BiPap St Cost $$$$$

DMEs seem to lie as standard practice. And of course, they make the most profit on the machines, so they really want to sell you a machine.

My insurance rents the first couple months and converts to a full purchase if you meet compliance. About 6 months in, they mailed a new SD card with a mailer to send the first one back. Since I met compliance, the purchase was finalized.

Now, the fun part. I had trouble getting the mask to fit. I learned on this forum that smaller headgear was available, so I requested it. The DME told me no such thing existed. I sent them a link to cpap.com with the smaller headgear. They replied that they cannot order it. I called another DME, one I did NOT buy the machine from. Three days later, the new headgear arrived in the mail. Solved my mask fitting problem. Never talked to the first DME again. I don't deal with liars.

I'm waiting for a follow up from insurance because I'd like to be sure just so I feel better about keeping gear coverage, but everything is pointing at the DME being a LIAR. That's loooking pretty clear. The thing that through me off was her encouraging me to look for masks online if I wanted to buy anything outright without insurance. Looking like that was a cover for the lie or they just simply don't care about the lower profit masks. I did get a free mask out of them yesterday. That also must have been an effort to smooth me over and get me off the idea of buying my own machine. Thing is I did talk to her about calling insurance to verify and see how I could make buying my own work.

There is a large part of me that wants to make a big deal out of this when I take my machine back. I'm nearly to the point that I would pay more $$ to take my business anywhere else I'm so ticked off at these losers. How do they stay in business if this is common practice?

I would consider paying out of pocket--no hassle from a DME and no worries about a deductible. The accessories are not that expensive because you don't have to replace them nearly as often as the DME claims.

Hoses are cheap and basically never have to be replaced unless they get a hole in them. There is no real reason to wash them (wear and tear) unless you get a cold.

Filters are super cheap on eBay and you can buy them in bulk should you wish.

Mask cushions should last at least several months. The headgear will last longer. The frame essentially forever. When I find a good deal on a cushion I just buy 5-6 of them and throw the spares in a drawer. I only use baby wipes to "clean" the cushion every day, which saves wear and tear on the cushion. I do an actual wash of the cushion in hot soapy water maybe once a month.

tsduke wrote: ↑

Fri Sep 13, 2019 7:00 am

How do they stay in business

They stay in business cause most people are like sheep and they do what ever the DME say's they have to do.
[/quote]

You know with your high deductible insurance...unless you routinely meet it or come close... your worry about the cost of the masks and other stuff being covered by insurance is sort of a moot point anyway.

Once the initial setup is complete and you have a mask you are happy with...it isn't horribly expensive from now on.

None of the consumables have to be replaced anywhere nearly as often as you see recommended.
Mask frames, hoses, water chambers will last years with common sense care.
Mask cushions can last months and months with common sense care.
Headgear ....depends on the headgear and how quickly it gets stretched out or falls apart....but typically will last at a minimum of 6 months.

In over 10 years I have replaced the water chamber twice from failure to keep the seal and both times it was a direct result of some dumb ass (me) dropping the chamber on the hardwood floor.
I had one heated hose that went through 3 different machines and had over 15K hours on it and was still working just fine when it got retired because I changed models of machines and it no longer would work on the new model.
Filters are dirt cheap when bought in bulk off EBay or Amazon or even OEM when bought in bulk.
I get filters in bulk that end up costing me less per filter than my co pay would cost me if I got them through my DME and used my insurance.

So unless you routinely meet that deductible for other health reasons or come close to it...having your insurance pay for your consumables isn't going to make that big of change in your wallet once the deductible resets come January.

Yea, I'm sure I will learn what works best over time. We have a weekend/vacation place on the Missippi River which means my machine and gear will be traveling back and forth a lot. Hopefully that doesn't add too much wear and tear. Looks like they charged $140 for my first mask with a net of $125.90. Had for under $100 anywhere else at their regular price.

I'll talk to my sleep doc monday at my appointment and make it clear I want to purchase my own and see what his thougts are. I won't cost me much to ride out as much of 2019 as I want with the rental, but at this point I want to cut my DME off out of spite.

I totally understand the "spite" reason.
Been there and done that myself. I fired my very first DME years ago because I caught them in a lie for one thing and the other thing was they talked to me like I was a dufus and didn't know anything. I absolutely hate being talked down to.

Had to go from a DME 1/2 mile from where I lived to another one 12 miles away and the first thing I told him was "don't ever lie to me about anything and we will get along just fine". I told him I already had my own machine (bought privately because I found a new one cheaper than my insurance copay) and I only wanted him for masks and accessory stuff as I need it...he said "we are fine with that but if you need help with the machine we will help you with it"....that's what they should say.

tsduke wrote: ↑

Fri Sep 13, 2019 9:35 am

Yea, I'm sure I will learn what works best over time. We have a weekend/vacation place on the Missippi River which means my machine and gear will be traveling back and forth a lot. Hopefully that doesn't add too much wear and tear. Looks like they charged $140 for my first mask with a net of $125.90. Had for under $100 anywhere else at their regular price.

I'll talk to my sleep doc monday at my appointment and make it clear I want to purchase my own and see what his thougts are. I won't cost me much to ride out as much of 2019 as I want with the rental, but at this point I want to cut my DME off out of spite.

