Who decides what CPAP Machine you get?

Just wondering here. I am feeling lucky that I was issued a ResMed Autoset 10 with Heated Hose when I was diagnosed with Sleep Apnea 2 weeks ago but I did not choose it, it was sort of assigned.

The doctor said a prescription would be completed and someone would be in contact with me. I was referred to a DME of their choosing and was told what I was getting.

Looking back I wonder if I would have had the option of telling the doctor of what specifically I wanted as far as a machine and equipment. I mean it is a prescription correct, and we have a say of what type of medicine we receive. Is a CPAP any different?

Just wanted to get your guys feedback. My brother may be a candidate for CPAP and I want to be sure he does not get stuck with something not good.

Thanks.

Usually the DME decides brand and model unless the doctor specifies something specific on the order for the machine.
So if someone wants something specific they need to get the doctor to be specific so that there's no room for the DME to substitute.

SJ-Paddler wrote: ↑

Fri Feb 18, 2022 10:10 am

Looking back I wonder if I would have had the option of telling the doctor of what specifically I wanted as far as a machine and equipment.

Pugsy nailed it. In most cases the DME decides which product will give them the most profit.

The patient can have the final say BUT -- in todays market it will depend on if the patient wants to hold out for who know how long for something that may never come.

I remember some years back I insisted on a certain make & model - has the doc write the make & model on the order. Once I had all the paperwork in hand I called a DME to make certain they where willing to provide this exact equipment to which they (the person on the phone) agreed which began the waiting period in which the Dr. rewrote the script 5x in 4 weeks (for some reason they weren't happy with what was written). At which point I went to Apria who I had done business with before, so was familiar with their tactics.

So I was up front with them, told them what was going on, and told them whoever came thru first I would do business with. The 1st DME tried several times to get me to accept what they wanted to give me but I insisted because I already have supplies for this model that IS what I want - you agree to it. I already had a cpap so it was not a problem waiting.

The short story is Apria came thru even tho they didn't accept the paperwork I gave them - for some reason I guess this happens a lot in medicine - they didn't accept the paperwork I brought to them in person but wanted to get the equipment order (we call it a script but) it is an equipment order directly from the Dr. and managed to do that in a week.

However, I did refuse to provide Apria with a credit card which they like to do to everyone. I let them know there would be no problem with billing if they got their billing codes right. Apria also screwed up and had me sign the wrong paperwork which I guess I could have yanked them around on but didn't - not my style.

Another 3 weeks later this 1st company called to say my cpap was in. I think I waited another week or two to call them back to tell them I was all set. She asked me where I got my cpap - I said that doesn't really matter but since you have all my paperwork IF you want I will get my supplies from you if you can provide my fav mask. She agreed and that went fine until they decided they didn't want to sell me the mask I was using.

Too bad, soo sad. They are now out of business.

Todays market is soo much diff so it depends on how the patient wants to handle things.
But I would insist on an auto cpap (most are today) as they give you more options and I would want one that is compatible with OSCAR. Anything else and not only are you a beta tester for some foreign company but the knowledge and help you get will be much slimmer.

HTH

A month ago I came due for a new cpap machine, being at the 5 year mark on Medicare. My DME called me to come in, saying they had a machine ready for me. When I asked which machine it was they said they couldn't tell me that information. When I got there, they brought out a Res Vent machine, singing it's praises but when I told them I didn't want it and would just wait until a ResMed became available, the tech started whispering to me that indeed, it was not as of as a good a quality or comparable to ResMed. She said she had no idea when I could receive a Resmed though, with the shortage, back orders, long waiting list, etc. I live in a tiny town in the mountains of SW Virginia. None of the DMEs near me have ever had any of the latest masks, supplies, etc. and as an example, they have never heard of the Bleep mask and ask if I was serious or making a joke and also said they had never seen or could get a For Her Resmed Airsense. It's really backwoods here. Anyway, I settled in for a long wait hoping my wheezing machine would hold out. The very next day my DME called and said they had a ResMed AirSense 11 autoset ready for me. I was completely surprised but didn't question how it came to be that they obtained this model so quickly after telling me it may be months to get even an AirSense 10 autoset, which I would've been happy with. So, if your DME tries to give you a machine you don't want, just hold out, if you can, for the one you do want. I think if they see that you won't take the less expensive brand they offer first, that they will come up with the one you prefer.

> Who decides what CPAP Machine you get?

You do. They can't make you take something you don't want.

One exception to the "ask the doctor to write the script for what you want" is HMO's.

Kaiser HMO, for example, is self-contained. That means they are the healthcare provider, the DME, and the insurer. And they have a formulary for everything including machines and masks. They use Crapria as the supplier, but you have to get exactly what's on Kaiser's script, and they specify the machine. My first machine was a PRS1, and if I'd preferred the ResMed of the time, I'd have to pay for it completely out of pocket, because it's "not on their formulary". Luckily when it came time for a new machine and I still had DME coverage, they had switched to ResMed Autoset 10 and that's what I got (recall aside, this machine is 1000% better than the PRS1). If a mask isn't on the formulary, you can't get Kaiser to cover it if you have DME coverage, and their prescriptions for masks, hoses, even filters are specific to what they think you should get. Then crapria messes up the order anyway.

