Do I need a DME?

Hi All.

I'm new hear and will provide a proper introduction soon but first I have a quick question.

I have federal Blue Cross/Blue Shield insurance. As such cpap.com is a covered provider and I can buy everything I would want/need from them.

Just today I had my follow up after my titration with my sleep doc and he put me in touch with a local DME.

I talked briefly with the DME and when I mentioned I was hoping to get an APAP he told me that wasn't necessary and I shouldn't get one because it was more expensive. Needless to say this rankled me and I told him I'd think about it and get back to him.

So if I can buy online and be covered what do I lose by not using a local DME?

This entire process has gone on with very little input from me and it's probably my fault. I have a hard time speaking up when they doctor I'm with is supposed to be a specialist in these areas.

If you can set up your VCR to record, or program your phone answering machine you don't need a DME. Some DMEs let you try different masks but others won't. An extra mask or two is $100-$150 each online. Not worth (in my opinion) the hassle of using a local DME.

Make sure your titrated pressure is not too high (BI LEVEL land) and you don't have other health issues that might cause an APAP to be inappropriate for you. You don't want to buy the wrong machine online. You won't be able to exchange it. But if your pressures are average and you buy a top of the line APAP (only about $200 more) than you can use it as a CPAP or APAP and I can't see why you should need to trade it). Some will say try a bunch of brands of machine. I know very few people that have been able to do that even with a local DME. Online you buy it, you own it.

If you are a normal, otherwise healthy individual with OSA the DME can be an annoying and expensive way to go.

If my insurance had covered CPAP.com I would have run here. As it is I am buying my back up machine (insurance won't cover another but I want it anyway) and all future supplies here.

You can use CPAP.com with insurance if your insurance allows you to purchase without rent to buy, and they allow YOU to submit the bills. CPAP.com will not submit bills or deal with insurance for you.

Bill my insurance will. Prices are similar to local DMEs.

At CPAP.com you can submit your CPAP prescription and get an APAP.

No matter what you decide to do get your prescription and copies of your sleep studies from the doc for your files.

sybert1ger wrote:So if I can buy online and be covered what do I lose by not using a local DME?

You will lose nothing, imho, by buying your machine online since you say your insurance covers buying from cpap.com. Or perhaps you are talking about cpap.com's sister company: billmyinsurance.com

A prescription from any doctor will let you buy whatever autopap you want from cpap.com as long as the prescription has at least one word on it... "cpap." The word "autopap" will do, too, but is not necessary..."cpap" will buy an autopap from cpap.com too.

You might want to check with the local DME about their mask try-outs. If the local DME will let you keep swapping masks until you get a mask you really like, that's about the only advantage in using the local DME. Just for masks.

I'd get the machine I wanted from cpap.com and try out some masks from the local DME. I don't think you have to buy everything from one place.

I've been on "cpap" (autopap) for over three years now, and have never dealt with a DME, not even at the beginning. Been getting good treatment all along by picking my own machine and my own mask(s). The mask is the most important part of the puzzle to get right. Far more important, imho, than what machine we choose.

Yeah, I do believe that with the help of the message board most people who are so inclined can handle their own equipment choices and their own treatment.

Do you need a DME?

That's a little difficult to have answered across an internet message board. There can be a lot of factors going into it.

My short-form answer to you would be:
So that would be my answer to you. The comfort level of not having local hand-on support against the reasons why you want an APAP.

The more in-depth answer would be:

If you are comforatble going it more or less alone, then you will be fine. You can get support here and on other message boards - but not hands on. So decide if that is something you are comfortable with. If so, then ordering online may be the way to go.

snoregirl wrote:If you are a normal, otherwise healthy individual with OSA the DME can be an annoying and expensive way to go.

That's the one thing everyone tends to get confused about. The costs WILL BE THE SAME either online or through a DME since you are using insurance. The Insurance Companies set the prices much higher than if you were to pay cash.

In my experience with most DME providers, things are actually generally less annoying then ordering online.

You didn't mention why you were looking to get an AutoPAP. The reasoning behind that may be the single largest determining factor as to which is easier to go.

Online providers are not regulated and therefore can provide Auto units without a specific prescription. Traditional DME providers, being regulated by the FDA and OIG do not have such leeway.

If you are simply wanting a unit that has data recording abilities and want to get a card reader and software - many regular CPAPs will provide this.

In this case you could just have your doc send over a prescription for such - the DME provider would collect all the needed paperwork, provide the equipment and then bill the insurance.

In 99.9% of our cases the sum total of work the patient has to provide is to sign the paperwork when we deliver. That's it.


mattman

P.S. - In case it wasn't already obvious and so no one accuses me of being underhanded - I work for a DME. No I don't stand to profit regardless of what this individual choses.

I started this "journey" almost 2 years ago. I've never had the need for a local DME. I purchased all of my equipment from CPAP.COM and submitted an invoice to my insurance provider.....who reimbursed me for 80% of my expenditures (excluding cardreader and software).

If you do your "homework" and can read, you can do this without a DME. IMO.

Best wishes,

Den

Being fairly new to this myself (June 2006), I never even thought about purchasing online. My local DME is 3 miles away and they are extremely personable and helpful. I have tried different masks in their office, picked up supplies same day (i.e. filters, chin strap), called with questions, etc. and have been very satisfied. While I'm sure that some may not have had the good experience that I have had, I personally would prefer dealing hands on with my local DME than ordering online and taking the chance that something is not right. I do plenty of shopping online, but I feel CPAP purchases are best done in person if at all possible.

