No Medical Necessity to replace a Brick

I guess what I was wondering is if the data capable machine has not yet met what's considered the 'standard of care' for cpap therapy.

Many times an APAP is used by professionals to titrate the patient. Without data it is like the saying "the blind leading the blind".

Kaiser...we all know what Kaiser is...routinely this is their procedure for diagnosing and treating OSA.
The sleep study is an in home sleep study using a WatchPat device.
Then if that is positive they send the patient home with a used auto cpap loaner set to apap mode to be used to find suitable pressure.
Then they take the results from that loaner and dispense another a brand new auto cpap at settings based on the loaner's results.
In lab sleep studies are only done if someone develops a problem based on the data that is available from the apap.
So...If Kaiser trusts the data from these machines...I think it must be pretty reliable.
There are studies available where full data machines were used and compared to the data provided by an in lab sleep study...that prove that the results were comparable.
I don't have links handy but it's been well documented for years that these machines are extremely accurate.

davep700 wrote:49er, I'm not sure yet what evidence for her position is that the data tends to be inaccurate.

On this forum I heard that machines might miscategorize apneas, hypopneas and centrals, but that's about it.

I could certainly use your argument if and only if I knew the measurement data I can get is reliable.
I might look for some studies or articles on the use of the data in CPAP therapy (??).

Fortunately, I am going to my visit my PCP tomorrow. I assume I need to inqurie about a prescription worded as, "data capable CPAP machine @ pressure 12cmh2o".

No, because all machines have some "data" -- even if the data is only a log of hours of use. That won't narrow things down. You could still be given a brick.

Best is to specify an exact model and write "Dispense as written" on the prescription.

Asking the PA for evidence is irrelevant in this case since the PA is talking mainly about her own experience. And there's some truth to her claim that the machines are not completely accurate. Our machines cannot distinguish between sleep and wake and they record limited data about our sleep. They will never be as accurate or complete as the data obtained from a polysomnographic study. But they are reliable*. And in the real clinical world when following and evaluating a patient's progress, the data from the patient's machine is the only objective data available (unless they do a repeat sleep study). And the data is certainly accurate enough to get a good sense of the therapy's efficacy. The PA's argument is just silly and empty.

* Kaiser Permanente relies entirely on the data from these machines to diagnose, titrate, and treat obstructive sleep apnea.

Pugsy wrote:viewtopic.php?f=1&t=109450&view=unread#unread

Check out this thread above...that machine is a full data machine and while primarily a fixed cpap machine like you are currently using it does have some limited apap mode capabilities.

I wonder if this machine would be better than my Luna? It would certainly be much cheaper than the $45 I am going to have to pay monthly, for 9 months to my DME provider under my insurance?

Pugsy wrote:Kaiser...we all know what Kaiser is...routinely this is their procedure for diagnosing and treating OSA.
The sleep study is an in home sleep study using a WatchPat device.
Then if that is positive they send the patient home with a used auto cpap loaner set to apap mode to be used to find suitable pressure.
Then they take the results from that loaner and dispense another a brand new auto cpap at settings based on the loaner's results.
In lab sleep studies are only done if someone develops a problem based on the data that is available from the apap.
So...If Kaiser trusts the data from these machines...I think it must be pretty reliable.
There are studies available where full data machines were used and compared to the data provided by an in lab sleep study...that prove that the results were comparable.
I don't have links handy but it's been well documented for years that these machines are extremely accurate.

Thanks Pugsy, that is what I thought about these machines being extremely accurate.

Kaisgram, of course, the PA is going by her experience but my point in asking people to give me evidence when I know they are doing that is to get them hopefully to come off of their position. For example, many years ago, a compound pharmacist said I was going too slow in tapering the Wellbutrin XL. So I asked for evidence that it was dangerous in a diplomatic manner. He hammered and hawed and then shut up and gave me my prescription without further hassle.

I agree in Dave's case, the PA is probably a lost cause. But if we keep letting medical professionals get away with this BS without learning how to deal with them hopefully in a non confrontational manner, in my opinion, this will continue. Of course, others will have a different opinion and I am willing to listen to better options.

49er

This is the reason so many of us have simply taken equipment acquisition into our own hands. It's not worth the hassle, delay and additional expense of dealing with a DME and sleep sleep specialists (or their physicians assistant). Next time let the PA know you're dissatisfied with not only getting the lowest tier machine, but that you don't even get to talk to a real doctor. I guess that's not medically necessary either.

Then, go to Amazon and pick up a brand new PRS1 Auto model 560 for $400. Why would anyone put up with this crap? http://www.amazon.com/gp/offer-listing/ ... dition=new

Janknitz wrote: Anyway, you're going to have to grow a pair and get fully educated to have a snowball's chance of getting your DME to replace the brick, RX or not. So if you're not the assertive type, ....

That's what I wanted to do first - get fully educated ... Thanks for assuming that I'm balless and unassertive..

Thanks sleeprider.

Do people need to provide a prescription for buying through amazon?

Hard to believe that a plastic box with a fan inside should cost Thousands of dollars, even if it is considered medical equipment.

Michelle-OH wrote: I wonder if this machine would be better than my Luna? It would certainly be much cheaper than the $45 I am going to have to pay monthly, for 9 months to my DME provider under my insurance?

Is this your machine?
https://www.cpap.com/productpage/3b-lun ... ifier.html

If it is I would take the PR S1 Pro CPAP model 460, which is what is offered for $200 in the thread I mentioned,
hands down over the Luna even if it didn't save me money on total out of pocket costs.
The Luna doesn't offer the depth of data detailed offered on the 460. It does offer some data so it isn't a "brick" but it offers numerical data only and no graphs to show exactly when and what happened.
Numbers don't always tell us the whole truth and sometimes leave a lot of unanswered questions.

