Time for a new DME

[bayourest]

I started xpap in November...the DME rep came out, fitted me with a quattro mirage small, and set up the S9. She called me a week or 10 days later to see how I was doing. I expressed some concerns but thought it would take more time. I called her maybe 10 days after that and told her I thought I needed a re-fitting for the mask, not sure it fit. She said (over the phone) It fits. (end of discussion!)
After seeing the sleep dr in January he had me see the tech in his office who was great, and most helpful. She gave me a medium ultra mirage. She said for my next mask I should try a quattro FX. I have been thinking that before the next mask is due in 6 weeks I'd like to try a hybrid as well.I called the Dr's tech and she suggested first line of approach is try to work with the DME and if that did not work out she would be happy to help me again. So I called the DME supervisor, who was helpful and made big effort to get back to me despite a lot of phone tag. I asked about a mask trial program and she said there was only a mask replacement program and I could try something for a couple of weeks and see how it worked. She does not see patients but said I would need to set up an appt with the 1st woman (who I did not find helpful). She thought she would be ideal "to partner with" me. Trying to be open minded, I went ahead and made the appt. The woman came in with FX mask and said "this is what you should get." I said I would like to try the hybrid. She was absolutely not open to that, listed reasons why it does not work. In fact she seemed unwilling to volunteer any info about the mask replacement program when I asked about it until I told her flatly what I had been told by the supervisor. At that point she admitted that the program exists. I said I have made a lot of progress but I think I could do better and I would like to try other masks. (During my titration I had a Liberty hybrid but at that time the FF was a lot more comfortable. Now that I am accustomed to a mask I think it would be a good time to try another style. Maybe it will work and maybe not). She said dont expect too much. Now she had not looked at my card or asked me ANYTHING about my progress, compliance, challenges etc. I did not think this was much of a "partner". It really was as though she did not care about anything except the sale of the FX. I took the quattro FX (because the tech had recommended it and I do want to try it out in any case.) When I got home I called another local hospital who has a sleep lab and asked if there are DME's they use and now I think it's time to switch DME.

[TalonNYC]

Stories like this one always throw me for a loop. I realize that DME companies are businesses, but a good hybrid costs about the same, so they wouldn't be losing money on billing the insurance company. I am an active partner in my healthcare, and like you I often give the medical professionals my opinions. If they don't at least *listen* then I switch providers. I understand that they may not agree with me (after all, I'm paying them for expertise) but to dismiss my opinion out of hand like that is uncalled for and insulting to me as a human and a patient.

[bayourest]

Thanks, Talon NYC. I have a hard time thinking it's about insurance because I have a high deductible which I have not yet reached this year so in effect I will be paying out of pocket for new supplies. It is hard to believe that the DME suppliers dont have some kind of arrangement with the mask companies for a tryout (or aka mask replacement) program, considering the personalized nature of this therapy. What percentage of the time is the first mask you try actually your "forever" mask? I trust this forum and I have repeatedly read suggestions to try different masks. I definitely depend on professionals for their expertise (just as I give the best counsel I possibly can in my own area of expertise) but this seems like I received NOTHING professional from the DME rep in terms of listening, evaluation, suggestion.

[BlackSpinner]

Thanks, Talon NYC. I have a hard time thinking it's about insurance because I have a high deductible which I have not yet reached this year so in effect I will be paying out of pocket for new supplies. It is hard to believe that the DME suppliers dont have some kind of arrangement with the mask companies for a tryout (or aka mask replacement) program, considering the personalized nature of this therapy. What percentage of the time is the first mask you try actually your "forever" mask? I trust this forum and I have repeatedly read suggestions to try different masks. I definitely depend on professionals for their expertise (just as I give the best counsel I possibly can in my own area of expertise) but this seems like I received NOTHING professional from the DME rep in terms of listening, evaluation, suggestion.

If you are paying out of pocket you may as well use our host and pay half the price. They have mask insurance but the Innomed hybrid is sent with all sizes of pillows and mouth pieces which means you can do a swap with other members, it is like getting 3 masks for the price of one.

[Pugsy]

It is hard to believe that the DME suppliers dont have some kind of arrangement with the mask companies for a tryout (or aka mask replacement) program, considering the personalized nature of this therapy.

