True or False? Questions from a newbie

I was recently diagnosed with severe apnea via an in-lab sleep study. (Mostly OSA with a touch of CSA for style points). I'm in the US and my insurance tells me they cover the full cost of a CPAP if I have a prescription. I definitely am very grateful for this and the help I'm able to get to fix this problem.

However, I talked to the lab today about next steps to get set up with CPAP and they are telling me there's only one way to do things, and it goes against a lot of the recommendations I've read here on the boards. Here's what they told me... I'd very much appreciate any comments on whether these things are actually inviolate truths or if there's some wiggle room if I insist in just the right way (or get my cool regular PCP to help somehow)...

• I have to go through a DME to get my equipment and there are two which I may use.

• I cannot get my Rx from the sleep lab or associated sleep specialist doctor and then use it to purchase my own CPAP (through insurance) from an online vendor.

• OK, maybe it would be possible to use an online vendor but it's a terrible idea because there would be no support and no trying out masks and the sleep lab couldn't deal with it.

• Insurance NEVER pays for a travel machine, even if it's used for an all-the-time home unit as well.

• I can ONLY get an Airsense 10 or a Dreamstation because those transmit the data cellularly to the lab/insurance.

• I have to have a sleep tech from the DME come to my house to set up the CPAP.

• I'm not allowed to adjust it or experiment in any way with pressures but have to go see a sleep specialist's PA several times who will do this remotely.

You might gather from my list of concerns that I'm pretty independent (and tech savvy and able to do research) and don't really want all this bother and hand-holding and being "locked in". I don't mean to sound cocky, I just want to do this right since it's an expensive piece of equipment I'm theoretically going to have for half a decade. I also would REALLY like a travel unit, as I have quite a bit of travel planned in the next 5 years and tend to go ultra-light with just a small backpack. I'm not going to be able to easily afford an expensive travel CPAP out of pocket and am totally willing to use a noisier unit all the time if I can get one as my main squeeze through insurance. I'm also sort of generally surprised about this ongoing relationship I have, apparently, to have with this sleep lab (at a local hospital). I understand support is important, but...

Thanks for any insight!

cordelia wrote: ↑

Thu Aug 15, 2019 8:22 pm

I was recently diagnosed with severe apnea via an in-lab sleep study. (Mostly OSA with a touch of CSA for style points).

I talked to the lab today about next steps to get set up with CPAP and they are telling me there's only one way to do things, and it goes against a lot of the recommendations I've read here on the boards. Here's what they told me... I'd very much appreciate any comments on whether these things are actually inviolate truths or if there's some wiggle room if I insist in just the right way (or get my cool regular PCP to help with the insurance co)...

• I have to go through a DME to get my equipment and there are two which I may use.

• I cannot get my Rx from the sleep lab or associated sleep specialist doctor and then use it to purchase my own CPAP (through insurance) from an online vendor.

• OK, maybe it would be possible to use an online vendor but it's a terrible idea because there would be no support and no trying out masks and the sleep lab couldn't deal with it.

• Insurance NEVER pays for a travel machine, even if it's used for an all-the-time home unit as well.

• I can ONLY get an Airsense 10 or a Dreamstation because those transmit the data cellularly to the lab/insurance.

• I have to have a sleep tech from the DME come to my house to set up the CPAP.

• I'm not allowed to adjust it or experiment in any way with pressures but have to go see a sleep specialist several times who will do this remotely.

You might gather from my list of concerns that I'm pretty independent (and tech savvy and able to do research) and don't really want all this bother and hand-holding and being "locked in". I also would REALLY like a travel unit, as I have quite a bit of travel planned in the next 5 years and tend to go ultra-light with just a small backpack. I'm not going to be able to easily afford an expensive travel CPAP out of pocket and am totally willing to use a noisier unit all the time if I can get one as my main squeeze through insurance. I'm also sort of generally surprised about this ongoing relationship I have, apparently, to have with this sleep lab (at a local hospital). I understand support is important, but...

Thanks for any insight!

With the exception of the question about insurance paying for an additional travel machine, in my opinion, the other answers are "False".


Den

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cordelia wrote: ↑

Thu Aug 15, 2019 8:22 pm

I have to go through a DME to get my equipment and there are two which I may use.

I cannot get my Rx from the sleep lab or associated sleep specialist doctor and then use it to purchase my own CPAP (through insurance) from an online vendor.

OK, maybe it would be possible to use an online vendor but it's a terrible idea because there would be no support and no trying out masks and the sleep lab couldn't deal with it.

Insurance NEVER pays for a travel machine, even if it's used for an all-the-time home unit as well.

I can ONLY get an Airsense 10 or a Dreamstation because those transmit the data cellularly to the lab/insurance.

I have to have a sleep tech from the DME come to my house to set up the CPAP.

I'm not allowed to adjust it or experiment in any way with pressures but have to go see a sleep specialist's PA several times who will do this remotely.

