new cpap user, picking dme, asking for s9/apap? help?

[bilnap]

My AHI's were in the 60's, my oxygen saturation was very low to the extent that insurance would pay for the night time supplemental oxygen. I switched to the ResMed S9 Autoset and to the Nasal gel mask and my AHI's are 1.3 to 4.7. Good news my blood oxygen saturation is now at 98% and I am feeling better. Good Luck to you. Fortunately am retired and we have great insurance here in Oklahoma.

[ResmedUser]

I actually believe in the beginning, you are better off starting on straight CPAP. On one fixed, titrated pressure. Adjust to that and then switch to APAP. That is how I did it and it worked great. I dont believe one fixed pressure from one night in a sleep lab covers ALL the ranges and bases of your breathing, sorry. But I do think straight CPAP works well, as long as you remain disciplined and do not drink at night, do not take sedative medications at night, do not gain weight, report to your doctor immediately if you do gain weight (for another sleep test for a new higher pressure).

A better solution might be to pay out of pocket, buy a good APAP and have the DME set it initially as straight CPAP at your titrated pressure. Give that a month or two and adjust to it, work on getting your mask issue straight during that adjustment phase. Then, if you still want to, you can switch over to APAP mode.

I went APAP for a variety of reasons:

1) my weight changes a lot, I go up and down

2) I take klonopin, an anxiety medication and sometimes I take more of it than other nights

3) I work out hard sometimes and when I work out hard, I have noticed my pressures increase

4) my pressures increase in the winter when the air is dry and the humidity low. My pressures go down in the spring thru early fall, when the humidity levels go up

I just do not believe that one pressure does it all. But as you can tell I am an opinionated person.

I dont drink booze anymore, but many do and if you drink a lot, IMO an APAP is really needed. Especially if you drink at night regularly.

[bradb]

I'm so annoyed. The saga has restarted. I ordered a mask from cpap.com (the sleepweaver cloth one!) and they needed a script. So, I called my sleep doctor's office and they were very upset to hear I wasn't going with their chosen DME (okay.. weird..) and intensely worried about me paying out of pocket (I guess not a lot do?), and had to know all of the details of this mask etc (this is when I started to wonder if they were just curious or if they felt that they had a right to know this, which I would argue no--their job is to write a script and the DME's job is to fill it appropriately)... but then they were also interested in what had happened with the DME. So I told them: the guy was nice but very much a salesperson, that I had to fight to get definite answers on everything, complain and threaten to buy elsewhere just to get a heated tube, and that even after they gave me a machine they still wouldn't budge on the AutoSet I had requested (yes, in CPAP mode as I was recommended by the Doc) without a script, including comments that my Doc would never allow it, etc. So I told them honestly, I didn't want to patronize the DME anymore and that's why I wanted to try some masks from another, online, friendly DME where I could choose exactly what I wanted. I even asked that they wouldn't say anything to the DME because I didn't want to offend anyone or get anyone in trouble--I had never intended on complaining any more.

But then I got a call from the DME, which the sleep doc had clearly told the whole saga to (in spite of my request), including my verbiage about how frustrating it all was. The person who called was very interested in my experience and seemed to be very genuinely caring about the fact that I didn't get the machine I had wanted and that the experience had left a bad taste. I did my best to explain how awkward the whole exchange had felt and that I did not feel fully listened to, and that I still did not get the machine that I wanted, and he said he'd investigate and call me back.

Two days later (today), he called me back to say that it was just all a big misunderstanding (the entire conversations I had with the other guy prove otherwise), and they have the AutoSets in stock and they could do an exchange, but that they would need a prescription from my sleep doctor to do it. I told him that I know that isn't true and that the billing codes are the same, and since I'm asking for it in CPAP mode that my existing script is sufficient. He then said nevermind, it's okay. I thought he was going to back down and realize that I was right, but then he just said he was going to call the sleep docs himself. I made very sure to tell him that I was *NOT* requesting an APAP prescription, I do not want APAP or a pressure range script, and I do not want the machine in APAP mode--I want it in CPAP mode just as the existing script states, just that I want the S9 AutoSet machine. He seemed to understand but then at the end of the call he said "So you want it in APAP, right?" and I dont' think he misspoke, so I again had to clarify that NO, I do not want it in APAP, I just want an AutoSet in CPAP mode! Anyway, I don't at all feel confident that he's going to relay this correctly to the sleep doc's office (when this will probably make less profit for them, or maybe a loss who knows, especially considering the 2 returned machines now), so I called the nurse line for the sleep doc's office and left a message clarifying that I definitely am not asking for APAP, autotitration, a pressure range script, or anything like that. Haven't heard back yet but I will update.

