New Here -- Have Questions

I confess I've been lurking the forum without an account for about a month or two. I got my official diagnosis in mid-June, for the second time in my life... long story, but didn't do anything about it when it was first diagnosed, many years ago.

I just got contacted by the DME today... I'd been told they usually got in touch within 2 weeks, so I was starting to think I'd never hear anything. They scheduled me for an appointment in person in a couple weeks, because they're sending a machine by mail, and want to make sure I have it first. So I asked what machine, and they said a Luna II, I think. I know it was a Luna, and I know they're not as good as Resmed... so I was thinking just go with that until I can afford something on my own (I'm on Medicaid) but then I was looking here and the Luna models don't support OSCAR. Now I'm feeling more anxious about this whole process than before I heard from them. If I can't get my own data, I'll be stuck trying to get appointments with/messages to the sleep clinic doctor every damned time anything needs adjusting, right? (Do the Luna models even have SD cards/card slots?)

I also found out they're willing to let me go in and try on masks if I want to, but that usually they're just matching people up via a photo of the patient's face. How the [censored] is that supposed to work? And given the machine they're offering, does this mean they're going to offer off-brand, uncomfortable, or old model masks?

I was just getting ready to look into how to go about everything without a DME, since I hadn't heard anything, so I'm still going to ask you (forum members) the questions I had about going it on my own.

First, I understand there are not only "for her" masks, which are smaller (and have pink headgear, because apparently that's how you designate gender), but also "for her" machines? What, exactly, do the machines do differently? Does the "for her" aspect affect price for mask or machine?

Second, if I bought a machine off Craigslist or an online store, how would I expect to go about selecting/testing masks?

I thought I had more questions, but either I didn't, or I'm not remembering them due to brain fog. A bit of basic info, though, from my sleep study/prescription: Diagnosis this time was mild (13.2 AHI) while the study from forever ago was severe. Not sure how that happened. In both cases, it's entirely hypopneas, rather than full apneas. Way back when, that registered to me as "it isn't as bad, because I never fully stop breathing"... I don't recall them mentioning that oxygen desaturation can still be pretty extreme. I don't have the full report from the original diagnosis, but I do have the current one, and despite the lower AHI, I was also diagnosed with hypoxemia, so clearly it's still bad. Sleep doctor's prescription for me is APAP. I asked about titration studies, and he said I could have one, but it would push things back even further for getting set up, because it would be late August before I could get in for that second study, so doing a broad range with APAP was a quicker way to at least get things started.

Oh! More in the questions department. Since my O2 is less than optimal, do I need to consider a pulse-ox device? Is that how people are getting their SpO2 data on OSCAR?

Also, my heart rate during the study was all over the place. The doctor pointed it out specifically, but didn't give any suggestions or indicate whether I should be monitoring it right now, while I'm in limbo.

If/when I think of anything more, I'll add a new comment to this thread (and maybe an edit to the main post saying I've added info?)

Thanks in advance!

Check with your Medicaid information people in the state you live in to see if they have anyone else that can supply you with a machine besides these yahoos who want to supply the Luna.
You can tell the current yahoo that you don't want the Luna....at this point they can't force you to accept it.
In the mean time you can try to find someone that accepts Medicaid who will supply you the machine you want.

You don't have to buy a machine or get supplied a machine from a supplier to use your insurance to get a mask.
I have Medicare...never used it to get a machine but I have a DME supplier who I can get masks from using my insurance if I wish. You don't have to get a machine from someone to be able to use your insurance to get masks and other supplies.

As for the "for Her" models...the "for Her" part is just nothing more than an extra mode of operation that ResMed says might be extra helpful for females. If you can find a "for Her" model...it's just an extra feature that may or may not be something you would find helpful. It's not really limited to females either....lots of men have found that the different algorithm for the women actually works well for them.

So think of the for Her model as a machine with an extra way of doing its job...and you get the standard way of doing things as well...so an extra potential benefit and not giving anything up. Win-win all the way around.