You are entitled to a copy of your prescription. As far as purchasing through an on line DME and having your insurance pay is a question for your insurance company to answer. Sometimes, they will reimburse on line purchases, but only for the amount they have negotiated with their in network suppliers. If the on line price is higher than what they pay their in network suppliers, you will most likely be responsible for the difference. There is nothing that says you can't get a copy of your prescription and pay for supplies out of your own pocket. Check with your insurance company to see which DMEs are in their network. If you want the insurance to pay for the machine and supplies, you will need to use a DME within their network. There may be more than two near where you live. You can't expect the sleep lab to know which DMEs are in every insurance company's network.

Many on line suppliers allow a 30 day trial period for masks. They can be returned any time during that period of time for a refund. There may be a small charge for "insurance" to allow the return.

The Air Sense 10 and Dreamstation are both very good machines. It is highly recommended to stay with one of these two brands.

The DME may, or may not come to the house. I picked mine up at the DME and it was preprogramed with my prescription. My wife's machine came from an on line DME and they came out to the house and programed it for her while sitting at the kitchen table.

As far as adjusting your machine, ALL DMEs tell you that you can not do it. However, most of us here on the forum do it. I was told the same thing, but it didn't stop me from making changes. When I went for my six month check, they commented about me making changes, but once they saw what my results were, they never said another word.

Thanks Okie bipap —

Somehow that all makes me feel better. I just want to make sure I'm not being dumb and getting manipulated by "the system" somehow.

I guess since the lab apparently only likes 2 machines and they're both good ones, and I can eventually go rogue with adjusting my treatment myself if I need to, it will really all be ok.

Contact your insurance, and get a list of THEIR providers.

Three levels of analysis.

Financial. You are in the US with decent insurance. In a broad sense, that likely means that your insurer has a list of DMEs that are in their network. In the long term, this often means the insurer will establish a price that the network providers agree to accept with you paying a certain percentage. With XPAP, it is typical that is converted into some sort of rental arrangement. You need to demonstrate compliance or the insurance will stop paying.

If you go out of network, you typically pay a higher percentage (although cost may be more or less). And the insurance viewing things as a rental is not always easy. You need to work out which way makes the most sense.

Convenience. If the DME is customer focused, a local shop can be very nice. For example, I was able to try at least six models in their shop. Several were an almost instant no. They let me take home two to try for a few weeks (and just bring at least one back within the 30 days). OTOH, if they only order stuff for you...

Relationship with the sleep clinic. They seem very rigid and some of their comments strike me as a bit, umm, untrue. My guess is that have developed a fairly cozy relationship with the DMEs they use. Your clinic will be unhappy if you don't use their DME. Do you care? (I likely would have already moved on from the clinic...)

cordelia wrote: ↑

Thu Aug 15, 2019 8:22 pm

I also would REALLY like a travel unit, as I have quite a bit of travel planned in the next 5 years and tend to go ultra-light with just a small backpack. I'm not going to be able to easily afford an expensive travel CPAP out of pocket and am totally willing to use a noisier unit all the time if I can get one as my main squeeze through insurance.

You think you really want a travel unit. There are a lot of compromises in a travel unit -- for some they are worth it. But you really don't know enough yet to know if the sound of one over the other will bother you, whether you are fine with the humidity options, etc.

When I throw my non-travel unit in the bag, it really isn't that huge. OTOH, if I was backpacking and needed to carry the unit and batteries....

cordelia wrote: ↑

Thu Aug 15, 2019 10:09 pm

I guess since the lab apparently only likes 2 machines and they're both good ones, and I can eventually go rogue with adjusting my treatment myself if I need to, it will really all be ok.

Except that they really are way more than two machines. There is the AirSense 10 (Autoset, Autoset for her, Elite) plus the Airstart and the AirMini. My pick off that list is the Autoset For Her followed by the autoset. Dreamstation also has many flavors...

If you are interested, I would ask here: ResMed or Respironics, which models to ask for; which ones to avoid.

cordelia wrote: ↑

Thu Aug 15, 2019 8:22 pm

I also would REALLY like a travel unit, as I have quite a bit of travel planned in the next 5 years and tend to go ultra-light with just a small backpack. I'm not going to be able to easily afford an expensive travel CPAP out of pocket and am totally willing to use a noisier unit all the time if I can get one as my main squeeze through insurance.

Buying a travel unit, especially as a first unit and your only unit is probably a mistake.

Depending on which one you get, disadvantages can be:

• Much noisier
• Less mask options
• No data
• Not well supported by community
• Less humidification options
• Possibly more

Simply put, if CPAP units could have all the features and functionality at the size of the travel units (without sacrifice) then they all would be.

Mostly False...Call your insurance regarding the purchase of a Travel Machine. If the lab sells equipment...DON'T buy from them.

I have an aircurve vauto. It is a bilevel machine. It comes with a really nice carry bag for travel and it is not all that big. I think if you take the humidifier out and buy a side cover it is pretty small to start with. My understanding is, as a medical device it is not counted toward your one bag carry on.

Cordelia, it’s great you are about to start treating your apnea. Be sure to get a machine that can auto-adjust and that has an SD card capability. As between a PR machine and a ResMed machine, I prefer the latter because it follows the timing of my breathing instead of trying to predict it. Much more comfortable, for me at any rate.