new user to be questions

I had my sleep lab 2 weeks ago and am now dealing with the medical supply place for the cpap machine. I thought with all the makes and models out there I would be able to chose one with the features I wanted. (My insurance is paying for it outright) - but they tell me they can only order what the sleep lab doctor prescribed(I've never met or spoken with him). What he prescribed doesn't have a smart card in it, yet my regular doctor that I'll be following up with doesn't specialize in this, so how will he know if it's working? Just subjective feedback, like I feel better doesn't seem too clinical. The sleep lab doctor or my reg. one won't see me till I've used the machien for 4 weeks, yet no one has explained my report to me. Is this the usual SAP for this condition? It's alittle nerve wracking to be told you have a severe condtion, then allowed any communication or options on treatment machines.

Is this the usual SAP for this condition? It's alittle nerve wracking to be told you have a severe condtion, then allowed any communication or options on treatment machines.

I am afraid you are experiencing the sad state of the Sleep industry in general. Starting with the insurance companies, on down, its a mess. That is why I have decided, at least for me, self-treatment without the DME, and insurance company is a better and less costly path to travel.

At this point I would suggest you get a copy of your PSG and your xPAP script. Next, if you can afford it, do it yourself.

By the way, there are places to pick up used stuff:

http://auctions.yahoo.com/i::14901709

But the very best place to buy new stuff is cpap dot com.

thanks for the advice, I'd be temped to go it alone, but never having used a machine before, I have alot of quesitons for the medical supply place and would feel more comfortable talking to someone than just ordering online. Plus if the perscription is for a specific machine, I'd have to order that one online anyway

Plus if the perscription is for a specific machine, I'd have to order that one online anyway

Not true, there is only one medicare code for the xPAP, and one code for a heated hunmidifier. Most online stores will fill your CPAP script with what ever you order.

jluddy, here's a clickable link that I highly recommend anyone with OSA read. CPAP user-to-be, or old hand at it -- there's a lot of good info here:

http://www.smart-sleep-apnea.blogspot.com
Mile High Sleeper's great information resource for cpap users.

Also, do a search (button up near the top) on this site for posts with keyword "insurance" (remove the quotes) and the registered member's nickname: snoregirl

snoregirl has posted a lot of useful information to help guide you through the wilderness of what insurance requires, what the DME may or may not be right about, etc.

Usually a doctor prescribes only the general type of machine (cpap, bi-level) and leaves it completely up to you and the DME to decide exactly which brand of machine (and which model within the prescribed "type" of machine) you receive from the DME.

Unfortunately, many DMEs shade the truth a little (or a lot) when pushing you to accept whatever machine they want you to have. They really don't expect to have a prospective cpap user come through the door with specific machine requests. Most people the DMEs see just accept whatever is handed to them without any questions. Most just assume that the machine the DME gives them is "exactly what the doctor wants you to have."

There's a steep learning curve for people who want to be pro-active about their own treatment. Getting there is made easier by the wonderful resources you'll find on this message board. Dig into the message board as if you were a med student studying for the exam of your life. 'Cause that's what this kind of treatment is about...your life.

Getting a mask that will suit you is even more key to getting successful treatment than what machine you receive, imho. But I'd want both -- a machine that can give FULL data via software (get the software online) AND make the DME earn their money by letting you try on several masks...not just one or two that they tell you are their "most popular."

Take your pillow and an old blanket (in case you have to lie down on the floor!) with you to the DME. Try the masks on while lying down, toss and turn in all your usual sleep positions. Be sure they have a CPAP hooked up, blowing at your prescribed pressure...not just blowing at a low pressure of "4" or "5". Don't settle for a mask "fitting" only while sitting up.

Good luck! Keep posting and keep asking questions.

Refuse to accept delivery of any CPAP equipment until you decide what you want. Then ask your sleep doctor to prescribe that particular equipment. This isn't so necessary w/the masks but most certainly it is for the actual PAP machine.

I KIND of agree with Guest about accepting stuff you don't want.

How much is your insurance company actually kicking in for this machine?

Will you face a new deductable in the new year Jan '07. Will you meet that deductable anyway on other stuff during 07 or is it just money out your pocket?


Depending on your answers to these questions (and looking at cash online prices here at CPAP.com) you can decide how much that insurance benefit is worth to you. If it is not a whole lot and the DME and doc give you trouble, then I suggest going out of pocket online. Either way get your prescription and a copy of your sleep studies.

