Where do I purchase CPAP machine: Internet or Dr. office?

Hunter1 wrote: ... I called Dr. office today and talked with nurse about the different types of machines. Since I am a self pay customer, I mentioned purchasing a new machine from the internet. Nurse went crazy and said Dr. would not allow me to purchase a new machine from the internet. She said she would have her company call me and discuss a used machine.

I would remind everyone that this was the doctor's NURSE who said this, NOT the doctor. BUT - WHY on earth should Hunter or anyone else pay as much for a USED CPAP locally as they could get a brand new one online? I do know that I have an EXCELLENT gastro that I've done well w/for years who recently added an NP to her practice. This NP has NOT been an asset to her practice in my estimation, or at least no asset to our doctor/patient relationship.

My own reaction to Hunter's experience would be to proceed w/caution, shop the local DME suppliers CAREFULLY. It may be that this sleep lab/doctor's office has the software for only one brand of xPAPs and should Hunter purchase a different brand they would have no way of monitoring the results unless Hunter also purchased software and reader. In our area we have a very good sleep neurologist who has only the Respironics software and for those w/Resmeds the patient must have a local DME supplier download, print out and FAX the results to this neurologist.

THEN decide whether the local DME's are going to work well w/Hunter and provide the service, support and advice needed AND whether the sleep doctor is going to be of support, held and advice w/follow-up, etc. or better off purchasing online and educating him/her self online or not. As experienced and good as some of our forum members are, we are NOT doctors.

I feel VERY COMFORTABLE bypassing my CPAP DME and relying on advice here BECAUSE I DO have a good sleep doctor and sleep lab. Starting out I'm not sure I would have felt AS confident if I hadn't had such a good sleep lab and doctor just a phone call away.

My doctor prescribed a specific machine. My insurance (CIGNA) only does business with Apria. Apria refused to supply the specific machine, only the most basic Remstar. I tried going out of network but none of the DME's in my area would accept CIGNA. So, I got my mask in the mail and had to drive 35 miles to spend 10 minutes with a RT who showed me how to put water in the humidifier and use the ramp function.

Tell me how this service is superior to using the internet.

It wasn't, of course. BUT - when one is self-paying one is wise to thoroughly investigate just how much support, help and advice will be provided by the sleep doctor and the various local DME suppliers. Believe it or not, there ARE some GOOD sleep doctors and GOOD local DME suppliers. If none are available locally, then no question this forum and buying online is the wiser choice, and not just financially!

My primary care pycisian referred me to my sleep doc. I went to my sleep doc and I had no reason to think he was deficient in any manner. Had my sleep lab study where I discovered that the sleep techs were grad students. Nothing against grad students, I was one at one time ... except that the grad student's field of study had nothing to do with sleep or the health industry at all (automobile engineering).

It was not until I found this life-saving forum and began to learn about my condition and its treatment that I realized I had been left to sink or swim by my sleep doc and his staff (they ran their own DME out of the sleep clinic). To this day, just over a year later, I have only recieved two non-solicited letters from the clinic to remind me about equipment renewal (mask and filters). I had to contact them about the ResMed recall and in the end they did absolutely nothing to help me get my S8 replaced. I had to do all of the research and spend lots of time on the phone to finally get it replaced ... trying to get help from the clinic was a total waste of my time.

The clinic's DME RT was a very polite young woman but not very helpful. Whenever I called it took her about 2 to 3 days for her to return my call and then it would trun out to be totaly useless for me. Half the time she was out taking care of her sick child. I'm pretty sure she does not have a college degree and yet she drives a brand new BMW (I certainly picked the wrong career so having a graduate education in science doesn't really mean much).

I know they have charged my insurance over $3,000 for the study and equipment ... I feel my insurance has been ripped off and I certainly don't feel I got my money's worth either.

Sure, statistically there should be very good sleep docs out there and also very good DME's who are proud of their career choice and are in it to help sick people get better rather than the money ... but those odds seem low based on my own experience and the experience I read about here. And the chances of getting both a very good doc and DME/RT would seem even lower.

