Things to Do/Inquiries to Make at Initial visit to DME

[Sabres]

Hello all,

I have been lurking for the last few weeks and now that I am about to start using
a CPAP machine have decided to join your rebel alliance.

I will be having my initial meeting with my DME (Apria near Anaheim, California)
in the next few days. Besides praying to the patron saint of obstructed airways
that this particular office does not suck I am wondering what else I should do.
Any suggestions on what questions I should ask or things I should
learn while at the office visit would be greatly appreciated.

I should be picking up the following equipment:
S9 Elite with humidifier (I will try to convince Apria to give me an AutoSet)
Swift LT with headgear
My pressure is 11 with an EPR of 3

Thanks for your responses
DC

[Sleeprider]

Your arguments for a Autoset will likely fall on deaf ears unless you can get your doctor to specify "auto" in the prescription. Call your doctor's office and discuss the prescription. Make your case there, because the DME will simply respond that its not part of your prescription. You need to have your argument WHY you need an autoset with the prescribing doctor. Without that, your equipment will be all lined up and you will only be choosing a mask interface. Swift LT or FX should be fine if you are not a mouth-breather.

[elena88]

do you have any lung situations, like asthma or shallow breathing?

do you gain and lose weight somewhat frequently or are you planning to go on a diet now that you have been diagnosed?

do you want to have the choice to run apap or cpap mode on your machine?

do you have positional apnea, where you may have a high pressure on your back, and a low pressure on your side?

Do you snore on your back, and not on your side? This can mean you do have positional apnea..

If you were not titrated in all positions in REM, you could use that as a reason you want the autoset..

tell the doctor you are certain that you dont need that pressure when you are on your stomach, and do not want to be forced into
that same pressure all night when its not needed.. that you will proably not be able to tolerate it and will very likely quit if you dont have an auto..

[jmcd]

I got my S9 through Apria here in AZ. They were very easy to work with and the contracted price (probably dependent upon your insurance carrier) for my machine and supplies great. Far better than I can get from any of the web retailers. I have an S9 Elite and didn't attempt to have it upgraded to an APAP. The machine was brand new. The only problem I've had with Apria is when I purchased a backup hose and mask (not a replacement that is covered by insurance but a backup). They initially charged me their regular price which of course is more than the cost of the supplies at online retailers like cpap.com. They finally refunded the overage to me but it took me about an hour on the phone with multiple people and two supervisors to get the situation corrected. The people in their call centers tend not to listen well and interrupt before you're done speaking making it difficult to get answers to questions. But when I read about what many people on this list go through to get decent equipment and the prices that some have to pay for equipment, I'm thankful for my VERY good insurance and their contract with Apria.

[jonquiljo]

Why do they make such a big squeal when the price differential between the Elite and Autoset is so small? Cpap.com has the difference at only $50?!

[Janknitz]

BEFORE you walk into your DME, you should know exactly what your insurance coverage is.

CALL your insurance company and ask the following questions:
1. How much does the insurance cover for CPAP equipment and supplies? What will my out of pocket costs be (co-pays and deductibles for DME)?
2. Does the insurer pay by HCPC code (billing code--all CPAP and AutoPAPs are HCPC code E0601 from cheap brick to most expensive Resmed S9 auto) or by model number? Most insurers pay by HCPC code, though many HMO's don't.
3. Does the insurer require you to rent your machine, or does it buy it outright? If a rental, is it a "capped rental" (rental for a period of time, then it's yours)? If so, for how long?
4. Does the insurer have a schedule for supply replacement? (supplies are: humidifier chambers, hose, filters, masks, mask cushions/nasal pillows).

It's important to know these things in advance so Crapria can't lie to you and say things like:
a. You can't have that machine because it's not covered by your insurance (almost NEVER true) or auto's require your doctor to fill out a medical justification for the "upgrade" (not true if they pay by HCPC's code). Or, you have to pay $XXX more if you want that "upgrade" (again, almost never true--check with your insurer).
b. You have to give us a 20% co-pay (this may be true, but they have been known to demand a co-pay even from people with 100% coverage, claiming they will refund it--but taking forever and a lot of work to get a refund)
c. Your insurer requires you to rent this machine on a monthly basis (most insurers do, but not all. Rental usually costs you more because you may hit two deductible periods on the calendar).

