Newbie question

Hello Everyone,

I've completed the sleep studies and doctors appointment was today. The polysomnogram results: AHI: 89, Supine AHI: 83.2, Oxyhemoglobin Desaturation Nadir: 67.0%, REM Sleep AHI: 60.8, non-supine AHI: 107.6 Hypoxic Burden: 30.1% of tst. The PAP tritation results: "PAP delivered at 19.0/15.0 cmH20 on room air demonstrated good control.", AHI: 0 events/hour, Oxyhemoglobin Desaturation nadir: 95%, Hypoxic Burden 0.3 minutes spent at Sp02 < 90% or 0.2% of Sleep Time.

My views: I slept normally during the first test for 6 hours and felt OK the next day. Could not get to sleep during the test with the PAP machine due to mask leaking, unfamiliar with the pressure, etc., however did sleep well for the last hour of the test. To my surprise, I felt OK that morning, however was tired afternoon/evening. The charts agree with my views on the awake/sleep times.

The machine I received today is a ResMed VPAP III. During the session with the technician, I asked if it was the only machine model available to me, and they said it's the only one they have for my insurance. After looking on the web a bit, this model is not discussed on the web much, and many posts available are years old. I also noticed most of the on-line retailers have it marked as discontinued. Therefore I called ResMed and they indicated that model was discontinued in July 2009, however they will repair it until 2014. They also indicated the replacement model is the "VPAP S". Further web searches indicate the "VPAP Auto 25" seems to have better reviews and is priced about the same. I do not know the amount the clinic is charging me for this machine, as the person that could answer that question had left by the time my appointment was complete (a little after 5pm) and I will be billed after the insurance claim. I will call tomorrow and find out the price. I also will call insurance (United Health Care) tomorrow, however their web site indicates they will pay up to $2500 every 3 years to repair/replace PAP machines, after I meet the $750 annual deductible.

Now for the question/request for comments...
- I now wonder if this machine is from their stock (or perhaps overstock), and is something I should avoid. Should I return this machine, and request/demand a different type/model? If they do not have another model, should I take my business elsewhere?
- Which make/model should I request? Does anyone have experience with the VPAP III, VPAP S or VPAP Auto 25 and any comments?

Thanks,
Ricky

Can't help you with the VPAP III in particular.

But---the Resmed VPAP series (VPAP III, VPAP S, and VPAP Auto 25) are collectively known as bi-level machines.

The main competitor's models (if you want to investigate it) are the Phillips Respironics System One BiPAP and the Phillips Respironics System One BiPAP Auto (the machine in my signature).

These machines are typically under the same insurance code as the Resmed VPAPs listed in your post. Is your insurance an HMO (in which case the VPAP may well be the only thing on their formulary) or is it a PPO or an insurance company where you will be working through a DME? Because in that case, educating the DME may be in order.

If it were me, I'd try to get the DME to replace the VPAP III with the S8 VPAP Auto 25.

ResMed's S8 VPAP Auto 25 is, first and foremost, a bilevel machine. Medicare's HCPCS code for a "bilevel" machine applies to the VPAP Auto -- EO470.

So the VPAP Auto 25 can fill a "bilevel" prescription just as surely as the VPAP III does. Even though it has "Auto" in its name and is capable of being set to "autotitrate" while operating as a bilevel, autotitration doesn't have to be turned on.

If the DME sets the VPAP Auto 25's operating mode for "bilevel" (not auto bilevel) then the machine will operate in just bilevel mode. Exactly like what your prescription calls for... bilevel treatment, with the IPAP/EPAP pressures set for what's on your Rx.

As robysue pointed out, the amount of balking or cooperating with your request to swap the older VPAP III for the newer VPAP Auto 25 can depend in part on what kind of insurance you have. HMOs are a different breed of cat.

But now's the time to try, while you're still in the first month rental period.

Check out Jan's great info about DMEs and insurance:
LINK to Janknitz's excellent - "WHAT YOU NEED TO KNOW BEFORE YOU MEET YOUR DME Part I"
http://maskarrayed.wordpress.com/what-y ... me-part-i/

What Jan's written might help you sort out truth or fiction from whatever the DME tells you if you decide to run the idea of a machine swap by them.

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Thanks for the replies!

I called the clinic this morning and the billing department could not give me an exact figure, however indicated the total would be around $2000. They would not know the actual price for a few days. Sounds like they charge whatever the maximum they can with each particular insurance company/plan. I told them I was not happy that I received a new machine that was discontinued 1 ½ years ago and would not be repairable by the manufacture in 3 ½ years. They acted surprised and said the manager of that department would call me asap. The only pricing information I received before was 1275 from insurance, so I assume 750 as my annual deductible and 127.50 for co-pay(10%), for a total of 2152.50. Web prices (advertised) total to $2459 for the same equipment (humidifier and mirage quattro).

I then called insurance (United Health Care Choice Plus- PPO) and discussed the situation. They said I could use other vendors, and they recommend not to accept that machine/model since it was a discontinued model. They even provided the name and number for two national vendors.

I called one of the recommended vendors, and they could not quote an exact price, only the retail price, unless I placed an order, as they have rates with individual insurance companies. I told them that I would have to use the retail price for a comparison, so it did not look good for my business.

I was just about to go to the clinic to return the machine, and they called. They apologized and indicated they did not know the machine was a discontinued model and asked which machine I wanted. I requested the VPAP Auto 25, and after a brief check they said no problem, and started scheduling an appointment. I asked for pricing, and they indicated the price would be the same as the VPAP III. The appointment is scheduled for late tomorrow.

I'm still concerned over the fact I was told there were no other options in my previous office visit. I now feel a bit leery of this particular clinic, as I have concerns about others that may receive this same service, and not know better or speak up. I consider this an ethical issue. If the discontinued machines were sold at a discount, and presented as an option, then it would have been OK.

Thanks again!

Ricky

Yes basically they are ripping you off. My family owns and runs a DME the good kind, we have not used those machines since 2007, my guess is that it is not only old but used because there is no way they would have one of those new. We have been using the Resmed Vpap Auto and Auto 25 for a while now. Go with a different company is my advice.

Dane