Waiting for CPAP/APAP machine is torture!

My experiences with the DME providers convinced me that there was a need for another entry into that business, an entry focused on customer satisfaction and service. I think that need was filled online by companies like CPAP.com. It seemed to me that the local providers have become accustomed to customers, often elderly, who don't know how to take charge of their needs, or are not in good enough shape to do so, or are not internet savvy enough to look for alternatives, they just tell the customers whatever they want to tell them and the fact that insurance only pays them a flat rate per machine(or so I have read), further takes any incentive away for them to even care about the patient. Once I asked for and received a copy of my prescription, I no longer needed the local providers and I'm fine buying my equipment outright in lieu of paying inflated 'rental rates'.

ScottGA wrote:My experiences with the DME providers convinced me that there was a need for another entry into that business, an entry focused on customer satisfaction and service. I think that need was filled online by companies like CPAP.com. It seemed to me that the local providers have become accustomed to customers

You see the results, but your understanding of the cause is a little weak.

The DME industry is one of the most highly regulated in the country. DMEs have to keep their licenses and follow tight regulations. To some great degree, the licensing and regulating authorities are what DMEs have to concentrate on. Satisfying these authorities has to receive priority over customers.

The other problem is that customers don't pay. Insurance companies do the paying. So now, here comes insurance companies also receiving priority over customers.

So, you can see customers are far down on the list of those who have to be satisfied.

In any industry that is heavily regulated, you have less competition, worse customer service, poorer quality and higher prices. DMEs are no exception.

Internet DMEs have an advantage in that they don't have the costs of a brick-and-mortar store, and the bulk of their revenue comes from customers paying, instead of dealing with insurance companies.

DME industry badly needs deregulation. So does insurance. None of the buttheads that are trying to get to Washington for the next four years will make any change.

The Choker wrote: DME industry badly needs deregulation.

I don't know if I would completely agree with that. I think they need different regulations, probably fewer, but since they are selling medical devices that can have a serious impact on people's health there have to be some. Think of the used machines and other crap they try to palm off with the current regulations. Open it up and who knows what some of them would do.

Improving payment times, simplifying the claim process and actually using reasonable reimbursement rates would go a long way to attracting quality players to the market.

Update for you guys and girls,

I rang up the Doctors nurse and she explained to me that they had not received the result from the Sleep Lab even though the sleep lab told me they will send it straight over, I find it hard to believe that it would take 4 days to carry out analysis on the results which was already conducted by the computer software.

Then she informed me the doctor is off until Aug 8th.

I have selected a DME, what should i be looking out for? What should i be getting with my equipment?

evilmoose1987 wrote:Update for you guys and girls,

I rang up the Doctors nurse and she explained to me that they had not received the result from the Sleep Lab even though the sleep lab told me they will send it straight over, I find it hard to believe that it would take 4 days to carry out analysis on the results which was already conducted by the computer software.

Then she informed me the doctor is off until Aug 8th.

I have selected a DME, what should i be looking out for? What should i be getting with my equipment?

I had similar experiences with my DME. I waited and waited. They would say they sent the info to my doctor and were waiting on the RX. My doctor never received it. My doctor sent them a request.. This went on for quite some time. During that time, I tried to educate myself as much as possible but boy was I underprepared! I was under the FALSE impression that all machines gave you data access to your efficacy. I downloaded the dream mapper app after the first night and the following day attempted to learn how the night went only to discover it only showed the total number of hours I wore the mask. LIke I needed the app for that info! I called the DME because I thought I had done something wrong. The books provided with my machine indicated I could access much more info. The DME explained my book was for two different modeles and because I had the basic model, I did not have access to that info. She further advised I could request a compliance report from her at any time.
I became more and more frustrated as time went on because it is hard to stick with something when you have no way to know if your're doing well. Fast forward to the day before yesterday, when I requested an exchange of the machine for a data capable one. She advised she would have to check with her boss and would be in meetings for the next two days. Then this morning, she emailed to say they would charge me a $200 fee for the exchange. So, I have decided to return her equipment (keeping the things I already paid for) and go to a different DME. My insurance requires a two month rental before purchase. I'm so thankful I realized this lack of data issue so quickly.
The other problem was that I felt rushed during my initial visit the day I received the equipment. She seemed put out with the fact that I didn't know what mask I wanted. I had researched them but they all fit differently. Basically, go into the appointment asking lots of questions! Try to narrow down your machine choice and make sure the DME you select carries it. Best of luck to you!

