And So The DME Saga Continues AGAIN
Apria isn't much better. but if they are your last choice you have to deal with them. I would like to get rid of them completely.
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I need more Coffee&Old Bushmills!
"Without Truckdrivers America Stops!"
I'm not always wrong,but I'm not always right!
"Semper Fi"
I have apria. I was diagnosed in April and still don't have a machine yet. I have heard every excuse in the book from them. If you can use any other DME instead of apria DO! Apria has already told me they only have RTs check for compliance...wether or not you're having a problem is between you and your doctor!
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Tracy
Good grief! And at the same time we have Resmed touting the crucial followup care and education provided by DMEs. Go figure. Wasn't it Resmed's argument that internet retailers couldn't provide such stellar service and that's why they're raising their prices 40-60% effective September 4th? Let's see... where have I gotten the very best followup care and education; Apria, or cpap.com/cpaptalk.com?
Perhaps it's all a ruse. Perhaps Resmed is acutely aware of the inferior service provided by DMEs and they're raising the internet prices so the poor folks stuck with the likes of Apria will no longer appear to be paying a premium for the privilege of being subjected to such crappy service.
Perhaps it's all a ruse. Perhaps Resmed is acutely aware of the inferior service provided by DMEs and they're raising the internet prices so the poor folks stuck with the likes of Apria will no longer appear to be paying a premium for the privilege of being subjected to such crappy service.
Whatever their (warped) logic is, it's going to cost them.....business, customers and profit. They done screwed up!.....Big time!Tracy wrote:Good grief! And at the same time we have Resmed touting the crucial followup care and education provided by DMEs. Go figure. Wasn't it Resmed's argument that internet retailers couldn't provide such stellar service and that's why they're raising their prices 40-60% effective September 4th? Let's see... where have I gotten the very best followup care and education; Apria, or cpap.com/cpaptalk.com?
Perhaps it's all a ruse. Perhaps Resmed is acutely aware of the inferior service provided by DMEs and they're raising the internet prices so the poor folks stuck with the likes of Apria will no longer appear to be paying a premium for the privilege of being subjected to such crappy service.
Den
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05
It's not at all obvious that it's going to cost them. And if they have any smarts at all, they'll have already done the study and projections to support their decisions.
If they get most of their business through DMEs, then such a decision won't cost them, and will in fact profit them. This is particularly true if their products are genuinely competitive in the marketplace -- which I suspect they are.
I suspect that the real forces at work here are the relationships between the DMEs and insurers. The equipment manufacturers may be victims as much as are the end users. We don't know the figures, of course, but to suppose that their market share is skewed towards independent purchases as opposed to purchases from DMEs seems outrightly silly to me.
The real question is why insurers are willing to pay such outrageous (i.e., above free market) prices and to inhibit competition that would result in lower pricing by constraining their providers to a narrow group of DMEs.
These are actually fairly complex issues since anything in the medical domain is subject to regulatory pressures and the ever-present threat of litigation. Virtually every move (of providers) is fear-driven, and it is difficult not to have some sympathy with them under those circumstances.
So the best tactic (for providers) is to be conservative and to pass the cost on to the consumer. I don't have any suggestion concerning how to avoid this in the current environment. A regulated environment puts you into a limbo between a fully regulated market (i.e., socialist health care) and a fully free market (i.e., anything goes). How to survive in such a market (for a supplier) is not an easy task.
If they get most of their business through DMEs, then such a decision won't cost them, and will in fact profit them. This is particularly true if their products are genuinely competitive in the marketplace -- which I suspect they are.
I suspect that the real forces at work here are the relationships between the DMEs and insurers. The equipment manufacturers may be victims as much as are the end users. We don't know the figures, of course, but to suppose that their market share is skewed towards independent purchases as opposed to purchases from DMEs seems outrightly silly to me.
The real question is why insurers are willing to pay such outrageous (i.e., above free market) prices and to inhibit competition that would result in lower pricing by constraining their providers to a narrow group of DMEs.
These are actually fairly complex issues since anything in the medical domain is subject to regulatory pressures and the ever-present threat of litigation. Virtually every move (of providers) is fear-driven, and it is difficult not to have some sympathy with them under those circumstances.
So the best tactic (for providers) is to be conservative and to pass the cost on to the consumer. I don't have any suggestion concerning how to avoid this in the current environment. A regulated environment puts you into a limbo between a fully regulated market (i.e., socialist health care) and a fully free market (i.e., anything goes). How to survive in such a market (for a supplier) is not an easy task.
A new start
Hi jayPSU,
i suggest you slow down and start from the beginning rather than getting focused on how to get the machine you think you want and the deficiencies of DME's. A bit of background first-I am a physcian who has been on CPAP since 2000. I have been thru much of the same trevail as you have, feeling I got poor support from DME's. Also, my prescribing physician not all that conversant with the machines or DME's. I write this as a very informed patient, not as a physician. I must also add that I like gadgets and am into getting the "latest technology."
First off, did you have a sleep study, which I presume you did? And what was the recommended pressure? The lower it is, the less likely c-flex, or epr will solve the problem you described of labored breathing, ear popping. You seemed to assume that c-flex or epr would. But there are other possible causes. And when starting cpap, I urge you not to let the experience of one night determine your course of action. I am not clear what, if any machine you now have access to, but if you can get one, have it set at the sleep study cpap pressure with C-flex (respironics) or epr (resmed) and see if you feel more comfortable.
