Self-Titrating Help / Mask Cost DME vs online?

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Hi there! 3 days under my belt with my S9 Vpap S, and I don't feel...magical yet, but the numbers are looking good, so there's that.

QUESTION: is buying through DME's with insurance rates cheaper than online for masks? I'm 100% out of pocket, but maybe the negotiated rates with insurance are cheaper through DME's, even if I have to pay for it? I'm absolutely sure I want to try a tap pap, as my surprisingly delicate nose-skin is really not having this TrueBlue nasal mask.

WARNING: Long, sorry.. I'm going to post SH data for the three days just below; on Pugsy's advice, I set the machine at 10/6, and while I didn't have a problem with it the first night, last night I wanted...I don't know, it felt like a relief when the inhale air would start, you know? Like I wanted slightly more. For reference, testing AHI was over 20, mostly hypoxias, with a basically ridiculous amount of snoring. Anyway, quick recap:

Day 1, night: This isn't bad at all! Zzzzz.
Day 2, waking up: Why are my eyes so puffy? Why is my face all marked up? (Face marks went away, except for the bridge of my nose, which stayed red ALL DAY)
Day 2, night: Bandaid on my nose! Ready to go! Well, maybe I'll lie here a little while, doot doot doot, ok, finally, zzzz.
Day 3, waking up: Rip off mask, because blech it feels oppressive. Hmm, maybe I just want to nap for another hour....oh, maybe three hours. Eyes aren't so puffy, awesome. Peel off nose bandaid and - what!? Pimples!?! I have literally never had them there in my life, am I a teenager again?! (*checks waistline*: drat, no.) Still needed a nap later. Did not use machine in morning 'nap' or afternoon. So I probably undid a lot of the good work of the therapy, which is maybe why I didn't feel energetic?
Day 3, night: Read in bed 45 minutes! Ok, mask feels...more annoying tonight. Have a hard time believing that it really monitors mouth breathing, so I try that during the mask fit portion, when it still claims a good seal, but then just straight up hold my breath right at 2, to see if it'll show up on the monitors. It does, as a serious event. Have a really difficult time falling asleep. In fact, I think that big cluster of events was not long after I fell asleep, and I did wake up right around there, so...
Day 4, waking up: Woke up early and thought, NOPE, slept for another hour and a half (with mask), eyes puffy again, nose looking....not happy at all. V. red. Hopefully it fades, but it is not a good look at all. Not sure yet about energy levels, but here I am typing away, so, I guess time will tell. This was definitely my worst night numbers wise. I did turn up the humidity by a half point and then felt sliiiiight congestion, maybe I'll drop it back down.

I have always been a night owl, and for a long time I've been in the habit of resisting bed-time (maybe 'cause I was basically suffocating at night?). I've taken a couple of days off and am trying to be very gentle with myself about this, but I'm hoping to learn from all y'all. So...advice? Thoughts? Snarky comments? Thanks in advance for all!

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Hmmm image uploading try 2:







Also, I would just like to point out: NO SNORING, whoa.

[Pugsy]

Most of the time retail online prices from cpap.com end up being less than what my insurance allows as a negotiated allowable amount.
I have Medicare...your insurance may or may not "allow"/negotiate a similar amount. If you can find out from your insurance company what they pay for each HCPCS billing code you can then compare online prices to running it through your insurance.

But here is an example of what costs were for me.
The nasal pillow mask AirFit P10 that I got a couple of months ago through my DME and insurance I ended up paying $30 out of pocket. My out of pocket expense is 20% of the allowed amount....so between the mask and headgear Medicare allows around $150 (allowed amounts can vary with region but it is going to be close to that amount in other regions).
That same mask available from cpap.com is $99 and comes with free return insurance.
If your insurance goes by something similar and the allowable amount is $150...you would save $50 by buying that mask online from cpap.com. Of course it wouldn't go towards your deductible....and one needs to weigh in just how important it is to satisfy a high deductble.

Insurance normally pays by HCPCS code...not specific brand or model. They use a code for nasal pillow mask and headgear or nasal cushion mask and headgear. They always breakdown the mask and headgear separately even if the package includes everything.
A code for the mask and another code for the headgear.
Here's an example that shows the HCPCS billing codes for the various parts

[Pugsy]

Your reports look good. Nothing there needs any work.

I would suggest figuring out the mask situation first. With a different mask you might find you no longer have that feeling that "something" is lacking.
The other thing might be the 6 cm EPAP is giving you a little of the air starved feeling and that's why the 10 IPAP is a relief.
You might try EPAP of 7 and see how it feels but there's nothing on the reports that says therapy wise that it needs to be changed. It might be more comfortable though...and comfort is a suitable reason.

If you get a nasal pillow mask like the Tap Pap or one of the others I think that the air movement might offer you more comfort anyway even without changing the settings.

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Thanks, Pugsy! I'll try the 7 tonight. Just ordered a Tap Pap, so hopefully that'll make a difference, too. Man, this board is invaluable. I can't believe how much I've learned in a week.

[library lady]

You will also want to check with your insurance on whether they will reimburse you. Some insurance companies will not reimburse you directly and usually do not pay the online suppliers, but they will pay the local DME. You did say you would be out of pocket, but I sense you were wondering about reimbursement.

[Pugsy]

OP has insurance but a really high deductible.
I think OP is trying to compare online prices vs DME insurance negotiated prices which would what would eventually be owed if she got a mask from a DME. It's going to be out of pocket anyway it is done until deductible is met. Insurance won't be paying anything until deductible has been reached. If the negotiated price at a DME is about the same as an online price for same mask then it would make sense to go ahead and get the mask from a local DME to help satisfy any deductible but if the deductible is unlikely to be met and online prices are substantially lower than what would be paid to the DME then it would make sense to just buy online.
What needs to be figured out is the allowable/negotiated price for a mask from the insurance company and sometimes that's not so easy to get from them.

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So I got my Tap Pap from our hosts here, and I used it for several days before I realized I needed to change the mask type on the machine settings. I had been getting pretty consistent AHI numbers under 3, using the nasal mask (trueblue nasal mask), and then same using the tap pap but with the machine set to 'nasal'. I changed it a couple nights ago to 'pillows', and whoa, I spent most of the night over the leak limit. Last night, I tried to tighten things up better and made more of a mental effort to clamp down on the mouth guard part. Couldn't feel any leaks around my nose, so....I mean, leaks would be obvious, right? When I take the pillows out, it sounds like I'm on a runway. So if it's quiet, that means I've got a good seal. I'm assuming.

Anyway, so leaks were much better last night, but now my AHI has jumped up to 7.6! Are different titrations required for pillows vs. nasal masks? I plan to give this a few days to settle, but if I have several more nights like this...what should I look at changing?



(Thanks, everyone, btw, for what you do on this board here. Amazing how rapidly my conception of a 'good night's sleep' has evolved, and what a difference it's making already. I mean, look at that snore line. [Also, does anyone know what that scale even measures on the snore line? 5.0 is construction equipment and 0.2 snores is, like, the sweet whuffling of a curtain in the breeze?])