I would first look at the machines on CPAP.com's web site and try to understand what you want from a CPAP. It is a little hard to say something is not working for you since they can always send you back for another expensive titration study. Then they can say you don't need the data card capability. And in reality they would be correct. But how much do those titration studies cost you out of your own pocket?

You don't mention your pressure (or I missed it). That can be a factor in choosing a machine. I for one at 13 prefer an APAP since I spend very little of the night at 13 and the rest at 10 or a bit above. Makes me more comfortable. Makes my mask seal better, makes me swallow less air. If your pressure is 7 or 8 then the AUTO doesn't buy you much other than the ability to retitrate yourself easily. You can do this on a CPAP with data, just a little more cumbersome.

Is exhale relief important to you. This depends on how you exhale and your pressure.

Do you need auto altitude compensation? and on and on. The comparison function at CPAP.com is great for seeing what each machine does vs the other.

As for needing the DME. If you can program your VCR or set up your telephone answering machine I would bet you can set up your CPAP. If you have trouble with either of the other two things, you may indeed want to let the DME do it. But be aware all DME's don't get it right. Mine didn't. I had to go home and fix it and correct him in the office.

Usually the Insurance will only buy the machine once (in a certain number of years). What happens if you don't like the machine, and can't PROVE it doesn't work? How hard is it going to be to get them to change it especially if it is an outright purchase.

Will your insurance work with Bill-my-insurance? Most likely not once you take something from a DME. Check with them FIRST.

Your CPAP prescription will be good for your choice of machine CPAP/APAP at Cpap.com so get it in your hands. Doesn't have to be for a particular machine.

Even if you don't like the machine they offer you at the DME, you may be able to use them for mask and hose and humidifier... and get the machine you want online. Up to you.

My guess is that the insurance company won't have a clue if you get what the script says or something better. All they see is E0601. Which is the code for CPAP. There are more codes for humidifier, mask etc.

It will have a name but my insurance company didn't even look at the name. They paid the contract rate for E0601.

On the other hand, most DME's (local) won't give anything but what the doc prescribes. If the prescription isn't specific sometimes you can insist on better. But be prepared to wait them out and maybe not win.

Did you ask the doc why he won't prescribe a machine that can give data? Are you telling us if you make an appointment he will tell you to go away if it hasn't been 4 weeks? He will have his office people cancel it?

That doesn't seem very professional. I would be tempted to take my sleep study and see another doc. If your regular doc won't help either is he the guy you really want to be going to?

All these questions are up to you. Just my non-medical opinion.

thank you all for your advice. I will bring a pillow to the appointment with the med. supply house. I would never have thought of that. I talked to them yesterday and asked questions about the features of different machines, but they had already ordered me one and said since that's what the doctor ordered, that's it. It doesn't have a data card, or ramp features, and when I asked about altitude adj.(i'm at sea level, but we're traveling to CO this summer) they said I'd have to bring it in and they'd adjust it for me. They called it an A machine - not sure if they mean apap or not ( I didn't find out about apaps till after I talked to them). They told me I'd have to rent a different machine and pay out of pocket if my doctor needs any kind of read-out.

My pressure was at 8 at the sleep lab, although the doc. put in his report that since I was only asleep for less than an hour at that pressure they're not sure what I really need, and suggested close clinical follow-up. Yet, the med. supply place they ordered one without a data card? I don't get this! My neighbor works there, so she said she'd check into what was really ordered for me and why. I left a message at the sleep lab that I want a copy of my prescription!

My pressure was at 8 at the sleep lab, although the doc. put in his report that since I was only asleep for less than an hour at that pressure they're not sure what I really need,

That comment alone, "screams" Auto Pap.

I agree with oldgearhead about screaming APAP.

Do yourself a big favor. Find out how much YOU will be paying for this machine with no data and needs to be adjusted for altitude etc.

SOUNDS CHEAP. You could buy one like this online for $300 - 350.

DON't PAY THEM MORE OF YOUR OWN MONEY than that.

If you really can't do better with a study that is unsure of your titration, take that copay money and apply it towards the Remstar AUTO $689 with humidifier I think and set it for 6-10 or 7-11 (since you say you were sort of titrated at 8 ) and go from there.

Close clinical follow up = $$$ out of your pocket. How much are they going to charge you for every "followup"? With the right equipment you don't need them for that. RENT ANOTHER MACHINE FOR FOLLOWUP??? That screams $$$ to me. They typically rent machines for $100 - $125 per month. That money could be applied towards a good machine with all the features you need and want.

AND email BILL MY INSURANCE.com before you give them any money at the DME or take equipment.

