CPAPtalk.com

I hope I am not hijacking a thread. I though about starting a new one, but I thought the title fit my experience.

I was recently diagnosed and was given a ResMed Airsense 10 CPAP by my Sleep Specialist. I went to my sleep specialist office and spoke to the technician who gave me that machine. I told her that I wanted an Autoset machine. She looked at me like I was crazy. She told me that they do not give AutoSet machines to people. They only use them when they do the titration. She said that since I had the titration, I do not need an Autoset machine. She gave me the ResMed Compliance Report. She said that was all the data that I needed. I talked to her for awhile and I realized that I was pretty much stuck with the machine I had. I had gotten my machine on 12/28/2015. I really really like my sleep doctor. He spends a lot of time answering all my questions whenever I see him. I will be seeing him next week for my checkup after starting treatment. I plan to discuss this with him at that appointment. My diagnosis was Moderate Sleep Apnea when I did my sleep study. I do not stop breathing. My initial AHI was 7.8, which I now realize is not bad at all compared to others. Since using my machine, My AHI is .8. I think I am doing very well with treatment. My problem is that I am very technically inclined. I want to know everything I can know about my treatment so that I can get the best result. There are some nights that my AHI is almost 2. I realize this is still in a good range, but I would like to look at the data and see if there is a reason for the change. I have learned so much from this website and I want to learn as much as possible but I am limited by my machine. Now to get to the subject of being limited. I think that is their objective. By limiting me to the machine I am currently using, I have to go back to the doctor to get help if there is a problem. This could involve more sleep studies or if nothing else, just the copays to see the doctor. I think for some people the no data machines are fine since they are not going to use data anyway. But if a person wants to have that access and the insurance company would pay for it, then why can't they have what they want. I wish I had done more research before I got my machine. The problem is that when you are diagnosed, you just do what they tell you to do. You don't know any better.

The beauty of an Apap is that not only will it run in cpap mode, but can be used at
any given time to fine tune your titration--especially important if you are working on
WEIGHT LOSS, which can alter your needed pressure. Eliminating UNNECESSARY
titration studies is good medicine, because they are prohibitively expensive.

red_roni wrote:You don't know any better.

I could have been in your exact situation but ended up needing bipap and they are all data capable. You don't know and are taken advantage of by people who should have your best interest. You are told this is the machine and given very little information. I had no idea there were forums to get information and it is so overwhelming to begin with that you feel like you are on a conveyor belt and you don't know where you are going. Granted your titration may be spot on now but there can be many changes, in the at least 5 years, before insurance pays for a new machine. I can think of no good reason for a machine that does not give the necessary information for success except greed.

red_roni wrote:I hope I am not hijacking a thread. I though about starting a new one, but I thought the title fit my experience.

I was recently diagnosed and was given a ResMed Airsense 10 CPAP by my Sleep Specialist. I went to my sleep specialist office and spoke to the technician who gave me that machine. I told her that I wanted an Autoset machine. She looked at me like I was crazy. She told me that they do not give AutoSet machines to people. They only use them when they do the titration. She said that since I had the titration, I do not need an Autoset machine. She gave me the ResMed Compliance Report. She said that was all the data that I needed. I talked to her for awhile and I realized that I was pretty much stuck with the machine I had. I had gotten my machine on 12/28/2015. I really really like my sleep doctor. He spends a lot of time answering all my questions whenever I see him. I will be seeing him next week for my checkup after starting treatment. I plan to discuss this with him at that appointment. My diagnosis was Moderate Sleep Apnea when I did my sleep study. I do not stop breathing. My initial AHI was 7.8, which I now realize is not bad at all compared to others. Since using my machine, My AHI is .8. I think I am doing very well with treatment. My problem is that I am very technically inclined. I want to know everything I can know about my treatment so that I can get the best result. There are some nights that my AHI is almost 2. I realize this is still in a good range, but I would like to look at the data and see if there is a reason for the change. I have learned so much from this website and I want to learn as much as possible but I am limited by my machine. Now to get to the subject of being limited. I think that is their objective. By limiting me to the machine I am currently using, I have to go back to the doctor to get help if there is a problem. This could involve more sleep studies or if nothing else, just the copays to see the doctor. I think for some people the no data machines are fine since they are not going to use data anyway. But if a person wants to have that access and the insurance company would pay for it, then why can't they have what they want. I wish I had done more research before I got my machine. The problem is that when you are diagnosed, you just do what they tell you to do. You don't know any better.

That's extremely frustrating that your doctor doesn't seem very enlightened. If you're not up for changing doctors and the DME won't cooperate, my advice to you at this point is to watch Craigslist. You'd be amazed what you can find very affordably there if you're persistent.

red_roni wrote:I hope I am not hijacking a thread. I though about starting a new one, but I thought the title fit my experience.