I hope they're frustrated with this DME when this is over, because this DME has now wasted everyone's time including the doctor's *and* their own! They could have just given me what I requested and put this issue to bed a long time ago. I've already paid upgrades of $20 on the mask (a wash since ResMed has a $20 rebate on their site), $30 for an additional tube (kept the one they gave me when I got the ClimateLine), and $100 for the machine, so in total $150 plus my insurance payments (they've submitted several). All in all, with the doctor visits, sleep study, follow-ups, cpap machine, cpap parts, upgrades, and the things I've bought on cpap.com like a hose cover and pillow, this has gotten to be so expensive. You'd think for the amount of profit involved, this would be a luxury experience instead of the frustration to just get the machine I asked for in the beginning.

[Pugsy]

So sorry for all your hurdles. They just don't want to make it easy.

When I called my doctor asking for a written script they asked "Why....." with a long pause. Rather than get into sparring match I just told them I was going on a holiday across the country to spend some time with my daughter and I wanted the script just in case I needed to replace either the machine or mask due to breakage or whatever. Much easier to have script in had in case doctor wasn't available or office closed and "they didn't want me to go without did they?" LOL

So okay, no problem, got it in the mail and immediately got it to cpap.com.. The trip to the daughter did happen but was several months later.

Also, remember any physician and even dentist can write the RX Wasn't there someone on this board that had a vet write a script once? Maybe I dreamed that.

[SleepingUgly]

Brad, my fellow 6-pack lover (the abs, not the beer)... I confess that I didn't read the whole story because I'm too tired. But why are you concerned about whether it's in CPAP mode or APAP mode as long as you get the Autoset? Once you have it, you can set it to whatever mode you like. I'm sure I missed something in skimming your posts, and maybe it's more complicated than that.

[bradb]

Brad, my fellow 6-pack lover (the abs, not the beer)... I confess that I didn't read the whole story because I'm too tired. But why are you concerned about whether it's in CPAP mode or APAP mode as long as you get the Autoset? Once you have it, you can set it to whatever mode you like. I'm sure I missed something in skimming your posts, and maybe it's more complicated than that.

Hehe. Well, I don't really care, I'm just not wanting to make waves by asking the doctor to reconsider the prescription/treatment/therapy at this time. I just thought it would be easier if it was in CPAP mode, and then they would tell the DME that they don't need to get them any different prescription, thereby not chancing the doctor saying no.

[Hephaestus]

I had a similar situation to yours. When I started CPAP I went in asking for the S9 Auto, but they didn't have any in stock, so I accepted a PR1. It was a good machine, but I would have had to pay extra for the software. I stuck with it until I got a new job and insurance changed, then went back to my doctor and asked for a new script specifying the S9 Auto along with a FFM. Turned out I didn't really speak to my doctor, but a rep at the doctor's office but it still worked out.

Because of everything I'd learned on this site, I was able talk intelligently to the rep and they agreed to change my script to auto and FFM. Apria agreed to change out my machine and mask, so now I'm set with right equipment and mask. I really like the S9 Software, it provides much more detailed information that I'd had before.

I started out with a pressure range of 8 to 10, but am adjusting the high setting up. I'm now at 8 to 12.5 and had only two episodes of central apnia last night, not bad!

My best advise is that it all starts with your doctor's office, not the DME. Get your script written exactly to what you need, THEN go to the DME and insist that they stick with the script, notwithstanding what their codes say.

Good luck!

