CPAP (APAP) success and DME question

So I first posted on here before I got my own machine, and only about my mom’s apnea since then.

But to follow up, my therapy is going great. I got the AirSense 10 auto set and after trying another mask have settled on the ResMed f30i I think. Based on reading on here, I got a cover from pad-a-cheek and a tube cover. The mask was causing some skin irritation — even with washing it and washing my face every night. So the Pad a cheek doesn’t feel like it’s as tight a seal, but according to Oscar I’m having very few air leaks, and my pressure is running lower than ever. Also my AHI is getting lower. I had a period in the first weeks where it would pop up over 6 sometimes, but it’s been super low since the pad a cheek. I love my machine and wouldn’t think of going without it.

I also got a battery for it, got a relatively big EasyLonger, the $400 one, runs 24VDC. I ran it last night without humidifier or heated hose on the battery, got all the way through the night and the battery indicator showed 100% still. It’s a chunky four bar indicator, so that probably means it’s just something above 75%. So this will get me through a power failure (and we have a gas generator so I can recharge it).

Only question I have is whether to buy supplies from the DME. I got a second mask to try, and I saw the insurance bill. They tried to bill Blue Cross $400 for this mask and headgear, which I could buy online for $130 or less. When Blue Cross wouldn’t pay the full $400, the DME tried to bill me the $129 that insurance wouldn’t pay. I complained, and they ate that one. But I see what they are up to. This just seems like waste, if they are going to bill insurance for 400% and then bill me for the remaining 100%. So that seems like a stupid rip off waste.

I might as well buy supplies directly, right? I at least need new filters, it’s been two months for this one now.

cpvtnh wrote: ↑

Thu Oct 19, 2023 2:08 pm

But I see what they are up to. This just seems like waste, if they are going to bill insurance for 400% and then bill me for the remaining 100%. So that seems like a stupid rip off waste.

I might as well buy supplies directly, right? I at least need new filters, it’s been two months for this one now.

you are absolutely right, grasshopper. it's a cash cow and totally unnecessary. just buy your stuff directly when YOU need it, not when THEY want to make some money.

but thanks for posting. the only supply i care about is filters. and i only check mine when someone on the forum mentions it.

will go check now!

cpvtnh wrote: ↑

Thu Oct 19, 2023 2:08 pm

They tried to bill Blue Cross $400 for this mask and headgear, which I could buy online for $130 or less. When Blue Cross wouldn’t pay the full $400, the DME tried to bill me the $129 that insurance wouldn’t pay. I complained, and they ate that one. But I see what they are up to. This just seems like waste, if they are going to bill insurance for 400% and then bill me for the remaining 100%. So that seems like a stupid rip off waste.

There are some things you don't yet understand about billing practices and your benefits. Rather than try to explain it without knowing the details of your insurance policy, I suggest you talk to your insurance company about this. Let them educate you. Be sure to ask them if it is illegal to "balance bill" in your state. Many states have laws prohibiting balance billing. Also, ask them how they determine how much your portion of the cost of CPAP supplies/mask is.

If you do self-pay without understanding your insurance benefits, you might be saving the insurance company money and leaving less money in your pocket.

Yes! I called my insurance company this morning, before reading this last reply.

They said this kind of balance billing is in fact illegal. When I said that must be why the DME dropped my bill right away when I called them on it, she said yeah, probably. Had a nice chat with a nice insurance person.

Tried to switch DME today too, but the new one I called wouldn’t give me supplies while I was on a rent to own with the original DME. She said to call them when I own the machine. Too bad, because I don’t like my DME much for a number of reasons, not least of which is they send me these annoying automated chatbot messages to my phone, which are distracting, useless, and annoying.

So I ordered filters and cushions from the original DME today. I'm way overdue on the filter change I guess.

Had another .5 AHI night last night. I really think the Pad a cheek is making a big difference, unless it’s coincidence that everything has suddenly smoothed out all of a sudden. Even the CA events I had been getting through the night are fewer. I suspect that may be because I might have been for some reason holding my breath in response to some silicone thing with the mask. I don’t know. I was sleeping. Before the Pad a Cheek there were higher pressures and definitely more CA events.

Check with your INSURANCE on whether they will let you buy other supplies from a different DME.
It sounds like the old one is feeding you ca-ca.
They are known to do that.

It was the new DME that said they wouldn’t do it. Insurance said it was fine. I guess I could try yet another DME

cpvtnh wrote: ↑

Sat Oct 21, 2023 6:39 pm

I guess I could try yet another DME

See if you can find a local or regional DME. Check their reviews on Yelp and other sites.