So if you want to buy from the doc, just think of being in Las Vegas or having Clint Eastwood come up to you and say "Do you feel lucky ... punk?".



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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, DME

If you buy online from the internet with a dealer as good as cpap.com, they include all the info you need including the forbidden manuel, Most people who travel the internet have basic reading skills and can pour water. It's not that hard to cut open the package with the mask in it.

The good thing about my DME, you never have to open a product, by the time you get it most of the extra parts are gone. Jim

Goofproof wrote:If you buy online from the internet with a dealer as good as cpap.com, they include all the info you need including the forbidden manuel, Most people who travel the internet have basic reading skills and can pour water. It's not that hard to cut open the package with the mask in it.

The good thing about my DME, you never have to open a product, by the time you get it most of the extra parts are gone. Jim

But Jim ... you can always re-purchase your missing parts on E-bay.

DreamStalker wrote:

Goofproof wrote:If you buy online from the internet with a dealer as good as CPAP.COM, they include all the info you need including the forbidden manuel, Most people who travel the internet have basic reading skills and can pour water. It's not that hard to cut open the package with the mask in it.

The good thing about my DME, you never have to open a product, by the time you get it most of the extra parts are gone. Jim

But Jim ... you can always re-purchase your missing parts on E-bay.

AND, the missing manuals.

Den

Thanks to all who replied. I have learned a lot from this site.

If I can get the doctor to call me back, I think I now have enough knowledge to work with.

Hunter1

Anonymous wrote:............

If I can get the doctor to call me back,.....

Hunter1

Uh-oh, one thing we forgot to tell you .....

Welcome Hunter!

I have a very good, very sympathetic GP. In fact, he was the one who prodded me to get the sleep study done. He is enthusiastic about the fact that I have the software and am monitoring my own progress and bringing him the charts when I see him.

However, the for-profit sleep study place that he referred me to (because they had a shorter waitlist than the 2 major hospitals) was a different story. They didn't do a good job and the sleep doctor did a darn poor job of report writing. My biggest gripe was that the tech only titrated me at 5, and was considering 4. Luckily my GP was willing to prescribe an auto machine with a pressure range. With the bottom number set at my titrated pressure and my top number at 10, my apneas were not taken care of, and I had an AHI of 7-9. Only when the lower number was raised did my AHI get better. Conclusion: I was mistitrated. I showed that study to someone locally who is familiar with the field and he said "What, did the tech just set you at a pressure and fall asleep herself?" He thought she'd done a poor job.

The best DME in our area did a pretty good job with mask fitting and spent 1.5 hours with me during the initial visit. They give reasonable service, too. But they did want to give me a cheap machine. They pulled some dirty tricks to get my doc to give me a machine that didn't record data and wasn't an auto. Luckily, he didn't go for it and I have appropriate therapy now.

Certainly a number of doctors are not greedy, in fact, I believe the majority are not, and care about their patients. Certainly some are, and I don't do business with them. I do think doctors deserve to made a very good living for what they do, however. I want them paid well.

But what I do think is that the system is very, very, very broken. Greed is present at a systemic level, beginning with the insurers. There's a standard operating procedure that isn't working. The doctors that try to make this work for them have to fight the system to a greater or lesser degree. Ditto the RTs and techs. I believe that a number of the RT's and techs are not well trained when it comes to sleep apnea and how to treat it. I was given misinformation about important things and have heard other misinformation repeated (about mouth leaks not mattering, for instance). I do think that people (including medical professionals) tend to let systems begin to shape they way they do things. It's not straight greed, however.

Patients need to be extremely proactive and advocate for themselves in this system, even if they have great doctors.

I wouldn't get a new or used machine from a doctor unless it was the doctor trying do right by me by getting me a good quality machine at a competitive price. Then I'd say that the doctor was trying to help me. (I could see my GP getting a cheap used machine for uninsured patients if he had a sleep clinic).

Good luck!

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CPAPopedia Keywords Contained In This Post (Click For Definition): DME, AHI, auto

Here is what I learned when I started using xPAP a couple years back.

My Sleep Doc and Lab did a good job, no complaints against either. Doc was willing to give me a Rx for APAP even though he didn't think I needed it.