[rested gal]

Also, remember any physician and even dentist can write the RX Wasn't there someone on this board that had a vet write a script once? Maybe I dreamed that.

You didn't dream it (about the vet) but as it turned out I didn't have to go to that extreme. I would have, though! And the vet would have done it for me.

You probably saw it here, Pugsy:
My story - why/how I started using "cpap":
viewtopic.php?p=5977#5977

There was an old retired family doctor in town. My parents and grandparents had always gone to him. I'd been healthy all my life, so wasn't a patient of his; but it being a small town, he knew me through the family. I called him up out of the blue, explained what I wanted to do and asked him if he'd write me a prescription for an "autopap". He said, "Sure."

I faxed the Rx to an online cpap supply store, ordered everything I thought I might need...and have never looked back. I've not spent one sleeping moment since the first night with the old borrowed cpap, without turning on the machine. It's been all good, every step of the way. Had the old doctor not been willing to give me the Rx, my next step was going to be to ask my vet for it - no kidding! - and I'm sure he would have written it. That's how determined I was to get the machine I knew I needed.

Piece of cake.

[Pugsy]

You didn't dream it (about the vet) but as it turned out I didn't have to go to that extreme. I would have, though! And the vet would have done it for me.

That's where I saw it. My memory was only partial.
I bet he would have too. Good to see that you are still here. You are a jewel.

[Kahfree]

Great reading on all this information! I have questions though.

I have a machine, and a mask. I want control over having the ability to purchase a mask anytime I want it, on my own, no insurance involved, even though I have insurance. I want to have the ability to purchase a machine, any machine of my choice at any time in the future if I want to change machines, at my cost. No insurance involved. I will pay out of pocket to get this kind of control.

My question, is there a "law" that says I can only have ONE machine? If I have the means to, and can purchase another machine, am I allowed to do what I want as long as I have a prescription?

Also, people are stating that any doctor can write the prescription, but my question is, will they? Will one doctor who is NOT treating the OSA write a prescription for a patient based on the fact that they simply want the prescription?

As long as the pressure is set to what the doctor requested, I feel anything else is just merchandise to deliver that pressure. Am I missing something?

I just need to arm myself with information for my Feb 14th 4 week check up. Its my first check up and to be honest the DME is there at Scripps Hospital here in San Diego. Its weird, they work along side the doctor and were in the room last time (January 17th when I was given the machine) and I had to discuss medical issues with two of the reps in the room. At the time, I had no idea they were with the DME and I have no idea what medical training they have, but either way, isn't confidential discussion a must? Should I have been asked if they were allowed to stay while I discussed my condition (and other personal information) with my doctor? Of the two men, one of them was rude and was mad at me for wanting a version of mask I thought would work for me. It turns out, it did not, but I found on on Amazon.com that is working great for me, except for the slipping headgear)

They are really going to be upset when they find out I never called them for a new mask and instead went to Amazon.com and got one, without a prescription. I can see it now.....

I want the software, but I know that wont happen because the Premo Icon from F&P wont allow it. Another control freak. The machine is great, but the company wants to dictate my care and choices. What machine has the best software allowed for the patient? Is it the s9?

Kelly

Kelly

[bradb]

Hahaha! Well, it is good to have options right?

Thankfully I got a call back from the DME and they are sticking with the "Oh, we just didn't understand what you wanted! Oops!" story - that's okay with me - and I am heading in tomorrow to get my S9 AutoSet!

Moral of the story, you really will have to play games with these DMEs, even the best of them and the mom-n-pops, and you'll probably have to repeat yourself a few times. Even if there was a misunderstanding, I'm not sure how there could have been after I had explained myself clearly several times. Maybe if I had gone in with my request written down: "ResMed S9 AutoSet in CPAP mode according to prescribed continuous pressure, H5i humidifier, ClimateLine heated tube" and maybe that would have saved time/frustration/two exchanges.

Anyway, I will report back with my AutoSet. Since I've only had the Elite a few days I haven't checked out ResScan but I will once I'm on my final machine.

