newbie looking for tips/advice

rested gal · Post by **rested gal** » Mon Nov 19, 2007 12:04 am

differentdave wrote:I have spent 2-4 hours a day reading/researching on apnea, treatment, etc. The wisdom and faq areas had tons of great info throughout.

Dave, I've often said that if people want to really take as much control as possible of their own "cpap" treatment, they should dig into this message board as if they were med students studying for the exam of their life.

You get an A.

snoregirl · Post by **snoregirl** » Mon Nov 19, 2007 12:39 am

One more thought from me.

Although you have a prescription in hand for an auto, be prepared for either the DME or the Insurance to try to say no.

Lots of info on that here as well as options to fight it.

I really hope you waltz in and out with the auto, but if you hit a roadblock, don't take what they want to give you. Go elsewhere.

10% copay is pretty good. What is your deductable? You will likely be paying one for 2007 and 2008 as we are in Nov already if you have to rent for a couple months before your insurance will buy. Consider that in your decision.

Your 20% out of network is also good. If you hit a roadblock on the auto, cpap.com is a great place to go for that.

As for the mask. I second two DIFFERENT types. You have the nose, then go for the full face for congestion. If your insurance is paying, then all the better as ff masks are more expensive.

My insurance only buys 1 mask every 6 months (unlike the other poster who can get one at 3 months). I don't bother with that even since my deductable after the year that I bought the machine makes it so I pay the full (more expensive dme) cost for a mask.

You can always buy a pillow online.

Moby · Post by **Moby** » Mon Nov 19, 2007 4:11 am

differentdave wrote:Not sure if anyone cares but I will update anyhow

'Course we're interested!

We need a fish-slap emoticon...as in "slap with a wet fish for being silly"
And I thought this was a good message board...
exit, grumbling

Di

mindy · Post by **mindy** » Mon Nov 19, 2007 7:12 am

Sometimes machine rental is dictated by your insurance company ....

Also, you might ask if the sleep techs as your sleep lab do mask fittings/trouble shooting. My DME doesn't do much with that ... we rely on the techs!

Mindy

sleepie · Post by **sleepie** » Mon Nov 19, 2007 9:08 am

dave---i have been on cpap since july---i have read many posts here---this site is a wealth of knowledge---as i see it---there are four major points to contend with for good treatment--

1--the right machine--data capable
2--hose management--do not overlook this
3--mask leaks--the right fit
4--finally make it comfortable for yourself--pillow etc.

just my thoughts------hope you sleep well----pat

differentdave · Post by **differentdave** » Mon Nov 19, 2007 2:51 pm

Found DME that was responsive to my questions and needs. They stocked the m series with a -flex but said they could get any machine as they were not tied to specific vendors. They provide mask fitting service, onsite respiratory therapist visits if need be (its only 6 miles from house). I faxed those copies of sleep studies and other notes, they are in process of getting approval from insurance.
The dme insists on rental at first for reasons of compliance and to make sure I am happy with product.
The DME seems to be at least twice as expensive as cpap or cpap supply though. Is this normal or did I happen to find the one dme I liked, that met my needs but is super expensive. Has anyone ever haggled with DME (i.e. they waive co pay due to high prices) or lower the cost to you, etc)
Thanks again and I am soo looking forward to getting some high quality sleep!!!!!!!

mindy · Post by **mindy** » Mon Nov 19, 2007 2:59 pm

Hi,

I'm glad the process is moving along well for you!

DME's are *very* expensive compared to the on-line vendors. They don't get the prices they list on the invoice ... they get what insurance will pay them which is typically a substantially reduced amount.

Thus, it's again the folks who don't have insurance who get the shaft.

I don't know about haggling with them .... give it a try! I wouldn't expect much but you never know. I'd be interested in hearing your experience if you do try it. I *hope* that they would be willing to reduce price if someone doesn't have insurance but wouldn't bet the farm on it.

On the other hand, I am in the process of getting a FFM and the first one I got (fitted by sleep tech) did not work. I had a different sleep tech who verified that I was getting huge leaks and tried another one and they're lending me that one for a few days. Then I talked with DME's respiratory therapist and asked about exchange --- "no problem" --- as soon as I've tried the new one and verified it will work, I just have to give DME the previous one and they will give me the new one for no charge ... they don't go through insurance for that.

