Which equipment provider should I use?

[SleepyHeadRCSD]

Hello,

I was provided with a list of equipment providers in my (small) city, by the sleep lab. I would like to know if anyone has any recommendations about who to use and/or who to stay away from. I'm leaning toward using a "local" provider, because I feel like they might treat their customers better, since they don't have a huge corporation behind them...

The list includes Apria, Breathe EZ Oxygen & Respiratory Supply, Lincare, and PSI Health Care, Inc, all of which are listed as "regional providers with offices located all over the US."

There are a couple of other "local" providers listed, as well (Regional Home Medical Equipment, WestMed Rehab.)

I've searched the forums for some of the providers and, not surprisingly, most of the feedback is negative.

One thing that I am curious about is the names and titles listed for each business. Apria has two "CRCP"s, Lincare has an "RT" and "RN", PSI has an "RCP", and Regional Home Medical has a "B.S. RRT." What is the difference in all of the titles? Is one more "educated" than another?

Thanks for your feedback.

[Slinky]

Call your insurance company and ask them what local DME CPAP providers they are contracted with.

I would guess that the list provided by your sleep lab might be those DME providers contracted w/your insurance - but - better safe than sorry. Why go to the trouble of "shopping" each of the providers on the sleep lab list if they aren't all contracted w/your insurance?

I would then "shop" each of the providers that appear on both lists - the sleep lab's list and your insurance's list of contracted providers.

I would ask what brand and model CPAP they prefer to provide and how lenient their mask exchange policy is. I would want to see how comfortable I was w/their staff and w/their RRT or "mask fitter" and the person who would be my contact if I ran into problems w/my CPAP therapy.

[rested gal]

One thing that I am curious about is the names and titles listed for each business. Apria has two "CRCP"s, Lincare has an "RT" and "RN", PSI has an "RCP", and Regional Home Medical has a "B.S. RRT." What is the difference in all of the titles? Is one more "educated" than another?

I think (could be wrong about some of them) this is what those letters stand for.

RN -- Registered Nurse

RRT -- Registered Respiratory Therapist

B.S. -- Bachelor of Science

CRCP -- Certified Respiratory Care Practitioner

RCP -- Respiratory Care Practitioner

RT -- Respiratory Therapist

My guess (again, could be wrong) is that the RN and the RRT are the credentials requiring the most "education" in the field they are practicing. B.S. is a college graduate degree.

Unless you have serious pulmonary or cardiac problems, I wouldn't worry about which credentialed employee of the DME is the most educated.

Supplemental O2 (oxygen) therapy is the bread and butter business for DMEs. Thus, so many mentions of respiratory care credentials. An RRT (Registered Respiratory Therapist) is, I believe, the most highly educated in respiratory matters.

Bear in mind -- respiratory related credentials are no guarantee at all that the highly credentialed employee will know much beyond the basics about CPAP therapy, CPAP machines, CPAP masks, ways to make using CPAP more comfortable, and how to deal with CPAP therapy problems.

If you have plain vanilla Obstructive Sleep Apnea, the most important thing to look for when choosing a DME your insurance accepts is what Slinky said:

I would ask what brand and model CPAP they prefer to provide and how lenient their mask exchange policy is. I would want to see how comfortable I was w/their staff and w/their RRT or "mask fitter" and the person who would be my contact if I ran into problems w/my CPAP therapy.

The mask is the #1 key to being able to do "CPAP" effectively. A DME store that will let you keep trying mask after mask after mask overnight at home would be great. If you can find such a DME.

I would far rather use a DME that let me keep returning uncomfortable, leaky masks and trying another mask during the first month until I found a mask I could actually sleep with, than use a DME that had a policy of "here's your mask; you can have a new one in six months." no matter how highly credentialed the latter's employees were.

For practical help, what I'd be looking for (just as you already have!) are people with the RMCt title -- Registered Member of CPAPtalk

Welcome to the forum, SleepyHeadRCSD RMCt.

What does the "RCSD" in your nickname stand for, by the way?
"Rapid City, South Dakota?" "Royal Canadian ___?" "___Sheriff Department?" "___School District?"

