One Month Checkup Questions

[RobertS975]

Next week, I go to see the R.N. at my DME dealer where I picked up my S9. I flunked my sleep study miserable enough so that they interrupted me at 0100 to try a nasal mask for the rest of the night.

For the past month, on the S9, pressure 10.0cm, using both nasal masks and FX , AHI results have been spectacular, usually below 1.0 and often below 0.5. I will probably ask to try to Fit P10 pillows as air leaks and vent noise have been a bother.

Here is my question: she asked me to bring the entire CPAP machine in with me. Why is this? She already has all the data from the telemetry system. What does she need the machine for? Just curious.

[Pugsy]

Maybe to remove the modem??
Is it still attached?

I can't think of any other possible reason for needing the machine unless they plan to change a setting.
You can bring the SD card and any changes in settings could be done with it...but given you have doing well...I don't know I would want to mess with it if it were me.

[RobertS975]

The "modem" is still attached... I always thought it was a small cell phone. Is that a device which gets returned? I had just assumed it was part of the unit.

Although I am a physician, I am still trying to understand all the financial and insurance angles here. After reading something on this board, I came right out and asked whether I own my machine or am I just renting it. The answer was "rent to own", although I still don't know the details. So far, I have walked out the door with an S9 +humidifier, 2 different style nasal masks and a Swift FX pillow mask and haven't paid a dime... yet.

[Pugsy]

The modem pops off...It's easy and that is probably why they want the machine.
You can do it yourself if you have a mind to.

Rent to own...common and time frame varies depending on insurance...best to check with your insurance to find out exactly...DMEs don't always know every little variable with every insurance plan out there.
It can vary from 30 days to 13 months and your insurance carrier is your best source to find out just how long.
With Medicare it is 13 months but other companies might just be 1 month or 3 months or 10 months.
It's termed a capped rental...after a capped time...it's yours and no further renting.

Since you are a physician...they might be giving you a little professional discount in regards to the bill..or they could just be lazy billing since it has only been 30 days...again the best choice of information is from your insurance company directly.
It's also possible that you have really good insurance.

[RobertS975]

A few days ago, I received an Explanation of Benefits (EOB) from Blue Cross... looks like my co-pay is $39 for the machine and the initial mask. I have no idea about the rental term... will have to check on that.

I know the modem pops off... I actually detach it when I blow dry the tube after rinsing. I just had no idea the modem was a loan.

[Pugsy]

The modem is strictly used to verify compliance hours of use.
The DME has to pay a monthly fee to use the software in the sky (for lack of remembering the real name) to connect to your machine's modem and they likely only have a limited number of modems and will want to use it on someone else.

Not all DMEs even use a modem for compliance tracking. It costs them money. I don't know if it is something that they can bill insurance for and make money on. I have never seen a billing code for the service but maybe it is something that gets billed as a misc service.

I have never heard of a DME leaving the modem on a machine unless someone just totally forgot it.
They sort of assume that once you have met compliance that no further follow up needs to be routinely done...unfortunately that's how some people fall through the cracks and the machines end up in the closet.
They seem to fixate on hours of use and if it is being used the required number of hours then things must be all hunky dory.

[dinycat]

Robert, I'm just like you. I received my machine January 15th, and haven't heard a word about anything yet. From anybody--not the DME, insurance company, or doctor. As far as they all know, I wrapped the hose around my neck the first night and died.

But I DO love the darn thing--I'm breathing and sleeping better than ever!

So, am I renting it? I guess, but at what cost? And how is the rental bill being paid? By my insurance company? I have Blue Cross, too, and it's been 2 months with no word. And is it cheaper to go along with the rent to buy program than buying outright?

I know absolutely NOTHING about any of this. I've never experienced such a lack of explanation of details when involved with any other program.

dinycat

[MitzyG]

This whole machine/insurance thing is the most bizarre thing to me.

