DME mistreatment and can't get a Resmed UPDATE

Someone asked about my script. My sleep doc emailed me a copy today, it does say Resmed S9 Autoset, "despense as prescribed, do not substitute" but he only prescribed a single pressure. I'm pretty sure if that becomes an issue, he will rewrite it with a narrow range, the sleep center have been really marvelous through this.

The new DME is willing to lend me a PR System One Auto, for a week or so, to see how I get on with that and I've jumped at the chance to try it out and maybe start getting some sleep. When the DME suggested borrowing a machine, I was like, can I come today? Within a week I can figure out if I like the machine, and if not, figure out if someone will supply an S9 and if not still be able to order it online and get it shipped to me.

In the meantime, tomorrow, when I go to the DME to pick up the PR machine I'm going to innocently inquire if they can supply me with the S8. If they can, that will set off a few alarm bells, as someone on another forum mentioned the S9 is supposed to be the same price.

I'm also going to call Resmed, see if they can point me in the direction of a supplier, and explain that no one in my area wants to give me a Resmed machine and that there is supposedly no Resmed rep in the area (according to my sleep center). That may help. Finally I'm going to call my insurance and see whats what. I can buy out of network. I'll pay 40% of what they'll pay if they reimburse us.I'm a bit worried if I buy an APAP, I'll be denied outright as the previous DME was somewhat right in that my Insurance has a 'must fail CPAP before getting an APAP stipulation in their rules'. But I'm hoping they'll reimburse at least for a basic CPAP and that way we'll get some money back. Apparently my max coverage (according to the new DME) is $800 for the CPAP and $231 for the Humidifier. I'd be stoked if I can get 60% of that back and be able to get what I want online, although I spoke to my husband and he said if we have to, we can buy outright online even without reimbursement, we have the money, but we obviously have to try and get our insurance to cover as much as possible if we can.

This whole process is a nightmare. I can barely take care of myself let alone deal with all this madness. My body has about had it with lack of sleep. I am so ready to start getting better.

Eva, I hope that everything works out to your satisfaction. You may even be happy with the PR System One Auto that they're loaning you. Many people like that machine. The only negatives that I've read about that one are the "puffs of air" that test the airway and that you can't see daily results data on the machine. It seems to give excellent therapy from what I've read. Be sure you know what kind of contract you're signing with them when you borrow it.

Something's a little odd, though. If your insurance company has a "must fail CPAP before getting an APAP" stipulation, then would they pay for the PR System One Auto, which is an APAP? And are you sure you're reading that stipulation correctly? I have heard of "must fail CPAP before getting a BiPAP", but never the way you stated it. And the stipulation as you stated it doesn't make sense. Why would the insurance care if the machine is a CPAP or an APAP? They pay the exact same amount for either type. The insurance billing code is exactly the same for both: E0601.

There is a small price difference between the S8 and S9 machines. The S8's are a bit less expensive. On cpap.com, the S8 AutoSet II is $812 and the S9 AutoSet is $853. Again, the insurance would pay your DME the exact same amount, whether it is a PR System One Auto, S8 AutoSet II, S9 Autoset, S8 Escape, S8 Elite II, or any other brand/model CPAP or APAP machine. The DME just makes more money on some models because they can get them at less cost.

If you are considering an S8 machine, be sure it is a fully data capable model -- either the S8 Elite II (CPAP) or S8 Autoset (APAP). Don't let them talk you into the S8 Escape, which can only report compliance data (hours used).

Your doctor seems very supportive in the way he wrote your script. If you decide after your trial with the Respironics machine that you really want the S9 Autoset, then you could try enlisting the help of your doctor, either to convince your current DME to supply you with one or help you find a DME who will.

We shouldn't have to go through all these hassles! It sounds like you'll end up with the machine you want in the end, and at least you'll be able to get started with therapy. I hope all works out smoothly and you're sleeping well soon!

beadedbiker, I went through a lot of hassle to get my S9 from a DME here. I'm happy with the machine but I think it's overhyped on this forum. It's the most modern machine, quiet, with good info on the face of the machine. I have the slimline hose which is slimmer than a regular hose. The slimline house poses no advantage over a stardard hose imho and it costs much more.

The other machine you are considering is a good machine. Don't get caught up in the S9 hype. If your DME gives you an auto machine, you'll be just fine. You need a machine to help you sleep good and the PR will do the job as well as the S9 although with less bells and whistles.

A couple of things I'll add here:

1) Filling a prescription... Yes an equipment provider has to provide what is on a prescription within some fairly undefined rules. HOWEVER - under no circumstances are they REQUIRED to accept a prescription. Meaning... let's say someone walks in with an Rx for an S9. set at 4-20cm. If that particular provider cannot or does not want to get an S9 they can basically just not take that patient. OR they could work with the patient to arrive at a mutually acceptable device that they can provide and then behind the scenes work with that patients doctor to get a new Rx. Looked at another one - all those docs who write those scripts for an autopap set at 4-20 which is ridiculous right? Well behind the scenes we've often worked with those doctors to get a new Rx for a more appropriate pressure so that we did NOT have to actually stick a patient with a wide-open device. Same concept.

