Okay, I had my titration study plus Lincare as DME

[TNT]

I did my titration study in the sleep lab Wednesday night. Unfortunately, I woke that morning with a sniffle that went away... but turned pretty ugly that evening as I went from warm to cold to warm to cold that evening. The tech said it would be better if I didn't have the sniffle, but we could go ahead anyway.

It took awhile to fall asleep... the mask and the wires were intimidating. It may seem childish, but I got into the whole thing by pretending I was an astronaut getting ready for liftoff. It worked, so... okay. The tech said it took about an hour to fall asleep. I think it was a little longer, but whatever. End result was that the tech confirmed a severe apnea and was able to find a good setting.

I didn't wake up refreshed, but I did wake up knowing I'd had some sleep that I haven't had for a long, long time. I also felt an unusual calm that lasted all day. I'm still kind of PO'd about having to spend the night with a machine for the rest of my life, but, at the same time, I want me some more of that kind of sleep.

The tech said it would take 7-10 days to get the results... instead, the order for a machine was placed this morning. I haven't heard from the DME yet... could be pre-authorization stuff. (Funny, in a not good way: my insurance will fill a $1,000 a month prescription without asking any questions, but has required pre-authorization during every step of the apnea adventure.)

Anyway, does anyone use Lincare as a DME? I looked at their website, but it doesn't say a whole lot.

Thanks again for the forum... it's getting me through a difficult time.

[Wulfman...]

I did my titration study in the sleep lab Wednesday night. Unfortunately, I woke that morning with a sniffle that went away... but turned pretty ugly that evening as I went from warm to cold to warm to cold that evening. The tech said it would be better if I didn't have the sniffle, but we could go ahead anyway.

It took awhile to fall asleep... the mask and the wires were intimidating. It may seem childish, but I got into the whole thing by pretending I was an astronaut getting ready for liftoff. It worked, so... okay. The tech said it took about an hour to fall asleep. I think it was a little longer, but whatever. End result was that the tech confirmed a severe apnea and was able to find a good setting.

I didn't wake up refreshed, but I did wake up knowing I'd had some sleep that I haven't had for a long, long time. I also felt an unusual calm that lasted all day. I'm still kind of PO'd about having to spend the night with a machine for the rest of my life, but, at the same time, I want me some more of that kind of sleep.

The tech said it would take 7-10 days to get the results... instead, the order for a machine was placed this morning. I haven't heard from the DME yet... could be pre-authorization stuff. (Funny, in a not good way: my insurance will fill a $1,000 a month prescription without asking any questions, but has required pre-authorization during every step of the apnea adventure.)

Anyway, does anyone use Lincare as a DME? I looked at their website, but it doesn't say a whole lot.

Thanks again for the forum... it's getting me through a difficult time.

If someone else placed the order for your machine, that could be problematic. Make sure YOU get a copy (or original) of the prescription/order.......you will probably need it in the future.

Become very familiar with the various makes and models of the machines and MAKE SURE YOU GET A FULLY-DATA-CAPABLE MACHINE. There are non-data-capable machines (we call "bricks") which only report hours used.

From reading your post, I can envision them trying to pull a switcheroo on you. Many DMEs are notorious for putting their profit ahead of the patient's therapy.


Den

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[Pugsy]

Read Jan's blogs here
http://maskarrayed.wordpress.com/what-y ... me-part-i/
http://maskarrayed.wordpress.com/

[College3girls]

I rapidly switched to another DME after trying Lincare. I don't know if all of Lincare is the same, but in my area, they were going to charge me $1000 out of pocket costs for a machine I could purchase on-line for $600. They did have a good mask policy, but again, they were more expensive. They did not carry the Resmed Auto 9 that I wanted. They gave me no other choices but the one machine. Whatever DME you are using, research what machine you want, get a prescription for that exact machine, and go to a DME who can supply it.

[purple]

http://maskarrayed.wordpress.com/what-y ... me-part-i/

I highly advocate you read the above blog. Despite the tone here on the forum, I have only had wonderful caring sleep doctors, and helpful DME's. Now including Lincare. Not to say there have not been some issues. Keep in mind a DME is composed of different parts.

If one calls them on the phone, then one is often talking to receptionist whose job it is to get you onto someone else, who is not always immediately available. That person will first, after putting you on hold for awhile, act like your questions do not matter and start asking for your name, insurance, and those details related to their getting paid. As I have Medicare, it is the same kind of drill with all medical things, be it doctors or whomever. I just do it, and wait for my moment to start asking questions. Then someone, hopefully the same person as the one on the phone, after getting your prescription, will want to meet with you, either at their office or your home to deliver the machine, and help you fit a mask. Like the blog above, if your doc writes for a specific machine, and dispense as written, then the DME must deliver that machine. I am referring to, you want a machine that has full data, not just compliance data (which the DME needs for the insurance company to pay for the machine) and, IMO, AUTO capability. Plus IMO, a heated hose.