1) "Rent to Own" is partially for you and partially for the insurance company. They want to make sure you're using the machine. If you are using it, great, you can "have" it for whatever copay. On the other hand, if you "bought" and it turns out that you need a Bipap instead of Apap, then you'd be financially "stuck" because all your/insurance funds went to the "wrong machine". once I understood it, I thought it was nice. My fear though is that you get used machines because they don't know if you'll "keep" it or not. To me...I think it's ok to take a used machine until you're sure you're keeping, then get a new one. But hey, that's just me.

2) The modem thing is usually for compliance, not for your on-going care. They just want to know that you're really using the machine and don't care whether it is "effective" for you or not. As a result, they usually take the modem once insurance determines that you're keeping the machine. My new doctor seems to indicate that she has the DME leave the modem with you so that she can actively monitor all of her patients' care. I suspect this is not "usual"

You can read on the board and other spots about how insurance pays the same for every machine so it's the DME or doctor's incentive to give you the cheapest machine that you'll use.

Oh...and I suspect they want you to bring your machine to check settings, possibly adjust and help you use it, in case. I suspect that the doctor doesn't know that you need no help, are quite pleased and that it's not necessary to bring your machine. Therefore, they tell everyone to bring their machines

[RobertS975]

OK, just a followup... went for my one month visit last week... remember, they requested that I bring my S9 machine with me... she checked it to make sure it was giving a pressure of 10cm with some test tube that had a marble in it. Changed the filter. And that was about the sum of it. The modem was left intact.

As far as the fact that I haven't been asked to pay anything yet towards my co=pay, she said that happens at about 90 days. And that after a year, I own my machine.

I mentioned that I had some APAP envy from my readings on this board, and why did I have a CPAP machine instead of an APAP capable machine? Her reply was that I was doing spectacularly well (AHI over 70 on my sleep test, consistently under 1.0 on treatment) and that I shouldn't worry about APAP.

[Pugsy]

why did I have a CPAP machine instead of an APAP capable machine? Her reply was that I was doing spectacularly well (AHI over 70 on my sleep test, consistently under 1.0 on treatment) and that I shouldn't worry about APAP.

Because they make more money selling the CPAP.
They could have given you an APAP and set it to cpap mode...maybe you don't need it but maybe it would come in handy some time in the future.

[RobertS975]

Pugsy, do you think it is an important enough issue to make a polite stink over... APAP capable S9 vs CPAP only?

[Pugsy]

Make a stink?? Wouldn't be the first time I have been in the middle of one. I fired my first DME before I even saw the machine they were going to give me because they wouldn't give me what I wanted and come to find out I happen to do better on APAP because sometimes during REM I need a LOT more pressure than I do the rest of the night and my sleep doctor's PA agreed with me once I presented my case. I still bought from a private party as I found a deal on a brand new machine exactly like I wanted for what my co pay would have been...and I was minus the headache and hassle.
DME number 2 is used for masks and incidental supplies that I might want from them and he knows I do my own thing with machines and just laughs at me. Wait till I tell him I got an ASV.

Anyway...if you are not having any problems I don't know that it is worth making a fuss over at this point. Heck, you might not even like auto adjusting pressures. Not every one does.

What you might do is keep an eye out for a spare machine to have for a back up or travel and maybe pick and APAP up then.

It's not like a person can't get optimal therapy with a cpap only mode machine because they sure can...only potential drawback would be if a person was like me and need 8 cm more pressure sometimes and not others. If I used a cpap only mode machine I would have to choose between using 18 cm all night to deal with the REM events..or use 10 cm and let the REM events happen. Tough choice...18 cm is way more of a hurricane than 10 cm is.

If you had a brick I would be telling you to make a fuss though. I feel much more strongly about the availability of data than I do having apap mode available.

I would respect DME that told me that they dispensed cpaps instead of apaps because of profit. I don't like being lied to and being told that is what the doctor ordered or that's all your insurance will pay for or in your case "it's all you need".

[sleeplessinaz]

It is nice to have the APAP. You can always use it in CPAP mode but I do love having the adjustable pressure.