Omne wrote:

The Choker wrote: DME industry badly needs deregulation.

I think they need different regulations, probably fewer, but since they are selling medical devices that can have a serious impact on people's health there have to be some.

What are these "serious impacts on health" that you speak of?

Another factor is price fixing by cpap makers. If you don't agree to sell the machines at the prices they say, they won't provide machines for you to sell.

Regarding having to wait for a machine, now you know why many of us have a backup machine or two or three! This is not something we are able or willing to do without.

evilmoose1987 wrote:I am waiting for the doctor to send the DME the Rx. Apparently when I rang on Monday they had not received the study from the lab even though the lab told me they all ready sent it and I'm pretty certain it's all electronic. I'm going to ring them tomorrow.

I think once you get a taste of how good sleep feels it makes your subsequent nights awful.

So true!

I slept a really good 5+ hours with cpap during the titration. The next night, at home, I had a dream that I would have to wait 6 months for my machine. And I was angry. So, even in my sleep, my brain was saying, get me one of those!

I was lucky and only had to wait 2 weeks between the sleep study and getting my machine. I dreaded getting a machine for about 10 years, but after that sleep study, I was excited to get one. I was totally thrilled to get my appointment and pick up my machine. I came home and took a nap with it right away.

Insurance should be changed so that it pays X amount of dollars for specific codes that relate directly to the Cpap machine your prescribed.
That way if you could find a cheaper deal online you could buy that and get reimbursed instead of paying more out of pocket from the DME your insurance has approved or is in network.
I have been battling Cigna over this issue for months and have been lied to or just given false information from cigna reps who seemed to actually care.
I had to buy my own equipment from a third party or I would have likely died. I was waking in the morning with my the dangly flesh at the back of my throat swollen like crazy and causing me to gag.
It took hours after waking for it to reduce in size. My wife would wake my many times during the night because I stopped breathing or was gasping for breath.
I knew I had sleep apnea from in lab sleep tests I had done 15 years ago. I had a Cpap machine that I would use as needed over the last 15 years but it broke.
I told my doctor the situation but he refused to give me a script to buy a new cpap machine without a new sleep study.
Cigna uses carecentrix and they denied the request as not medically necessary. I told my primary care doctor and he appealed but another 30 days went buy and nothing.
I was waking in a panic because I could not breath and was latterly afraid to go back to sleep so I sat in my easy chair until I calmed down.
Enough was enough and I decided to purchase used equipment at a higher price that I should have but I was totally grateful considering the situation I was in.
once received I and used I experienced instant results. It was a total godsend to me and I really believe I would have been dead if I had not purchased this used Apap machine.
I'm still messing with Cigna and carecentrix today. They approved a home sleep test and mailed The ARES forehead sleep test equipment to me. I did that but could not use it more than 1.5 hours befor a awoke in a panic because I could not breath and putmy cpapa machine on instead. I used the ARES the next night with the same results and then sent it back. They said they needed 4 hours of data and I hope they did received that over 2 nights. I was going to use it a third night to make sure but could not put myself thru that hell another night.
I use my Apap machine and sleepyhead shows my numbers are good with the AHI under 1-2
I sleep and don't wake in a panic. Cigna still won't give me a cpap machine. Now I;m being told if the test shows I have sleep Apnea they will send the results to my DR and then he will have to request a Cpap Machine. Then carecentix will approve a 3 month rental of a Cpap machine and If after 3 months it shows I have complied based on the data collected they will approve a cpap purchase for me.
The problem is I have now met my in network deductible of $1000 but by the time I actually get appoved for the rental Cpap and after 3 months I will be into a new policy year and have to meet the new $1000 deductible if it stays the same as this year and does not increase next year. my policy year starts oct 15 each year.
I have been trying to get treatment since may of this year thru my Cigna Primary care physician. The whole insurance bureaucracy is rigged against the patient.
I have asked for a Cigna Patient advocate to review and help with my case but come up empty every time I have called. Cigna tells me carecentrix handles sleep disorders and I have to contact them. Carecentrix claims MY DR can keep appealing the rejections . DR tells me they would only approve the Home sleep study even after he provided the information about me.
Who do I belive? My DR or carecentrix/Cigna?
I had to take matters into my own hands and buy my own equipment. My DR has now at least given me a written prescription so I can purchase equipment as needed but it would be out of network and at a higher deductible and I would pay 40% after that.