As a side note, I am really loving the SmartStart feature. No more getting the mask situated (glasses off), arranging the hose, laying down to test mask seal, and then getting up and leaning over to turn it on - it senses me breathing and turns on by itself. (Elite and AutoSet only.) Awesome!

[bradb]

I have a machine, and a mask. I want control over having the ability to purchase a mask anytime I want it, on my own, no insurance involved, even though I have insurance. I want to have the ability to purchase a machine, any machine of my choice at any time in the future if I want to change machines, at my cost. No insurance involved. I will pay out of pocket to get this kind of control.

You should request a copy of your prescription "for your records," and ask that it be written for "PAP machine in continuous pressure mode of ___ cm/h2o" (instead of CPAP, so any DME can't say CPAP and APAP must be specified on the script), as well as for "machine, humidifier, heated tubing, and mask of user's choice" so that DMEs can't hassle you as much.

Also, I know you don't want insurance involved, but now that I have my machine, if I wanted a second, insurance would not pay for it, *BUT* I would vastly benefit from their contracted rate (i.e. in-network, preferred provider) that they have negotiated with my DME. In other words, instead of paying retail cost ($$$) I could get it for the reasonable cost insurance has mandated. Granted, that won't work for places like cpap.com who are obviously out of network, so if you want something fancy like a cloth SleepWeaver mask you're out of pocket (OOP) anyway, but for your machine like the S9 AutoSet, it could save you $500-600, which could buy a variety of masks, accessories, and replacement parts for years to come. Just a recommendation.

Another benefit--uses up your deductible and out-of-pocket max. Even if you have a $2500 high deductible, it would suck to spend $1k on CPAP equipment and then have to start from $0 if you have some kind of major health event, tonsilitis, appendix, pneumonia, carpal tunnel, whatever. Might as well get credit for the money you are outlaying on this investment.

My question, is there a "law" that says I can only have ONE machine? If I have the means to, and can purchase another machine, am I allowed to do what I want as long as I have a prescription?

Of course not. There are no "refill" amounts on medical equipment. Just limits on what insurance will pay and how much of non-insurance-covered OOP stuff you can put on an FSA/HSA/HRA. But out of pocket there are no limits on crutches, no limits on diabetes testing supplies, no limits on shower chairs, no limits on CPAP items.

Also, people are stating that any doctor can write the prescription, but my question is, will they? Will one doctor who is NOT treating the OSA write a prescription for a patient based on the fact that they simply want the prescription?

That's a question only you and your doctor can answer. I've had family doctors (quacks?) who would basically give you whatever you asked for, even pills. But I have one now that takes great preventive care of me and my partner, and she wouldn't even give me a low dose SSRI without referring to a mental health specialist, and I am sure without her being fairly versed in sleep medicine she would defer to her specialist superiors and be a little bit suspicious as to why I was asking her anyway. But if you disagree with your sleep doctor, you should find another, and if you don't disagree, you should just ask! The nurse/assistant/prescription-writer lady for my sleep doctor was actually very caring about my experience and was very helpful when I talked with her on the phone. She seemed to get things done for me!

As another aside, I have a family member who has seen a lot of specialists for pain management. Once she went through the rigamarole for years and years, her primary care physician just asked her to write a statement of her condition and assess how each medicine was still working, and as long as she didn't see any negative changes in efficacy or side effects, he would rewrite the prescriptions for what she needed. Worked out well, and that would seem MUCH more risky giving out pain meds than a machine that gently blows air up your nose!

As long as the pressure is set to what the doctor requested, I feel anything else is just merchandise to deliver that pressure. Am I missing something?

THIS!! This is so true. Just remind them if you are asking for something they don't carry, don't often give out, don't want to give out right away until you 'try' it they way they want, or additional perks/features/bells/whistles, say that you are making an informed decision, you know what you want, and they should fill the script but let you choose the equipment. Say that you don't need any purchasing assistance, just for them to configure the machine as the script directs them to do. And don't be like me--don't let up. Ask for a minute to think about things or ask to speak with someone else politely if you don't feel you're getting through. They are SALESPEOPLE and will do their best to pressure you!