Note to lurkers: Do not accept anything less than a Resmed Autoset.
Do not settle for a "cpap", or even an Elite, unless you are over a barrel.

With all due respect to Janknitz above, Kaiser has a procedure (in the SF area anyway) whereby the patient can request an item not in the formulary. The patient provides the justification and there is a committee that makes the decision on whether an exception will be made. That may not be true of Kaiser everywhere, but it is true in this area. OP, I suggest having a conversation with your Kaiser doc.

chunkyfrog wrote: ↑

Fri Feb 18, 2022 4:25 pm

Note to lurkers: Do not accept anything less than a Resmed Autoset.
Do not settle for a "cpap", or even an Elite, unless you are over a barrel.

I am beginning to see that. It is not pretty and it is a bit on the large side but it works and seems durable and decent set of features.

If Resmed Autoset is the CPAP / APAP to have, what do people want to stay away from?

SJ-Paddler wrote: ↑

Sat Feb 19, 2022 6:53 am

chunkyfrog wrote: ↑

Fri Feb 18, 2022 4:25 pm

Note to lurkers: Do not accept anything less than a Resmed Autoset.
Do not settle for a "cpap", or even an Elite, unless you are over a barrel.

I am beginning to see that. It is not pretty and it is a bit on the large side but it works and seems durable and decent set of features.

If Resmed Autoset is the CPAP / APAP to have, what do people want to stay away from?

Who wants to stay away from them?

There will always be outliers.

SJ-Paddler wrote: ↑

Sat Feb 19, 2022 6:53 am

It is not pretty and it is a bit on the large side but it works and seems durable and decent set of features.

What machine are you referring to with your statement above?

SJ-Paddler wrote: ↑

Sat Feb 19, 2022 6:53 am

If Resmed Autoset is the CPAP / APAP to have, what do people want to stay away from?

It depends on what someone might want or need.

The ResMed AirSense 10 or 11 CPAP model isn't a full data machine. For people who won't ever look at their data or care...and only ever need a fixed pressure the CPAP model would probably work for them. What happens if someone decides they do want to review their data and maybe they are having problems and need to look at the data....they get to have another sleep study and all that.

Now the Elite model is a full data capable model but it offers fixed pressures only....what happens if a person needs more pressure for part of the night??? I tell you what happens...they get to use higher pressures all night long instead of part of the night. It might even be significantly higher pressures....it's doable but might not be much fun.
Like what if those higher pressures all night ends up feeding the aerophagia monster.
Or if the higher pressures cause extra leaks or wake ups.
I need higher pressures in REM stage sleep. Upwards of around 16 cm in fact. The rest of the time pressures around 8 or 9 do a good job preventing the airway collapse. If I were to have to use a fixed pressure machine it would have to be set at what I need to cover REM events and never mind that REM probably only composes around 20% of my sleep time.

I had single pressure (S9 Elite) for the first 9 months.
Changing to a Autoset with a range was a HUGE relief!
Especially for my poor gassy belly.

Got lucky with my sleep doctor right off the bat. He prescribed a ResMed AutoSet S9, and a ResMed Swift FX nasal pillow mask at the beginning. He was even pretty close on the initial pressure, 8 - 10cm...now on 11 - 13cm. Fine-tuned it myself, using SleepyHead, over time. Given that I didn't have enough sleep time for him to be able to do titration in the lab, not a bad place to start. Got to say, glad to have had that sleep doctor with me for the last 10 years or so *smile*.

I am a newbie. So what is the correct procedure? I have been diagnosed with Severe Obstructive Sleep Apnea (G47 33) with significant Hypoxemia. The sleep study Dr. recommended Auto-CPAP set at 12.0 to 16.0 cm/M:O and mask of patient's choice. This is all new to me and I'm not sure what I am likely to get or what I should request. From what I've read in these forums, I think I should ask for ResMed AirSense 10 (or 11) AutoSet, and F30i Full Face Mask. Any opinions on my decision? Thanks.

oklajohn wrote: ↑

Sun Feb 20, 2022 1:41 pm

I am a newbie. So what is the correct procedure? I have been diagnosed with Severe Obstructive Sleep Apnea (G47 33) with significant Hypoxemia. The sleep study Dr. recommended Auto-CPAP set at 12.0 to 16.0 cm/M:O and mask of patient's choice. This is all new to me and I'm not sure what I am likely to get or what I should request. From what I've read in these forums, I think I should ask for ResMed AirSense 10 (or 11) AutoSet, and F30i Full Face Mask. Any opinions on my decision? Thanks.

Welcome to the forum. I am also in the Oklahoma City area. Like many of the members of this forum, I would recommend the ResMed AirSense 10 or 11 autoset. Right now, ResMed machines are kind of hard to find. Once you get a machine, mask choice is a very personal thing. It seems like everyone has their favorite mask, or at one that works for them. I am still searching for that "perfect" mask, but doubt if I will ever find it. I have used my current mask for close to five years. I keep trying out new masks and going back to my current mask. If at all possible, try to keep a spare of everything on hand. Things have a habit of breaking at the worst possible time. For instance, my machine quit working on the first night of a four day trip to Branson. Since my wife also uses a machine, we keep two spares of everything, including machines.