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Anonymous wrote:Wow, thanks. Always great info here.

My prescription is just for CPAP. Other DME suppliers I have called say I need an Rx for auto before they can provide an auto machine.

So, does this mean a call to my Dr to get the script changed?

They are just playing stupid or really are stupid ... bad deal either way.

Like I said, an APAP can be set to CPAP pressure. Fact is, insurance pays DME one set price whether it is an top of the line APAP or bottom of the line CPAP ... but because they make more money selling the cheap CPAPs with no data capability, they feed ignorant patients all kinds of excuses to make the sale (like used car salesmen).

But yes ... having your doc specify machine make and model w/ "no substitution" noted on Rx forces DME to comply. SO what the DME's you have called are basically telling you is that they don't care about your treatment and thus won't cut into their bottom line unless they are forced to.

DreamStalker wrote:First get a copy of your PSG (sleep lab study) and the original copy of your prescription ... before signing any papers regarding machines or masks.

Then dermine your insurance copay if insurance is involved.

Then you have the minimum info to start shopping and demanding your health needs. You are then ready to demand your DME what you want/need and if they cannot provide you go to another ... you may discover that paying out of pocket is actually a better deal when you consider all of the headaches that insurance/DME will give you.

You will need to shop for a machine ... it's better to get an "auto titrating/adjusting" machine called an APAP. An APAP can be set to work just like a plain CPAP but CPAP cannot work as APAP ... and all APAP machines provide monitoring data which is essential to your treatment. Many here like the Respironics "M" series APAP with AFLEX ... also, you will be better of with a stand alone heated humidifer rather than the integrated one offered with the machine. The F&P HC 150 is a good choice for the HH.

The mask will be the most difficult to find since everyone has a different size/shape face and head ... you will just need to try enough of them to find what works best for you.

Wow Thanks that makes some sens! Thank you Very much

I got a call from the DME that they will see me monday and My machine is ready I as how that could be they told me it was in the perscrption and they new what I needed and that I would be able to pick a mask. I will call the Dr first thing monday to see about a difrent DME

Anonymous wrote:Wow, thanks. Always great info here.

My prescription is just for CPAP. Other DME suppliers I have called say I need an Rx for auto before they can provide an auto machine.

So, does this mean a call to my Dr to get the script changed?

Here's what I did: I found the machine I wanted (a respironics classic auto-titrating cpap machine with C-flex). I had the doctor write a script for that exact machine (keep the other script in your files, too). The doctor must also specify the pressure. My doctor didn't know what to put down, but based it on the titrated pressure for me which was 6. I think it was initially set at 5-10. That's 3 or 4 below and above a person's titrated pressure. (Machines don't go below 5). (The doctor may also add "dispense as written" meaning that they can't substitute).

If you call around to the DME's like I did, the ones covered by my insurance, you can find out which ones have that exact machine available. You may have to be very specific and say that your doctor won't accept a Plus machine, etc. Then fax them the script (keep the original for yourself). When you go in to pick up the machine. Based on my experience it is highly likely that they will pull a switcharoo. My DME tried this and so did the DME of a relative who I'm helping. Be ready to leave if they do this, and they may find one magically in the back room.

The other important issue is to find one that will let you try a lot of masks on. The mask fitting is important. Ask precisely which masks they carry, or better have a list of the ones you'd like to try and ask for each one specifically. When you go in be ready to walk out if they don't have at least 4 of the masks you wanted to try.

If they do, this is a DME you can work with, perhaps. . .

Mine's like this, and they will work with me, but I needed to have my doctor on my side. I needed to ask my Dr for a specific machine, since most docs don't know much about the equipment. Only some propaganda put out by the drug companies.

I have gotten good masks from them, including a couple of masks made by the smaller companies that the big chains don't cary. I tried these by purchasing them online first (not wanting to wait 6 months for my insurance to pay), but they do supply the nasal pillows and replacement masks. They've gotten used to me and give me good service at this point.

You have to be friendly but very clear about what you need and firm in order to get it. Look for a good local or regional company. Most aren't good, but the good local ones rely on the goodwill and word of mouth.

If I couldn't find one that was at least this good, and if my insuance covered an online supplier I'd be inclined to use billmyinsurance.com or cpap.com (sister companies). They don't play these games, but give you the machine and mask you request. The downside is that you can't try on the mask first and so will ahve to pay for return insurance.

Anonymous wrote:
So, does this mean a call to my Dr to get the script changed?

Yes. (Technically the DME COULD give you the higher end machine... they just choose not to because your doctor wasn't specific and they make more profit if they give you a cheaper machine.)

And your doctor, especially if he/she is inclined to the "don't be a pain in the arse and ask so many questions" tendencies...

