New and Desperate...

[causticcompliance]

Holy smokes Pugsy,
Talk about perfect timing...I was just reading this post and had the exact question you posted answers to...
viewtopic/t63376/Trying-to-upgrade-machine.html

Wow am I lucky to have found this place... I have already called my doctor to have a Rx ready for me with the words fully data capable on it and I have cleared things with my insurance company for anything I want... one down side though is that they will not allow me to buy one until I rent it for 6 months to make sure it will work for me....is there any feedback on the DME giving me a hard time about renting a "Fully data capable" one via my insurance company?

Also, several of you have talked about masks, I did like the nasal cushion one used in my titration but in case there may be better out there ...what are some that others have like that have also liked the nasal pillow ones? Do I get those from the DME as well? Do I pay out of pocket or do most incusrance companies cover those as well... I am using BCBS insurance.

I just got excited about this all over again, like I am getting my first nights sleep with a CPAP...

Cc

[Kilgore Trout]

I feel like we're in the same IT-geek-who-just-found-out-they're-bad-at-breathing freshman class. My DME meeting's tomorrow, but I'm thinking of canceling and doing things on my own terms (I've been getting shoved around by the sleep docs). Good luck, it sounds like you're off on the right foot!

[causticcompliance]

Kilgore, Ha...Ditto.

Got some info from a DME and you all are so right, just like a car dealer... pushed me right toward the floor model for best spread on the cash...turds...

Here is what I finally drug out of them
they have the
ResMed s9 CPAP with EPR
ResMed S8 Autoset II
Respironics PR System One

The S9 sounds like it would be the best...anyone?

Cc

[robysue]

Kilgore, Ha...Ditto.

Got some info from a DME and you all are so right, just like a car dealer... pushed me right toward the floor model for best spread on the cash...turds...

Here is what I finally drug out of them
they have the
ResMed s9 CPAP with EPR
ResMed S8 Autoset II
Respironics PR System One

The S9 sounds like it would be the best...anyone?

Cc

You MUST know EXACTLY WHICH Resmed S9 CPAP and WHICH Resmed System One they're trying to "give" you.

If the choice is between an S9 ESCAPE (basic S9 CPAP), a System One PLUS (basic System One CPAP), and an S8 Autoset II, then the DME is asking you to choose between:

• An "up-to-date" data-less Brick from Resmed (S9 ESCAPE CPAP)
• An "up-to-date" data-less Brick from PR (System One PLUS)
• An "out-of-date" full data APAP with a proprietary data card and reader that is no longer available for sale in the states---but you might luck into finding a used on on-line or being able to buy it from Australia.

My guess is NONE of these three choices is acceptable to you.

In any case, do NOT accept the Resmed S9 CPAP unless you know FOR SURE that it is a Resmed s9 ELITE.

Edited to add: And when you DO sign that contract: Check the exact model description. For the S9, make d**m sure it reads S9 ELITE or S9 AUTOSET and NOT S9 CPAP or S9 ESCAPE. Because if it reads either of the later, the DME will deliver an S9 Escape to you and tell you that's what you authorized.

And BEFORE you accept delivery, check the machine itself. It should have the word ELITE or AUTOSET clearly visible on the top of the machine somewhere. If is says ESCAPE do NOT accept delivery and wave the papers you signed in front of their nose. Of course, this only works if you didn't sign something that only specified S9 CPAP since an S9 Escape is, alas, an S9 CPAP.

[Pugsy]

Here is what I finally drug out of them
they have the
ResMed s9 CPAP with EPR
ResMed S8 Autoset II
Respironics PR System One

Nix the S8 Autoset. While an APAP the card reader needed for software use is next to impossible to find and runs around $90 from China or Israel (where last seen on Ebay) It is a discontinued model. Been sitting on shelf for a while and that is why it is offered.

ResMed S9 CPAP with EPR Does it say ESCAPE on it? Important to know. Don't want Escape. No data.

