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Shameless plug:

CPAP.com has mask insurance and good prices on machines. They are my online DME and I am a very happy camper. AND they sponsor my favorite forum, this one. They are heavy on the ethics and light on the finances.

End of shameless plug.

OSA can be insidious with its hidden damage that shows up later, sometimes suddenly. Every night of bad sleep and low O2 levels means one step closer to ending up somewhere you could have prevented being.

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My advice is to avoid local DMEs (on principle, based on the odds, and to prevent heartache), order an APAP machine and full-face mask tonight (it is good to have a full-face in the drawer even if you end up with another style of mask eventually), and let's get this show on the road, girl.

As for convenience, a mask arriving in a day or two in the mail is the very definition of convenience for me. Local is always more expensive because bricks and mortar and insurance specialists cost money, and you don't really know if you like a mask until you use it a while anyway.

Of course, if you have a local DME who actually provides good service and doesn't lie for a living (I haven't met one myself, but I hear there are exceptions out there), as attested to according to the written sworn testimony of several people you know personally, go the brick-and-mortar route. (Maybe they will serve you coffee, chat about the weather, and give you a back rub, or something, too.) But here at cpaptalk you have a whole board full of people who can attest to the stand-up policies and helpfulness found at cpap.com.

Renting, to my way of thinking, would be a waste of money if you are paying for it. Buy a machine and use it a while, I say, and if you don't like it, sell it at auction online here. But if insurance is in the mix, you may have to play the game their way.

That is only my opinion, though. I am sure there are plenty of other valid ways of looking at it, and hopefully you will get more input from others here.

jeff

secret agent girl wrote:I understand that, jnk. However, I want some hands-on help and attention in sampling different masks. (I have no useful data from my sleep study to help with that.)

I do intend to make several purchases from cpap.com. Next month. Are you voting with secret agent boy that I use the DME for a month and then drop them after I purchase?

Mask insurance is not the issue. I don't want to be waiting several days in between if I have to send one back and order a different one. My thought was to buy the machine (next month) and go to the DME for the mask. Local = most convenient.

Dang! Here I go again ... It depends!

And it does. I understand the need for a local DME. I made a similar decision this time around. My unit is quite expensive. Fortunately, my DME provided a reasonable price to the insurance company. And I do have good coverage. And they are working very hard to help make certain it works for me.

But I've purchased online as well, becuase in the past I got so frustrated with my local DME.

So, how to solve the tie? Well, I would interview the local DMEs that take your insurance (or to whom your insurance company points you). Some questions might include:

• I am interested in data capable machines to track things like mask leaks. What data capable brands do you carry?
• If not a Respironics unit, can you provide the software so I can produce my own reports?
• I have no clue what mask to use. Can you help me find one that works well for me?
• What happens if the mask just does not work? Do I need to purchase another to "try" it?
• Will the Respiratory Therapist come to our house, or can I go to the office to pick up the machine and masks?
• Do you carry accessories such as hose covers?

Frankly, you will probably find CPAP.com as a better source for accessories. But you never know.

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Secret,
Get a list together of the DME's in your area. See if anyone on here is from that area or is you know anyone that goes to one of them. Try and get a referral to a couple good ones. Then go talk to them and explain your options to them. Have your prescriptions ready so they know what kind of equipment you need and they can give you some suggestions and advice or tell you to go crawl up another tree.

I don't recall but are you paying for this out of your pocket or is insurance covering part of it. Many insurance companies do the rent to own, actually they rent it for a year then it's yours. Some will allow you to try as many different masks as you want. Some will even allow you to take a few home at a time to try out.

Now I know there are some on here who won't like me saying this. I think it helps people start out if they have a DME they can talk to and go to with problems. I do buy things online and support cpap.com but if you aren't successful in your treatment you won't be buying anything from them in the future. I got my equipment from my DME and I got the other stuff that my insurance didn't pay for from online.

I think you will find that most people who pay for their equipment themselves purchase it online and those who have insurance that pays for it get it from their DME, but not all. You can purchase here and other places online and submit it to your insurance for reimbursement.

I think I covered what you were asking.

This is only my opinion and everyone has one or two opinions.

Gerry

secret agent girl, I think I know where you're going with this and I'll give a shot at taking things in that direction...

I ended up doing exactly what you're describing: I rented for a month from a local DME and then decided to return and buy online. Why? Because it was much cheaper for me, even with insurance in the mix.