I researched the option of DME versus buying online very carefully, primarily because I have almost a dead zone in my brain when it comes to mechanical things and was worried about setting the system up. I opted for the online purchase, figuring that this forum's advice would get me through the mechanical difficulties eventually. I really wanted total control over my treatment and my decisions (I do have a good sleep doctor, who actually recommended cpap.com as a viable alternative.)

I've been on cpap for a month and couldn't be more thrilled with my decision to buy online. Carefully reading the posts on this forum and the evaluations on cpap.com helped me put together a machine, mask, and accessories that work great. Every time I had a question or a problem (and I've had a few), rthe kind folks on this forum have almost immediately provided online advice and assistance. The search function is also invaluable in researching issues that have already been addressed.

The most important advantage to buying online, in my mind, is the access to the software (I don't think you can normally obtain the software from the DME). Every morning, I look at my Encore Pro results from the night before. The numbers have helped me tweak a lot of things in my treatment, including taping versus the nosebreathe device, masks, and pillow sizes. It also helped me see that a full face mask worsens my OSA, something I'm not sure the DME would have figured out. Just seeing the results of using the cpap on a daily basis has been immensely encouraging. With only one month of experience, I simply can't imagine having to rely on a DME.

I'm not affiliated with cpap.com and know nothing about respiratory therapy. I'm just a fellow OSA sufferer who believes that nobody cares about my health as much as I do so I might as well take charge of it.

sleepergal wrote:I'm not affiliated with cpap.com and know nothing about respiratory therapy. I'm just a fellow OSA sufferer who believes that nobody cares about my health as much as I do so I might as well take charge of it.

My sentiments too, sleepergal. Ditto, ditto, to what you said!

Once again I have been quoted and interpreted out of context.

I said specifically further down in the previous post that if your insurance company allows YOU to bill them and allows a straight buy vs a rent to buy when referring to the lower cost and annoyance of the typical local DME. I don't think Mattman bothered to read my WHOLE post before latching onto this one issue (cost and annoyance) and commenting negatively.

THAT (online purchase where you are allowed to bill the insurance co yourself as in network) IS AND WILL BE cheaper. Not the same price as an local DME or Bill-My-Insurance. Even if you have no deductable and no copay it is at least equal even though in the latter case the insurance company pays significantly more even though you don't. But as I said, my original comment was based on you being allowed to bill the insurance yourself for the setup.

I will also add....

Even in some cases cash out of pocket with no insurance reimbursement may beat the local DME cost depending on your insurance copay and deductable

Excuse me mattman

How much personal online ordering of machines and supplies have you done? Seeing as you work for a local DME.

MY experience was everything about the DME was irritating. Waiting for them to order the machine, scheduling an appointment, driving 45 minutes to the place, sitting while my appt time goes by, having them set it up wrongly, not giving me the correct filters, having them run the machine without the hose attached as one is warned not to do in the manual, having them do it again after I asked them to stop, having them withhold the manual that I had to procure on ebay......etc.

I can't see how that is better than a nice package arriving at your door with all the manuals and parts that should be there and spending 15 minutes opening and setting up.

Coming up on my 4th year as a hosehead, and have NEVER been to a DME, and have only seen a sleep doctor twice (each time to get a prescription for a Remstar Auto).

If you are comfortable doing this yourself, you will probably save yourself alot of aggravation.

If you are comfortable doing this yourself, you will probably save yourself alot of aggravation

How true! Since January of 2001 I have used: The local DME, Yahoo Auction and cpap-dot-com.

If you place a dollar value on stress, do it yourself. For me, the out-of-pocket expenses have been about the same for
either the insurance-backed DME and just buying what I need when I need it..

I am 100% compliant, since February 2006. That's when I started doing it myself. Could there be an inverse relationship between DMEs and compliance?

One other option if you think you might be more comfortable at first w/a local DME is to have your scripting doctor write the order for the SPECIFIC machine that you want. That way the DME can have no argument w/providing you with that machine.

I have done both ... used a DME and ordered online.

If your insurance will accept/reimburse your online purchase ... ditch the DME cuz they are of minimal use and may even lead you in the wrong treatment direction so that they can maximize their profits.

If your insurance will only work with DME, then calculate and compare your costs savings in order to decide which way to purchase your equipment.

The DME folks I dealt with were nice (but service was minimal to incorrect -- told me it was not possible for me to get efficacy data out of my machine and thanks to this forum I discovered how to get the data out of my machine) ... but CPAP.COM folks are nice too (and more honest).

Well, you must understand that unless the scripting sleep doctor indicates on his script that you be given access to the Efficacy Data menu the local DME can NOT give you access to it.

The Efficacy Data menu can be accessed two ways: via the Advanced Menu for patients (I'm not even sure most sleep docs are even aware of or even think about allowing access to this) or via the Clinical Menu which the medical profession does NOT want you to have access to as this is the menu in which you can change your pressure settings.

The impression I've been getting is that MOST sleep doctors don't have the foggiest idea of what information the various manufacturers make available via the menus on the "smart" machines and/or which is which. I've also gotten the impression that most sleep doctors aren't interested too much in anything but the compliance data. UNLESS the patient contacts them w/problems or complaints and then it is often the sleep tech who has the answers rather than the sleep doctor. I got the impression from one sleep lab that the sleep tech or the person doing the actual scoring pretty much determined the pressure needed and the sleep doc didn't do much more than sign the script.