Respironics PR System One.... which model? Remstar Plus? Nix that one. Pro CPAP with CFlex Plus? That one is straight cpap and fully data capable.

Check with your particular insurance company and your plan for mask and replacement options. They will vary from plan to plan.

Masks you can get from DME also. Online purchases and even cpapauction are an option but RX is needed.

Most mask companies offer a 30 day trial of their masks. DME might have their on in house rules, best to clarify this up front. DMEs often don't want to do the paperwork for returns and thus have their own in house rules.

Check out the nasal pillow mask that I use in my Profile. Will be 2 years end of this month and I have used nothing but the nasal pillow type of mask. Don't want to use any other and some physical reasons why the others don't work well for me.
I have tried several of the nasal pillow types. This one is by far the least amount of "stuff on the face". You will find that mask fit, comfort and choice are highly personal. What works for me may not work for you or the other way around.
You are just going to have to try some to see what you like best.

Renting for 6 months may be your insurance requirement. It varies by company and plan. When doing the math factor in deductibles and co pays. Sometimes (depending on plan) the out of pocket cost is more, less or a wash.
I paid out of pocket for APAP and got what I really wanted and actually spent about the same amount of money as I would have paid with using my insurance and only get a straight cpap (I just had to have APAP )
When in doubt, always check with insurance company directly and don't rely on DME. Looks like they are already dancing a bit by offering the S8 and not telling you model names on the others.

[causticcompliance]

Cool Thanks Robysue....

I am thinking I should definitely look at them first. I did specifically ask the exact model name etc and the ones I typed were exactly what they said...but again, probably should make sure like you say and visually confirm as well....especially as ornery as these DME's sound...

One thing I noticed they don't seem to care about is how much I want to be involved in getting the data for myself as well as my doctor...that really gets under my craw A LOT...

I have a few more DME's to check out in my area. Will post back when I find out more.
One thing I know for sure is that BCBS won't let me buy one until I have rented it for a while so that gives me some bargaining power to say ...."uh this one stinks guys....need a different one..." At least that makes me feel a little safer according to that post I mentioned to pugsy.

[Pugsy]

One thing I noticed they don't seem to care about is how much I want to be involved in getting the data for myself as well as my doctor...that really gets under my craw A LOT...

They won't want you to be involved. It is a rare DME that will embrace it. Don't mention software, they will get their panties all in a wad.

Check other DMEs. There are some that will offer APAPs as standard equipment. Hard to find but some do.
Most offer the basic floor models like the ResMed Escape. Higher profit margin, that is only reason.

This part is the hardest, being patient till you figure out exactly what you want and from whom and then making it happen.
Do not accept less than what you want even if it means a few days wait.

[chunkyfrog]

Your doc sounds like a winner--the DME sounds iffy.
My doc seems to be impressed with my and my husband's competence with the data.
Keeping our fingers crossed. . .

[robysue]

Cool Thanks Robysue....

I am thinking I should definitely look at them first. I did specifically ask the exact model name etc and the ones I typed were exactly what they said...but again, probably should make sure like you say and visually confirm as well....especially as ornery as these DME's sound...

No "probably" about it: If you do NOT hold their toes to the fire, they WILL give you a data-less brick. That's why they didn't specify the model. They're fully expecting the conversation to go like this:

• They say, "Resmed S9 CPAP"
  
  You say, "Yes that's fine" thinking that they mean the ELITE, but S9 CPAP describes the Escape just as accurately as it does the Elite.
  
  They then deliver the Escape and you accept delivery (because you don't look at the machine) and sign for it. Which sets you up for MAJOR problems later when you decide you really need that full data machine.
  
  Or if you complain about the machine being an Escape, they get to say, "You signed a contract. This is what we'll provide. So either accept the machine (and don't complain) or don't. But until and unless your doctor specifies why a different machine is medically necessary, we're under no obligation to provide anything beyond the S9 CPAP (escape) we're ready to deliver right now."

