Feel like I'm suffocating

[flyingwithoutwings]

I'm hanging in there. Thanks to everyone who has given me advice, especially pugsy. I've been doing really well with the heated tubing. The problem with a FF mask is I'm very claustrophobic and I'm afraid I'll feel like I'm suffocating. I can't even do an open MRI.

As for the data capable machine. It seems my doctor called my DME rep and discussed my concerns about my basic CPAP machine with them and they (DME) just called me and said there is no way they can give me a data capable machine unless I'm willing to pay for it because my insurance only wants compliance and won't pay for a more expensive machine. She did admit that it's billed under one code and therefore they get paid the same regardless of which machine I get but since they only want compliance then that's what i get.

[Pugsy]

just called me and said there is no way they can give me a data capable machine unless I'm willing to pay for it because my insurance only wants compliance and won't pay for a more expensive machine.

Don't take the DMEs word.
Call up your insurance company and ask them if they pay by HCPSC code or machine brand and model.
There is only one code for a basic cpap/apap machine E0601. This covers full data, partial data or compliance only data machines.
Most insurance companies pay by the E0601 code...they don't care about brand or model or data or whatever.
They pay one set price for that E0601 code..and DMEs supply the less expensive compliance only machines so that they make more money on it.
Maybe your insurance is difference but if it is ...it's rare. I would bet you are getting the typical run around and being flat out lied to.
Have you read this
http://maskarrayed.wordpress.com/
and this
http://maskarrayed.wordpress.com/what-y ... me-part-i/
It explains a little more how the HCPSC code thing works.

[Pugsy]

Another thought...is this a rent to own thing?
When you call up your insurance company ask for a list of other possible DME suppliers in your area that they work with.
Call them up and tell them what you want and see if they will supply it.
Then go back to the 1st DME and tell them you are returning the machine since they won't give you what you want...9 times out of 10 they will "make an exception" like they are doing you a big favor and give you what you want. If they won't...go to the DME that will.

It's extremely unlikely that your insurance doesn't use the HCPSC coding system for payments...and if they do then your DME flat out lied to you and I don't know about you but I don't like being lied to.

If money permits you could also maybe purchase a machine on your own ..or if you don't like to fight....some people don't.
Or if data isn't important to you..you can just let things go as they are.
Me...when I get mad I usually get even too. I fired my first DME because they lied to me.

[flyingwithoutwings]

So I called my insurance company and the first guy I spoke with said they pay by brand and model. After speaking with him some more he decided to transfer me to CPAP dept. The second guy said they pay by HCPSC code but if "that's what your DME provider said, then that's what we pay for." WHAT??? You are my insurance provider. You say what you pay for not the DME! Then he agreed that it doesn't matter which machine because it's paid by code. He wasn't much help. I looked at what the DME is billing and it is coded E0601 Continuous. I do want the data, so the battle continues. I haven't met my deductible and we're two months away from a new year and a new deductible so it's like I'm paying for it myself.

I feel like such a dummy. Wish I had come here first but I was so unaware of what sleep apnea was all about. I always thought I slept like a baby.

[monster_tracks]

I have found that when using a whisp the silicone that seals around the my nose after a while blocks my nostril completely causing me to suffocate. I went back to the nasal pillows

[flyingwithoutwings]

I have found that when using a whisp the silicone that seals around the my nose after a while blocks my nostril completely causing me to suffocate. I went back to the nasal pillows

That is exactly what happened to me.

[flyingwithoutwings]

If you get the appropriate PRS1 or ResMed S9 machine, you can get free computer software that will let you look at your own data.

Many people on this board have been successful in exchanging machines like yours for data capable machines. Remember, it's usually a "rent to own" machine, so you have some leverage with the DME. Check the links in my signature line.

I think my doctor handled this wrong. Instead of writing the prescription, she met with the DME's rep who probably convinced her that this is the ONLY machine they can issue "because the insurance only requires compliance and therefore will not approve of a more expensive machine" like they told me after speaking with her.

