Just diagnosed with OSA

[SleepingUgly]

If someone's non-supine AHI is <5, and assuming that is true for all nights and not just the night of titration, why would they need to do any CPAP whatsoever? Why just not sleep non-supine?

[archangle]

Thanks everyone for the great information. So the S8 that I have does not record any data? My father told me that all I have to do is send the "card" to them or take it in to have the machine analyzed. Does that make sense to anyone?

In the "old" days, CPAPs didn't record anything about the therapy.

The biggest problem with CPAP is not using the machine, so if the patient uses the machine, you've done a lot of good in most cases.

Insurance companies wanted "compliance data" so they could deny claims to those who aren't using their CPAP and save money. Manufacturers came up with machines that recorded power on hours. Insurance companies said you had to have 4 hours per night or they wouldn't pay.

The insurance companies are stuck in the "4 hours means good therapy" mindset. So are lots of doctors and DMEs. You could be dying slowly from insufficiently treated apnea each night, but if they see 4 hours, they're happy. The only data many of them look at is hours.

10 years or so ago, manufacturers made much better machines that record lots of data. It's almost like having a mini sleep study every night. Your therapy can be tracked and adjusted much better with these new features.

The S8 Escape will do a fine job of delivering a fixed pressure. It just doesn't tell you much about whether the pressure is fixing your apnea.

[mrghos]

Again everyone, thank you all so much! I will call BCBS tomorrow to see what they will allow on my plan. I hope I don't tip my hand before I need too.

[myconoclast]

Welcome, mrghos, and good luck tomorrow!

Just to build on what others have said, it isn’t the fact that the machine is an S8 that is the issue, it is the fact that it is an S8 Escape. The Escape, while working just fine to blow air down your throat, doesn’t record any data that lets you know how well your OSA is being treated. Likewise, the S9 Escape is also a machine that you want to avoid because it doesn’t record the data that you need.

Both the S9 Elite or the S9 Autoset record full efficacy data, which is the information you need. The difference between the S9 Elite and the S9 Autoset is that the Elite will blow the air at a constant pressure for the whole night, while the Autoset will automatically adjust your pressure (between a set minimum and maximum) based on the flow limitations and apneas that the machine detects. Because you have such a difference in the number of events that occur depending on whether you are on your back or not, it makes sense for you to get the Autoset, since your pressure needs are going to vary so much throughout the night.

[mrghos]

If someone's non-supine AHI is <5, and assuming that is true for all nights and not just the night of titration, why would they need to do any CPAP whatsoever? Why just not sleep non-supine?

That is a pretty big assumption and even if I did assume this, sleeping on my side every night would seem to be a bit of a chore, coupled with the fact that doing so would probably cause me a bit of strain over a period of time.

[mrghos]

ok folks! I just spoke with BCBS and the rep told me that they dont get involved with which CPAP an insured gets. They pay based on the code E0601. (which that handy link I was referred to referenced) She stated it is up to the DME to give me the machine I want. They are going to pay based on that code regardless of what machine I get. Now how much of that they will pay regardless of the machine, I guess I will find out next Wednesday when they run the numbers. I see there is not much of a price difference, (at least on the online sites) between the S9 Elite and the S9 Autoset so I guess if I can squeeze the Autoset of the of DME I will be doing well...

As a side note, I made the statement to the BCBS rep, that I am anxious that since they pay the same no matter what type of machine I get and the DME knows this, that the DME is going to try to give me something other than what I want or need (which according to you nice folks is the Autoset) and pass me off with a lower (albeit) acceptable machine in order to increase their profits in some way.

At any rate, like I said, I will go in there next wednesday with my fathers S8 and the Hi5 humidifier he is not using and see how it all shakes out. I really like the idea of having the full data capability of either S9 model and already have the compatible humidifier so that will save money. If I have to got the S8 route for whatever reason, I guess I will just have to buy the Hi4 humidifier. The autoset seems to be a nice unit but if I have to start with the S9 Elite I guess that is ok also.

If the DME gives me static about my want/need for the autoset can you all give me some "buzz" words to toss their way to possibly sway them? I will if I have to, but I really dont want to have to go someplace else. So far the folks I have dealt with at the Sleep Fusion here in Atlanta, have been great.

I am hopeful this trend continues.

Thanks again to everyone for their comments and suggestions!

Best,

Mrghos

[ChicagoGranny]

sleeping on my side every night would seem to be a bit of a chore, coupled with the fact that doing so would probably cause me a bit of strain over a period of time.

Why? You can change sides during the night. There is also a website where a doctor shows a great method to sleep on stomach. That gives you three options to move around during the night.

[mrghos]

sleeping on my side every night would seem to be a bit of a chore, coupled with the fact that doing so would probably cause me a bit of strain over a period of time.

Why? You can change sides during the night. There is also a website where a doctor shows a great method to sleep on stomach. That gives you three options to move around during the night.

Completely understand. I am not a side or stomach sleeper. Always uncomfotable in those position. I sleep on my back most of the time so I am just going to go forward with CPAP therapy.