As to which manufacturer, the two big guys in the field are Philips Respironics and Resmed. Both make low end machines, which do not have full data, which you do not want, and some comparable higher level machines, with full data, and auto. Someone here, who has a lot more experience with using both the brands says, "There is not a dimes worth of difference between the machines of the two different manufacturers (which are comparable machines, made in the same time period) Some here swear by one manufacturer and sometimes swear at the other. There are some differences. Philips Respironics makes machines that feel to me like a soviet built tank, sturdy, almost unbreakable. (But never get water back inside them) PR has better software to read the data. I think many more people here have Resmed machines, which nearly always cost more, as Resmed does not give discounts to DME's, while PR apparently does. Many people say they have a higher comfort factor with a Resmed machine than a PR. I now have a Resmed, (after two PR machines of a different level) I like Resmed machine, it does a better job for me than anything before, and if I was getting a new one now, it would be a PR machine.

Masks, you may already have chosen a mask when you did your sleep study. Most DME's have a policy that you may try as many masks as you want during the first thirty days without additional charge. I think the majority here use a nasal mask. I have heard it said that of the two big manufacturers, more are satisfied with Resmed masks, but there are some masks from manufacturers that are not the two big companies that are well spoken of. If you look at the offerings of our forum sponsor, cpap.com, no affiliation, then you can see all the masks, and how people rank them.

OK, you asked about Lincare. Lincare has three arms, the guys in you local office, who are supposed to be focused on helping you, a warehouse somewhere (for me it is Florida, altho I live in Texas) which will ship you goods every so often, and the billing part, which is composed of people who are overworked, under paid, have a computer system that gets lost easily, and will bill you for things you have already paid for. In my experience, the local guys are kind good natured and over worked. Find the one who does mask fitting and such, keep their name and number, treat that person like a good friend, and they might be. A person on this level is tasked to help you and does not know, nor care about their own companies billing. They might get you stuff the warehouse will not send you because your insurance will not pay for it. If you want a mask not on the list, usually they will find it and get it to you. The local office can not tell you about prices, they do have folks who can talk with their billing part and straighten things out, try not to yell at them, no matter how stupid the bills look. Some people here hate Lincare, or even some of the other national DME chains. It is really about how their local office treats you as to how you feel.

I assume you have some kind of insurance, like I have Medicare. The asking price for stuff provided by DME is astronomical. Medicare requires my provider accept "Assignment", which is code for, Medicare decides what the total price for the product is to be, and I will, eventually be sent a bill for a co-pay. The Medicare price is far lower, and not cheap. DME's get to charge more than an internet provider of DME services because they are supposed to help you. Like you get an 800 (or 888) number to call during the time your local office is closed, and speak with a real tech about problems you might have. Fifty percent of the people who get a machine, quit. Help you fit a mask. A DME is supposed to help you through the frustrating part of getting started, so you will keep using the machine.

The reward for me, when getting rid of some sleep debt, and learning to cope with leaks, it was like coming back to life. I had forgotten how much fun life could be. Yes, using the machine can still be frustrating after six years.

In dealing with any DME, "be as wise as a serpent, as innocent as a dove." Try to tell them calmly, clearly, gently as to what your concerns are, and what you want. Then if you do not get them, ask to speak with the supervisor. Then keep in mind you can, usually get another DME company. I feel the DME people will try to help folks, but when they get cursed, or screamed at, you are indeed welcome to go somewhere else. It is only human nature to be nice to those who are nice to you.

DO NOT LET THEM TAKE ADVANTAGE OF YOU.

What no one will tell you right off, that I think you should know: Get the model with a heated hose, and the correct hose for it. (different manufacturers have different names for similar things) In some way, when you set up your machine, tie the hose down in some way. Maybe a bit of string or wire to the head board. I use the hose buddy from our sponsor, (cpap.com), which helps me to keep leaks down. The real goal of tying the hose down is to prevent one from dragging the machine off in the floor. NEVER MOVE A MACHINE WITH WATER IN IT. The one true way to ruin a machine is to get water back inside it.

Come back and let us know how you are doing, little bits of advice can help a lot, and there are a lot of people here who have some very good advice.

In acknowledgement to someone who said Lincare would not get them an S9, I did indeed get an S9 VPAP, because one, my doctor wrote, dispense as written, and then the local Lincare office had to get a supervisor somewhere to approve it, because indeed, Lincare would have preferred that I get the less expensive, but similar in feature machine. Sometimes the list price, for those with insurance does not matter. An internet selling of sleep apnea equipment will not be there to help you fit masks, and some other things. If one is an experienced user of Sleep Apnea equipment, then an internet seller is can offer it for less, for cash up front. Not the same if one has insurance. My local DME will send me things I need, when I need them and me not having paid my co-pay for months. My co pay being a lot less than the cash price that I see on the internet for the same thing. If I want something not covered by my insurance, like extra head straps, then using an internet provider is less expensive, because I would have to pay the full list from my own DME.