And yes...this current supplier wanting to dispense the cheap Chinese knock off Luna...there's a good chance they might also try to push masks made by the people that make the Luna. I haven't seen all of the off brand masks but I did get a chance to see one that was a knock off for the ResMed Swift FX ....and the quality was definitely lacking and the silicone for the nasal pillows was much harder and less pliable.
As much as I hate ResMed's business practices....I have to admit that their masks and machines are top notch quality.

You are on Medicaid so I know you don't have a lot of extra cash but if you can come up with some money to buy on your own the machine....you can get what you want and be much happier.
You can still use the supplier for masks if you wish or maybe I might have something you could work with and it not cost you anything. I have a "donations" box where people might try a mask and it not work...so they send it to me and I find a new home for it. These are totally free.

I also have a small selection of masks that I purchased that I can sell well below retail price.
But I usually tell people to use their insurance if they can and/or maybe try something from the donations box at least until they figure out what the like before they go buying anything on their own.

Also...online suppliers like our forum host cpap.com have a 30 day free return policy with their complete mask packages that they sell....so that's an option as well.

And when you call up the Medicaid people find out what their replacement allowance time frame is for masks and supplies.
Some states use Medicare's replacement allowance time frame but other states may have their own.
I knew one woman years ago that her Medicaid allowed only one nasal pillow replacement to be covered, one every 12 months.
That's a ridiculous time frame...Medicare allows 2 per MONTH

Medicaid patients are often treated like the ugly step child...I am sure you already know that. You get the cheapest of everything because the states simply don't pay much for anything. Very likely why your supplier wants to sell you the Luna.....wholesale price wise...it costs about 1/3 what the ResMed would cost. The supplier is looking more at their profit margin than giving you good quality equipment.

You don't have to accept the Luna if you don't want it but you would have to figure out another source. Not impossible though but cost is a big factor.
If you have some cash handy or know someone...check out secondwindcpap.com as well as your local craigslist.
Come back here with what you spotted BEFORE buying so we can tell you for sure if it has data and works with OSCAR and is a good machine to start with.

Thank you, Pugsy!

I just thought of another question. Do mask sizes tend to be consistent across styles and brands, or is it like shopping for clothes, where you might be a small in one brand and a medium or large in another?

It's like shopping for clothes....one brand's small could be another brand's medium or even large.
Heck even between types of masks within the same brand it's not always a guaranteed good fit.
You simply have to try them on especially at first. Later with time and experience you will get a feel for what size fits your face the best but that takes months of mask trials to get to that stage in things.
A lot of masks come with a "fit pack" which is multiple sizes of whatever. Makes figuring out size needs much easier.

Not aware of any 'for her' masks, only machines, so don't let that confuse you.

Julie wrote: ↑

Tue Jul 19, 2022 6:42 pm

Not aware of any 'for her' masks, only machines, so don't let that confuse you.

There are "for her masks" they are exactly the same as a small size mask only they are branded "for her" and have pink accents. I have the N-20 "for her" because the medium kept leaking.

latskogkatt wrote: ↑

Tue Jul 19, 2022 5:17 pm

If/when I think of anything more, I'll add a new comment to this thread (and maybe an edit to the main post saying I've added info?)

Thanks in advance!

welcome to the zoo!

i have nothing to add to what pugsy said as she pretty much covers it and certainly knows her onions regarding medicare.

i just wanted to comment on what i quoted. you don't have to change the thread title each time. we'll see when you come in and post something new. there will be a little red rectangle, sort of like a piece of notebook paper, than will appear when you post something new.

you've got enough on your plate without worrying about that. as long as you stay in this thread, which is now your therapy thread, all will be well.

good luck!

Julie wrote: ↑

Tue Jul 19, 2022 6:42 pm

Not aware of any 'for her' masks, only machines, so don't let that confuse you.

