Meeting with DME for the first time tomorrow

[sleepy-k]

Hi all -

I'm meeting with the DME for the first time tomorrow after having two sleep studies (one for diagnosis, one for titration.) I feel a little bit like I'm going in blind, so if you have suggestions about what I need to ask/find out from them or beforehand, I'd love to learn from your experiences.

From what it sounded like on the phone, I don't really get a choice of machine - they mentioned it was a Respironics with c-flex, said I would like it, but didn't give me an exact model. I tried to ask if it was fully data capable, but I think we were talking past each other. She said it had a smart card, and that I could come in and get it read, but it sounded like apart from that I could only get compliance data? I'm not sure.

I also am a little unsure of how my insurance company deals with this. The benefits book only says that purchase or rental of DME is covered when authorized - but only the basic versions of things and that it's the property of the supplier or ins. company.

Thoughts or suggestions before heading out tomorrow? My AHI was pretty low, all things considered, but I'm always so sleepy that I really hope this helps.

P.S. I haven't actually gotten the results from the titration study from my doctor yet; when I went in for my follow-up appt it hadn't been read yet...

[Emilia]

Read this blog post, written by one of esteemed forum members: http://maskarrayed.wordpress.com/what-y ... me-part-i/

[Lizistired]

No such thing as THE DME. You are meeting with A DME. There are lots more to choose from and you get to choose. Don't forget that you are the customer.

[StevenXXXX]

It is much easier to get the machine you want / need than to try to get it exchanged later (even if it means postphoning your meeting with your DME until you have had time to digest all of this information).

I do not think you will be happy with the machine they are trying to force upon you.

Take your time & do this right the first time. You will be happy you did.

[Janknitz]

Please, please, please make sure to read my blogpost referenced above and in my signature entitled "What you need to know BEFORE you meet your DME"!!!! You are really vulnerable if you do not.

You need to understand that you are NOT limited to this DME (unless you have an HMO) or to the particular machine this DME intends to provide you. My blogpost instructs you to CALL your insurance company and ask particular questions that will help you understand what your insurer will cover and how they will pay for it.

Most important thing to understand is NEVER, NEVER, NEVER rely on a DME to tell you what your insurance will cover--you are likely to get incorrect information. ASK your insurance company yourself, decide what you want in a machine (at the very least, a machine that provides EFFICACY data, not just compliance data) and make sure you get what you want and need to make your therapy effective for you. Be careful not to believe everything a DME tells you about data. As you have already surmised, the presence of a card in a machine does not necessarily mean you are going to get efficacy data. For example, if the machine this DME sells you is the Respironics Plus with C-Flex (and it most likely is) it does NOT have efficacy data!

[CruzTerri]

One concern that pops right out at me is the term "smart card" if that is true with the machine they are wanting to hoist upon you, run, it's possibly an outdated model that they are trying to clear out of inventory.

READ Janknitz Blog!!!

[Mary Z]

Please read the blog post.
But to keep it simple I think the most important thing is to be able to read your leak, AI and AHI data. So I would tell them I want to do this, and be sure they showed me how to access that data before I left. They also should help you with selecting a mask. Some DMEs are better than this than others. Find out their mask exchange policy. They should take back a mask (or other interface- nasal pillows for example) that doesn't work for you and exchange it within 30 days.
This doesn't have to be real complicated, just be sure you get a machine that gives you data.

I have also found it extremely helpful to find one person in the office who will go out of their way to help me and cultivate a relationship with that person. The RT I deal with brought numerous masks for me to try when the quattro began to cause breakdown on the bridge of my nose. He's available to me by phone and email.

Finding out about your insurance is a good thing to do before you go. Make sure your DME is "in network" or has a contract with your insurance company.

Most of all have fun!

[Slartybartfast]

I'd like to echo what everyone else has told you. You don't have to take what THIS DME says. Don't rely on them to tell you whether the machine is fully data capable or not. To the DME, "fully data capable" means "does the machine collect compliance data?" Becasue that's all they're interested in (usually). Insist on an automatic machine. Don't believe them when they tell you that your prescription is for a constant pressure machine, or that your insurance won't pay for it. That's bunk (a technical term.) The cost differential between a fully data capable APAP and a fully data capable CPAP is about $50. And the insurance billing codes don't distinguish between the two. But if they can sell you the cheaper unit they will do so. And once you walk out the door it's like returning underwear to get them to take it back. Lots of folks here have been saddled with a sub-par machine and have regretted it when they have come here and found out that they didn't have to settle for what that particular DME had. Best to call your insurance company and get a list of all the DMEs in your area that they are affiliated with. Then go shopping, and don't be shy about telling them you are looking for a particular machine, and if they don't carry it, thank them, turn on your heel and walk out.

Don't be in a hurry. You've lasted this long, you can wait a few more days to get the RIGHT machine.
If you have any question at all, walk out, come back here and get more advice.

These machines are fuly data capable automatic machines. You want one of these:

https://www.cpap.com/cpap-machines/apap ... :108:::20:

These are full data capable CPAP machines, if your doctor insists on constant pressure, which he/she shouldn't:

https://www.cpap.com/cpap-machines/cpap ... :108:::20:

I don't think I'll get flamed if I tell you that the general consensus here is that the Resmed S9 Autoset has the best software available at this time (and it's available free).