It might be worth getting a backup machine and mask for the weekend place once you have proved compliancy that will save you lugging one machine arround

Pugsy wrote: ↑

Fri Sep 13, 2019 9:03 am

So unless you routinely meet that deductible for other health reasons or come close to it...having your insurance pay for your consumables isn't going to make that big of change in your wallet once the deductible resets come January.

I got my main machine with insurance in 2012. The sleep study went past my deductible. I got 3 masks that year, and I still have them. This is the first year since then that I have met my deductible. I actually met my out of pocket cap. I should get another DME and get some supplies while I am at 100% coverage. technically, I could probably get a new machine, but I have no idea if I would have to do a sleep study and that would probably push compliance into the new year and cost me. I don't really need a new machine yet anyway. I have two ResmedS9 autosets. And I was recently given an Airsense 10 Autoset which I set up for my mom in case she wants to sleep in the bedroom recliner. She normally sleeps in the living room. So, we have 4 machines in the house, all good and functional.

Since I had several years of not getting past the deductible, I just bough mask cushions on ebay or craigslist when I would find a good deal. I usually get 6-8 months per cushion on the main machine. Longer on the travel machine since I don't use it that much. I have a spare hose, spare headgear, spare complete masks, an extra cushion, and even an extra power pack. I do a lot of shopping via craigslist and sometimes ebay. I have a list of things that I am looking for, most without any rush. Just things I would like or know I will need in the future. I check for them a couple times a week, so when a good deal comes along, I can get it. And I can find most items without having to pay full price.

Jas_williams wrote: ↑

Fri Sep 13, 2019 10:46 am

tsduke wrote: ↑

Fri Sep 13, 2019 9:35 am

Yea, I'm sure I will learn what works best over time. We have a weekend/vacation place on the Missippi River which means my machine and gear will be traveling back and forth a lot. Hopefully that doesn't add too much wear and tear. Looks like they charged $140 for my first mask with a net of $125.90. Had for under $100 anywhere else at their regular price.

I'll talk to my sleep doc monday at my appointment and make it clear I want to purchase my own and see what his thougts are. I won't cost me much to ride out as much of 2019 as I want with the rental, but at this point I want to cut my DME off out of spite.

It might be worth getting a backup machine and mask for the weekend place once you have proved compliancy that will save you lugging one machine arround

I'm a *strong* believer in having a spare *everything* ... including the machine, whether that spare stays in a bag ready to be grabbed to go somewhere (hospital, vacation, whatever) or it's at a different house...

So had follow up with my sleep doctor and is on board with ASV\AutoSV if I want to give it a try. He cautioned that not all patients take to that style of machine but he's open to it. Also cautioned on cost if it doesn't work. He also mentioned something about a study of increased mortality rates in patients with certain heart condition and insurance sometimes wants an echo done first. I had an echo last year and not planning to use insurance anyway.

He seems very easy to work with and actually likes that I'm educating myself in order to get best treatment. Said best results come from patients who take some ownership in this. Only thing I wasn't really excited about is he was actually happy with my results of 7-8 AHI at this point. I want better, but I'm also impatient

He wrote a script for Auto SV but I think it should be good for either PR or Resmed version if I assume correctly.

Here's the deal with ASV and people in congestive heart failure (and pretty bad failure at that).
Some years ago there was a limited study (not many patients) done on the mortality rate for ASV users that had bad congestive heart failure (ejection rates below 45) and it seemed like more of them died than was consistent with ASV users without congestive heart failure issues. Some things to note about the patients in the study...the bulk of the ones that died weren't even using the machine all night or every night. Average hours of usage was less than 4 hours a night.
So they had a higher death rate among ASV users who were already very sick with a bad heart to start with and those people weren't very compliant or consistent with their ASV use.
Hmmmm....was it the lack of consistent use that was a factor in the increased mortality or the fact that they were really sick to begin with that was the problem.
We don't really know...it wasn't a big study and it was full of holes since the bulk of the participants didn't even use the machine all night anyway.
But the final result, because people wanted to play it safe, was to advise people with really bad congestive heart failure to not use an ASV at all because it might increase the mortality rate.

Hopefully one of these days they will do a better study with participants who actually use the machine like they are supposed to use it.

But that's why people who need or want to try ASV are advised to know the status of their heart and have an echo done if they haven't ever had one done just to make sure they aren't at risk...if there is a risk. Your echo last year should be sufficient documentation that your heart is okay if your insurance requires it. Not all insurance will require it.

Any study is only as objective as they WANT it to be.
Like stacking the deck.

Doc talked of the study with similar tone and also said a better study really should be done as well.

My heart all checked out fine. Had several heart related tests done last year chasing that before cardio suggested sleep study when all the testing was good. Probably a dead point anyway since I'm likely bipassing insurance.

The ASV will likely be priced higher than the ST was and you already know what your insurance allowed for the ST and what will happen after the first of the year.

It's pretty much a no brainer to bypass insurance at this point once you factor in all potential out of pocket costs after the first of the year.

I do recommend the ResMed ASV though. I think that you will be happier with it than the equivalent in the Respironics models.
It is quieter for one thing and the algorithm is a bit superior IMHO.