insurance will not pay for apap

I work for a DME company and i can tell you first hand that we know more about the equiptment than any of your DOCTORS, so please consult us on which machine is best for you, because sleep is still a pretty new medical field and not many of your DOCTORS even prescribe the right machine or test. So if you are worried about the DME companies " stealing your money", you should ask your DOCTOR why you have to come back and pay for another office visit when the person who ran your study can tell you everything and more than what he knows, because believe it or not, they are the ones that watched you sleep.

On another not, you do not need to complain to get APAP.. or an autoset machine. There is a new feature on CPAP machines dispensed by respironics that is called CFLEX that improves compliance, so, instead of complaining for what you need/want /deserve, just ask for a reccommendation, then if you are not happy any DME company will be more than happy to get you what you need to sleep, because believe it or not they care!

Thank you, KALDEX, for bringing up this excellent old thread.

Newbies would do well to read the post by Ric (just prior to KALDEX's post) which summarizes the APAP situation quite well.

Regards,
Bill ( . . . thinking there's a lot more truth in Ric's perspective than KALDEX's.)

I second Bill's comment.

KALDEX wrote:I work for a DME company and i can tell you first hand that we know more about the equiptment than any of your DOCTORS, so please consult us on which machine is best for you, because sleep is still a pretty new medical field and not many of your DOCTORS even prescribe the right machine or test. So if you are worried about the DME companies " stealing your money", you should ask your DOCTOR why you have to come back and pay for another office visit when the person who ran your study can tell you everything and more than what he knows, because believe it or not, they are the ones that watched you sleep.

On another not, you do not need to complain to get APAP.. or an autoset machine. There is a new feature on CPAP machines dispensed by respironics that is called CFLEX that improves compliance, so, instead of complaining for what you need/want /deserve, just ask for a reccommendation, then if you are not happy any DME company will be more than happy to get you what you need to sleep, because believe it or not they care!

Well if KALDEX the DME knows more than the doctors and we know more than KALDEX the DME ... then should not we the patients be the ones getting paid to treat ourselves?

CFLEX does not equal APAP!!

Care does not equal $$$

CG!! ... where are you? Is this another spammer?

Happy St Paddy's Day to all! That being said:

Welcome, Kaldex. Its always a pleasure to see a DME rep or RT take part in the forum. And I do have to agree w/you that many, probably most, DME RTs do understand the CPAP machines better than a good many, if not most, of the doctors who order them.

HOWEVER, you "must" work for one of the smaller, local DME suppliers, maybe even a "mom & pop" DME? You certainly don't work for Apria, Lincare or even "my" local 3 state-wide DME!!!

And, I take it maybe you are fairly new to working as a DME RT?? I say that 'cause you "should" know that a C-Flex or EPR capable machine is NOT necessarily the same as an AutoPAP and that most do not need an AutoPAP due to needing expiratory relief but rather due to poor titration results, health problems causing inconsistent breathing/apnea needs, etc.

You should also be aware no one can be sure of which machine BEST suits each patient's needs short of each patient trying AT LEAST each manufacturer's brand of xPAP. True, most patients will do well on a Puritan Bennett, a Resmed or a Respironics, etc BUT there are those patients who would do BETTER on the algorhythm of one than another, those who do better w/C-Flex, those who do better w/EPR and those who do better w/neither, etc.

And in the long run, NO doctor, NO DME RT, NO ONE can know better than the patient how they FEEL. Those precious stats and numbers these xPAP machines spit out via their software and readers are only PART of the story.

Ideally, patient, doctor, DME RT "and" DME supplier would work together as a team. THAT is a RARITY, if it happens at all.

So, again, welcome to the forum, but perhaps it would best best that you not post in generalities for all DMEs but rather speak only from your personal experience and your particular DME supplier's policies. Doing so should save you a lot of "heat" from those of us who have experienced situations directly opposite of those you've encountered w/your patients and employer.

Well said Slinky,

When someone is stating absolutes, and they are not talking about death or taxes, I am immediately skeptical.

Seems to me that the key is what your Dr. prescribed, not what the DME wants to sell you. If your prescription does not have a APAP you will not be allowed to have one, not even from the sponsor of this site. If your Dr. prescribes an APAP and completes the statement of medical necessity most insurance companies and DMEs will follow it. I would suggest double checking the prescription your Dr. wrote for you.

Anonymous wrote:Seems to me that the key is what your Dr. prescribed, not what the DME wants to sell you. If your prescription does not have a APAP you will not be allowed to have one, not even from the sponsor of this site. If your Dr. prescribes an APAP and completes the statement of medical necessity most insurance companies and DMEs will follow it. I would suggest double checking the prescription your Dr. wrote for you.

You CAN purchase a APAP with a CPAP prescription from CPAP.COM.

Billmyinsurance.com and Cpapforseniors.com is a different story.

Den

Actually no you can't. Take a look at the requirements and they specifically say that the prescription needs to say APAP and the pressure settings. That also applies to CPAP.com. I recently purchased a Remstart Auto from CPAP.com and they specifically required a prescription for an APAP. Suggest you check the facts before spouting off your wisdom providing incorrect information.

Anonymous wrote:Actually no you can't. Take a look at the requirements and they specifically say that the prescription needs to say APAP and the pressure settings. That also applies to CPAP.com. I recently purchased a Remstart Auto from CPAP.com and they specifically required a prescription for an APAP. Suggest you check the facts before spouting off your wisdom providing incorrect information.

I DID!!!!......Jerkweed....
I just called CPAP.COM to straighten this out......

Because:
I purchased a REMstar Auto from them last August on my CPAP prescription.

I was told that the only stipulation is that IF your prescription says "APAP" or "Auto", they cannot sell you a straight CPAP. Otherwise, a person with a CPAP prescription CAN purchase an Auto.

So......shut up!.....and quit spouting things of which YOU haven't checked the facts! SHEESH!!!

Den

Nice talk. Typical person from Hickland (AKA Wyoming).

Anonymous wrote:Nice talk. Typical person from Hickland (AKA Wyoming).

And PROUD of it!
I've lived in the cities (I wasn't born in WY) so if YOU live in a metropolitan area.....you have my sympathies......well, almost in your case.

If you're the arrogant "jerkweed" I was speaking to previously, where you chose to live doesn't determine intelligence.

Besides......you started it.

Suggest you check the facts before spouting off your wisdom providing incorrect information.

Have a good day.

Den

Aw, cut it out! I've never seen Wulfman "lose" it like this before. You've managed to really rattle his chain.

However, he "is" CORRECT! You "can" buy an AutoPAP direct from cpap.com w/"just" a CPAP script. Don't get them confused w/cpapforseniors.com and billmyinsurance.com. I don't know about bi-levels (Bi-PAPS) tho.

Come on now, folks. Play nice. You can disagree and correct each other w/o getting nasty and/or personal. Have some consideration for others who read the posts in this forum.

Speaking from personal experience, you can get an auto with the cpap prescription, but you may have to pay extra for it. This was done at my DME, and insurance paid what it would pay for the cpap as prescribed, and $150 was added (one time charge) to copay.

This may not be true elsewhere, but it happened here. I have not tried it elsewhere.

Catnapper -Joanie

Actually, it was "improper" for your DME to charge you extra for an AutoPAP. Its the same insurance code as a straight CPAP. If I'm not mistaken they can get "in trouble" w/Medicare for a stunt like that.