guage the business solely by what you read here - it will sound all negative.

The other important thing to remember is that DME companies aren't artifically jacking up equipment prices. The prices are set by the insurance companies who tell a provider exactly how much to bill. This is not to say that buying your equipment cash out of pocket won't be cheaper - it absolutely will. The difference being that when you buy your equipment online - the company you buy from can set the price. When buying from a DME provider the provider has no control over the price you are charged - even if you are paying cash and not using your insurance. This is why even if you use the company that owns this website if you have them bill your insurance they will be billing the same amount as your local provider.

But yeah, since it sounds like you are prepared to research the equipment and research how to manage your own care you probably are the sort of person who could save some money by just doing it yourself and buying your equipment. FYI - you might even be able to find a local provider who doesn't bill insurance and can sell you the equipment at a really good cash price.

mattman

[Sport]

I researched whole thing also, only after I picked up my machine from the Service Provider. I have BCBS on Fed program. I have basic so they pay 70% (not 80% like the standard). I am hearing all the chatter online about how you would make out better going direct online. However, when I ran the numbers, my out of pocket was less going with insurance than straight to provider. Plus, they aren't so bad, although I agree with you, not really needed for the supposed services. Can pretty much figure out yourself. I am preparing to take mine back before billed and rattle the insurance (most likely to no avail) to let me go less expensive route. Heck, I could by an industrial compressor and then some for the price being charged for this unit. Healthcare system really does suck -- legal scam, rip off, shakedown. Good luck.

[GumbyCT]

Greg,
The short answer is Yes, as long as you have your prescription, you can decide where to go. Tho I would not want the modem part on mine. Using a modem, your data will by-pass you and go to a database somewhere you likely won't have access to. This is to make collecting compliance data easier for the DME's.

Sounds like you've done your homework but you need to start asking your insurance questions so you aren't surprised. I wouldn't even mention compliance unless they do.

As far as Mattman is concerned - I know I don't believe that Insurance companies 'insist' they are billed such extremely high prices. If you do a search - you'll see he usually gets run out of here but for some reason he comes back spoutin' the same stuff, over & over. I think he has some beef with the hosts of this forum - cpap.com.

Check with your sleep center - many of them offer mask fittings cuz it is a billable service they can provide to you. Getting a mask to fit properly is the key to success.

The rest will involve reading here at the very best forum on the internet.

Wishing you the very best.
Good Luck

[fidelfs]

I am also thinking to bypass my DME and go online for my next purchases (masks, filters, etc.).

I didn't get excellent service nor I got bad service but I don't like to give many explanations. I knew I had 30 days to change my mask if didn't fit properly. I have the Ultra Mirage Full Face mask, this mask for me does not work, leaks everywhere. I emailed the DME (he said that he work better with emails) that my mask didn't fit properly and I have been using the opus 360 but my sinus was suffering.

He said that was nothing he could do until I fix my sinus and contact my ENT. I emailed him again that I wanted to switch the mask, got same response. Finally I said I WANT TO SWITCH MY MASK. He agreed to it. I went to his office and we tried the flexifit 431, same result leaks everywhere. He gave me the Mirage Softgel Nasal (it is working fine). He said it was a demo so I won't be bill for this but he don't want to exchange the Ultra Mirage mask. (I know it was a new mask, because he open the box and bag in front of me.)

I think that is enough to not go to them again.

I got a question about going online. If I go to DME I have 30 days to switch a mask, Can I have the same online, let's say cpap.com? if not why not?

[rested gal]

I've always thought Mattman was one of the "good'uns" -- still do. In my view, anyway. I think he's always told it like it is from the other side of the fence. He's often agreed with people on here who've said about DME and insurance practices, "this should be changed" and "that should be fixed" while trying to explain why a DME has to do some things a certain way to stay in business at all.

I've not seen him be "run off." I've seen Matt be very patient, very polite, and I've seen him courteously put up with a lot of flak for trying to be honest with us.