Appt with DME set up tomorrow AM!

Bluebonnet_Gal · Post by **Bluebonnet_Gal** » Tue Dec 09, 2008 11:36 am

I have the appointment set up with my DME for tomorrow morning. Here's hoping I have a good DME!

I've been researching A-PAP machines on cpap.com. My Doc didn't specify a machine, so I want to have a good idea of 2 or 3 machines that would be my top picks.

I'm going in with a list of the 5 most popular self adjusting C-PAPs https://www.cpap.com/cpap-compare-chart ... sting-CPAP and a lot of questions. In case my DME does not satisfactorily answer my questions, I'm hoping I can get some of them answered here before I go in tomorrow.

• Do all Auto Pap machines provide full data? It would seem that without providing full data, an auto pap would be somewhat meaningless.
• I found a description of C-Flex on cpap.com, but I don’t really understand A-Flex. Can someone help me understand?
• My sleep study states “CPAP was tittered from 4 – 14 cm. Fourteen centimeters appeared optimal in eliminating snoring, respiratory events and desaturations and was observed supine REM sleep with an index of 3.6 events per hour. Is 14 considered high? Would I benefit from something like C-Flex if a high pressure is needed? I slept on my back for the sleep study, but I normally sleep on my side, so I hope I won’t need a pressure of 14 cm on a regular basis when I’m at home.
• Some of the machines apparently don’t come with a Data Card. What disadvantages are there with no data card?
• Cpap.com’s list of ALL self adjusting C-PAP machines (https://www.cpap.com/cpap-compare-chart ... sting-CPAP) includes one I’m interested in that isn’t in the “top five”. I believe that might be the case because it is new. It’s the ResMed S8 AutoSet II. I don’t know if my DME will even offer this machine, but in case they do, does anyone have any experience with it?
• I know I need to check their policy on rental of a machine and at what point during rental will I own the machine (if they’re even set up that way). I know I want to keep an auto pap with full data. If it’s not feasible to keep the one I get from them, I will purchase out of pocket from cpap.com.
• Have I missed anything? Does anyone have any other advice to offer?

I certainly appreciate your responses and any help you all can provide!

Slinky · Post by **Slinky** » Tue Dec 09, 2008 12:14 pm

FIRST, call your insurance company and ask them what local DME CPAP suppliers they are contracted with. HOPEFULLY you will have the option of more than one. That gives you more bargaining/negotiating room to get the equipment you want.

They you might as well ask just how your insurance does handle CPAP DME purchase. Deducatbles, copays, outright purchase, "capped rental", i.e. rent to own? If you purchase out of pocket and submit a paid invoice w/proper coding would you as the policy holder by considered "in network" and will they reimburse you? At what percent?

As for the APAPs you've run the comparison on: you could also include the Covidien Sandman Auto. The Resmed S8 II AutoSet is a newer edtion of the Resmed S8 AutoSet Vantage. The S8 II AutoSet has EPR in APAP as well as CPAP mode and has the new EasyBreathe technology. The PB Goodknight 420E, the Covidien Sandman and the DeVilBiss AutoAdjust IntelliPAP don't need a data card as they download direct to your PC via a cable.

The Resmed S8 II AutoSet, Covidien Sandman Auto and DeVilBiss AutoAdjust IntelliPAP were all newly introduced by their manufacturers in 2008. I believe the Resmed S8 AutoSet Vantage came out in 2006, the M Series w/C-Flex came out in 2006 and the M Series w/A-Flex in 2007. All of the APAPs you listed and mentioned in this post are fully data capable APAPs.

Be diplomatic, but BE FIRM, don't settle for less than what you want. All of the above APAPs are reimbursed by insurance as HCPCS code e0601, the same as a bare-bone compliance data only CPAP, not by brand and model. You should NOT have to pay one penny more for a fully data capable APAP than for the bottom of the line CPAP. Remember: diplomatic but firm.

rested gal · Post by **rested gal** » Tue Dec 09, 2008 12:41 pm

I agree with Slinky -- add the Covidien Sandman Auto to your list.

Bluebonnet_Gal wrote:• Do all Auto Pap machines provide full data?

The ones you mentioned are. Fisher & Paykel has recently developed an autopap, but I don't think they offer software for it yet. Perhaps they will in the future, but better to stick with "already does."

Bluebonnet_Gal wrote:• I found a description of C-Flex on cpap.com, but I don’t really understand A-Flex. Can someone help me understand?

