Need arguments for DME

[DLuke]

Hello, I've been recently diagnosed with moderate OSA, and I've been trying to do a lot of research around the Internet to help stave off my anxiety around sleeping with a mask from now on!

I am due to go into my DME provider this week to get my first machine and, I guess, get fitted with a mask, etc. I did know enough to ask a few questions when I scheduled my appointment, and found out that I will be getting a Respironics System 1 Plus machine. After digging around here for a while, it appears that the System 1 machine is pretty solid. However, it does look like if I want full data, I would need to get either the Pro or Auto version of the System 1.

My first task is to make sure I get a good fitting mask and that I'm able to sleep through the night, but I know I'm going to want to look at my data fairly soon. What arguments can I use with my DME to convince them to give me a Pro or Auto machine. Also, what's the main difference between these two machines?

Thanks, and I'm sure I'll be coming back for more good advice!

--Doug--

[Wulfman]

Welcome to the forum, Doug.

The (basic) difference between the two machines is that the APAP/Auto will either work between a range of pressures or it can be set to a single pressure in CPAP mode......and the Pro is also a fully-data-capable CPAP machine that operates at a single pressure during the night.

The arguments?
Whose therapy is it?
Whose money (and insurance provider) is purchasing the machine?

In case of resistance by the DME......
Why are you putting your profits ahead of my therapy? (by trying to give me a cheaper, non-data-capable machine)
Why would you not want me to be able to know how my therapy is working?

Do NOT let them try to tell you that the "Plus" is data capable. They would either be liars or stupid......you don't want to deal with one in either category.


Den

[GumbyCT]

Don't argue -

You can let them know that this therapy will require monitoring to insure if it is working or not. Of course they should know that there is absolutely no way to monitor how you are doing each nite without data. If they deny that fact then you should run, away. Consider POOP (paying Out of Pocket).

But I think you start with your insurance to find out which DME's you "can" do businiess with. If there is more than one choice that will give you leverage.

If you have Cigna and/or Apria is your only choice then your ONLY option will be to get the doc to write a make & model specific prescription. That is the ONLY sure way.

viewtopic/t35702/Where-A-CPAP-Newbie-Should-Start.html

Edit: Have to agree with Scrapper too. A data capable machine should be FIRST. So doing your homework is a MUST.

[scrapper]

My first task is to make sure I get a good fitting mask and that I'm able to sleep through the night

WRONG.......Your first task is ensure that you get the machine you need and want from a DME....and that may mean that you change DME's if you cannot come to agreement. You shouldn't have to give off of one being fully data capable........and go in armed with your own facts from this board. Don't take anything less than fully data capabilities........ then you can worry about the mask etc...

[DreamOn]

Hi Doug, and welcome to the forum!

It was very, very smart of you to ask questions of the DME before meeting with them. As you've discovered, the Respironics System One Plus cannot report any information other than the hours that you used the machine. This tells you and your doctor nothing about the effectiveness of your therapy. If you have any problems with therapy, it can help immensely to know what your nightly results are -- things like AHI and the leak rate. If you don't have that information, then the only way to judge the effectiveness of your therapy is by how you feel. That may be fine if all is going well, but not so good when you need to troubleshoot problems.

This chart compares the three Respironics System One machines: http://respironicsremstars.respironics.com/. The important column is "Advanced event detection and reporting". That shows whether the particular machine is capable of reporting full data, not just compliance (usage) data.

The DME may try to convince you that since the Plus has a data card it can report results. Don't buy it.

I agree that it's a good idea to know what your other DME options are too. You can always walk out if they won't give you what you need. It's like any other item that you purchase. You should have a choice. You're the one who has to live with it every night! And a fully data capable CPAP or APAP machine shouldn't cost you any more than a bare-bones model either. They all use the exact same insurance billing code. Bare bones machine = more profit to the DME is what it comes down to.

As to mask fitting, make sure they spend lots of time with you. Try on as many masks as you can, under full pressure, in different sizes. Move around alot to make sure it won't leak. If they have a bed there, use it. See how the mask works with the pillow. The mask is very important and should be comfortable (as much as a mask on your face can be, anyway).

I hope your therapy goes well. Please let us know how it goes!

~ DreamOn

[uperrsc]

You are way ahead of the curve just by reading this site. Just getting the lingo down will make you so much better prepared. The other key piece of knowledge is that the DME is a PROFIT seeking organization. It is up to YOU to make sure you get the right equipment your doctor specified. Take lots of time trying out various equipment and remember that only you look after you. They are looking to bill high and provide low...... good luck!!

[Scarlet834]

If you can get your doctor on your side he/she can write you a script specifying a data-capable machine, or even a specific model. That is one way to get past a recalcitrant DME.
If your DME can't be moved from giving you the Plus or nothing I would definitely loop back with your doctor to see if you can get a more specific script. (Or, as advised, switch DMEs if you can.)
I second everyone in advising you to hold out for full data.

[jules]

arguments don't work with DME's

the only way is to get the script

[GumbyCT]

arguments don't work with DME's

the only way is to get the script

Don't argue - ..."get the doc to write a make & model specific prescription. That is the ONLY sure way."
viewtopic/t35702/Where-A-CPAP-Newbie-Should-Start.html

[jules]

arguments don't work with DME's

the only way is to get the script

Don't argue - ..."get the doc to write a make & model specific prescription. That is the ONLY sure way."
viewtopic/t35702/Where-A-CPAP-Newbie-Should-Start.html

you hearing an echo now?

[kteague]

I didn't have to get another script when I said I wouldn't accept a non data machine. They ordered the M Series Pro for me, no discussion. However, if I had pushed for an autopap, it would have likely been a different story. My doc wasn't gonna go for a new auto anyway as she was adamant on me going back to straight cpap so fluctuating pressure couldn't affect my fragile sleep. I was fine with that and eventually sold the autoap anyhow.

I would suggest calling them in advance and explain that you will not be taking home a Plus and want a data capable machine from day one. (When it becomes an exchange they are likely to be even more resistant.) This way you'll know if it's going to require a doctor's intervention and avoid a delay after the visit, or worse yet, walking out with a Plus just to have something to get started. Watch out what you sign. If you really do want to take something home that day and the other machine isn't in yet, ask for a loaner machine, not a new one that will need exchanged. Just be sure any papers you sign indicate you have been given a temporary loaner. This terminology is not the same as the ageements many insurances make with DMEs to pay a monthly rental fee for a specified time before paying in full for the machine.

One more line of arguement for your arsenal... Let me see if I understand this correctly. Your reimbursement from my insurance is the same whether I get the Plus or an upgraded machine, right? So MY insurance is going to pay you an amount that would cover a machine that will better help me succeed in this treatment, but you're asking me to accept a machine of lesser value (and usefulness) than what my insurance can provide, for the sake of your bottom line? This is your insurance, obtained by you and for you. Reimbursement issues are between them and the insurer. If you don't separate things in your head you could end up feeling guilty, or that you are asking them for a favor. You are simply utilizing the provisions of your policy. That's what it's there for.

Sounds like you are on top of things. Let us know how it goes.