Not to mention the fact that Respironics and ResMed have a long history of providing quality cpap products.
The Luna is marketed as a "budget" product to suppliers so that they can optimize profit.
In simple terms...it's cheaper and since insurance typically pays the same no matter what brand is used then the DME makes more money.
When it comes to my health I don't know that "cheaper" is where I want to go just so some DME can make more money....not when a viable other alternative that is tried and proven is available.

So I would definitely go with the 460 before I would go with the Luna for a bunch of reasons.

How long are you supposed to be paying that $45 a month before you don't have to pay it anymore?

Yes, that's my machine and I haven't even figured out how to access the data because it seems so difficult( so not good with tech stuff)
I called my DME provider to see if I could just bring back the Luna, which I got on 12/01/15, she said she wasn't sure and would get back with me. I can't imagine no one has tried to return one in the past?? I have to pay the $45 for 9 mos. So, buying the $200 would be a great savings, although I have some concern about giving someone $200 before I know the machine is in top condition, etc.

Pugsy wrote:

Michelle-OH wrote: I wonder if this machine would be better than my Luna? It would certainly be much cheaper than the $45 I am going to have to pay monthly, for 9 months to my DME provider under my insurance?

Is this your machine?
https://www.cpap.com/productpage/3b-lun ... ifier.html

If it is I would take the PR S1 Pro CPAP model 460, which is what is offered for $200 in the thread I mentioned,
hands down over the Luna even if it didn't save me money on total out of pocket costs.
The Luna doesn't offer the depth of data detailed offered on the 460. It does offer some data so it isn't a "brick" but it offers numerical data only and no graphs to show exactly when and what happened.
Numbers don't always tell us the whole truth and sometimes leave a lot of unanswered questions.

Not to mention the fact that Respironics and ResMed have a long history of providing quality cpap products.
The Luna is marketed as a "budget" product to suppliers so that they can optimize profit.
In simple terms...it's cheaper and since insurance typically pays the same no matter what brand is used then the DME makes more money.
When it comes to my health I don't know that "cheaper" is where I want to go just so some DME can make more money....not when a viable other alternative that is tried and proven is available.

So I would definitely go with the 460 before I would go with the Luna for a bunch of reasons.

How long are you supposed to be paying that $45 a month before you don't have to pay it anymore?

Michelle-OH wrote:although I have some concern about giving someone $200 before I know the machine is in top condition, etc.

Understandable concern especially when that person is new to the forum and doesn't have a lot of history here.
For sure you use PayPal because that way there is some recourse if the machine isn't as presented.
While most people who post here are honest straight forward people....there always seems to be a low life who just wants to screw someone to spoils things.
We do the best we can to protect ourselves...ask for pictures of the machine and model number and hours of use and we use PayPal or we don't take the risk.
If someone can't provide some proof that what they are selling is as stated and they won't use PayPal...I won't even consider doing any business with them.

Now I do know some forum members whom I trust completely and I would just take them at their word but I won't do it with someone I don't know.
I know of one such person with a model 460 and I think he was asking $250 but I can't swear to it at the moment. If buying from someone like that would ease your fears I could do a little more checking to make sure my memory is correct. Send me a private message if you want to look at that option and I will check further.

davep700 wrote:

Janknitz wrote: Anyway, you're going to have to grow a pair and get fully educated to have a snowball's chance of getting your DME to replace the brick, RX or not. So if you're not the assertive type, ....

That's what I wanted to do first - get fully educated ... Thanks for assuming that I'm balless and unassertive..

I see that you are persistent and ask great questions.
Take what you learn from this and decide what is best for you and your health.

I have used CPAP for one year and still have a lot to learn. Unfortunately my doctors did not listen to me when I complained about fatigue and many years went by before I got angry and demanded testing. Ongoing objective data coupled with how you feel simply provides more information both for diagnosis and optimizing treatment.

My CPAP machine will be with me every night for the rest of my life. I want to know as much as I can about my CPAP machine, how it works, and how to optimize treatment. For sure, I know I don't want to have to depend on how a doctor, PA, NP, nurse, or DME interprets subjective statements alone.

Since my insurance only covered my Elite when I got started, I set my Flex account
to cover my S9 Autoset after the first of the year. A backup is good to have.
Of course the lesser machine is the reserve.
I quickly discovered that the revered lab sleep study had my pressure a full 3 cm HIGH.

davep700 wrote:Thanks sleeprider.

Do people need to provide a prescription for buying through amazon?

Hard to believe that a plastic box with a fan inside should cost Thousands of dollars, even if it is considered medical equipment.

Amazon is a sales platform for DME vendors. Rules for prescriptons vary among those vendors. I know someone who purchased an auto-CPAP from CareerMedical this week that did not require a prescription. Note that the PRS1 60 series is in the process of being replaced by the DreamStation series, and this has opened the door to some clearance prices for a very worthy machine.

I have also seen some good alternatives for people that don't have prescriptions to obtain them reasonably. Easybreathe.com offers a fixed $400 package for a real home sleep study, analysis by a physician, and issuance of prescriptions as indicated by that study. This kind of access and service is a step in the right direction. EasyBreathe even bills most insurance if you have it.

Edit to add: You clearly have a prescription or you wouldn't have the machine you were issued. A CPAP prescription doesn't need to specify Auto or anything. It is the DME and insurance that are motivated to give you the lowest possible piece of equipment. When you buy out of pocket, it's a free marketplace, and the bullshit goes away.