[Emilia]

@Slartybartfast... good post, but the only exception to the rule, as Janknitz alluded to, is the HMO. Some HMO's only use ONE DME company and can deny you the type of machines a doctor may Rx. I know this because it happened to me regardless of all I learned here before it happend. My HMO refused every Rx my doc wrote.... using their medical review of each instance to deny it on medical necessity grounds. I could have spent weeks or months contesting it, and still wound up with the brick they wanted to give me. That's when I decided buying my own out of pocket was SO MUCH LESS hassle.

[Janknitz]

But to keep it simple I think the most important thing is to be able to read your leak, AI and AHI data. So I would tell them I want to do this, and be sure they showed me how to access that data before I left.

Mary's suggestion is a great one, but this won't work with all DME's. Be prepared for them to tell you things like:
"There is no patient access to the data--it's only for doctors or we could download it for you and send it to your doctor." OR "It's illegal for you to look at your data." OR "You don't need to look at your data." (Lies, all lies!!!)

It's really not worth arguing with the DME's about this. They don't care about your treatment as much as you do, and they are simply parrot the party line. So the best suggestion (see Slarty's post) is to learn what machines are data capable and refuse to accept anything less. If the DME won't show you how to access data or locks you out, it's NOT a problem--we can teach you how to get it anyway, as long as your machine can gather it.

[Janknitz]

Slartybartfast... good post, but the only exception to the rule, as Janknitz alluded to, is the HMO. Some HMO's only use ONE DME company and can deny you the type of machines a doctor may Rx. I know this because it happened to me regardless of all I learned here before it happend. My HMO refused every Rx my doc wrote.... using their medical review of each instance to deny it on medical necessity grounds. I could have spent weeks or months contesting it, and still wound up with the brick they wanted to give me. That's when I decided buying my own out of pocket was SO MUCH LESS hassle.

True for me as well. Kaiser is it's own DME. Kaiser decides if you meet their criteria for an auto or straight CPAP and you get either a PR S1 Pro or Auto. PERIOD. Not even any discussion about auto vs. CPAP if you would prefer but don't "qualify" for an auto. Crapria is the supplier, but Kaiser calls the shots. It's a PITA, but at least they offer decent machines WITH data (and they will use the data to help you optimize your therapy, too!).

[Slartybartfast]

Correct-o. The O.P. DID say "THE DME" as if there's only one. So it might be an HMO. Kaiser, for example. But it seems I recall Kaiser was going with Resmed Autosets. Might be wrong there, though. However, on the chance that it isn't an HMO, that's why I said what I did.

I, too, was offered a CPAP machine, and even though it was an S9 Elite, opted to walk and give CPAP.com the business. Sometimes it's just not worth the hassle, and I really don't like arguing.

I see Janknitz and I were typing at the same time, so I'll add this: I agree. It's YOUR treatment. Not the DME's. If you have to, walk into the DME with a printout of what I supplied you above and point to the machine you want and say, "I want THAT one!" And if they say "No," take a drive to the next DME on your list. Eventually you'll find what you're looking for. And since you're going to be spending 1/3 of your life with it, like a mate, make sure it's the RIGHT one!

[Slartybartfast]

In fact, I don't think I'd even GO to the DME until they tell you specifically which machine they intend to supply you with. You have the right to know beforehand. And it's not unreasonable for you to insist on a specific machine go somewhere else if they don't have it.

All the above presumes, of course, that you're not tied to an HMO.

[sleepy-k]

Thanks for all the advice, everyone.

I said "the DME" as it's the one associated with the health system I go to. The doctor sent the prescription there and they called me. I haven't seen my prescription yet, nor do I know about other DMEs in the area. As you can imagine, I'm quite new to this.

I've read the blog post, and it sounds like I need to talk to my insurance (not an HMO, but they certainly have "preferred" providers.) The benefits guide says for DME in general (not specifically CPAP):

Rental or purchase of durable medical equipment is limited to the basic equipment.

So without having talked to them yet, I'm not sure how much I can "fight" for a better machine. (Also, it says the equipment is the property of the supplier or insurance company, and must be returned when it's no longer medically necessary. Is this normal?) I'll try contacting them before my appointment tomorrow, but I might run out of time before my appointment. I will try to get a copy of my prescription, and hopefully walk out if something doesn't seem right.

For what it's worth, I'll also be moving/changing insurance at the end of the summer. That's another issue, so I may have to return this machine when that happens and start the whole process over with a new DME. I'm hoping these next few months will be a trial where I figure out exactly what I need/want when I get a new DME.

[sleepy-k]

I, too, was offered a CPAP machine, and even though it was an S9 Elite, opted to walk and give CPAP.com the business. Sometimes it's just not worth the hassle, and I really don't like arguing.

This is tempting if I don't like what I hear. I really don't like arguing either, and while machines aren't cheap on CPAP.com and I'd prefer to have insurance chip in, it's not entirely cost-prohibitive.