Dme vs. buying myself

Hi. I am new to cpap therapy. I am using a PR a System one that is too loud for me. I've been dealing with my DME but it's a hassle. I wondering what happens if I buy my own machine from cpap.com, bill my insurance under my deductible -- who will then control the therapy settings on my machine? The DME? My sleep center? Thanks much.

msr27 wrote:Hi. I am new to cpap therapy. I am using a PR a System one that is too loud for me. I've been dealing with my DME but it's a hassle. I wondering what happens if I buy my own machine from cpap.com, bill my insurance under my deductible -- who will then control the therapy settings on my machine? The DME? My sleep center? Thanks much.

generally the answer is "you".

If your insce. co's ok with your just submitting the invoices, go for it (remind them how much cheaper it is to buy here), and of course you do your own settings!

Whatever machine you buy, you can get the clinical manual and it will show you how to change the settings. It doesn't matter if the insurance buys the machine or not. That being said, please educate yourself before tinkering with the settings and make the changes in small increments over a long period of time.

Sheriff

The ResMeds are a little quieter than the Respironics machines, but not very much quieter. Are you sure the sound is coming from the machine and not from the mask or hose? If the mask or hose are the sources, then changing machines won't help very much. To fix that you need to find a quieter mask or use a cover for the hose.

I buy my machines myself because: (a) I don't have to work with difficult DME's and (b) I rarely hit my very high deductible anyway so I would be paying "DME prices" instead of online prices (DME prices are higher by a factor of 2 to 5 depending on whether you buy new or used)

Our sponser is a DME. The question is on line vs brick and mortar. Then there are some hybids like Aprea and Lincare, that incorperate the worst aspects of both while "serving" us nationaly.
The first question which needs to be answered by your insurance company, is which DMEs will they allow you to use, and still pay the bill.
Next question is what price tag is the DME putting on the equipment, and what is you copay. My first DME oriced my Resmed S9 Autoset at $2500 and provided it on a rental basis. They never requested or received my copay. After about 16 months my insurance said no more out of network DME. They stopped paying rent or anything else to that first DME. The only problem I had is they wanted to keep sending me supplies, even when I told them they would no longer be paid.
Once you answer those questions some simple arithmetic will tell you buy here and pay a $1000 deductable plus copay or buy there for $800 total cost. sometimes the numbers are close and you facor in the hasle.

Thanks for the replies. I'd actually much prefer to just have my sleep doc muck around with the settings. Would they have access if I buy on my own?

As for the sound, it's coming from the intake. I've turned off c-flex. That helped a little. I'm using the airfit p10

msr27 wrote:Hi. I am new to cpap therapy. I am using a PR a System one that is too loud for me. I've been dealing with my DME but it's a hassle. I wondering what happens if I buy my own machine from cpap-dot-com, bill my insurance under my deductible -- who will then control the therapy settings on my machine? The DME? My sleep center? Thanks much.

That's essentially what I did.......bypassed the local brick & mortar DMEs and bought from CPAP-dot-COM. I also purchased the software (Encore Pro) in that initial order (it was available from them then) and started monitoring my therapy from the get-go. My insurance provider reimbursed me for 80% of my purchase. But, I discussed it with them beforehand and they also considered me to be "in-network". After purchasing the equipment, I used the invoice from CPAP-dot-COM and created one of my own for my insurance provider with me as the billing party and my insurance provider being the party being billed. The one from CPAP-dot-COM comes with all the correct billing codes on it.

I've always said "If you can read, you can configure these machines and do it yourself." Actually, I didn't feel comfortable with someone else "controlling" my therapy (actually "adamantly opposed" would be a better term to use).

In the 9+ years I've been on this forum, I've seen numerous horror stories of DMEs incorrectly configuring machines and the users struggled for long times before finally getting help here.

They won't care about your therapy more than YOU will. After all, it's not their therapy, it's YOURS. YOU need to take charge of it as soon as possible.


Den

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Whoever physically has the machine and manual (or prior knowledge) can do whatever they want with it and the settings. And don't let anyone tell you different. Unfortunately, while many doctors (not all!) know something about OSA science, most do not know zip about the machines or how to turn them on, let alone do anything else with them. That's why this forum is here, and the terrific people who've learned how to do things and help everyone else. And of course why we use the manuals.