Newly Diagnosed, looking to confirm equipment selection

[rested gal]

I still suspect the auto is the better choice, but rather than "fight city hall" I am going to proceed so I can get started. Worst case I will bite the bullet and pay for it myself if the sleep doc doesn't convince me otherwise.

You're doing the right thing -- going ahead and starting treatment now. The REMstar Pro 2 with C-Flex is a very good machine and records data onto the smart card -- important if you're interested in getting software/card reader and monitoring your own treatment.

A lot of sleep doctors are against autopaps. Quite a few people have reported that their sleep doctors were perfectly amenable to prescribing autopaps. I believe a good many sleep doctors who don't like autopaps for permanent treatment purposes base their misgivings on rather old studies that were not using today's modern auto-titrating machines.

Here's an old topic you might enjoy reading before you see the sleep doc:

Feb 19, 2005 subject: "Sleep Doctor" doesn't like autopaps 5 page discussion

[Wulfman]

Jack,

As RG said, "you're doing the right thing". You should be just fine with that machine. And, if you monitor your therapy, you can still make adjustments if necessary.
Please keep us informed on your progress.

Best wishes,

Den

[Midnight Son]

I lied, my earlier post "Final Update" is not the end of this saga. New CPAP users may want to take note of my experience, and anticipate (and avoid) some of the frustrations.

The Good: I had 7.5 hours of restful sleep last night, my first full night at home using the CPAP Equipment. This is better than good, it is GREAT and the first restful night of sleep I have had in a long time. javascript:emoticon(':D')
Very Happy

The Bad: Yesterday I had my appointment with the DME, to receive the Remstar Pro 2 w/ CFLEX, heated humidifier, Mirage Swift Nasal Pillows, Chinstrat, etc (see earlier notes). Earlier in the day I called my HMO to confirm the coverage for the equipment.

Bad #1: Despite being previously told my HMO covers the equipment, yesterday I learned the "conversion HMO coverage" I have requires a 50% co-pay. Not the end of the world, 50% is better than nothing (or so I assumed), I just wanted to get clarity on what I would have to pay. javascript:emoticon(':roll:')
Rolling Eyes

Bad #2: When I arrived for my appointment lo and behold the unit being provided was not the Remstar Pro 2 w/ CFlex, Smart Card, etc, it was a bare bones Remstar Plus. No monitoring, no smartcard, no cflex (exhaust relief), etc. My prescription specifically called for the Pro model. I was told I had to have a different prescription to get the CFLEX unit, blah, blah, blah More later... javascript:emoticon(':twisted:')
Twisted Evil

UGLY: I had a very hard time pinning down the HMO and the DME on what I would be charged. Basic contract law requires agreement on terms, and I was not about to sign an open ended commitment for financial responsibility, without getting the details of what I was committing to.

That is where is got real ugly. javascript:emoticon(':evil:')
Evil or Very Mad

For my 50% co=pay I was asked to commit to 15 months of rental payments at $65/month = $975.00 Supposedly the insurance company is also paying $975, for a total of $1,950.00. This was the cost for a machine (The Remstar Plus) that I can purchase on CPAP.com for $335 ($445 with humidifier). So, my 50% at $975 is twice as much as the unit costs.

I am a financial consultant, and understand the need for operating margins (overhead, staff, loaner equipment, respiratory therapist on staff, etc) but do not know of any other business with 440% markups.

So, I ended up getting the machine as a "loaner" while we sort through this mess. I spoke with the CPAP.com consultant last night and plan to order today the Remstar Auto Cflex unit (am my complete cost). The bottom line is I get a much better unit (from all the info here) at 25% savings from my supposed 50% covered costs for a much inferior unit. Go figure...

Even with the recent postings of last night by Derek on the potential benefit
of straight CPAP the unit will give me the option of running in this mode, and then occasionally using the auto mode to verify my setting (at 9cm) is still appropriate.

Lessons learned:

1) Don't assume the "expert" knows what they are talking about. Get educated yourself until you are conversant with your options, here or somewhere else. (specifically on Insurance coverage, Equipment choices, etc).

2) Question the costs. I have all the "billing codes", and the range of coverage rates quoted by my HMO. They made a big deal out of this.

3) Make informed choices. Don't assume the logical (ie having 50% coverage is "better" than no coverage at all). Not in my case.

Thanks again for the help and info sharing on this forum.

Midnight Son

ps. The good is really GREAT, the ugly is really ugly...

[Darth Vader Look]

That was a great post Midnight Son. It is really unfortunate that people get the shaft when they deal with the medical/insurance community at large. Relaying your experience as everybody else does here gives hope and education that they can take this bull by the horns and steer it in a direction that is advantageous to them and their treatment of OSA.

[Linda3032]

Son, would your insurance company not let you deal with cpap.com or billmyinsurance? Why did you have to deal with the DME?

[Midnight Son]

Linda3032,
My insurance would not let me deal with other than their certified list of providers (DMEs). I went up the chain but got no where explaining how we would both save significant $$.

Jack

[Wulfman]

Linda3032,
My insurance would not let me deal with other than their certified list of providers (DMEs). I went up the chain but got no where explaining how we would both save significant $$.

Jack

Jack,

Will your insurance provider reimburse YOU for out-of-pocket purchases?
I purchased my equipment and then submitted a bill (from ME) to my insurance provider and got reimbursed at 80%.
My insurance provider would have considered CPAP.COM "out-of-network" and would have only paid 60%, but since I was considered "in-network", I got the higher reimbursement.

Just a thought.

Den