Just tell him "Look, I have insurance coverage, and I personally will not be paying any more for the APAP with A-flex machine then I would for a bare bones model.

I'm shelling out a deductible for this stuff, and as far as I'm concerned I deserve the best machine/most options for the money. I presume, as my doctor, you're MY advocate, so I would truly appreciate if you back me up, support me and write me a prescription for a Respironics M Series AutoPap with Aflex. (Or another machine of your choice, but that one is frequently recommended)

If he asks "Why do you think you need that 'extra' stuff." Say, "I don't KNOW if I want or if I'll need that "extra" stuff, but it will be X# of years before my insurance will pay for another machine, and having a machine that will give me the most options for the money seems to make the most logical sense. Especially since it's not going to cost me a dime more."

And re-assure him that you are not (at least at this point) asking him to change your therapy to APAP, you're not questioning his medical expertise. The APAP machine still does straight CPAP. This is about you as a consumer, and his being your advocate.

And I have learned that if you say all this, in the most matter of fact, non confrontational way, as if OF COURSE, he'd want to help you out, who wouldn't, and just logically sticking to your point and with repetitive persistance -- it helps to keep them from becoming too defensive. You don't want them to think you're being "accusatory".

But again, bottom line is, you're a consumer. Your doctor is supposed to be YOUR advocate. You simply want the best machine you can get for the money, or at least the one the provides the most option for the money. Logically, what possible motivation could he have for PREVENTING you from getting the machine?? I mean, is it really so much to ask?

If the sleep doctor still refuses, presuming you've been diagnosed with OSA, your general practitioner can write the prescription for you, maybe he or she will be more receptive to you.

Just don't feel guilty like you're trying to do something wrong or selfish. I struggled with that myself and pushed passed it with the help of so many who supported me here. I'm so glad I did.

Lots of good info, lots to digest. If your doc is affiliated with the DME services, as in they sell them out of the sleep lab, you may be hard pressed to get cooperation from them.

If you do the math on copays and deductibles and rental, you may find it wouldn't cost you any more to buy from cpap.com, and it would be even better if they accept your insurance.

I've used both cpap and apap machines. While an apap would be useful in retitrating, otherwise the cpap is acceptable for my purposes. As long as it has therapy data (not just compliance data), I can tell if my numbers look good. The tweaking if a problem could be more of a rabbit chase, but not impossible.

I don't know your circumstances. Of course, if you can, why not get a machine that you will have no regrets on? But if you decide you can't pay more and your doctors won't cooperate, all I can say is I would not settle for a RemStar M Series Plus, but the RemStar M Series Pro is serving my purposes just fine. A compliance data only cpap will deliver the same basic therapy as the top of the line cpap. Just hope you don't have a problem and need to figure out what's not working.

Personally, I "settled" on the machine I have. Told the DME I refused to accept the Plus model, but I didn't want to fight with the docs to go up yet another level and get an apap. Spent so much mental effort battling doctors in the first year, that I just decided at this point to pick my battles, and getting another apap just wasn't one of them. Getting therapy data though was not negotiable.

Good luck sorting thru your options and getting what you believe will best serve your purposes. Be careful on the machine names. Some are so similar you might think you're getting one thing and you're not. Be exact in machine names. Let us know how it works out.

Kathy

Ditto to all the above. To see links to machine comparisons on cpap.com, and for more information, go to the yellow light bulb above, our collective wisdom,
cpaptalk-articles/CPAP-machine-choices.html

Well, this should be fun.

I called the DME supplier and told them I was bringing everything back today. Since they were putting profit before my health I felt it was best to find another supplier.

Needless to say, it was not well received. "But we already billed it out". I was under the impression I had two weeks to decide on the equip, turns out they meant only the mask. I said I wanted to speak to whomever was in charge. She said I could talk to the director, said good by, and hung up. (now that wasn't very nice)

My ins says return what you can and make note of the date. The supplier will have to submit an adjusted bill based on the days actually used. Then, go find another supplier and move on.

So, I'm getting good support from my insurance co. Yeah for that!

But, I anticipate some hassle when I return the cpap stuff. It's likely I bought what I used, 'cept the mask and headgear, and the machine since its rental. Depends on how much noise I make I suppose.

I would still try to speak with the Director. He might be able to adjust the bill farther. Also if nothing else, when you drop the stuff off ask to speak with him then. Who knows, maybe the man in charge will be more inclinded to listen but most likely not.

Ether way stick to your guns and Good Luck in your search.

Make sure you get something in writing saying you returned everything that you returned!!!!!

I was in a similar situation and here is my own experience.

I was given a sleep test on August 14, 2007. My titration test was about a week later. I never met the sleep doctor at any time. My PCP doctor ordered the sleep test and everything went through her. She (my PCP) received the dictated sleep and titration reports, along with the notation to prescribe me a "smart cpap set @ 8 to 12 cm with heated humidifier and a F & P 431 full face mask", My pcp wrote the script word for word directly off the dictated titration report.

