My excursion down the "yellow brick road"

I met with my Doc this morning to discuss the results of my sleep study. The study indicated I stopped breathing 146 times in a 6hr 11 minute period, 40 seconds as the longest, the average 24 seconds. I guess my oxygen level was about 80%.

He indicated the CPAP used in the study was able to correct the situation. I asked that he prescribe and S9 Autoset and he did so without hesitation.

However...when I started asking about data I'm not sure he had a clue. I asked what kind of data he gets from other patients, and didn't get much of an answer. I think he gets usage.

Now...someone said early make sure you don't get a "brick". On my way home, I stopped by a DME (Lincare) and asked if they could provide my equipment. They required copies of the sleep study, prescription, and insurance. I told him exactly what I wanted an S9 Autoset and Humidier. He tried to give me an S9 Escape. I told him "no thanks" and left.

Now, the search is on...then, once I get it I'll need to find the software.

I'm happy with my S9 Elite, but if your doc wrote the script for the Autoset, explicitly, the DME can't withhold it. Their reason for doing so is that they'll get (I think) the same $$ from the insurance company, so will make less money off the S9 Escape.

See if your insurance provider will give you "in network" benes at cpap.com. The only problem with cpap.com is the inability to go to them or have an RT visit your house.

Contact your insurance provider first and see who (DME) they consider to be in network. Then contact the local or national-chain DMEs in your area. I started with Lincare, but all they wanted to give me was a DeVilbiss IntelliPAP. I found American Home Patient would give me the S9 Elite. I don't need the APAP and have, through a few good people here, got the ResScan software. Purchased the SD card reader at Staples for like $15 - USB port.

You'll get your answers here.

Roman Hokie wrote:I'm happy with my S9 Elite, but if your doc wrote the script for the Autoset, explicitly, the DME can't withhold it. Their reason for doing so is that they'll get (I think) the same $$ from the insurance company, so will make less money off the S9 Escape.

Roman... don't you mean:
Their reason for doing so is that they'll get (I think) the same $$ from the insurance company, so will make more money off the S9 Escape

cflame1 wrote:

Roman Hokie wrote:I'm happy with my S9 Elite, but if your doc wrote the script for the Autoset, explicitly, the DME can't withhold it. Their reason for doing so is that they'll get (I think) the same $$ from the insurance company, so will make less money off the S9 Escape.

Roman... don't you mean:
Their reason for doing so is that they'll get (I think) the same $$ from the insurance company, so will make more money off the S9 Escape

Yeah. Thanks for the catch. My bad.

Roman-

I have Medicare and an AARP Supplement, so I'm not restricted to DME's. I did find a DME that has the S9 Autoset and is sending a rep to my home tomorrow afternoon. I'll let you know how the journey progresses.

Good call, Wonka. Yeah, the Medicare and AARP supplement... they probably both pay a fixed amount for xPAP and they'd make more (lose less) if you went with the Autoset.

Glad you found someone to work with you on it.

Wonka wrote:I have Medicare and an AARP Supplement, so I'm not restricted to DME's. I did find a DME that has the S9 Autoset and is sending a rep to my home tomorrow afternoon. I'll let you know how the journey progresses.

In the meantime, I think I would call/write whichever one (Medicare, AARP) handles this aspect of your coverage and tell them that Lincare refused to fill your prescription as written, and request that Lincare be stricken from their list of DME's, given that they can't actually supply what is needed.

Yeah, I'm kind of wondering what game Lincare was playing. If you went into a pharmacy for a prescription for penicillin and came out with percocet instead, it would be a mistake. Why can a DME get away with that????

Or, were they trying to foist an Escape Autoset on you?

Down the Yellow Brick Road, I'm bound.
Got'a diagnosi'es in my hand,
got'a S9 on my mind,
think'n about what it might be like to be
dream'n.

I'll be do'n it on the five year plan,
might be an apap or it might be a cpap....
don't want no blower that makes any sound,
don't want no vibrations tranmitt'n when I'm
adrift on the Climate Line.

Sometimes I can't wait to sleep....
sometimes it scares me to think
that a mask can define my day......
that a skew on a line can set me free.

Down the Yellow Brick Road, I'm bound.
Got'a feel'n that someone different is wait'n up ahead....
just guess'n that someone gets left behind.....
So glad I'll not be travel'n alone.