In a nutshell, C-flex affects only the beginning of exhaling. As I understand it (and I could be wrong) A-flex does that too, but A-flex also "smooths" the transition of the pressure moving back up. A-flex rounds out the transitions, smoothing more than just the beginning of exhaling. I've used both, and A-flex is definitely more comfortable to me than just C-flex. Each person is different though. Some like one better than the other. Some like both turned off. The nice thing about getting the auto with A-flex is that is does also have C-flex. You can use whichever suits you better, or... neither.

Bluebonnet_Gal wrote:• My sleep study states “CPAP was tittered from 4 – 14 cm. Fourteen centimeters appeared optimal in eliminating snoring, respiratory events and desaturations and was observed supine REM sleep with an index of 3.6 events per hour. Is 14 considered high? Would I benefit from something like C-Flex if a high pressure is needed? I slept on my back for the sleep study, but I normally sleep on my side, so I hope I won’t need a pressure of 14 cm on a regular basis when I’m at home.

What each person considers "high pressure" can be different. 14 cm's is probably considered moderately high to most people. A straight pressure of fourteen would feel high to me... 14's a pretty strong blast of air. We tend to get used to the feel of "whatever" pressure as the night goes on. So 14 might feel very high when you first turn the machine on, but feel like not much at all if you wake up during the night, or by morning.

Bluebonnet_Gal wrote:• Some of the machines apparently don’t come with a Data Card. What disadvantages are there with no data card?

I've used both methods.. Smart Card in the Respironics machines, and cable download directly to my computer from the 420E. The only disadvantage I found with "no data card" was having to unplug and carry my 420E to my computer to do a download. I don't have a laptop to carry to the cpap machine. Either way (data card or direct download) has its own pros and cons. Either way is fine with me.

Bluebonnet_Gal wrote:• Cpap.com’s list of ALL self adjusting C-PAP machines (https://www.cpap.com/cpap-compare-chart ... sting-CPAP) includes one I’m interested in that isn’t in the “top five”. I believe that might be the case because it is new. It’s the ResMed S8 AutoSet II. I don’t know if my DME will even offer this machine, but in case they do, does anyone have any experience with it?

I've not used that particular one, but I have used ResMed's older S8 Vantage auto and (even older) S7 Spirit auto. From what I've read about the S8 "II" machines, it should be a very good machine...EPR in auto mode was added, and "quieter" operation. If the DME offered that machine, I'd take it in a heartbeat.

Bluebonnet_Gal wrote:• I know I need to check their policy on rental of a machine and at what point during rental will I own the machine (if they’re even set up that way). I know I want to keep an auto pap with full data. If it’s not feasible to keep the one I get from them, I will purchase out of pocket from cpap.com.
• Have I missed anything? Does anyone have any other advice to offer?

Sounds like you're preparing yourself very well.

Just look what's happened since the thought first crossed your mind, "Hmmm... 'cpaptalk' sounds interesting...believe I'll take a peek at that forum." You're on your way to becoming your own best advocate. And a DME's worst nightmare.

rested gal · Post by **rested gal** » Tue Dec 09, 2008 12:44 pm

rested gal wrote:I agree with Slinky -- add the Covidien Sandman Auto to your list.

Bluebonnet_Gal wrote:• Do all Auto Pap machines provide full data?
The ones you mentioned are. Fisher & Paykel has recently developed an autopap, but I don't think they offer software for it yet. Perhaps they will in the future, but better to stick with "already does."

Bluebonnet_Gal wrote:• I found a description of C-Flex on cpap.com, but I don’t really understand A-Flex. Can someone help me understand?
In a nutshell, C-flex affects only the beginning of exhaling. As I understand it (and I could be wrong) A-flex does that too, but A-flex also "smooths" the transition of the pressure moving back up. A-flex rounds out the transitions, smoothing more than just the beginning of exhaling. I've used both, and A-flex is definitely more comfortable to me than just C-flex. Each person is different though. Some like one better than the other. Some like both turned off. The nice thing about getting the auto with A-flex is that is does also have C-flex. You can use whichever suits you better, or... neither.