Or...it's perfectly ok to answer my nosy question with -- "Really Can't Say, Darlin'.'"

[Slinky]

And what I didn't bring up earlier to keep from muddying the waters is that you are going to want a fully data capable CPAP. Trust me. You will NOT be happy if the CPAP you end up w/is NOT fully data capable. Just because a CPAP has a data card does NOT mean it is fully data capable. By fully data capable we mean ACCESS TO LEAK, AHI and AI DATA, preferably via the LCD screen but okay if only by SD card.

Local DME providers often work w/only one manufacturer for their CPAPs. They buy them in bulk and get a better price. So be flexible on CPAP brand, as long as the model is fully data capable.

[dtsm]

Insist on a apap unit that has full data capability. ResMed has two S8 autoelite II and S9 equivalent. Check for the Respironics models.
Second - as others have mentioned, what is their mask usage and refund/exchange policy. I use a local [not national chain] DME and they said I could swap masks within 2 wks period if not satisfied and try new mask.

[Julie]

And for what it's worth, the first company on your highlighted list is often known for being customer un-friendly, though obviously individual places have individual employees.

[Sillyme]

I would guess that the list provided by your sleep lab might be those DME providers contracted w/your insurance - but - better safe than sorry.

I agree. Call your insurance company. I just assumed and was referred to an out-of-network DME. I went without a machine for several weeks after returning it and getting the insurance problems straightened out. I got DME to agree not to submit any bills to my insurance since they did not inform me of charges. They just said the insurance co would take care of it. Without the advice I got from this board I could have been stuck good.
I found my local chain DME was the best (Binson's). I called and asked if they could get me the machine I wanted (ResMed S9). They called my doctor for a copy of my Rx. They replace the whole mask every three months because they buy in quantity and the cost to them is about the same as replacing parts. I could try a whole new mask every three months if needed. The key is knowing what to ask for. And a bigger DME is better able to absorb the cost of a less profitable machine.

[Hose_Head]

One thing that I am curious about is the names and titles listed for each business. Apria has two "CRCP"s, Lincare has an "RT" and "RN", PSI has an "RCP", and Regional Home Medical has a "B.S. RRT." What is the difference in all of the titles? Is one more "educated" than another?

I think (could be wrong about some of them) this is what those letters stand for.

RN -- Registered Nurse

RRT -- Registered Respiratory Therapist

B.S. -- Bachelor of Science

CRCP -- Certified Respiratory Care Practitioner

RCP -- Respiratory Care Practitioner

RT -- Respiratory Therapist

My guess (again, could be wrong) is that the RN and the RRT are the credentials requiring the most "education" in the field they are practicing. B.S. is a college graduate degree.

Unless you have serious pulmonary or cardiac problems, I wouldn't worry about which credentialed employee of the DME is the most educated.

Supplemental O2 (oxygen) therapy is the bread and butter business for DMEs. Thus, so many mentions of respiratory care credentials. An RRT (Registered Respiratory Therapist) is, I believe, the most highly educated in respiratory matters.

Bear in mind -- respiratory related credentials are no guarantee at all that the highly credentialed employee will know much beyond the basics about CPAP therapy, CPAP machines, CPAP masks, ways to make using CPAP more comfortable, and how to deal with CPAP therapy problems.

If you have plain vanilla Obstructive Sleep Apnea, the most important thing to look for when choosing a DME your insurance accepts is what Slinky said:

I would ask what brand and model CPAP they prefer to provide and how lenient their mask exchange policy is. I would want to see how comfortable I was w/their staff and w/their RRT or "mask fitter" and the person who would be my contact if I ran into problems w/my CPAP therapy.

The mask is the #1 key to being able to do "CPAP" effectively. A DME store that will let you keep trying mask after mask after mask overnight at home would be great. If you can find such a DME.

I would far rather use a DME that let me keep returning uncomfortable, leaky masks and trying another mask during the first month until I found a mask I could actually sleep with, than use a DME that had a policy of "here's your mask; you can have a new one in six months." no matter how highly credentialed the latter's employees were.

For practical help, what I'd be looking for (just as you already have!) are people with the RMCt title -- Registered Member of CPAPtalk

Welcome to the forum, SleepyHeadRCSD RMCt.