One thing I noticed they don't seem to care about is how much I want to be involved in getting the data for myself as well as my doctor...that really gets under my craw A LOT...

Welcome to the club. The DME is only interested in their bottom line (most o the time). And to get paid, all they need is the compliance data. And to be honest, it's not entirely the DME's fault: Most insurance companies don't give a hoot about the efficacy data either---they'll pay for the machine as long as "compliance" is being met. To heck with whether the therapy is working or not.

And even sadder, you may well find out at your first follow up that the doc doesn't care either. After all, the prescription was NOT written with "full efficacy data available to patient" or some such thing to FORCE the DME to give you the ELITE or the S9 Autoset in the first place.

I have a few more DME's to check out in my area. Will post back when I find out more.
One thing I know for sure is that BCBS won't let me buy one until I have rented it for a while so that gives me some bargaining power to say ...."uh this one stinks guys....need a different one..." At least that makes me feel a little safer according to that post I mentioned to pugsy.

This is why I said in my first response to your thread that you may need to take some time in identifying the DME to locate the RIGHT machine for you. It's also possible that when you finally get a cooperative DME, they may have to "special order" the S9 Eliet or S9 Autoset for you and that it will take 2 or 3 days to come in. And then another 2 or 3 days of waiting for the RT to set it up (if they don't have a full time RT) or playing phone tag with you. Just don't get so impatient to start therapy that you decide to accept an inferior machine now thinking it will be easy to upgrade in the near future.

[old guy]

Before I was first diagnosed with sleep aporia, my wife said that I slept more than a baby, but I was tired all the time. Then one day I was driving down an expressway at 70 miles per hour. My eyes became so heavy that I said that If I could just close them for a second every thing would be fine. I could not keep my eyes open, I blinked and the car swayed, lucky for me I was not alone.

At that point I knew that something had to be done. I went to my doctor who set me up to be tested for sleep aporia. I stopped breathing in my sleep 30 some times and hour. But my doctor told me that when your body is ready to shut down you can not fight it, and it's going to, and it did.

I have been using a cpap machine for over five years. At first I was waking up at night finding that in my sleep I had removed the head gear and mask. I got with my doctor and tried different mask until I found one that was suitable. This is an on going process. Using my cpap now I am waking up with a terrible dry mouth, and my doctor is working on this.

Some cpap machines have a card that records the usage, which is very helpful. On my last visit to my doctor I carried my machine. I thought that I was using my machine all the time. But when they dumped the recorded information from the card It showed that my usage had dropped form 7 hrs a night down to 3 hrs per night. I am trying to get this usage back up.

I asked my Doctor one day that a lot of people take sleep disorders lightly; his reply was it can kill you, you can have a stroke, a heart attack, congestive heart failure or you can die.

Hang in there and be patient. Work with your doctor and don't fight it.

[Pugsy]

Renting to own may give you an out if you end up with a machine that you don't want but I would want to have everything spelled out in black and white first. It may not be so easy to swap a month from now as you might think. That's why we suggest get it right the first time. PITA but trust me, worth it in the long run.

Your insurance company may be "in network" with some DMEs and "out of network" for others. Make sure this is in black and white also. Best to check directly with insurance company on this also. Depending on policy, could make a huge difference in cost to you.

Again, do the math. See what the overall out of pocket expense will be. A brand spanking new PR System One Auto (APAP) can be bought online with humidifier for $700. This is APAP and not just straight CPAP. APAP machines are like 2 machines in one because it can also be used in straight CPAP mode.

[causticcompliance]

Good stuff....keep it coming...

BCBS is covering 80% In and 75% Out

I have confirmed that S9 CPAP with EPR (Exhalation Pressure Relief) is not an Escape model....I believe this is the link...
http://www.resmed.com/us/products/s9_au ... nc=dealers

This looks like what I may want but how would I access the data? Is there a USB port on it or do I need to get an SD card reader or something?