Isn't it "balance billing" when the DME said I can pay the difference if I want a more expensive machine than the one I have?

[monster_tracks]

I don't think you understood me. It was the way the mask is created. Not my nose. When air pressure is applied to the mask it fills that seal like a balloon in turn it pushes the silicone agents the holes of my nose blocking them completely. I can exhale 100% normal with the wisp but when i inhale it is as if blocked 100 percent. Then panic sets in and it is over. Inspect the mask by removing it from the headgear and the hose look in a mirror through the hose hole while breathing then plug the hose hole with your hand. You should be able to see the silicone flap ( for lack of better term ) suck over your nose hole ( nasal passage ). The mask is just to small. There are many types of masks out there. Talk to your DME and find one that works. If they won't help you find a different DME. Remember if your paying for a service from them they are your employee. This is your health care not theirs.

[flyingwithoutwings]

I don't think you understood me. It was the way the mask is created. Not my nose.

Oh yes, your problem is totally different.
I'm doing really good with the pillows now that I have the heated tubing. I slept from 11:30 pm to 7:00 am (just like old times), I did wake up a couple of times but went right back to sleep.

[flyingwithoutwings]

If money permits you could also maybe purchase a machine on your own ..or if you don't like to fight....some people don't.
Or if data isn't important to you..you can just let things go as they are.
Me...when I get mad I usually get even too. I fired my first DME because they lied to me.

I don't have many options as to DME's to choose from sooooo, in the event that I cannot get DME to change my CPAP machine and I buy one, will the insurance still pay for supplies every 3 - 6 months?

There's a PR System One REMstar Auto CPAP 550P with Heated Humidifier (litely used - 32 hours for blower, 18 hours for therapy), for sale for $250.

Also, a new Respironics CPAP w/humidifier, #DS560S for $200. It comes with the carrying case, new tubing, filters, water chamber, the sd memory card and the manuals.

[Julie]

You have to ask your insce. co. if they'll pay - they're not all the same. You don't want just a 'Cpap' because while an Apap can be used in Cpap mode, you can't turn a Cpap into an Apap, and I'm sure you'd like the option.

[Pugsy]

Also, a new Respironics CPAP w/humidifier, #DS560S for $200. It comes with the carrying case, new tubing, filters, water chamber, the sd memory card and the manuals.

If it is really a 560 machine...snatch it up...just make sure it is the 560...that's the newer version of the 550.
The 560 is a 60 series machine like your current machine...and works with your heated hose which you like.
Just make sure the 560 and not some 260 machine which is not any better than what you have when it comes to useful data.
The 550 won't work with your heated hose.
The 550 and 560 are the APAP models...has cpap and apap mode available and are full data machines....great machine.

You can still use your insurance and the current DME for masks or other equipment supplies.
You can keep the SE and pay for it and use it as a spare after insurance compliance is met...or return it and tell the DME where to go. Or be nicer than me and tell them thanks but no thanks you will use them for masks only. They can't do a thing about it.

[flyingwithoutwings]

If it is really a 560 machine...snatch it up...just make sure it is the 560...that's the newer version of the 550.

I am definitely going to snatch it up if it is what they say it is. Expecting a call this morning. She also has a New Respironics Bipap Auto - $300 Brand new Respironics BIPAP AUTO with the humidifier, nasal mask, water chamber, tubing still in the packaging and filters and carrying case. This machine can be set on bipap auto, bipap, or cpap. The model number is DS750.

Someone else is selling this one - Very nice, slightly used Respironics Remstar C-Flex CPAP and humidifier - $175 . Includes humidifier and water chamber. Used about 3 months. Includes brand new tubing, travel bag, info card, and filters. They don't know the Model # though.

[Julie]

The Remstar is not an auto!

[Pugsy]

Be careful with the word Remstar...it isn't telling you much because it has been used on every model machine that Respironics has made since time began.
Sometimes it's the only word that shows prominently and those are the really old machines (old in terms of when they were made).
Stick with model numbers that you can verify.

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