Please don't fall into their sucker trap. I have absolutely no stake in this. I do not work for anyone (not a cpcp manufacturer or website) I just hate to see people taken advantage of.

If you really feel you need a local DME call another one. Get another opinion before you get stuck with this. Many insurances have multiple approved suppliers. Not all but many.

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CPAPopedia Keywords Contained In This Post (Click For Definition): humidifier, Titration, DME, Altitude, auto, APAP

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CPAPopedia Keywords Contained In This Post (Click For Definition): humidifier, Titration, DME, Altitude, auto, APAP

Hiya jluddy.

I'll try to toss in a couple answers as well, though you've already recieved some great information.

In many cases a doctor will order a specific brand and/or specific model of CPAP. If that happens a DME company cannot change that without getting specific written orders to change.

If the doc does not specify a brand or model then a DME can choose among anything that DOES fit what was prescribed. For example, if a Doc writes a prescription for a "Respironics CPAPat 10cm" then any Respironics CPAP that can provide 10cm of pressure can be provided. If the order was for "CPAP at 10cm" then ANY brand of CPAP that provides 10cm can be provided. In neither case could an APAP be provided since that was not prescribed.

Online providers are NOT bound by these same restrictions and can provide anything that falls within the broad scope of the order. If it says 'CPAP' they can provide any cpap or autopap. I believe, though I'm not sure, they can even go against specific brand names or models that may be ordered. It's something DME companies have been wanting for a long, long time but we haven't been able to get the legislation passed yet.

Also, DME companies are required by both federal law and by most insurance contracts not to give a discount to cash customers (It's the "Best Customer" clause Medicare and most insurance companies use). Online providers are also NOT bound by this and therefore can charge very low amounts to cash customers.

Note that the above does not apply if you use an online source to bill your insurance. In that case you will then see the same price if you use a traditional DME or you use an online company.

If your order did not otherwise go against it you should be able to get a machine with data collection capabilities. Be aware that not every company will always carry these though, so that may require a bit of work on your end - either to work something out with your current provider or to find another provider who carries them or can get them.

Many companies choose stripped down machines for the simple fact that the easier the machine is, the less service calls you tend to get. A machine that accurately and consistently works well is usually the primary factor followed closely by the service call issue in a DME company choosing which machine to focus on.

As far as the 'close monitoring' goes that would usually indicate followup by the Sleep Lab and your DME company - neither of which would be something that would normally cost anything. These are the typical services labs and DME companies provide. Such as smart cart downloads, verbal and written followup, verbal and written instructions, etc etc.

It certainly sounds like you would be someone who would benefit from a machine with data collection and possibly even an Auto Unit.

If I were yourself I would first contact the DME company and ask them about getting a machine that provides for data collection. If they do not have one or were not planning on providing you with one I would reference the comment in your sleep study about the lack of good data on your titration and see if they could get you a machine that does collect data. In most cases if you treat and work with a DME provider as a partner in your care they will do the same for you.
If they are simply unable to get a machine with data collection you might ask them about having a loaner of an Auto-PAP for 30 days to see if your pressure needs change.
If they are unable or unwilling to do that then I would certainly advocate trying to find another provider at that point. Almost any company really should be able to do the former, and in the worst case provide an auto as a loner.

Regarding insurance - insurance comapays pay for CPAP equipment and supplies. They've never actually agreed that an Auto-PAP is deserving of reimbursement. HOWEVER - since an autopap CAN work as a regular CPAP a provider can sort of "cheat" by billing an AUTO unit as a regular CPAP. Not all companies are willing to do this since as you can imagine the auto units do cost more.
In a typical situation (BCBS Federal) the submitted amount for a CPAP is just over $1,900.00. The allowable (The amount BCBS considers should be paid of what is submitted which for this plan is 40% of submitted) is $760. Add in the massive documentation work that has to be done for the claim and the average 6 months or so to get paid (That's counting the current denial rate for BCBS which is just HUGE) and you can understand why not everyone is willing to eat the cost of billing an APAP as a CPAP.

Obviously, since I am a DME provider I do feel we have a lot to offer to someone in your case - a new patient who has some issues and may require a lot of extra help to get settled. Which ever way you go though - I hope you hang in there and get setup with someone who can really help you.

Data collection would certainly be the easiest and most cost effective way to go. If you have any problems, please feel free to PM me and I'll do what I can to try and put you in touch with a good provider in your area if I can!

I know this is a WHOLE lot all in one post so I hope it's not overwhelming.

Good luck!

mattman