Thanks!

[ChicagoGranny]

I am not a side or stomach sleeper.

In that case you probably did not sleep long on your side during the sleep study (although it might surprise you if you looked at the study) and therefore the "AHI<5 on sides" could well be bogus.

Good luck.

[avi123]

ok folks! I just spoke with BCBS and the rep told me that they dont get involved with which CPAP an insured gets. They pay based on the code E0601. (which that handy link I was referred to referenced) She stated it is up to the DME to give me the machine I want. They are going to pay based on that code regardless of what machine I get. Now how much of that they will pay regardless of the machine, I guess I will find out next Wednesday when they run the numbers. I see there is not much of a price difference, (at least on the online sites) between the S9 Elite and the S9 Autoset so I guess if I can squeeze the Autoset of the of DME I will be doing well...

As a side note, I made the statement to the BCBS rep, that I am anxious that since they pay the same no matter what type of machine I get and the DME knows this, that the DME is going to try to give me something other than what I want or need (which according to you nice folks is the Autoset) and pass me off with a lower (albeit) acceptable machine in order to increase their profits in some way.

At any rate, like I said, I will go in there next wednesday with my fathers S8 and the Hi5 humidifier he is not using and see how it all shakes out. I really like the idea of having the full data capability of either S9 model and already have the compatible humidifier so that will save money. If I have to got the S8 route for whatever reason, I guess I will just have to buy the Hi4 humidifier. The autoset seems to be a nice unit but if I have to start with the S9 Elite I guess that is ok also.

If the DME gives me static about my want/need for the autoset can you all give me some "buzz" words to toss their way to possibly sway them? I will if I have to, but I really dont want to have to go someplace else. So far the folks I have dealt with at the Sleep Fusion here in Atlanta, have been great.

I am hopeful this trend continues.

Thanks again to everyone for their comments and suggestions!

Best,

Mrghos

Comment,

The autoset has the same code as a CPAP but costs almost twice. There is no way that you'll get an Autoset without paying from your pockets. Even if your Doc specify an S9 Autoset, your DME will look to BCBS for approval. In my case, I got an S9 Elite from my DME on a Medicare 13 months contract. After 3 months I wanted the machine changed to S9 Autoset, and had an Rx for it from my Sleep Doc. But the DME refused. So I paid $830 from my pockets for a new S9 Autoset, the flow generator section only. The other accessories are the same as for the S9 Elite.

[mrghos]

Thanks. I will try to get the S9 Autoset but if that does not work out, I will get the S9 Elite. I already have the Hi5 so I can save a little money either way.
At this point, I just want to be able to see the date. Hopefully the "auto" function will be something of a want, more than a need...

We will see!

[archangle]

The autoset has the same code as a CPAP but costs almost twice.

Not correct. An S9 AutoSet vs. the data capable manual S9 Elite is 6% more online. An S9 AutoSet vs. the S9 Escape is 12% more. I doubt the DME's price varies much more than that.

ResMed costs more online than Philips Respironics, but that's probably mostly MAP (Minimum Advertised Price) requirements from ResMed. I doubt the DMEs pay much more for ResMed than Philips. If it did, none of them would chose ResMed as their recommended brand.

There is no way that you'll get an Autoset without paying from your pockets.

Many well informed new patients have succeeded in doing exactly that after they learn how to deal with the DME on this forum. I think one of the most important things is to find out what DMEs in your area are in network for your insurance. If DME #1 won't give you what you want, call up DME #2 and say, "Do you want my business?"

[chunkyfrog]

Get a list of providers contracted with your insurance, and sing each one this little ditty:
"If you want my money,
And I have insurance,
Here is what you've got to do:
I want massive data, and without an upcharge;
That is what I have to have.
So tell me now; do you want my business?
Now and to the future.
Come on people tell me now."
Cross off the ones that say, "no", and continue from there.
(my apologies to Rod Stewart)

[Sleep2Die4]

Thanks. I will try to get the S9 Autoset but if that does not work out,

MAKE it happen!

Why let people making $8.00/hour doing paperwork for a DME f^&* you over healthwise?

[mrghos]

OK, two days to go before I go to the DME. I am going to try to get the S9 AutoSet as I have said before. I have heard people talk about getting my doctor to write a specific perscription. Silly question here but which doctor are you all referring too? My general practioner who originally referred me to the FusionSleep folks or someone else.

The way it was explained to me, is that on wednesday morning, I will get my results from the main "nurse" or "clinician" and then I will be sent to another room to be given an actual machine, mask and other goodies.

I hope that they will not try to give me a S9 Escape but if they do, what is my move? I really need to get this machine and start therapy as I feel like I am about to die without it. I dont want to screw myself out of something I NEED but I also dont want to wait weeks to "hopefully" get the Autoset...

I hope that makes sense.

Can someone give me some insight as to who this "Dr." is that I get the perscription from and ultimately show to the person who gives me the machine?

Thanks a bunch!