Bluebonnet_Gal wrote:• My sleep study states “CPAP was tittered from 4 – 14 cm. Fourteen centimeters appeared optimal in eliminating snoring, respiratory events and desaturations and was observed supine REM sleep with an index of 3.6 events per hour. Is 14 considered high? Would I benefit from something like C-Flex if a high pressure is needed? I slept on my back for the sleep study, but I normally sleep on my side, so I hope I won’t need a pressure of 14 cm on a regular basis when I’m at home.
What each person considers "high pressure" can be different. 14 cm's is probably considered moderately high to most people. A straight pressure of fourteen would feel high to me... 14's a pretty strong blast of air. We tend to get used to the feel of "whatever" pressure as the night goes on. So 14 might feel very high when you first turn the machine on, but feel like not much at all if you wake up during the night, or by morning.

Bluebonnet_Gal wrote:• Some of the machines apparently don’t come with a Data Card. What disadvantages are there with no data card?
I've used both methods.. Smart Card in the Respironics machines, and cable download directly to my computer from the 420E. The only disadvantage I found with "no data card" was having to unplug and carry my 420E to my computer to do a download. I don't have a laptop to carry to the cpap machine. Either way (data card or direct download) has its own pros and cons. Either way is fine with me.

Bluebonnet_Gal wrote:• Cpap.com’s list of ALL self adjusting C-PAP machines (https://www.cpap.com/cpap-compare-chart ... sting-CPAP) includes one I’m interested in that isn’t in the “top five”. I believe that might be the case because it is new. It’s the ResMed S8 AutoSet II. I don’t know if my DME will even offer this machine, but in case they do, does anyone have any experience with it?
I've not used that particular one, but I have used ResMed's older S8 Vantage auto and (even older) S7 Spirit auto. From what I've read about the S8 "II" machines, it should be a very good machine...EPR in auto mode was added to the "II", and quieter operation. If the DME offered that machine, I'd take it in a heartbeat. I'd much rather have the S8 Autoset II than the S8 Vantage you have on your list.

Bluebonnet_Gal wrote:• I know I need to check their policy on rental of a machine and at what point during rental will I own the machine (if they’re even set up that way). I know I want to keep an auto pap with full data. If it’s not feasible to keep the one I get from them, I will purchase out of pocket from cpap.com.
• Have I missed anything? Does anyone have any other advice to offer?
Sounds like you're preparing yourself very well.

Just look what's happened since the thought first crossed your mind, "Hmmm... 'cpaptalk' sounds interesting...believe I'll take a peek at that forum." You're on your way to becoming your own best advocate. And a DME's worst nightmare.

Bluebonnet_Gal · Post by **Bluebonnet_Gal** » Tue Dec 09, 2008 2:32 pm

Thanks for the great advice guys!

I do have choices in my DME. I live in a rural area and I prefer to use the one closest to my home & work (about 30 min drive). There are numerous other choices about 1 hour drive from here. Being a rural area, I know a lot of local people use the DME I will be meeting with tomorrow and I don't recall anyone having any complaints. However, I haven't talked to anyone specifically about C-PAP equipment. My major concern is the choices may be more limited since they are in a small town.

Thanks for the recommendation of the Sandman. I have added it to my list.

RG - thanks so much for the explanation of C-flex and A-flex. Now I know why the model with A-flex is more expensive. Sounds like it's worth it!

I called my insurance carrier. They do the "capped rental". The only major drawback to that is I start a new deductible year on Jan 1st and my deductible is $1,000.

I'm so glad I found this group. I feel so much better prepared and educated and now is the best time to get that education and get started on the right foot!

Paul56 · Post by **Paul56** » Tue Dec 09, 2008 2:46 pm

Don't be dumb like me and jump through the DMEs hoops for nothing...

I insisted on an Auto machine.

The DME insisted on a prescription written specifically for an Auto machine without any other specifics.

I provided said prescription.

Then DME says the prescription for Auto machine is no good since it does not specify a range to set the machine at.

Me: ARGH!!!!!!! Fortunately, the Doc was very good and just wrote the prescription for a wide-open APAP with the actual numbers on the paper.

Talk about a bunch of unnecessary back & forth and grief for the patient who just wants to start treatment.

I purchased the machine back in September and haven't heard a thing from the DME since. They have my money... no correction they have the insurance companies money... and realize any more time spent on me is not a good ROI (return on investment) as I won't be making another major purchase for at least 5 years.

Do I have a cynical view of the DMEs? Yes.

Appt with DME set up tomorrow AM!

Appt with DME set up tomorrow AM!

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