What is not clear is why auto-adjust was prescribed, unless the DME or MD want the data feedback they can get from it and do not realize non-auto adjust machines by both manufacturers can also give this feedback.
Both companies make good machines but use different algorhythms for the auto adjust feature. The also use different ones for the decrease pressure during exhalation (which has nothing to do with efficacy of CPAP but only comfort and therfore compliance).
I have reviewed what i can online iincluding medical journals when I recently bought a new machine. My old respironics-a sturdy friend of many years, used with the fischer pychel heated humidifier was fine but I seemed to have flutuating pressure needs due to an ongoing medical condition. (No mystery-I am on/off steroids and these cause tissue swelling including the soft pallate so central to sleep apnea.) Also, i wanted something smaller for travel. I have no expertise other than self taught in sleep medicine so i cannot say get this or that machine.
I decided on the resmed vantage. I also bought the card reader and rescan software to play around with, but that's me. My insurance paid only for the machine with humidifier of course. Realize that the DME gets a flat payment no matter what model supplied, so the higher cost of the vantage was off the bottom line of the DME. It was medically justified, but I am not sure they would have supplied it had I not been a physician. I did tell them that if they did not I would get it online.
Wow-I went on and on a bit, but I hope some of this helps. I had a good deal of trouble at first-poor support from DME, physician not up on this stuff. It was worth it. The occasional night when I first started that things went well and I felt great the next day kept me going. Take care.
i suggest you slow down and start from the beginning rather than getting focused on how to get the machine you think you want and the deficiencies of DME's. A bit of background first-I am a physcian who has been on CPAP since 2000. I have been thru much of the same trevail as you have, feeling I got poor support from DME's. Also, my prescribing physician not all that conversant with the machines or DME's. I write this as a very informed patient, not as a physician. I must also add that I like gadgets and am into getting the "latest technology."
First off, did you have a sleep study, which I presume you did? And what was the recommended pressure? The lower it is, the less likely c-flex, or epr will solve the problem you described of labored breathing, ear popping. You seemed to assume that c-flex or epr would. But there are other possible causes. And when starting cpap, I urge you not to let the experience of one night determine your course of action. I am not clear what, if any machine you now have access to, but if you can get one, have it set at the sleep study cpap pressure with C-flex (respironics) or epr (resmed) and see if you feel more comfortable.
What is not clear is why auto-adjust was prescribed, unless the DME or MD want the data feedback they can get from it and do not realize non-auto adjust machines by both manufacturers can also give this feedback.
Both companies make good machines but use different algorhythms for the auto adjust feature. The also use different ones for the decrease pressure during exhalation (which has nothing to do with efficacy of CPAP but only comfort and therfore compliance).
I have reviewed what i can online iincluding medical journals when I recently bought a new machine. My old respironics-a sturdy friend of many years, used with the fischer pychel heated humidifier was fine but I seemed to have flutuating pressure needs due to an ongoing medical condition. (No mystery-I am on/off steroids and these cause tissue swelling including the soft pallate so central to sleep apnea.) Also, i wanted something smaller for travel. I have no expertise other than self taught in sleep medicine so i cannot say get this or that machine.
I decided on the resmed vantage. I also bought the card reader and rescan software to play around with, but that's me. My insurance paid only for the machine with humidifier of course. Realize that the DME gets a flat payment no matter what model supplied, so the higher cost of the vantage was off the bottom line of the DME. It was medically justified, but I am not sure they would have supplied it had I not been a physician. I did tell them that if they did not I would get it online.
Wow-I went on and on a bit, but I hope some of this helps. I had a good deal of trouble at first-poor support from DME, physician not up on this stuff. It was worth it. The occasional night when I first started that things went well and I felt great the next day kept me going. Take care.
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Guest
Re: A new start
Diddler, if you read all of JayPSU's previous posts, you will be brought up to speed on this situation---including his PSG titrated pressure.diddler wrote:Hi jayPSU,
i suggest you slow down and start from the beginning rather than getting focused on how to get the machine you think you want and the deficiencies of DME's.
First off, did you have a sleep study, which I presume you did? And what was the recommended pressure?
presribed pressure
To guest who wrote:
Posted: Sat Jul 29, 2006 10:04 am
Diddler, if you read all of JayPSU's previous posts, you will be brought up to speed on this situation---including his PSG titrated pressure.
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Sorry, but I could not find PSG results on this thread. It may be there but not readily evident to me. Plse advise.
A comment on being constructive in tone. The point of this thread in my view is to help jsyPSU. Fine to point out my shortcommings (no problem from me). But not so fine to then not help the process along by simply stating the results or directing me to specific post.
Just my opinion.
Posted: Sat Jul 29, 2006 10:04 am
Diddler, if you read all of JayPSU's previous posts, you will be brought up to speed on this situation---including his PSG titrated pressure.
_________________
Sorry, but I could not find PSG results on this thread. It may be there but not readily evident to me. Plse advise.
A comment on being constructive in tone. The point of this thread in my view is to help jsyPSU. Fine to point out my shortcommings (no problem from me). But not so fine to then not help the process along by simply stating the results or directing me to specific post.
Just my opinion.