Both Pugsy and Janknitz know a great deal more than I do.

It usually takes a number of days to evaluate a titration study because it is done by two different human beings looking at the data in 30 second intervals. Also ask your sleep doc for a copy of your sleep study, that is the short one-two page summary, and a copy of your prescription. then carefully save them.

[KentuckyHoser]

Re Lincare: YMMV, but I've had nothing but good experiences with them locally so far. Granted I've only been in to get my machine and then pick up the Nuance headgear and frame. But they did give me said headgear and frame without charging insurance (I already had the Nuance Pro so I had the pillows and the short hose setup).

[TNT]

Wow. Just wow. I'm amazed a the responses I've gotten... this is a great forum (and yes, I've read the mentioned blogs, too). Thank you all.

In theory, I have very good insurance, or at least the company says so -- I work for Total World Media Domination, LLC -- so they're big on that kind of stuff even though I'm a lowly runt. Still, the insurance seems fussy... I have a 10% co-pay, which sounds great, but lately it seems like pre-certifying any treatment is coming right out of the pre-certifier's pocket. Whatever. I can't afford to go on my own and get any equipment from a non-network provider. It's only because my doctor is very demanding that things are moving along as fast as they are. "No, waiting three days for you to approve treatment is not okay. He needs this done now."

Things are happening kind of rapidly, so I've only been able to mention to the doctor that I wanted a machine with downloadable information. She's a techie wonk, too, and she acted as though she'd never even thought of not prescribing that.

I'm reasonably skilled at negotiation, having been taught that by father from a very young age. (Dad used to pull me out of elementary school to teach me stuff like that... I was the first kid in my kindergarten class who could read past performances from the horse racing newspaper, "The Morning Telegraph," now known as the "Daily Racing Form.")

I digress. I think now I now know the kind of machine I want (I'm pretty much going to marry it, so might as well go for it, right?) and how to get it. We'll see what actually happens, but I'm hopeful.

[purple]

To be more clear. Most machines are on a rent to own. Medicare is 13 month rent to own, with the first two months having higher payments than the rest. Medicare says I must prove I use the machine. I was given different stories about the exact requirement is. The last one was 30 consecutive days over four hours a day in the first sixty. ?????

Anyway, the other thing I should mention, when you get the machine, you may be asked to sign for it, and the document will have prices on it, that are likely that full number Lincare would really wish people would pay. The guy who gives you the machine puts those numbers on the document, knowing that your insurance will have a negotiated deal with Lincare, which is a lot lot lot less than those numbers. The individual who hands you the machine and shows you how to connect that hose, and turn it on and off, change the humidifier setting, help you with a mask does not do numbers. That person can not be expected to know what your insurance is going to pay, or what you will pay. What I am getting at, do not freak about those dollar amounts. They have nothing to do with the reality of what will be paid by the insurer or you. It is not a moment to feel abused.

If you get an S9, you want the easy to clean humidifier tank. The one which is easy to open to clean. I forgot to mention it before. When I got my S9 VPAP auto, I did not know about the different humidifier tanks. Lincare rep just brought to me the more expensive one.

The other advantage to a real brick and mortar DME is what happens if you have problems. If you buy from an internet DME, and have problems, their answer is likely. Sent the machine back to them, pay a fee to evaluate it, if they find something wrong, and the machine is still in Warranty, they will work out the new machine.

I have a friend on Medicare with a brick and mortar DME, whose machine starting quitting intermittently at night. She calls the 800 number at one AM in the morning Saturday night. They go through their trouble shooting guide. Make sure the power cord is plugged in. blah blah blah. Since it starting working, not much more to say. The tech offered to arrange for her to get a replacement machine, more current model, as a replacement, (her machine was out of warranty) Problem was that no one could deliver it until Monday in her area. She was going to a class on Monday. So he offered to have it delivered at the parking lot of the college she was going to, into her hands. or have someone come by during Monday evening. No money needed to change hands.

If she was using an internet DME, who do not take insurance, then she would have had to first get a prescription to them, then pay the full price for a new machine before getting the machine. Service with a brick and mortar DME should be worlds better. I will buy things from an internet DME, but not things I can get as part of my Medicare.

I think one of the reasons a lot of folks on the forum are cool with an internet DME, is that they have been using a machine long enough that they do not need any advice or help. The other reason, is a lot of them have had bad DME's, that would not help them anyway.

BTW. Medicare will replace broken or stolen machines without consideration as to whether the stupidity of the user is involved.

Get some distilled water to use in the humidifier chamber. I keep my distilled water closed in the fridge to make sure it is not not contaminated.

Anyway, to repeat a piece of advice. NEVER MOVE A SLEEP APNEA MACHINE WITH WATER IN IT.