Cc

[Pugsy]

S9 Autoset? That is what link points too. I would want to confirm that is the correct machine link.
If so APAP doesn't get any better than that one.. S9 Autoset is the "equivalent" to my PR System One APAP. 2 machines in one.

SD card for data. If your computer has SD slot, nothing else is needed. If the computer does not have SD slot than any cheap SD card reader that goes into the USB port will work. Does NOT have to be ResMed brand name. Heck, even the SD cards don't have to be ResMed brand.

[robysue]

Good stuff....keep it coming...

BCBS is covering 80% In and 75% Out

I have confirmed that S9 CPAP with EPR (Exhalation Pressure Relief) is not an Escape model....I believe this is the link...
http://www.resmed.com/us/products/s9_au ... nc=dealers

This looks like what I may want but how would I access the data? Is there a USB port on it or do I need to get an SD card reader or something?

Cc

Provided the machine really is an Elite, here's how you access the data---if the DME doesn't lock you out of it:

There's an on-board menu item called the Sleep Quality Report. If it is turned on, you will be able to see a significant portion of the data that is collected each night by a few button clicks. The data includes overnight usage, overnight numbers on the AHI, and 95% leak rate. The AHI numbers are broken down into total AHI, total AI, and total CAI which allows you to quickly compute OAI and HI. The 95% leak rate lets you tell immediately if you have a really significant leak problem. The on-board reporting perid cn quickly be changed from overnight, to one week, to one month, to three months, to six months if you want to.

More detailed data can be obtained by using the SD card (which will likely be provided by the DME since they will use it to download the compliance data). The SD card can be read by any standard SD card reader. But you'll need to obtain a copy of the ResScan software---which is technically not supposed to be available to patients. However, a user here named Uncle_Bob has links in his signature to where the current version of ResScan can be downloaded. ResScan only works on Windows computers.

In ResScan you can get additional data on your AHI's and leaks. In particular if you choose the "download all data" option when doing the download, you will get "detailed graphs" that will show you what went on breath-by-breath during the night if you want to look at it in that much detail. There will be a useful overview of exactly when each recorded event happened during the night AND how long each apnea lasted. You'll also be able to see a graph of your UNINTENTIONAL leak rate which is useful in identifying annoying leak problems that are not severe enough to be flagged by the "Mr. Red Frowny Face" icon on the machine's Sleep Quality report. There will also be graphs that show how much flow limitation you had and how bad your snoring was. But the detailed data has to be downloaded at least once a week because the machine overwrites the files once they turn seven days old. (The summary data is NOT overwritten for a year, if I recall correctly.)

EDITED TO ADD:
If the machine really is an AUTOSET, then information about the 95% pressure reading will also be on the on-board Sleep Quality Report and additional information about how the pressure changed over the course of the night will be available in ResScan.

But I still urge caution because something sounds fishy here: There is absolutely NO reason I can fathom that the DME would say you have a choice between an S8 AutoSet II and a machine they initially described as an "S9 CPAP" when they really mean to supply you with the S9 AutoSet. Make sure that S9 is NOT an S9 Auto Escape which, while it's an APAP, only provides a minimal amount of efficacy data and is NOT considered a full efficacy data machine. You'd be better off with an S9 Elite than an S9 Auto Escape. Order of preference should be:

S9 AutoSet > S9 Elite >>> S9 Auto Escape >>> S9 Escape

where number of > is relevant in indicating a greater difference in the machine's data abilities.

And if the DME does lock you out of the data? Have no fear: Post hear and someone will quickly tell you how to get at it.

[causticcompliance]

Confirmed it all Pugsy and we are good to go...that will be a whopping 3 grand for the whole kit and Kaboodle... whew...$600 to me but its worth it...I hope...

Also, Robysue that is the S9 AutoSet. The lady did not read the correct one....<tsk tsk tsk> ...little stinker was a fibber ...shew was a bad bad girl.

Thank you both so much, don't know what I would have done without ya's...will let you know what I find out asap...or is it "cpap"

Cc