What does the "RCSD" in your nickname stand for, by the way?
"Rapid City, South Dakota?" "Royal Canadian ___?" "___Sheriff Department?" "___School District?"

Or...it's perfectly ok to answer my nosy question with -- "Really Can't Say, Darlin'.'"

A picky point: BS is a college Under-Graduate degree.

[SleepyHeadRCSD]

Thanks for all of the replies!

I'm hoping that most all of them will take my insurance (United Healthcare), but I will certainly make sure.

The doctor's prescription is for a "data-storage capable nCPAP." I already have a follow-up appointment scheduled at the lab, with instructions to have my information downloaded and printed out by the DME before my appointment.

The sleep lab seems to be pretty independent of the DMEs. They gave me a piece of paper titled "MASK FITTING WITH THE VENDOR." It says to make sure that you are fitted lying down and that the vendor allows you to lay down and change body positions to be fitted well. They also highlighted "You can exchange a mask at no charge in the first 30 days." The sleep tech said, "They probably won't tell you this.." I don't know how they can be so sure that this is the case at all of the vendors, unless it is a local/state law or something...

Anyway, I'm going to call around tomorrow and find out what machine each provider uses and ask about exchanging masks. I'll probably go with the one that has the best answers.

I'll be in touch.

Thanks again!

Brian

[SleepyHeadRCSD]

P.S. RCSD = Rapid City, SD

I was surprised to find that one of the local DMEs has a website (http://www.westmedrehab.com/)which makes them sound like a pretty good place. I think I may have my mind made up, assuming that they accept my insurance.

[Slinky]

Wow! Your sleep lab sounds impressive. What great information they provide on the printed sheet they gave you.

About that 30 day mask exchange: Resmed, Respironics (now Philips Respironics = PR) and Fisher & Paykel all will exchange free to the local DME providers most any of their masks that patients have tried and been unsuccessful with IF the local provider will fill out a form and return mask and form to the manufacturer w/in 30 days.

[rested gal]

My list of machines that record "full data" (AHI and leak info) and those that don't -- updated through March 2010:
viewtopic.php?p=307168#p307168

The ones in blue record full data. The ones in red do not.

In case the DME tries to convince you that a machine provides the kind of "data" you want to see, simply because it happens to have a card stuck in it:
viewtopic.php?p=344265#p344265

For some entertaining reading about that check out LinkC's post on page 2 of this thread:
viewtopic.php?p=342111#p342111
And roster's post on page 3 of that same thread.

[linagee]

APAP reviews:
http://www.sleepreviewmag.com/issues/ar ... -09_02.asp

[SleepyHeadRCSD]

Thanks again for the replies!

I looked online and all of the DMEs provided by the sleep lab are contracted with my insurance.

I called West Med first and found out that they provide the S9 Elite, which looks like a pretty sweet machine. They are currently awaiting a new shipment (hopefully, this means I'll get a brand new machine!), so I've scheduled an appointment on Friday.

I don't recall if I've mentioned that I have previously used CPAP, but I used it for a short time a couple of years ago. The DME I visited at that time had me sitting in a chair in his office while he fitted me. West Med has "private fitting rooms with beds," which sounds nice..

The RT I spoke to suggested that I try a nasal pillow, since my prescribed pressure is only 6.

Does anyone have any suggestions or comments on using a nasal pillow versus a mask?

[jonnybee]

snip...

Does anyone have any suggestions or comments on using a nasal pillow versus a mask?

An important factor to consider when choosing any mask is whether or not you have a problem with your lower jaw dropping when you relax and fall asleep. No matter how well a mask fits/feels when you are trying it on for comfort, if your mouth opens when you fall asleep, it can change the game completely. I have this problem and am forced to use a chinstrap (I use the PapCap) otherwise my mouth falls open allowing the air to escape thru my mouth, defeating the purpose of the cpap. I tried two full face masks, the Mirage Quattro and the Hybrid, both of which felt good when I tried them on while awake, but neither worked during sleep because when my jaw drops it changes the shape of my face and causes excessive leaking. So I am back to my Swift LT pillow mask and the PapCap. The combination works well for me.