Self Reporting

I was recently prescribed a bipap with backup rate. The DME my doctor initially referred me to quoted me $6417.19 at total insuranced cost (not including masks, filters, etc. which are also high but reasonable after insurance). With my deductible already met, I only get 50% coverage which gets me a nice ~$3200 bill for a machine (Aircurve 10 ST) that seems to be commonly priced at $3100-3200. This is the claimed insurance medical contracted rate (spread across 4 hcpc codes). As this seems ridiculous, I tried contacting 5 other local DMES but only got prices back from 2. They are only slightly cheaper at face value (a few hundred) but those two are contracted as rental rates and it becomes more expensive overall once my deductible resets part way through.

I had been looking at buying direct, but my prescription has "RT required" on it for monitoring by a respiratory therapist. I asked the DME and they said this is included in the insurance agreement, I assume for compliance purposes. My understanding is the Aircurve just phones in data and they kick out a report. When I contacted my doctor's office though, one of things they brought up is if I didn't go through a DME, I was responsible for all that they normally take care of. While I don't like this, for the cost difference it didn't seem like a huge deal until she listed reports were required for prescriptions. A big part of why I am getting the machine I believe is because my doctor wants to prescribe me medication at night for my narcolepsy and will only do so for use with the bipap. I am of the understanding he will only prescribe it if he has proof the bipap is working consistently and has been for a period of time.

Does anyone self report to their doctor or know what respiratory therapist monitoring companies do? Assuming my doctor will accept reports generated by me, what does producing a report consist of? Is it just pulling the SD card and uploading it to software like sleepyhead (that seems a common mention on here) and the software does most the work? Alternatively, anyone aware of a way I can sign up for respiratory monitoring myself? When I briefly looked, companies only seemed to marketing to DME and doctor office type clients rather than individuals.

I feel like the DME is ripping me off (to the tune of $1200-1500 if in fact I can buy an Aircurve 10 ST for $1726 and my insurance won't reimburse anything) but I also am concerned if I go solo I'm going to be in over my head or mess something up.

If I understand what you're saying, the information reports are only for purposes of compliance - the insurance company requires them to make sure the equipment is being used. If you buy your own equipment, there are no reporting requirements. As long as you have a prescription and are paying yourself, you can buy directly and save lots of money over the inflated insurance/list price. I don't think the "RT required" will be a problem. You can call our sponsor at cpap.com and ask them about it.

It's a crazy system we have to deal with between the doctors and the DMEs. Many decide to just take their prescription and buy their equipment themselves.

You can, of course, provide the data from the memory card to your doctor's office and, for some machines, they may be able to just access it directly online.

I doubt the doc will accept SleepyHead reports but should accept ResMed's software reports...ResScan and you can get that software easily.
http://www.apneaboard.com/forums/Thread ... -available
Now whether he will be happy with it coming from you..that's between you and him but he is most likely familiar with ResScan and I bet will want ResScan reports.
Some docs have the software themselves and can print out their own reports. Other docs have the DME who supplied the machine do the reports and then forward the reports to them.

Othy, I think you need to talk directly with your insurer. They will pay the DME only the approved contracted cost for the BiPAP ST, and your deductibles and copay should be based on that reduced amount. You need to find out what the full approved cost is for that provider, not the fantasy price that the DME will bill.

I would think Resmed or Encore reports should satisfy your doctor. The RT can't produce anything better, and if your doctor is unwilling to review reports you generate, well, you need a different doctor. You have complications in that you're attempting to manage sleep apnea using a machine with a backup rate in anticipation of taking medication which might induce complex or central apnea. A curious thing is the prescription for ST rather than ASV which might be ore effective treating periodic breathing and complex apnea. ST machines are generally intended for patients with hypoventilation problems related to obstructive disease like COPD or obesity, as opposed to SV machines intended for complex apnea that serve as adaptive servo ventilators. I am not knowledgeable in the side effects of the medications your doctor might consider, so ST might well be the tool of choice. It would be good of your doctor to take the time to explain his approach and rationale for ST rather than SV to you, and discuss your options in self-reporting. If he is not professional in approaching such questions, I really would look elsewhere. You've got quite a lot of skin in the game to invest in this.

Do you have a copy of the prescription with all of the machine settings?

I would think that you could acquire your own machine and program it to those settings and then give your doctor a copy of the reports. If they want an RT to review them, they could very easily have that done.

At the same time, if you have the software and are downloading the data, you could additionally review the reports and determine on your own how your therapy is working.


Den

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I print the reports for my Sleep Doctor using ResScan (She is aware). I even fill out the "Health Care Provider" section with my name and logo. My reports are much more detailed than she would get from my DME who would likely only report summary data.
Although I have SleepyHead, for "official" reports I always use ResScan, ResMed's software, with which the Doctor and others are familiar.

Only real advantage that I can see going through a DME in your case is if there is a chance the doc is grilling to order into a different type of machine. You wouldn't be paying more because the contract usually requires the DME to simply transfer costs to the new machine.