ResMed cpap 10 vs the 11

Pugsy wrote: ↑

Thu Nov 18, 2021 2:00 pm

The DME might bill out 1440 to Medicare but Medicare will NOT approve that amount and they only pay 80% of whatever amount they approve and then the patient (or their co insurance or supplement) is required to pay the remaining 20% of the APPROVED amount.

Medicare will NOT ever approve any cpap machine billed out as an E0601 at 1440.... which is what the AirSense 10 or 11 models are billed out as.
Now when we get to the higher end bilevel devices that are more special machines and have a different HCPCS billing code from the E0601 machines....those approved amounts are higher.
Actual amount approved for E0601 machines will vary a bit depending on where you live but its somewhere around $600.
Let's use that 600 as an example...it's close...Medicare approves 600 and they pay 80% of the 600 or 480 bucks and you or your co insurance is responsible for the 120 remaining.

The difference between the billed amount of 1440 and what Medicare actually approves gets written off if the DME is a Medicare participating provider (and if they aren't participating you don't want to use them).

^^ 100% accurate, but I will add a couple more details I learned recently...

If the machine includes a heated humidifier -- even integrated and inseparable from the machine itself, as it is in the AS10 or AS11 -- the DME can also bill for CPT code E0562. As with E0601, approved amounts vary for E0562 but are typically around $200. So for the typical AS10 or AS11 purchase, there will be two charges approved -- E0601 and E0562 -- for a total of around $800.

Even when the CPAP machine is billed as a 10-month or 13-month rental, the E0562 charge for the integrated humidifier is often billed "up-front" as a one-time sale. If the machine is subsequently returned during rental, the DME gets to keep that up-front E0562 humidifier payment (patient can keep the "water tub" only, since it is separable). And -- if the DME replaces the water tub and rents the CPAP to another patient, they can bill for a E0562-UE, which effectively gets them roughly another $175 for the humidifier they already sold once before (less the cost of the replacement tub).

Some supporting details here: https://document.resmed.com/documents/a ... gories.pdf

Waiting to get my new Airsense 11...4 more days. The Airsense 10 has been making noises that make sleep difficult.

I have "high deductible" insurance so I opted to pay out of pocket...Insurance doesn't kick in until I've paid out $3500.

Airsense 11
New heated hose
New P10 full mask/headgear/pillow

Total: $668

Care Medical, Athens, GA

gearscout wrote: ↑

Sat Apr 16, 2022 11:51 am

Airsense 11

Praying you bought an AutoSet.

ChicagoGranny wrote: ↑

Sat Apr 16, 2022 1:58 pm

gearscout wrote: ↑

Sat Apr 16, 2022 11:51 am

Airsense 11

Praying you bought an AutoSet.

+1,000,000
(I also hope you compared prices. My first Autoset came from cpap.com,
--the sponsors of this free forum)
If the local guys have not yet delivered; and they are screwing you,
it's not too late to cancel the sale

Follow-Up - Initial Impressions

I got my Airsense 11 (Autosense) on 4/20/2022 and have had a chance to try it out. I purchased it "in cash" with no use of Medicare or my private insurance (because it's a high-deductible policy, it wouldn't cover it.) I had requested it months ago from my usual DME supplier, CARE Medical in Athens, GA.

Airsense 11 $550 (including new heated tubing and standard carrying case + filter pad)
Tax 33

The Airsense 11 is very quiet. I bought this unit to replace my noisy Airsense 10. I suspect the older unit (3 years) was dropped or fell. The onset of the noise came suddenly and I have no other explanation. I will now research the best way to send in the older unit and get it repaired (if possible). Hard to say its quieter than the older unit because I've been listening to it "wheeze" on intake for months. But the Airsense 11 seems almost silent to me.

The newer unit is sleeker in design but the plastic is noticeably thinner. You immediately notice this when examining the water reservoir and body of the Airsense 11. That doesn't mean it won't be durable but you will see a difference.

You need a new heated tubing hose. (Approx. $30) because the one that worked with your Airsense 10 doesn't fit. Everything seems the same but the older hose-to-machine fitting is just a tiny bit larger and can't fit in the new Airsense 11. That said, the new connection does not permit you to rotate it so you can reduce any bending by turning the connector. I keep my CPAP on the nightstand. This means an almost 90-degree bend in the hose at the back of the machine. I will reposition it as best I can to reduce that, but Resmed has clearly "cut corners" by eliminating the ability to rotate the connector to reduce the manufacturing costs IMHO. I never really had to replace my old hoses because of any leaks. I routinely switched them out at least once a year. The new hose appears just as durable but I wonder if the "bend" will lead to more strain and wear.

The new LED screen is bright enough and clear to read despite its small size. Options for the Airsense 11 are very similar to the Airsense 10. Depending on your night vision, it shouldn't pose any problems but some of the onscreen choices like "Options" or "Sleep Report" are small and "Subsets" of Data info are tiny. Gone is the rotating knob that would toggle between those choices. You've got to press the screen. There is a single "Power" button on top of the Airsense 11 that will turn the unit on and start or stop the CPAP function.

[You access "Clinical Mode" by pressing both main onscreen buttons (Options and Sleep Report) at the same time. Experienced users still get easy access to these settings they're never supposed to see.]

You can adjust your "Options" to enable auto-start and auto-stop for the CPAP functions. Put on your mask and start breathing into it and the Airsense 11 will initiate a ramp-up or quickly increase your pressure to your lowest threshold in a matter of seconds. Remove the mask and air will rush out for about 5 seconds before the Airsense 11 powers that off. It's an improvement. No need to fiddle with buttons in the dark.

Your "Sleep Report" has expanded the access you have to Data. Some of what you might have found by putting your Data through OSCAR is now available. None of the cool graphics, but the core readings. Small options appear on the display screen to enable you to select the amount of time the Airsense 11 was in use. Or you can select the number of "incidents per hour" without having to use the "My Air" app on your phone. It appears no matter which view you select, you can get a complete overview by swiping UP on your Airsense11 touchscreen. This will include time used, highest pressure reached, AHI counts, leakage etc. It's an improvement, IMHO.

Connecting the new Resmed Airsense 11 to your phone is easy enough. Guides appear onscreen. That's Bluetooth. But the data connection from the unit to the outside world appears weak. I only get one bar...the tiniest one, of course. Too early to say if that poses any problems. My healthcare provider monitors those.

A final note: even the power unit and cabling appears lighter weight. Specifically, the cord from the USB-like plug on the back of the Airsense 11 to the power block is about half the "weight and size" of the old Airsense 10's cable. Hard to judge whether it will mean future failures like every Apple Macbook Pro charger I've ever owned!

I hope this information helps someone.

gearscout wrote: ↑

Thu Apr 21, 2022 7:26 am

Follow-Up - Initial Impressions

thank you very much for the detailed review!

i'm sure it will help someone.