Mask and machine advice please

[College3girls]

I was contacted by my DME provider today. I have a prescription of an Auto CPAP and a full face mask (start out breathing through my nose, but breath through my mouth most often.) I am asking to try the Resmed Mirage liberty as well as the Resmed Mirage Quattro Full Face (that is what was used during the titration study). I asked to have the Resmed s9 autoset CPAP, but was told the DME only has the F and P Icon auto. My concern is we like to camp, and do not always have electricity available. The ICoN does not have DC option, but the RESMED does. Does anyone else camp, and use the Icon? I see lots of users of the S9, but not much information on the ICOn. Should I call my provider and tell her I want a different DME, or a more specific prescription? The Quattro mask gave me a headache by morning, which is the reasoning for trying the Liberty. How long does the average person need to know if a mask is good for them or not. I will be checking with the DME on mask return policies. Thanks for any advice you can give me. I just want to get on to the next phase- actually using CPAP, after being diagnosed 2 months ago.

[LSAT]

Insist on the S9...if that DME will not get it for you tell them you are going to shop elsewhere.

[College3girls]

Thanks for the advice. I was kind of expecting that. It has taken so long to get this far. I have a recheck appointment date with the sleep Dr. (April), and don't even have any equipment yet! I will need to call the sleep lap and ask for the entire list of DME's and contact them one by one to find the one that will allow the S9, with heated hose and humidifier. I'm also still waiting for a copy of my sleep study and titration. I'll have to firmly remind them of that also. Regardless of where I get the equipment, my insurance only covers half. The price I was given seems very inflated. Does it seem sensible to skip the insurance and buy from an on-line site? I could get the s9 for less than the monthly payments I'll be charged for the ICON. The only potential advantage for going through a DME is the ability of monthly payments, the service the DME provides for mask fitting, and if needed, loaner equipment should my unit need repair. Are these factor's an important advantage or am I better off going on-line and following my gut instincts for a mask.

[Pugsy]

Buying a machine online doesn't stop you from using a local DME for masks and other supplies. You don't have to get the machine from the same place you get your masks and you can change DMEs if you want to even after establishing buying anything.

When calling other DMEs...make sure you mention S9 AutoSet and don't let them sneak an Escape Auto in....the Escape Auto does do a tiny bit of data..AHI (no category breakdown) and average pressure..nothing else.

Do the math...how much do you pay out of pocket with your insurance only paying half...check with your insurance though because you would pay half of the contracted allowable amount and not necessarily half of the pie in the sky billed amount.
Often the DME has to adjust off part of that pie in the sky amount.

[College3girls]

I know I will have a $200 down-payment up front, and then $80/month payments for 10 months. That adds up to $1000. The ICON the DME wants to supply is online for less than $600. The Resmed S9 auto, with heated hose and humidifier, and even the fancy "ladies"model sold for $883. So it seems regardless of what the insurance and DME figures come out to be, I'd still be spending less by going on-line. The problem is having to pay the whole bill without spreading it out in monthly payments. Hubby and I will have to discuss how to proceed together. That is a good suggestion about using the DME for the masks, and getting the CPAP elsewhere. Do I ask for a copy of the prescription to supply to the on-line company, or does my Sleep Dr. have to do that?

[HerbM]

Don't know where you are, but if you are in the US and no in Beverly Hills, then you might want to shop.

I got a S9 Autoset with ClimateLine hose and H5i Humidifier on my 80/20 insurance for $61.67 plus $11.17 x 10 months.

Let's assume that this 20% then the total prices is:
$62 x 5 = $310
$11.17 x 5 x 10 months = $56 x 10 months

At half you should be paying not much worse than $155 plus $28 x 10 months

At $200 plus $80 month they gouging you.

The DME offered me my CHOICE of this or two other top line machines that are similar. I did NOT have to negotiate nor beg for a better machine. They almost scoffed when I asked if the heated hose and humidifier were include as if who would ever try to offer less.

They also gave me my choice of mask, even special order (with the caveat that if I took the special order then I was stuck with it rather than being able to trade for 30 days.)

My DME is American Home Patient -- if they are in your area, I would suggest you include them on your list of contacts to check.

I have only been involved with CPAP for 2 weeks but based on everything I have heard here about problems with DMEs, these folks are great.

[Pugsy]

Get the machine that you want...you will be using it a long time. You won't regret it.
My personal preference would be the S9 AutoSet over the Icon...never heard of anyone unhappy with the AutoSet.
Heard quite a few unhappy with the Icon..
You know the DMEs get paid the same from the insurance company for the less expensive Icon...as they would for the S9..that's why they push the less expensive machines.
Insurance companies pay by HCPCS code...not brand or model...and the code for the Icon and the Autoset are the same.
In fact the code for all cpap/apap machines is the same.

