TUFTS and upgrading my machine to APAP

Hi all,

I currently have TUFTs HMO for insurance and they are handling my CPAP machine paying 80%. The first 2 months is a rental then after I make payments toward purchase. The DME brought me the F&P HC234.
Before I am stuck with this machine, I'd like to get something where I can track data, preferably an APAP such as the 420E or the Remstar Pro II CFlex (leaning toward the CFLEX).
My DME says I need a prescription because the C-Flex is Auto (which I believe it is a CPAP) .. In any case, he is of no help .. that's why I am coming here.

If I call my doctor for a prescription, what is the best way to ask about getting a new machine? This may sound silly, but I'd hate to say to him "I haven't been compliant" .. then have him reply "OK, you need another sleep test". I want to tell him that I'd like to track data and so on ...
I'd rather not buy it straight from cpap.com because I'd like my insurance to handle it. I called billmyinsurance and they can't do it for me.

Any advice, especially those who go through TUFTS, will be greatly appreciated.

Thanks,

jcarn

Hi jcarn,

The DME was incorrect if he told you the Pro 2 was an autopap. It's a straight cpap machine, just as you said.

C-Flex is not, in and of itself, a machine. C-Flex is the trademarked name for a feature that Respironics has in some of its machines...a feature to give a drop in pressure each time you exhale. That feature can be turned on or off in any Respironics machine that has it.

These are probably the two most popular Respironics machines since a person can get full data downloads from them if you have the Encore Pro software and the card reader:

Respironics REMstar Auto with C-Flex (autopap)
Respironics REMstar Pro 2 with C-Flex (straight cpap)

The other machine you mentioned you were interested in -- Puritan Bennett 420E -- is an autopap. Full data downloads from PB machines are accomplished with a simple download cable and the Silverlining software. PB makes a straight cpap (420S) that also can give full downloads of data. PB's 420E doesn't have any reduction on exhale.

If I recall correctly, your prescribed pressure is 13? You probably would get more comfort from the Respironics' machines since their C-flex feature offers exhalation pressure relief.

I'd stick with trying to get an autopap, if I were you. The REMstar Auto with C-Flex. With that machine, you'll have 4 machines in one, as it can be operated in any of 4 modes:

1. CPAP - (straight cpap, not using C-Flex)
2. CFLE - (straight cpap, using C-Flex)
3. APAP - (autopap, not using C-Flex)
4. AFLE - (autopap, using C-Flex)

In any of those modes you can download full data.

Good luck getting your doctor, your DME, and your insurance all working with you!!

I don't have insurance, so I just make my purchases online. I think my nice normal blood pressure would go sky-high if I had to go through the kind of red tape, delays, and DME misinformation that so many run up against.

You can get an integrated heated humidifier with the machine, or get a separate heated humidifier. I like the Fisher and Paykel HC 150 separate heated humidifier...works with any brand of cpap or autopap.

thanks RG .. you know your stuff.
Yes my pressure is 13 .. I really don't have problems on the exhale .. but I'd like to get the best machine possible instead of the "DME model".
Criteria:
1. quiet running.
2. able to access data on my PC for monitoring.

sounds like the Respironics REMstar Auto with C-Flex is the one to go for.

Thanks again!

It shouldn't be all that bad to talk to your doctor and request a prescription for Autopap. Go from the angle that you are trying to get the best machine you can out of your insurance..and that a APAP really IS a cpap machine (they all will run in straight CPAP mode as well as APAP). You are just trying to get a machine that will be sure to meet your needs currently as well as whatever might arise in the future. See if that works.

Jan in Colo.

Hi jcarn. I too have Tufts. I have a new ResMed S8 which is very quiet. I'm waiting for the software to arrive so that I can see my results myself, but I'm not clear whether I'll get what I want. What my DME will do is send me a chip that I can download my results to, then fax me the report. I was told by my DME rep (whom I like a lot; she knows her stuff) that the software and cardreader was around $150 or so, and that Tufts might not pay for it, so I can probably shop around and buy it myself if I want (perhaps cheaper).

I haven't gotten a firm answer about this yet, though. I've been on CPAP for a bunch of years already, so it's not a huge deal for me to see my results on my own laptop asap. I know from my own behavior and experience if I'm doing well or not. For me, a fax'd analysis and a quick checkin with my doc via phone or fax is perfectly ok. I realize that that might not be sufficient for you. The upshot is that you can almost certainly get the software, but you might well have to pay for it yourself, since there's no really *good* reason why Tufts should foot the bill for it..

Also, Tufts won't spring for an APAP if your doc doesn't specifically say you need one (as opposed to a straight CPAP). Keep us updated!

Hi dsg,

You must have the same DME as a friend of mine .. he also got the S8 (we're from the Boston area).
To me, I like to have control and viewing the results myself without a doctor involved would be the best case scenario.
Is the Respironics REMstar Auto with C-Flex the best to fit this need?
I will probably have to spring for the card reader and software, but that's not a problem.

Thanks again

http://cpaptalk.com/viewtopic.php?p=55194#55194

Ditto in regard to this thread too!

Hi,
I'm from outside of Boston too, and found a great DME who has worked with me to get 2 apaps. I have HPHC, having recently switched from BCBS, but call them. They have several different companies, and I'm pretty sure they also deal with Tufts through one of them. The company is North Atlantic, located in Leominster. My experience has been that they have listened to me and worked with me to provide me with the equipment I have wanted. For example, when I got my first apap they brought out a PB 420E. I told them I wanted a Spirit, and the tech went into the supply room and came back a few minutes later with the Spirit. Give them a call. You have nothing to lose! Also, I bought my software from CPAP.com. Insurance usually will not cover that.
Good luck!

nodding off wrote:Hi,
I'm from outside of Boston too, and found a great DME who has worked with me to get 2 apaps. I have HPHC, having recently switched from BCBS, but call them. They have several different companies, and I'm pretty sure they also deal with Tufts through one of them. The company is North Atlantic, located in Leominster. My experience has been that they have listened to me and worked with me to provide me with the equipment I have wanted. For example, when I got my first apap they brought out a PB 420E. I told them I wanted a Spirit, and the tech went into the supply room and came back a few minutes later with the Spirit. Give them a call. You have nothing to lose! Also, I bought my software from CPAP.com. Insurance usually will not cover that.
Good luck!

Yep, that's the one. I use North Atlantic too. My rep is Baiba (pronounced BYE-bah). She's very good. My experience with North Atlantic is the same as noddingoff's. I originally had MediRents, who was AWFUL. North Atlantic is terrific, and obviously they work with Tufts. You've got nothing to lose. Call them up!

dsg wrote:I have a new ResMed S8 which is very quiet. I'm waiting for the software to arrive so that I can see my results myself, but I'm not clear whether I'll get what I want.

I have the S8 Escape (the tiny wonder). If that is what you have, I believe you will find that the data is limited to hour of use over any given night. The S8 Elite will provide detailed data.

I go through North Atlantic too .. they seem OK. I probably just have to make the phone call to my doctor and tell him I want the APAP script.
Hopefully North Atlantic will be cool and hook me up with something nice.