Doc was going to supply me with a "loaner" (read "rental") machine at first to make sure I was able to tolerate treatment, then if that went well he would supply the basic Remstar "tank" machine, mask, case, hose, etc. and bill my insurance directly, I just had to pay my 20%. All sounded very reasonable and convenient. The assitant spent about 15 minutes with me figuing out mask size and showing me how to use the machine.

After 1 week, all was good and I wanted my own machine. Here is what it was going to cost me:

A)1 Week cpap rental- $200, insurance allowed $150, $50 write-off, my share $30
B)Mask- $150, insurance allow $125, $25 w/o, my share $25
C)Headgear- $75, insurance allow $50, $25 w/o, my share $10
D)Swivel connector- $50, insurance allow $35, $15 w/o, my share $7
E)Hose- $50, insurance allow $25, $25 w/o, my share $5
F)Respironcs Remstar CPAP machine- $1040, insurance allow $900, $140 w/o, my share $180
G)Carry case for CPAP-$50, insurance allow $50, my share $10
H)Heated humidifier-$365, insurance allow $365, my share $73

So for mask and machine, I was looking at $310 out of pocket, plus another $30 for the rental week. Insurance was contributing $1360, for a total to the Dr. of $1700.

What a bargain, huh!

Before commiting, I did a little research on the internet and made several calls to a not terribly helpful insurance person. It was like pulling teeth, but I learned a little bit about the way insurance works for DME.

First thing first, everything has a "billing code" and for every "billing code" there is an "allowable amount" that varies with your geographic location (or the providers location actually).

Coincidentally, there are billing codes for:
CPAP Rental
CPAP Mask
CPAP Mask headgear
CPAP Mask Swivel connection
CPAP Tubing
CPAP Machine
CPAP Heated Humidifier
CPAP Machine carry case

Now, make/model makes NO differnence for billing code or allowable amount. Whether you get a Blows-at-night model 1 el'cheapo, or a Super-deluxe twilight dream-maker supreme, the billing code is E0601 and it has a maximum allowable amount that has nothing to do with the actual unit purchased.

So the Dr, who knows exactly what insurance allows, bills the max (or more) regardless of what his cost was for the machine.

Next, guess what ... EVERY xPAP machine sold in this country (or at least everyone sold by cpap.com) comes from the manufacturer sealed in a box with a hose and a carry case included. The one your Dr buys came with hose and case to, he/she is just billing those items seperately because there are billing codes for them and it is a way to get more money.

Same with the mask. Most masks come complete with mask, swivel, and headgear. Dr. splits it out though. So after spending considerable effort to learn the "system" I decided to do this...

Buy a Remstar Auto w/C-Flex and Heated Humidifier from cpap.com - $760
Buy a Mask with swivel and headgear from cpap.com - $100
Buy Encore Pro Software and reader from cpap.com - $125

My out of pocket cost was $985 since cpap.com doesn't bill insurance. After getting my goodies, I went through a fast and painless re-imbursement process with my insurance (Aetna) and got a check for $788, bottom line my cost was $197, a savings of $113 to me and a savings of $572 for my insurance (they didn't even thank me!).

On top of that, I got the top end (at the time) APAP machine with data recording instead of the basic CPAP with compliance info. I also got the Software to monitor and provide feedback on my therapy.

It has been quite an education. Was my Dr. going to "Rip me off", no. He is in busines to make money. He has overhead, and everything he was doing was legitimate and legal. Taking advantage of a system isn't necessarily "wrong" or "unethical". That said, the Dr. was going to collect $1700 for equipment he probably was paying no more than $700 for, about $1000 profit. I know, his time etc was spent and he should be compensated. He was- I and my insurance paid for the office visits, the sleep tests, the follow up. I personally think $1000 is a little much for the service of having equipment drop shipped to his office. As far as "24 hour service and support" that was never offered and I doubt few hoseheads can call their RT in the middle of the night if the box stops blowing. Was it the best thing for me? no.

Knowledge is power. Take control of your therapy, look at your options, listen to the advice of the professionals, but make your own decisions and then take responsibility for them.