jtravel wrote:Insurance should be changed so that it pays X amount of dollars for specific codes that relate directly to the Cpap machine your prescribed.
That way if you could find a cheaper deal online you could buy that and get reimbursed instead of paying more out of pocket from the DME your insurance has approved or is in network.

Let us know when you get Obama to sign off on that.

I would refuse a machine if it werent data capable.

If you insist on an auto of either Resmed or Respironics, you can be sure that you have data capable. Many DMEs think the compliance information makes the machine data capable. Ask them if it shows the wave forms and they will look at you like..what?? what are you talking about!? Then say, since you don't know, I want an auto-machine. If they offer you anything else, refuse it. The reality is that you are stuck with the machine you get for 5 years and you want a machine that is flexible - both straight and auto pressure, unless you know for certain that you won't ever be doing auto pressure and as a newbie, you won't know.

SewTired wrote:

I would refuse a machine if it werent data capable.

If you insist on an auto of either Resmed ... you can be sure that you have data capable

not all autos are full data. please start checking your facts.

palerider wrote:

SewTired wrote:

I would refuse a machine if it werent data capable.

If you insist on an auto of either Resmed ... you can be sure that you have data capable

not all autos are full data. please start checking your facts.

Please quote the entire sentence: "If you insist on an auto of either Resmed or Respironics, you can be sure that you have data capable. "

Show me an example of a Resmed or Respironics Auto that is not data capable? I mean something you could actually BUY NEW in the last 5 years?

To the original OP: there are many people here and on the other boards who can't get insurance to approve their CPAP for a variety of reasons. I understand your frustrations!! BUT, it looks like from here on out, you are on your own, unless you can figure out a way to do a sleep study, so do find the most economical options for purchasing your supplies. Cigna is not unique in the fact that they refuse to allow reimbursement if you buy out of network (the same stuff at lower cost even!) because I suspect that it is part of the contract they sign with the DME network. At least you are ABLE to get a machine without the prescription. It's unfortunate you went 15 years before getting a new machine - 10 years would have qualified you without another study. My brother's was 9 years, so just in under the wire, although ultimately, he had to have a new study this year.

When they did your home study, did the pressure start out close to what you already had? If not, that may have been the whole problem. My bro had to have a study earlier this month and they started it close to the pressures he already had.

ChicagoGranny wrote:

klm49 wrote:I would refuse a machine if it werent data capable.

+1

You may find this useful in getting a data capable machine.
Here's a reasonably up-to-date database that tells you if a machine has data capability, sometimes called full data function... yes, even a few of the newest models are NOT data capable, sad to say. Some other features are covered also. This links to one database but there are two views – use whichever one is expedient for you:

https://sleep.tnet.com/equipment/cpapmachines

https://sleep.tnet.com/cmd

SewTired wrote:

palerider wrote:

SewTired wrote:

I would refuse a machine if it werent data capable.

If you insist on an auto of either Resmed ... you can be sure that you have data capable

not all autos are full data. please start checking your facts.

Please quote the entire sentence: "If you insist on an auto of either Resmed or Respironics, you can be sure that you have data capable. "

Show me an example of a Resmed or Respironics Auto that is not data capable? I mean something you could actually BUY NEW in the last 5 years?

Resmed S9 Escape Auto. auto machine, almost no data.

and since you said "SHOW ME":


again, please start checking your 'facts', in your zeal to 'help', you are frequently inaccurate and misleading.