[Sillyme]

Reading this thread would have saved me much time, trouble and anxiety. I was totally clueless. Didn't even know I needed to ask questions. It would be nice to see this info at the top of the forum where the announcements are. ( I didn't even know what a DME was.)

[GumbyCT]

Apria is hardcore. Study hard and take notes. Write ALL of your questions in a notebook, leaving room under each question to write in an answer. Just a line or two.

As mentioned, start with your insurance on page one of your notebook with their number. Always ask for the name of the person you are speaking to, even if it's the very last thing you ask. Write their name down.....

Did you know that OSA impacts our memories? - - - Severely.

Apria does.

You have been given some very good info above.
Also search for Rested Gal's list of machines that record data. Take notes
EDIT : Here is a link - viewtopic.php?f=1&t=55743&p=522049&hili ... st#p522049

Don't forget to bring your notebook with you to the DME

Good Luck

[Sillyme]

Do you have to deal with Apria? See who else might be 'in network' and compare. Even DMEs in the same network have different replacement policies for supplies.

[Muse-Inc]

Best argument for APAP: chronic allergies/rhinitis (esp vasomotor) that unpredictably plugs up the nose and narrows the airways meaning that needed therapeutic air is dependant on the level of congestion. In my case, I can easily be completely closed, get up and walk around a few mins then decongest...frustrating as hell as it's unpredictable. I have an APAP and normally run a range of 7/8-15, the pressure goes up and down as needed to accommodate my blasted nasal passages. Having lots of ragween pollen reaction so I am less tolerant of my dratted allergies...can ya tell?

Next best: significant wt change as it might (in my case it does) change the airway, usually making it larger thus decreasing the amt of pressure needed.

[Sabres]

Thanks to everyone who replied. There is always something you either do not
know to ask or would forget if it were not for this community.

I have already spoken to my insurance company and have most
of the info Janknitz referenced. I did not ask about the length of the
rental period so another phone call is in order. That was some excellent advice.

As to the AutoSet, I had read several of the posts about how important
collecting/analyzing data is and how the AutoSet allows for so much more flexibility.
Unfortunately, I let the sleep study center convince me that a CPAP machine
was all I needed before seeing my primary care physician.

The good news is my doctor is very understanding, is not very familiar with apnea
and would most likely write a new prescription if I talk to after a few months
of using this machine. The doc already knows how my sinuses bother me and has
prescribed several different meds so I will likely go that route.
My insurance pays for a "CPAP Device"by procedure code
so that might help.
Has anyone successfully traded a regular
CPAP machine for an AutoSet after a few months of use?

At the moment, Apria is my one and only choice.
It would be great if the local office is an outlier since
I live within a few miles of it. I will have my machine in a few days
and will follow up with my experience with Apria and my first few nights with the machine.

Thanks again.
DC

[Muse-Inc]

Gotta trade within the first month maybe a shorter time period. Easier to start off with an APAP if at all possible.

[GumbyCT]

Gotta trade within the first month maybe a shorter time period. Easier to start off with an APAP if at all possible.

It will be soo much easier (for you) if you get the auto right off. Call the docs office and request the change, ask to pick it up to hand deliver to Apria or risk the ol' "never got the fax routine".

You will have to climb mountains to change later. Your call.

[elena88]

if it were me, I would refuse to accept the cpap, and hold out for the apap..

I traded one auto for another before my thirty days was up, and it was like pulling teeth to switch THAT..

If you have a nice doc, just have him write it for an auto...


allergies, great reason.. congestion.. great reason...

and you can run it as a cpap to your hearts desire, but youll never know what you like if you dont get to try a range first..
if they have set up something for you, see if you can cancel it and have the prescription rewritten. I have seen many people get this far, find
out they wanted an auto, and managed to get one before they went thru with the cpap..

[mayondair]

I switched to an auto after 2 weeks, easier to get it right the first time. No sense in delaying the best therapy and haggling with DMEs about a change. Stick to your guns, call MDs office and insist on a change. Good luck, let bus know how things go.