The problem is that when you are diagnosed, you just do what they tell you to do. You don't know any better.

Exactly! That was me with the first one I got too many years ago. They just showed up at my home with a machine and a mask...

kcl wrote:

red_roni wrote:I hope I am not hijacking a thread. I though about starting a new one, but I thought the title fit my experience.

The problem is that when you are diagnosed, you just do what they tell you to do. You don't know any better.

Exactly! That was me with the first one I got too many years ago. They just showed up at my home with a machine and a mask...

To KCI and Red; one more time DO NOT ACCEPT the machine; Red, take yours back, the insurance is most likely only renting it right now while they see how you do. Your insurance does not care what machine you get, only your DME does because they get paid the same and the bricks are cheaper.

Please, we have watched this happen too many times. KCI, you are in control, Red, you are too, take the machine back and tell them if they want to do business with you they will provide you with the AutoSET. even if your doc does not play ball, get a copy of your sleep study and see a different doc. The Bricks are old tech with a new box, don't let them do this to you.

kcl wrote:
I can't tell if you are replying to my original post or my update. It sounds like the DME will be getting me a DreamStation Auto Cpap. They are not associated with the Dr. and I think my Dr. is good, its the sleep lab that I'm ticked at for how he was talking stupid to me. But it all may be just fine, will know more next week but I'll be insistent to get the apap. The prescription does say cflex 2. I will be sure to insist on the heated hose, I have cover on mine now and that works but makes cleaning big pain. I will also get a heated humidifier (have to in the winter).

I am curious about the pricing, CPAP.com has it for $639.00 as list price, is that about what they will bill the insurance company? I always feel like they jack up the price but then I have to pay my 20% co pay on their jacked up price.

They will bill your insurance for more than 639.00. Its not necessarily anyone jacking up the price but every insurance has an allowable for CPAP. Some insurances pay more and some less, but most insurance is somewhere between 800-1500 for PAP machine. Also remember that mask, tubing, humidifier, etc all are billed separately (i.e. its not bundled) so typically the total billed to insurance is closer to that 1500 mark. Like you said, if you factor in your copay, deductible, etc you can see if its worth it to go through insurance or pay cash.

You might also decide if you want to rent the machine (this is most likely), but some insurances will allow you to receive the machine as a purchase rather than a rental. Nice part is then you just pay your copay upfront and the machine is yours without any more hassle down the road.

OKCSleepDoc wrote:
They will bill your insurance for more than 639.00. Its not necessarily anyone jacking up the price but every insurance has an allowable for CPAP. Some insurances pay more and some less, ...

I don't quite understand how a DME setting their price based on what the insurance is contracted or willing to pay is not jacking up the price, since I've not had a DME ever charge me an amount that was not higher than open market price for any piece of equipment or for supplies. In my experience their prices are consistently higher than market, sometimes substantially higher. Jacked up.

My suggestion is to go to your doctor's office and get a copy of the prescription. Return your machine to your DME and tell them that you will buy an Apap elsewhere since they provide what YOU want. Contact your insurance company for other providers and interview them over the phone about availability of products. Or bypass it all together and buy online - you have a prescription, they can sell it to you.

You don't NEED medical justification for a machine that handles both apap and cpap. Current apaps provide more detailed information for your therapy than any of the cpap machines. A nightly summary is insufficient.

Due to moving, changing insurance companies, then going on Medicare, I have had eight sleep studies over the past 20 yrs.

Never has anyone at the sleep clinic been involved with prescribing a machine. The sleep doctor or neurologist who sent me to the clinic for a study was the one who does that. They get the reports from the clinic and make the equipment decision based on that... and then a durable medical equipment provider takes it from there.

Not sure why a clinic tech would even be involved. However, this is just my experience. Perhaps some states are different in who can prescribe CPAP machines.

Iamagolfer wrote:Due to moving, changing insurance companies, then going on Medicare, I have had eight sleep studies over the past 20 yrs.

Never has anyone at the sleep clinic been involved with prescribing a machine. The sleep doctor or neurologist who sent me to the clinic for a study was the one who does that. They get the reports from the clinic and make the equipment decision based on that... and then a durable medical equipment provider takes it from there.

Not sure why a clinic tech would even be involved. However, this is just my experience. Perhaps some states are different in who can prescribe CPAP machines.

These are good points. This is all due to my many questions to the tech about machines and what the prescription would be for. I was just trying to figure it all out. He never did say that it was my Dr. who would write the prescription. If he had, this thread wouldn't exist Well, other than his condescending attitude, haha!

SewTired wrote: Current apaps provide more detailed information for your therapy than any of the cpap machines. .

this is simply *not true*

the information provided by a fully data capable cpap and an apap from the same manufacturer is nearly identical.