I was new and didn't know diddly squat about cpaps, masks, humidifiers, etc. I went to a locally owned DME and gave them my script. The RT went to the back and carried an M series Plus machine to the front, intergrated humidifier for the M series, and the F & P 431 mask. She kept going on and on about how the doctor had prescribed me the "Cadillac" of masks -- how it was the best you could buy, etc. She proudly pushed the Plus cpap over and told me to look at it. Then we went through the routine about how to turn it on, etc. She told me that she had set my pressure at 10. When I asked about the 8 to 12 which was on the script she said that was the way all scripts were written and they went with the middle number -- being 10. I figured if it had plus in the name it had to be good!!! She also showed me the "smart card" and told me they could read the data off from it. I admit I was awfully dumb and swallowed it all!!!

I came home all excited to be using my cpap. I set it up and looked forward to going to bed. While waiting for bedtime I was looking up sleep apnea on the internet and found this forum!!!! Best thing that could have happened to me.

I soon discovered that I was fed a line of bull. The Plus was not a smart cpap as my script was written for -- a single pressure was not was ordered by the doctor.

I called the doctor and explained the situation with her. Called the insurance company and explained what was happening. With them knowing what I was about to do I felt pretty confident.

I took the Plus machine back -- set it on the counter and told them they were fired!! Boy did I get some static!!! Do NOT let them BULLY you -- they will (or at least the one I dealt with) threaten, cajole, try to convince you THEY know what is best, intimidate you, threaten to call the insurance company and tell them you QUIT cpap, on and on. I stayed calm (although I wasn't calm on the inside) and said I was NOT signing their paperwork stating I was stopping treatment that I fully intended to keep using a cpap. I kept the mask that I had received from them as it was a purchase, but the cpap, humidifier (which was on the rental agreement), hoses, and filters stayed with them. I did demand a returned item invoice so I had proof that they were returned so they couldn't keep charging my insurance. They even called my doctor, while I was standing there and tried to bully her -- she hung up on them!!

My insurance was kind enough to pay them a full months rental even though I had the machine for only 2 weeks. My insurance also picked up a full months rental at the new DME that I chose.

When dealing with them stay calm, know before hand what the agenda is and keep on that agenda. Do not let them convince you differently.

I have an M series APAP set at a pressure of 8 to 12 just like the doctor ordered!!! It was well worth the fight, aggravation, and time it took to get it instead of settling on the PLUS. But it does make me wonder how many times that DME has screwed people with the cheapo machine instead of what was ordered.

Sleepless in IL,

You should expect that the DME will take back the rented CPAP and heated humidifier, but they you have already committed to buy the hose, mask, and headgear. Much the same happened to me. Since they’re now “used” they can’t re-sell them.

Get a receipt for the return of the CPAP & HH.

Ask your insurance if they will reimburse you if you buy on-line (from cpap.com) and submit the receipt with all the proper codes, etc. Mine did this. I paid 30% of the low cpap.com price instead of 30% of the inflated DME price. My insurance company saved money, too.

My Rx said “CPAP 13 cm” and that was good enough to get a REMstar Auto from cpap.com.

Wayne

Thanks everyone for the advice.

Actually, it went better than I thought it would. I called ahead and spoke to the director. We talked for 10 minutes or so - clearly they want to provide bottom line equip at over inflated prices but, I could tell she didn't want to see this go any further (ie up the chain). So, they agreed to take everything back, used equip and all. I got signed return receipts (funny how all the paper work was waiting for me at the receptionist desk when I walked in. Apparently they didn't want any personal contact.)

So, I'm off to a fresh start. Still, it grinds me that they charge ins companies $1500 for the Yugo version of a CPAP machine (not including humidifier, that was $450).

Glad it all worked out "crosses fingers" hopely there will be no more surprises from that DME at least.

Good Luck hope you find a DME you can work with if not well there is always stuff online =)

This thread has been great

I am feeling better knowing that I am no alone in my struggles.

I chose a different rought I went with the DME because the other DME I contacted would not deal with insurance. So my thought was let get the machine that they picked out for me so I could start my treatment.
I have been having Migraines every morning. Diagnose with 76 episodes per Hr and Oxygen dropping to 48. My thought was start treat men then fight from the other side.

Time will tell If I will regret my decision or not

Guest Posted: Tue Feb 05, 2008 8:35 am Post subject:

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So, I'm off to a fresh start. Still, it grinds me that they charge ins companies $1500 for the Yugo version of a CPAP machine (not including humidifier, that was $450).

A Yugo can not be compared to our cpap's. I LOVE the Yugo -- I have one!!!