Right CPAP machine

I have been reading a lot about the differenct machines and I think that the one with the Cflex would work best for me - I am going for my titration study in a couple of weeks. Do I have a choice of which machine I can get from my supplier? And, does it affect the insurance coverage? Thanks.

First off, CFLEX is a fancy way of saying "automatic biPAP". As I understand it from my doctor, biPAP has a specific low and high pressure setting. On inspiration, you have your high pressure, and on expiration (exhaling), your low.

CFLEX only has one pressure setting, and then "drops" during expiration. Doctors don't like it much, because they don't have any control over it. Also, just because a machine has CFLEX doesn't mean it's turned on. My RemStar Pro-2 has CFLEX, but they didn't turn it on, because they didn't think I needed it. If you have a titration study (and I'd think you will), go with whatever it suggests as a start, and don't (IMO) start mucking around until or unless you determine that's not working for you. (And yes, this is strange advice coming from someone who's about to give up on his CPAP, since he can't seem to sleep with it on...)

Now, the don't get me started.... Insurance.... I think it's going to depend on your particular insurance company, plan, and state, if you go with insurance. Here's my experience, dealing with Cigna's Open Access Plus plan in NH:

If I buy the machine myself, from someplace like CPAP.COM (which seemed to have the best prices on-line), I could buy a reasonable setup for $565 (for a ResMed S7 Elite or $679 for the one I currently have) plus the cost of a mask, which was about another $100. Total outlay under $700 (or $800 for the Pro2). BUT... they're not a Cigna preferred provider, so my $1000 out-of-network deductible kicks in, and so I have to pay for it all myself.

On the other hand, if I go through a preferred provider.... They all had the same thing to say: The cost of a CPAP machine is $1500 (roughly) plus several hundred for a heated humidifier, plus hoses plus masks plus plus plus, ran to about $2500 total. Which machine is that? Any. That's "the NH price for a CPAP machine". Oh, really? Yeah, I only get the more expensive one because that's the one my hospital recommends, and in order to get the contract, the medical equipment company had to agree to provide it.

Now, as a Cigna preferred provider, they then have a negotiated price break off of this inflated price. Cigna prefers to rent the machine for a while first, negotiated rent-to-own price is $144/month for 10 months, or $1440. With all the other gear, it comes to about $1900. But since I have a $700 yearly cap on durable medical equipment, that means I'm out of pocket $1200.

So, to recap, in my situation, I can go with insurance and be out of pocket $1200, or go all on my own and be out about $700-800. Nice, huh?

Now, there are some tricks which can be played. For example, my IN-network deductible is $500. But I'm going to have to pay that somewhere, so if I pay it to the medical equipment company, then I WON'T have to pay it somewhere else, and I'll end up getting $1200 worth of equipment before I'm out of pocket. (Yes, I know, I still have to pay the $500, but as I said, if I didn't pay it here, I'd have to pay it for the sleep study). The trick here, though, is to make sure the medical equipment company is your FIRST charged medical care of the year. Only really works around this time of year.

The other trick I'm going with is I'm going to let Cigna rent it for me for the first 2 months, plus buy the H/H and all the hoses, masks, etc (only the CPAP is rentable, the rest is outright purchase). That will run me the limit of my $700. After that, if I decide to continue on CPAP, I can buy my own machine from CPAP.COM for $435 (ResMed) or $520 (RemStar Pro-2), because I'll already HAVE the mask, hoses, etc.

A lot to take in, I'm sure, but that's what I've learned so far. The true answer is that the cost of them is a scam and price-fixing at it's worst, and you'll have to find out from your specific insurance carrier just how much they pay and how much you'll be out of pocket, and compare that to how much you'll be out of pocket if you just buy the damn thing yourself (the only constant number in the whole lot, I'm afraid).

--Liam

I just noticed a typo on re-reading.

The NH price for a CPAP machine is $1800, roughly. I typed $1500.