ResMed and Respironics actually do have a program. Don't know about others but I bet they have something similar.
30 day trial if don't work can swap it for another one. But DME has to fill out paperwork each time to get credit so they often will establish their own in house rules regarding trials. My DME had such in house rules. First 30 days of treatment I could swap as many times as I felt I needed, after that you try it, you buy it.

I got lucky with my first DME supplied mask the Swift LT, and I did well with it and only switched when ResMed offered the Swift FX which is very similar. I had already decided that I was going to use the nasal pillow mask though. I had titration done with the Optilife. Though I did experiment early into treatment on my own with masks purchased through the cpapauction, I always came back to the LT.

I do understand that the full face masks are so much harder to decide which one will work just because of size and individual face characteristics.

Regarding not looking at data or anything... Some just won't do anything unless they have to or unless you really push. Once they have their payment from insurance company for the machine, they won't make much effort to see if you are doing well. Maybe they think that they did their job so well at the beginning they can't imagine things not working perfectly. cough, cough. In the end you are your own best judge.

I know you are irritated and have lost confidence in the DME and my first gut feeling was to suggest a new DME but I see you have been on the machine well past the 30 day mark and they still offer a trial period (even if you had to push to get it). Before I switched, I would make darn sure the new DME offered same. They may not. You have high deductible? More reason to utilize their trial offerings. Try it, you buy it gets real expensive with a high deductible...

The Innomed Hybrid is very similar to the ResMed Liberty. Plus it comes in 3 sizes of cushions which the Liberty does not.
Check out the cpapauction, while no ResMed stuff is allowed, you might find a good deal on the Innomed Hybrid or just ask here at the forum and someone may have a gently used (tried and failed) one that they will part with cheap or trade. I gave away an unused one because I wasn't going to use it.

[bayourest]

Thanks Pugsy
I will check it all out at the new potential DME before I do anything rash...I am also going to investigate the Resmed and Repironics tryout program so that I will be an informed consumer.
I have emailed sleepnation tv to try to get a loaner hybrid (innomed).
I did not find this forum until after I was on cpap and thus was totally clueless about options or questions to ask. I was just so happy to have a real diagnosis and a real treatment possibility that none of the potential problems would ever have occurred to me. It would seem to me that newbies should get a year or so for tryouts.
The cost of the mask and supplies is put towards my annual deductible so in that sense it's not a loss. However it has been my intention to purchase from cpap.com once I know what really works for me in an ongoing way.

[Pugsy]

It would seem to me that newbies should get a year or so for tryouts.

They should, but they don't. Most DME's don't want to bother with the paperwork necessary to document the returns or trade to get credit or reimbursement. Most will have a 30 day window, a few might offer 60 days. Then they cut us off. '' Oops, so sorry you are past the time limit allowed for trials." People don't know and shrug their shoulders and go off and hate the mask, the machine and it ends up in the closet. Stupid business practice in my opinion. Gotta sell stuff to make money. Most people can't afford to pay out of pocket DME charges for masks that can cost upwards of $200 each and might need several of them before finding one that works, especially since DME may not really know how to fit a mask in the first place. They don't know about this forum and they end up not using anything and DME just lost another potential customer, all because they didn't want to mess with some paperwork.

[Janknitz]

DME's also get FREE sample masks for customers to try out to help them find the right mask--not just in the store but to take home and use to make sure they REALLY work. Some DME's actually use the free samples this way, other DME's sell the samples on the gray market to make money. So if your DME doesn't allow you to try on masks or take them home to try on, guess what's happening to the samples?

If you leave this DME, a polite letter outlining exactly what you told us, to the supervisor would be a great thing. You are becoming an informed consumer but many people just go to the DME, get a mask that doesn't work well because that same tech told them "it fits", and give up on CPAP altogether--to their great peril. This type of customer "service" will continue unless pesmart people like you make sure that the supervisor knows what's happening.

[bayourest]

Janknitz, it's interesting that you suggest a polite letter to the company...when the rep came out the very first time she gave me a customer evaluation sheet and said I was free to send it in or not. I tend to be the kind of person who gives good evaluations wherever I can and tries to give constructive criticism where necessary. I almost just checked that sheet off as everything good...because that's what I thought the 1st day...but something kept me from sending it in. It's still in the drawer and I think it might be time to look it over and fill it out when I send the polite letter.