2) It's absolutely believable that some (if not many) providers cannot buy at our hosts pricing. Consider a local provider who does maybe 10 cpaps a month. They may be a mostly Respironics shop for example. Now someone comes bouncing in who wants an S9 so they will be making let's say their first Resmed Purchase in a year. This sites host is selling millions of dollars worth of cpap stuff every year. There is no chance in hell the guy who buys one Resmed device a year is getting anything remotely close to the same price! Add in the local guy who has to have a warehouse and who has to track the patient and device for the next 7 years etc etc etc versus our host who can have product shipped straight from a vendor (No warehouse/no overhead) and doesn't have to track anything after the sale. It's the same old brick-n-mortar vs internet story that's been going on for years. So yeah, it's absolutely believable and not surprising.

3) It sounds like the new company is really trying to bend over backward for you. I'm sorry that the first company didn't followup with you - that's not excusable and it sucks to be sure. But don't let that one experience sour you on giving anyone else a shot. If they are willing to loan you something - what do you have to lose trying it out? And if you can't afford the device you want with all the bells and whistles then you could do well to set your sights a bit lower and at least try the machine they are offering to loan you. Just my opinion!

mattman

So I picked up my loaner PR APAP from the DME. Then came home and took a 4 hour nap with it. My initial thoughts are that its not bad. Its so quiet I can't hear it. Just the noise of me breathing with the mask (A Swift LT), and I think I may give the larger pillows a try tonight as they seemed to be quieter on me. I cranked up the humidifier and cranked down the A/C and didn't get rainout, so I'm pretty impressed with that. The Aflex seemed to work pretty well, and it felt comfy to breathe. We set the pressure at 8-14cm.

The RT had promised me software to download the card, but gave me two discs that didn't work at all (Encore Viewer 1.0 and some driver for the card reader version 2.0). How can deal exclusively with Respironics machines and have no idea what software reads the damn card? Anyway, went by there and got them to read the data from my nap, and I'm not happy with its reading of Vibratory Snore. It has me at over 100 events an hour. But no flow limitations or disturbances other than VS. I had no events until the pressure went to 14, when my AHI, went from 0 to 3.1, and I'm wondering if its the VS thats causing it to go that high and giving me reactive apneas. But it was just a nap so I'll sleep with it tonight and go by the store tomorrow and get them to download the card again, so I can look at the data (which is quite miserably inadequate in the form they give me - encore anywhere). It may also be something to do with the pillows on the mask, I had very little leak - less than the chart indicated it should be, and when I tried the bigger pillows on after I woke up, there seemed to be less flow limitation so maybe that was affected the VS score. I'll use the bigger size tonight and see if it makes a difference.

Finally I spoke with Resmed, who contacted their rep for my area. Apparently my DME is the biggest Resmed dealer in my area, but the Respironics rep has a stranglehold on my parish, and my DME told the Resmed rep that they will not supply the resmed machines under any circumstances. Of course the DME told me they'd never met nor talked to the Resmed rep. So I'm just assuming they are both lying
However they did put me in contact with a DME who apparently does sell a lot of Resmed machines and is very familiar with the S9 (according the the rep). Its about an hour and a half from where I live, but my husband works offshore there, so it would be easy to do business with them and they are in network. By the time I got this info, it was after business hours, but I'm going to call them in the morning and see if they can hook me up with an S9.

beadedbiker wrote: loaner PR APAP

Encore Viewer 1.0 and some driver for the card reader version 2.0

what machine exactly? m series? tank? PR1?

EV 1.0 will work with the m series or the tank but not the PR1

driver for card reader I assume for a card reader you don't have? I understand EV has the mako card reader driver on it

please post exactly what machine (model number on the bottom for example) or check the pictures at cpap.com and someone can help you further on what you NEXT need to yell at the DME about.

Well, butter my butt and call me a biscuit.

I just had a call from the DME that Resmed put me in contact with. I called them with my request for an S9 Autoset, 3 days ago, faxed them all my details, etc and they told me it would take about 3 days to hear back from the insurance.

This morning they call me back, its all back from the insurance and the machine came in yesterday. I was waiting for the 'but' and there wasn't one!



Then as if sensing this the other DME called, told me the correct mask (Swift LT for Her) was in, and I told them that I really wasn't getting on with the PR System One Auto they had loaned me, and she told me to keep the machine until the S9 comes in. (She thinks I'm buying it online).

So tomorrow I'll drive to Houma pick up my shiny new S9, and on Monday, return the PR and tell the company I found another DME who was happy to fill my script as it was written. Because all is fair in love, war and sleep apnea.

So the lesson of the day folks. If in doubt call the company. They'll soon find you a DME who actually buys their product. Oh and persistance is not futile

That's WONDERFUL, beadedbiker!!! Enjoy your shiny new S9!

beadedbiker wrote: Because all is fair in love, war and sleep apnea.

So the lesson of the day folks. If in doubt call the company. They'll soon find you a DME who actually buys their product. Oh and persistance is not futile

This is an important lesson. Good for you, for taking such a proactive approach, to get what you need.

Way to go BB!

Let us know how you think the two machines compare (not that I could get a Resmed S9 if my life depended on it, but I'm still curious ).