I just need to arm myself with information for my Feb 14th 4 week check up. Its my first check up and to be honest the DME is there at Scripps Hospital here in San Diego. Its weird, they work along side the doctor and were in the room last time (January 17th when I was given the machine) and I had to discuss medical issues with two of the reps in the room. At the time, I had no idea they were with the DME and I have no idea what medical training they have, but either way, isn't confidential discussion a must? Should I have been asked if they were allowed to stay while I discussed my condition (and other personal information) with my doctor? Of the two men, one of them was rude and was mad at me for wanting a version of mask I thought would work for me. It turns out, it did not, but I found on on Amazon.com that is working great for me, except for the slipping headgear)

They are really going to be upset when they find out I never called them for a new mask and instead went to Amazon.com and got one, without a prescription. I can see it now.....

I want the software, but I know that wont happen because the Premo Icon from F&P wont allow it. Another control freak. The machine is great, but the company wants to dictate my care and choices. What machine has the best software allowed for the patient? Is it the s9?

Kelly

Kelly

I would say that the S9 is the best all-around, between features, niceties, add-ons, easy to use and available software (search this forum for links to other forums where you can get it), as well as just being compact and aesthetically pleasant. And of the S9 series, the Elite or AutoSet is what you want--do not leave with an Escape! And if you WANT the AutoSet capability for the future (think 3-5 years! who knows!), don't back down!

Good luck!

[Pugsy]

Also, people are stating that any doctor can write the prescription, but my question is, will they? Will one doctor who is NOT treating the OSA write a prescription for a patient based on the fact that they simply want the prescription?

Sometimes they will, sometimes they won't. I think it depends on the doctor and the relationship that you might have with them.
I got mine from sleep doctor. I just told his nurse I needed a copy in case my machine crapped out and I was traveling. Cpap RX will get an APAP machine set in cpap mode at cpap.com. It was all I needed. I just asked them to also include mask of choice to make sure it was covered in case I found mask online somewhere. My sleep doctor is not affiliated with any particular DME though.

There is no law that limits you to one machine.

Regarding software choice thus machine choice. Back when I got my first machine I studied the reports that I saw from the 2 main players (ResMed and Respironics) and determined I liked the Respironics better. I bought EncoreViewer 1.0 back then because I liked it better. So I got the machine that went with the software I liked. I don't doubt that the ResMed machine would be just as effective, it was simply the fact that at that time EncoreViewer offered a tiny bit more info on the reports.

EncorePro and ResMed's software are available if you know where to look. Why not see if one suits you better than the other?

I am a bit ticked off by ResMed's restrictions (no patient version of software, no ResMed products at the cpapauction) and for this reason should I get another machine it will be the latest Respironics even though I have sort of wondered if ResMed would be any different. Just me being stubborn.

All that aside. You will feel so much better when you aren't under their thumb. Believe me I know. I got both my machines off craigslist. Never used my insurance. Out of pocket costs were probably a wash. I did find a DME that was happy just to supply masks and other supplies. He didn't care where I got my machine and was in his words "Happy to do anything it took to help me get effective treatment". It was he that got the doctor to order overnight pulse ox to see if morning headaches were maybe OSA related or not. He sells ResMed machines, always jokes with me about "I have a new machine you will love" but admitted from the start that my machine is also excellent.

I have always been the type of person or patient that demanded to be proactive in my treatment of anything. It is just the way I am. Good luck on your journey, it will be worth it when it is done.

[bradb]

Also, just as an update, I got my AutoSet today.. and after I got home with it, the delivery guy came with my cpap.com order, so now I can try the Circadian SleepWeaver ZZZephyr cloth mask and also a nasal pillows mask! Woohoo!

[SleepingUgly]

Also, just as an update, I got my AutoSet today.. and after I got home with it, the delivery guy came with my cpap.com order, so now I can try the Circadian SleepWeaver ZZZephyr cloth mask and also a nasal pillows mask! Woohoo!

Is this the best day ever, or what?! Good luck with all your new toys!