Did you forget these


P10 https://www.cpap.com/productpage/bleep- ... ght-supply

F20 https://www.cpap.com/productpage/resmed ... -cpap-mask

F20 cushion https://www.cpap.com/productpage/resmed ... -cpap-mask

N20 https://www.cpap.com/productpage/resmed ... p-headgear

Swift FX https://www.cpap.com/productpage/resmed ... k-headgear

granted most of the time the sizing of whatever is really just a small size for men and women and a different color
but like with the P10 the for Her headgear is a bit smaller in addition to a different color.
Plus the fit packs in the "for Her" packages are often XS, Small and Medium while on the regular size package they might offer Small, Medium and Large.

Mostly it's "fluff" from the marketing team to playcate the women into thinking they made an effort to do something special for women.

--A morning update--

I spent awhile on the website for my insurance plan last night (in the middle of the night, because, of course that's when I was awake) and eventually found how to search for "in network" DME's... and the one I'd been sent to by the sleep doctor wasn't on there. Apparently he thought they took Medicaid. They had verified my insurance when I talked to them yesterday, and never said anything about not having a contract with insurance.

This morning I called the insurance provider to verify, because it's mentioned on their site that you should double check current providers and their new patient acceptance status, just in case the website isn't up to date. The DME isn't on there at all, which leads me to feel like either the DME is grossly incompetent at tracking which insurance they contract with, or that they were deliberately deceptive. Part of their information packet they emailed was talking about needing to sign an agreement where they could automatically charge your credit card or auto-debit a bank account for anything insurance doesn't cover. I don't know if that's standard practice, or a further sign of sketchy behaviour, but now I'm trying to get back in touch with them to cancel my appointment and to tell them to stuff their Luna somewhere dark and quiet.

I find it hard to believe that someone at that DME didn't know that they weren't a Medicaid participating provider but...they obviously didn't bother to check with Medicaid to verify coverage or they would have found out for sure at that time.
Good thing you found this all out ahead of time or you would have had a really ugly surprise at bill paying time.
They can't even supply a mask to you and expect Medicaid to pay for it.
Sketchy doesn't begin to describe them.

Time to figure out a DME who is in network and then work on them to supply you with what you want.

Good job on doing your homework.

OP mentions the sketchy DME wanting her "to sign an agreement where they could automatically charge your credit card or auto-debit a bank account for anything insurance doesn't cover." I believe that is known as "balance billing" and is prohibited my Medicare and probably by other insurers as well. The DME may figure they can get away with it if the patient is unaware and insurance is not watching.

Also, it is entirely possible that the doc has a financial interest in the DME company and thus directs patients there. You are free to use ANY DME that your insurance will cover. Good job doing your homework. That patient is in charge!!

OP mentions the sketchy DME wanting her "to sign an agreement where they could automatically charge your credit card or auto-debit a bank account for anything insurance doesn't cover." I believe that is known as "balance billing" and is prohibited my Medicare and probably by other insurers as well.

Oh, that's what balance billing is? In that case, no, Medicaid doesn't allow it either.

Also, it is entirely possible that the doc has a financial interest in the DME company and thus directs patients there.

While this is certainly possible, the sleep clinic itself apparently has an in-house DME, also not covered by Medicaid, which leads me to wonder if the doctor was confused. After all, it would make more sense for him to route me to their in-house DME, I think? My Medicaid plan is essentially subcontracted through a provider who also offers marketplace plans that aren't government subsidized, with the main plans just having the insurance company name, and the Medicare/Medicaid being [provider] Community Solutions.

Quick edit to add: It occurs to me that Medicaid might have dropped the DME when they put the balance billing policy into effect, and they may have at one time had a contract.

latskogkatt wrote: ↑

Thu Jul 21, 2022 2:31 am

It occurs to me that Medicaid might have dropped the DME when they put the balance billing policy into effect, and they may have at one time had a contract.

It is also possible the the DME used to have a Medicaid contract and decided not to renew it because of reimbursement rates or really any reason that their management might come up with.
They simply changed their minds about handling Medicaid patients.

If you decide to purchase your own machine without going through Medicaid, check your Facebook Marketplace. I find machine listed there all of the time. In fact, I found my back up machine there.

check your Facebook Marketplace.

Thank you for the suggestion! I tend to completely forget fb marketplace exists. So far it's looking like more offerings and lower prices than craigslist.