I still think it's insane that there's no differentiation based on specific make or model, and that there's one price everyone charges that's as much as $1400 more than the $435 a base machine can be had for. And I still think that it should fall under the heading of illegal price fixing, but what can I do?

Liam, I think your Dr. is confused about C-Flex. But I wont debate it since its my experience that Drs. dont know anything about cpap equipment and treatment except what they are told by the sales people. .

As far as the cost. Buy it out of pocket Save yourself and the rest of us some cash. Sure the insurance company is off the hook but you dont do anyone a favor by getting gouged (except the DMEs) just to get what you are paying for from your insurance.

Buy from the internet at cpap.com . Save $$ and aggrivation.

Learn what seasoned self help DIY hoseheads already know. The system is a ripoff.

Bonehead

If I decide to keep it, I will buy it myself. As I said, it works out to my benefit.

But for a two month trial, while I determine if it works for me, etc, why not get that trial for free? Yes, the price being charged is seriously gouging, but if (as it's currently looking) it turns out that it DOESN'T work for me, why would I want to be out of pocket between $700 and $800, when the insurance company could be out a similar amount and I out nothing?

And if I DO keep it up, I can buy the machine but still have all the hoses and stuff purchased for me by the insurance company.

Play the system to your benefit, that's my advice. Yes, someone's gouging some cash, but you have insurance to limit your out of pocket. So figure out which way is going to most limit your out of pocket and go that way. I didn't set up a system where it was encouraged for one company to gouge prices and another to set up sham discounts which still result in a 2.5-3 times markup over what the machine can be bought for. I'm just trying to minimize my out-of-pocket.

Liam.

Liam, if your prescription says BiPap or whatever, try to talk the DME into letting you try as many of the machines that fit the prescription as you can until you find one you like. They probably have the Remstar Spirit, an autopap that you might like better than the straight CPAPs. If your levels at titration are below 12 you could probably use them very well without the BiPap unless you have problems with your lungs, and it is quite possible you don't need the higher pressure except for only certain times of the night, so why "overtreat"?

As for the hoses, all CPAPs bought online come with the hoses, so you are not really getting ahead there.

One small clarification:

CFLEX only has one pressure setting, and then "drops" during expiration

Liam, I realize you were comparing "C-Flex" as a feature, with the way true Bi-Level machines (bipaps) work.

All the different machines and their mix/match features can get confusing. C-Flex has 3 settings, actually, for 3 different degrees of pressure drop on exhalation - some people like a little drop, some like more.

Lest Jennifer get the impression that any machine that mentions having "C-Flex" has to be a "one pressure setting" straight cpap machine (and I know that wasn't what you were saying, Liam, but the wording might sound that way to someone new) there is now a new autopap available with C-Flex. Similar in exhalation relief to a BiPap, but with an autopap's ability to vary the pressure throughout the night. Not using the "always the same" higher inhalation pressure of a BiPap.

The new Respironics REMstar Autopap with C-Flex can run in any of four modes:

1. cpap (single prescribed pressure)

2. cpap with C-Flex (single prescribed pressure AND pressure-drop relief on each exhalation)

3. autopap (varies the pressure as needed within a range - usually set several notches above and below the prescribed pressure.)

4. autopap with C-Flex (varies the pressure as needed within a range usually set several notches above and below the prescribed pressure, AND pressure-drop relief on each exhalation.)

I use my Auto with C-Flex in the #4 mode. The "best of both worlds" for effective comfortable treatment, imho.

As Janelle put it so well: "...it is quite possible you don't need the higher pressure except for only certain times of the night, so why 'overtreat'?"

I think there may be quite a few people who have had to use BiPaps for exhalation relief, but could now benefit from the new autopap with C-Flex. Some BiPap users might find it nice to get relief from that steady higher inhalation pressure they've been receiving on BiPap, yet still get a nice pressure drop on every exhalation.

Straight "CPAP with C-Flex" users might also like having an autopap that lets them keep enjoying C-Flex relief. Just a thought from a non-medical happy "auto/C-flex" user.