Newbie w/ Equip and DME Questions

I am wondering what kind of customer service I should expect from cpapforseniors.com or billmyinsurance.com or even a local DME. I am a newbie, recently diagnosed and thanks to all the collective wisdom of the wise ones in this community, I am shopping for a DME and my first round of equipment

I have copies of doctor's summary reports from both sleep lab studies as well as a prescription (on a DME's preprinted script pad, Classic Sleep Care of Agoura Hills, CA), checked by the dr. on the script is the following: "E0601 NU CPAP Unit w/C-Flex and SmartCard", "MASK: fit to Pt's comfort" and "All CPAP Supplies" and "CmH2O: 9"

Based on all the help I have gleaned from you wise ones (and a lot of additional web surfing), I am thinking I may do well with: Respironics ResMed M Series Auto CPAP with A-Flex (I understand this can be used in straight CPAP mode, C-Flex mode, A-Flex mode or neither), heated humidifier (the M-series would be convenient, especially for travel but I have heard that it has a small volume, is difficult to fill and some leakage problems have been reported so would a Fisher & Paykel HC150 heated humidifier be better?). Also, I think a nasal mask (not pillow, prong or full face mask) would be best for me to start with but I need suggestions on which one and how to find that elusive "good fit".

I have Medicare (due to a disability) and Blue Cross PPO through my husband's employer. I have been trying to deal with Classic Sleep Care (since that is the DME the doc usually uses) and they have been remarkable unresponsive and have already been giving me the run around. I have called Blue Cross and Apria is contracted with them and has an office with "sleep specialists" in the next town over, not too far a drive but not really convenient. Talking with them (there are "2 of us here in the sleep office"), they want me to send Rx, insurance info, etc to get pre-certified prior to making an appt to have me "come in and let us set you us with what you need". When I pressed and asked what equipment they carry, etc., she abruptly told me "Respironics" (would they only carry one line? If they do carry Respironics equip, do they carry the whole line? Or was that just a brush off to get me off the phone?).

I have checked out cpap.com and their cpapforseniors.com (their Medicare affiliate). According to their website, the Medicare/insurance code for CPAP or Auto CPAP is the same so they let YOU choose what equipment you want. The problem is that there is no telephone number to contact them and they have not responded to the email I sent more than 30 hours ago.

I know this pre-certification process is one of the first steps - is this something I could do on my own (given the Rx I have in hand and the equipment I think I want?) or does it have to go through a DME (who may try to pressure me into equip that is not ideal for me, aka cheaper for them)?

Would it be possible and/or make sense to buy (with Medicare and insurance coverage plus whatever out of pocket cost there may be) an auto CPAP through cpapforsensiors.com or billmyinsurance.com and then work with a local DME to try different masks and actually have a "rep" that I can talk to and hopefully will return a mask if need be.

Sorry for the long post and many questions. I really appreciate any help and words of wisdom you may have for me.

I believe cpapforseniors and billmyinsurance are pretty dead. There were problems servicing medicare and insurance patients across state lines. If these are still active companies, the area they can service and insurances they work with are very limited.

I suggest you call cpap.com and inquire. They have a toll free number on the main cpap.com page. Buying using cpap.com is not going to work with tying to use Medicare from what I understand.

It sounds like they can give you a Remstar Plus m series with that script. They can add the card module so you get compliance data is all. I don't think that is what you want. If you want the Pro or the APAP, you need to get the doctor to write the script as being machine specific - i.e. Remstar Pro m series, 9cm, DO NOT SUBSTITUTE. The same goes for the humidifier - if you want something besides an integrated humidifier, you need the script to spell it out. There are a few DME's that issue APAP automatically, but they are the exception. There are posts by slinky and Rested gal on what needs to be on a script; I am not the expert.

Precertification is necessary for many insurance policies. Some DME's won't let you out the door with a machine until they know they will get paid. Others are more flexible on that. Again, you have to be assertive and know what you are dealing with etc. You might ask your insurance what their policy is. With Medicare the rules all change sometimes so you need to know which is primary and which is secondary when you talk to the DME's.

I don't know that I can answer all the questions but hope this helps some.

Jules,

Thanks so much for your help. A couple of questions for you: what is the difference between the Pro and APAP? Also, anywhere I can get recommendations for a decent DME and do you have any idea which DMEs do automatically issue APAP?

Thanks for taking your time to help me.

The m series Pro is the straight cpap (has cflex) but once the machine is done with ramp the pressure is fixed. An apap will have a range of pressures.

For example I use 8.5 - 10 for my APAP range but for a straight cpap I use 9.5. The APAP will start at 8.5 and move up when it detects snores or apneas until it either doesn't detect more events or when it reaches 10. After a certain time with no more events it will start going back down. My range is very very narrow. Some ppl have wide open on the high end ranges but I found that detrimental in my case. A machine will go up only so far on trying to handle an event but if you have a series of events during the night the machine can reach the top of the range such as plr66 has been reporting on her thread.
viewtopic/t37354/These-runaway-aberatio ... ng-me.html

As far as what DME - well you might need to list the city or county you live in - start a thread - any good DME's in ..... or ask anyone with experience with Apria in ..... There are many DME's in each state and local office manager policies might determine what happens so that will vary from location to location.

The DME I used 3 years ago only issued APAP's with a script for an APAP. These are things you need to ask - this is what my script says ----- this is my insurance - what machine can I get with it? I asked specifically what machine I could get with the script I had and since it wasn't an APAP script I couldn't get an APAP from the DME with it. I did order one in time from cpap.com out of pocket.

Thanks again for your guidance - there sure is an awful lot to learn... I posted a thread asking for DME recommendations - great suggestion (if I weren't so sleep deprived, I may have thought of it myself!).

Your input really does make a difference.