I would ask my doctor for a prescription to keep in my hot little hands to give to whomever I wanted to give it to.
I don't know if the supply company will give it to you or not.
You will need to find out from your insurance company who the other DMEs in your area that they will work with.

Only you and your husband can make the decision about buying out of pocket or using insurance. I understand that monthly payments are easier and we don't all have the extra cash laying around for a big purchase.
If it's a hardship...continue to look for a DME that will supply the S9 AutoSet...they are out there...just have to find one and hope they will work with your insurance company.

You will need to find out who will work with your insurance company though...that's up to your insurance company.

[College3girls]

Thanks for the input everyone. This is most helpful. I'll be making more phone calls, gathering prescriptions, and getting the machine I want. I'm not giving up camping to fix sleep apnea.

[HerbM]

I agree that you should get the prescription in hand yourself if possible but also know that if you find the DME of your choice (who is willing to handle your insurance) then you can likely just have them call/fax the doctor to get a copy of the prescription.

You have a right to take the prescription to the place of your choice.

It was lucky in that my doctor's office made the recommendation of the DME and mine turned out to be great, but you can chose if you know that you have that choice.

Good luck. Sweet dreams.

[teleute]

Might want to consider the PR System One machines as well - they're arguably even better for camping (actually has an input jack for DC power instead of needing an adapter).

[College3girls]

I now have a copy of my prescription, and a copy of my sleep study. I also obtained a complete list of all the DME's available in my area. I cancelled the original DME. I started making phone calls and did find a DME the will provide a Resmed s9 Auto with heated hose and humidifier for much less than I was going to be charged for the ICON. Their mask trial policy is not as good, and they don't have the Quattro Liberty I wanted to try, but as they said, they have many to chose from. I get to try 2 masks within a 30 day period. After that, I can not use insurance to try another mask until after 3 months. I can work with that. I was able to get an appointment to get my APAP and mask on Monday. The learning curve from this is that after a night in the sleep lab and an unsuccessful titration due to a 26% sleep efficiency, being handed a list of DME's and being told to "pick one" is not the way to go. Better to take the list home and be able to ask questions. I do not fault the sleep lab in this; overall I have to say the sleep lab has been very helpful in this process.

Thanks again to all the responders to my question and their advice and information. The cost break-down was especially helpful.

[Badnvsleep]

I camp, well in a trailer out in the middle of a mountain, during the summer. I cannot give first hand advise as I have only had my APAP since this January. I looked into the S9 but went with the PR system 560, only required a DC plug that cost me $25 like teleute said above. Just make sure you follow the manufactures recommendations for DC power.

The big thing is don't let someone talk you into a machine you don't want. It sounds like you have done some research and have an idea of what you want, stick with that.

There are a lot of great people here that can provide advise once you start your treatment, when you have questions. My DME was of little help, I have learned more here about my treatment and machine. The site sponsor has some pretty good prices on supplies and very quick turn around on orders.

Good luck.........

[ptl4now]

If I was paying hundreds of dollars out of my own pocket, I would also look at non traditional avenues, such as Craigslist and Ebay, for used machines at a greatly reduced price.
I am glad you made some phone calls. Sounds like the first place was a rip off artist. Before committing to the the DME you are looking at now, I would still call the rest, and see what options you have for the mask. When I first was fitted, my company had me try on multiple styles of masks and lie down, to see which felt the best. I think the current place I go to now has samples, trials masks I can try. And, just because you get the machine from one DME, I don't think that means you have to get the mask and supplies from them as well, does it? Get the machine from the supplier with the best deal, and keep shopping for the mask you want with a policies you like. Three months in a bad mask can be miserable.

[HerbM]

You might also wish to call your insurance company to learn THEIR OFFICIAL RULES.

While my DME is great, ordering they mask I chose, they warned me that since it was special order that the "30 day" return policy was not in effect and that I would have to wait 3-6 months for the insurance company to buy a new one.

However, the mask doesn't work for me, so I called the insurance company and ask for their official rules on mask. I want to know if they had a different agreement with the DME than had been offered to me AND when the insurance company would pay for a new mask.

The phone rep had to put me on hold and go talk to a supervisor (twice) but came back with a surprising answer:

"Go buy another mask now and we'll pay for it. And make sure you pick one of our in plan suppliers so we'll pay 80% instead of 60%, and here is a phone name and phone number."

Aetna.

So far Aetna is a great replacement to the really great insurance company (Symmetra) we had for 20 years until ObamaCare forced them to cancel.


It's amazing how much stuff we all miss just by not asking.

So the recommendation is to ASK YOUR INSURANCE COMPANY.

They are paying for it and you are paying them to do the right thing; give them a fair chance to make it right.