Cathy,
I'm a longstanding CPAP user who recently switched from an old machine to a REMStar M Series Auto, the machine you want. Even though I got this machine, I am using it in CPAP mode because I have had significantly increased apnea, including central apneaa, in APAP mode. Although I haven't finished experimenting, in terms of treatment, I wouldn't have been worse off if I had gotten a Pro instead.
However, my 90% pressure is 9 cms H2O. You didn't say what your titrated pressure was after your sleep study. If it was reasonable and you can tolerate that pressure well under normal CPAP (with or without C-flex and/or ramping), there really is no compelling reason to get the Auto over the Pro. The Pro gives the same access to the software as the Auto does, and that is what you need to monitor your treatment. Furthermore, the changing pressure of the Auto may in fact contribute to more events than the steady pressure of CPAP.
Many carriers will not pay for a purchase of an XPAP machine until after the patient has demonstrated that they can tolerate and will use the treatment: that is why they insist on a rental arrangement for a few months. They even go to absurd extremes. For example, even though I have been on CPAP for 9 years, my new insurance carrier refused to pay for a new machine until I rented. Why? Because that was the way that they do things. They also would rather pay 50% of $1500 for a new machine to an approved DME that 50% 0f $750 to CPAP.COM for the same machine. Go figure!
Given that it's December 8 and you have a $1000 deductible, unless you expect to use that up quickly next year, if it were me, I'd buy the machine I want from CPAP.COM (either the M Series Pro for $596 or the Classic Pro for $540, both with C-flex and heated humidifier -- both are great machines), get the reader and software, and forget about the reimbursement.
The important thing is to start (and stay with) the treatment. Just my two cents!
Good luck.
Michael
Newbie bummed after appointment w/DME
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I agree with snoregirl,
Sometimes the cost does not rule everything.
That is for you to figure out.
If keeping that DME is less stressful for you, that may way in your decission. As Den said the M pro is a good machine.
I know I had to weigh the difference of going online to buy a machine with a two year warrenty, instead of a DME with a three year warrenty. The way I justified it was that at the difference in price, I may get another machine. Machines other break at the beginning or last longer. Time will tell. (My insurance will pay out to me an online purchase.)
I was still able to find a DME (and thus insurace coverage) that would deal with me even if the machine did not come from them. I am able to try most mask on at home for a trial etc, that is important to me. And I was willing to pay a bit more for that service.
Make sure the DME gives you that service you are looking for, whatever it may be.
Some people like the fact that their DME goes to them for in home care.
The peice of mind if the machine breaks.
Others like to know if they are traveling they can have a DME to deal with.
The list goes on and on as to the benefits of a DME.
Another thing a DME may do is if you get the M Pro now and you need a different machine as a Bi-level, they may exchange it for you (additional cost) without having to buy a new machine.
How does your DME handle trying and buying interfaces (masks). That is where I needed the DME the most.
Cathy I hope you resolve the machine issue quickly so you start your treatment.
Sometimes the cost does not rule everything.
That is for you to figure out.
If keeping that DME is less stressful for you, that may way in your decission. As Den said the M pro is a good machine.
I know I had to weigh the difference of going online to buy a machine with a two year warrenty, instead of a DME with a three year warrenty. The way I justified it was that at the difference in price, I may get another machine. Machines other break at the beginning or last longer. Time will tell. (My insurance will pay out to me an online purchase.)
I was still able to find a DME (and thus insurace coverage) that would deal with me even if the machine did not come from them. I am able to try most mask on at home for a trial etc, that is important to me. And I was willing to pay a bit more for that service.
Make sure the DME gives you that service you are looking for, whatever it may be.
Some people like the fact that their DME goes to them for in home care.
The peice of mind if the machine breaks.
Others like to know if they are traveling they can have a DME to deal with.
The list goes on and on as to the benefits of a DME.
Another thing a DME may do is if you get the M Pro now and you need a different machine as a Bi-level, they may exchange it for you (additional cost) without having to buy a new machine.
How does your DME handle trying and buying interfaces (masks). That is where I needed the DME the most.
Cathy I hope you resolve the machine issue quickly so you start your treatment.
snoregirl wrote:...
But as I said, you sound like you want DME support and I want you to do what makes you comfortable and you where you feel you have the support to succeed. Sometimes $$ don't rule everything.
I can do this, I will do this.
My disclaimer: I'm not a doctor, nor have I ever worked in the health care field Just my personal opinions.
My disclaimer: I'm not a doctor, nor have I ever worked in the health care field Just my personal opinions.
First of all you need to know how bad this centrals issue is. Is it without CPAP? is it at a few pressures on CPAP? is it at many pressures on CPAP and worse than off CPAP? If you had centrals during your original sleep study to any degree, you need all the professional help you can get to treat them.
If you had a lot of centrals in the original study then a specialized bipap machine might be needed and O2 might need to be added. Treating Central Sleep Apnea requires a lot more attention to details and perhaps repeated sleep studies.