Mindy

differentdave · Post by **differentdave** » Tue Nov 20, 2007 6:24 am

Things keep getting better, my insurance covers a new machine every 36 months, a new mask every 3 months, and replacement part(s) every month (unclear if its one item per month or unlimited) but this includes pads, filters, tubing, straps, etc). All covered at 90% without deductible. The dme I chose already dealt with insurance company got their approvals, today I am speaking with respiratory therapist on the phone, hopefully can get appointment within next week.
So where is the down side to all this With all the reading I was doing I was prepared and almost expecting road blocks by doctor, insurance and/or dme. Thus far all parties involved have been very easy and pleasurable to deal with (at least on the surface I guess). Maybe its that because of the education/advice and support from here and elsewhere that I asked all the right questions and did things a certain way (i.e. getting all the sleep study papers and prescription from doctor, and interviewing the local dme's, having my doctor write the script for the specific model machine, etc but this truly was not a painful/long or otherwise uncomfortable experience by any means.

mindy · Post by **mindy** » Tue Nov 20, 2007 6:38 am

Hi Dave,

I'm sure that doing your homework made a big difference. And glad to hear things are going smoothly so far. Just make sure the DME actually delivers the right machine! I was lucky and things went smoothly for me but many others have a lot of challenges.

Keep up the good work!

Mindy

TXKajun · Post by **TXKajun** » Tue Nov 20, 2007 11:39 am

Dave, "where's the downside to this?" Well, to start with, they should be able to get you in today! Ok, tomorrow at the latest! You're losin' brain cells, raising your blood pressure, strainin' your heart every night you aren't on XPAP. Second, you ain't got your machine yet. There was a post here today about a poor soul who's DME promised one machine, delivered an inferior one and said "take it or leave it" basically.

Soooooooo, until you've got your XPAP in your hot little sleepy hands, be suspect.....especially if things seem like they're going good!

Suspiciously yours,
Kajun

PS
A little paranoia is a good thing!! LOL

differentdave · Post by **differentdave** » Tue Nov 20, 2007 1:01 pm

Therapist called me last night seeing her today at 3, while I dont think I will be getting machine today the entire process has been running very soothly comapred to other posts I have read (i.e. waiting to do a sleep study, I scheduled both of mine within 10 days of doctors ordering them. Or the fact that doctor wouldn't recommend apap or givce ascript for specific machine. B I am still a little skeptic due to my previous exposure to health insurance and doctors though.

TXKajun · Post by **TXKajun** » Tue Nov 20, 2007 2:50 pm

Best of luck getting your XPAP today, dave!!

Yep, I've been following your "saga" and you've had a lot less problems or delays than most. I hope it keeps up for you!

Keep us posted, please.

Kajun

differentdave · Post by **differentdave** » Tue Nov 20, 2007 4:08 pm

Got to DME, met with RT and she had a different machine than the one I thought I was getting (a small white resmed). I explained that I thought I was getting a m series, she looked at paperwork apologized and was back with minutes with the m series with a flex (exact machine I wanted) as well as the correct humidifier, etc. Only issue after that was sleep doctor did not include range for apap only one number for cpap. SO it took a few extra minutes for straighting that out. Aside from that they gave me two masks, one set of tubing, the devices, carrying bags, etc.
Even though insurances gives me a new mask every three dme policy is every six but they made a notation on my file about the 3 month plan.

So once again I can only report positive things and I will probably start using it tomorrow night (long story and a long night tonight) as among other things I need distilled water.

Guest · Post by **Guest** » Tue Nov 20, 2007 4:27 pm

Dave,

Thanks for sharing your progress!

I hope your therapy goes as well as the rest. It sounds like you are very methodical and thorough so, in my book, that bodes well for the outcome

Mindy

differentdave · Post by **differentdave** » Tue Nov 20, 2007 4:55 pm

I forgot a few questions:
Is memory reader and software for home covered by insurance? The folks at the dme were some what perplexed by a few of my questions inluding ones invloving the data portion of the machine (I assume others have not yet asked for such features as of yet)
How often do you clean masks and hoses and do you use distilled water in humidifer (i know what the recommendations are but was wondering if you wind up doing it more often or less often in actuallity)?

Humidifier

Additional Comments: ozzie heated hose.