A straight cpap such as a Pro M series is not neesssarily the best treeatment however it might be if there was one pressure they found during titration that minimized the centrals ans so a straight machine would work.
An APAP might be wrong period if there are a lot of centrals and one of the newer (year old or so or less) machines such as the Resmed VPAP Adapt SV might be needed.
An APAP is not the right machine for everyone and maybe it isn't the right machine for you.
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, bipap, Titration, CPAP, APAP
If you had a lot of centrals in the original study then a specialized bipap machine might be needed and O2 might need to be added. Treating Central Sleep Apnea requires a lot more attention to details and perhaps repeated sleep studies.
A straight cpap such as a Pro M series is not neesssarily the best treeatment however it might be if there was one pressure they found during titration that minimized the centrals ans so a straight machine would work.
An APAP might be wrong period if there are a lot of centrals and one of the newer (year old or so or less) machines such as the Resmed VPAP Adapt SV might be needed.
An APAP is not the right machine for everyone and maybe it isn't the right machine for you.
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, bipap, Titration, CPAP, APAP
Excellent points, Jules, I should have mentioned those as well.jules wrote:First of all you need to know how bad this centrals issue is. Is it without CPAP? is it at a few pressures on CPAP? is it at many pressures on CPAP and worse than off CPAP? If you had centrals during your original sleep study to any degree, you need all the professional help you can get to treat them.
If you had a lot of centrals in the original study then a specialized bipap machine might be needed and O2 might need to be added. Treating Central Sleep Apnea requires a lot more attention to details and perhaps repeated sleep studies.
A straight cpap such as a Pro M series is not neesssarily the best treeatment however it might be if there was one pressure they found during titration that minimized the centrals ans so a straight machine would work.
An APAP might be wrong period if there are a lot of centrals and one of the newer (year old or so or less) machines such as the Resmed VPAP Adapt SV might be needed.
An APAP is not the right machine for everyone and maybe it isn't the right machine for you.
Michael
9cms of airflow makes me a happy camper!
snoregirl wrote:
Whoa, didn't know about that misc billing code. Good point. My case I was already into my rental period by 7 months so it was a non issue. Starting out I can see where the DME could try some billing gymnastics to retrieve more $$$. If I knew what was going on when I started my treatment, I would have checked with my insurance to see if I could get reimbursement after buying online. Don't see a lot of value in my DME, they never call to see how things are going, have only spent a total of 40 minutes with them (over 8 months) and half that time was arguing with them to get the Auto that my doctor had prescribed. No customer care. I understand cpap.com gives great customer care so what would I be missing out on?
Oh well, just my $.02 - maybe only worth $.01
DB
if the DME won't give the APAP as e0601 and wants to use that other misc billing code -- mattman mentioned the numcer in a previous thread (to try to recoop more $$ and they do this because the contract between the DME and the Insurance excludes APAP (whichgives them leverage not to spend the money) and this is a very real possibility, then, while the Insurance company does not have a say in what treatment provides, they do very definately have a say in what they pay for. They all have doctors who review cases and can rule that the treatment is unnecessary or some other treatment will suffice and deny coverage for the treatement (in this case APAP)
Whoa, didn't know about that misc billing code. Good point. My case I was already into my rental period by 7 months so it was a non issue. Starting out I can see where the DME could try some billing gymnastics to retrieve more $$$. If I knew what was going on when I started my treatment, I would have checked with my insurance to see if I could get reimbursement after buying online. Don't see a lot of value in my DME, they never call to see how things are going, have only spent a total of 40 minutes with them (over 8 months) and half that time was arguing with them to get the Auto that my doctor had prescribed. No customer care. I understand cpap.com gives great customer care so what would I be missing out on?
Oh well, just my $.02 - maybe only worth $.01
DB
Yes I know what you mean about little value of DME (to me at least, to some people there is great value, if only we could do what was best for our own situation). But then again I am a plain generic mild apnea patient who is more far impacted by snores waking herself up than the actual apnea. So really I don't need anything from them.
I actually did check out buying online before I settled on using the DME, but my insurance wouldn't hear of it (since they requried a minimum of 3 month rental), so I hauled myself an hour up the road to deal with the DME I didn't need, but in the process saved myself over $400 over buying cash, of course it cost the insurance company a lot more than if I had bought cash, but even with letters and phonecalls I couldn't make them see the light. I console myself with the fact that I gave it a good try for the sake of controlling healthcare costs but in the end accomplished nothing.
Naw, your opinion is worth at least 50 cents!!
I actually did check out buying online before I settled on using the DME, but my insurance wouldn't hear of it (since they requried a minimum of 3 month rental), so I hauled myself an hour up the road to deal with the DME I didn't need, but in the process saved myself over $400 over buying cash, of course it cost the insurance company a lot more than if I had bought cash, but even with letters and phonecalls I couldn't make them see the light. I console myself with the fact that I gave it a good try for the sake of controlling healthcare costs but in the end accomplished nothing.
Naw, your opinion is worth at least 50 cents!!