After my sleep study, I was given a machine by the DME that is part of the sleep center I went to. It was a good experience, I must say. They were very nice, knew "enough" about the machine and masks, and let me try as many masks as I wanted -- but they were indeed going to charge my insurance much more than the equipment goes for online... At that point, I was a complete newbie and the help I got from the DME was good, but not critical -- I could have figured it out by myself. Anyway, after coming home and doing some online research and finding this site, I came to the conclusion that, given my coverage, deductibles, the fact that my insurance would rent the machine for the first ten months, etc, it was going to be cheaper for me to buy online, out of pocket. So, being totally upfront with the DME and telling them how my numbers worked out (no dollar values, just the general idea), I told them I was going to return the equipment and buy online. They were totally cool with it and understood.

So, though I didn't rent and return with that intention in mind, I did end up doing that -- and don't feel the least bit bad about it. Also keep in mind that most DMEs are also in the rental business. So renting for a month is still business to them and they're making money. My suggestion is that you do rent if you feel you need it, and don't feel conflicted about it. If the DME didn't want that sort of thing, they wouldn't be in the rental business!

I just think that since you found this site first, and already know all about online pricing, you're way ahead of where I was at the beginning. You should make the best informed choice you can and don't feel bad about it. These are my two cents!

-F

Do you have insurance that will pay for the xPAP you want? Will this local DME provider provide the xPAP you want? Will you have a copay and how much will your total copay end up being when you own your xPAP outright?

I'd be inclined, to salvage my conscience as I do understand your "moral" dilemna and would feel the same way, to be right up front w/this local provider. Their hands are tied if they accept Medicare and can NOT sell you an xPAP for less than what Medicare allows so most likely the xPAP you want will cost more than what it is available for online at cpap.com

I'd frankly ask them if they were okay w/my buying the xPAP I want online but getting the rest of my supplies from them and if so how lenient their mask exchange policy would be if you have trouble finding a mask that is right and works for you.

My problem w/the mask return insurance from cpap.com and a couple of other online providers I've noticed is that its expensive. Expensive enough that if it takes more than one or two mask returns to find the right mask it could end up being MORE expensive than if you have a good local DME w/a lenient mask exchange policy. Unfortunately, shipping is just NOT cheap anymore so I understand why the mask return insurance is expensive.

My local DME provider is the second one I've used. I fired the first one in short order! They were sheisters. But I've been right up front w/my current local provider from the get-go and we work fine together. I have no complaints at all. My only wish would be that my provider's RRT be more familiar w/my Resmed VPAP Auto. To his credit he has worked w/the local Resmed Rep to learn more about it and its features for me and he's a good guy. On the other hand, I have good secondary insurance as well as Medicare so I've done very little online buying of xPAP equipment.

secret agent girl wrote:I guess I'm not explaining myself well enough, because I'm not getting the conversation I want. Sorry 'bout that. I'll think about this some more on my own, and post again if I decide to give it another try.

Sorry if I derailed thing, secret agent girl.

There is nothing unethical about renting a machine, but it may, or may not, be in your best interests financially to do so, depending on what your goal is and what it will end up costing you, which has a lot to do with your particular financial situation and insurance provider.

As for the masks, again, it depends on what is important to you and what you hope to accomplish as far as service and cost. If a DME knows you are going to allow them to give you new mask parts every 3 months so they can bill your insurance for them, the DME is motivated to give you service. It fits their business model. If you are paying out of pocket for masks and won't be continuing to give them your business for replacement parts, they are less motivated to be helpful to you and may feel they are being used, even though there is nothing unethical about it. It becomes a business "relationship" where trust is the most important factor, which, for me, means getting policies in writing, because I was lied to and manipulated before I found cpap.com.

So, although your question may be simple on its face, it has complications becuase of how convoluted the "system" is these days. Many either go the insurance-and-local-DME route exclusively or go the online route exclusively. Yes, there are ways of mixing the two routes--it depends on exactly what you hope to accomplish with money and service. That is why, I think, many of the answers here may sound like they are missing the point, but they are trying to get to the heart of the matter based on the way businesses think and how we as customers have to be smart in how we control things to our advantage while covering our butts and not getting surprised by what things end up costing us in time, effort, money, and frustration.

I would not lie to a DME or attempt to mislead them. That would make me just like the DMEs that treat customers that way. If you find a business you have reason to believe is worthy of your trust, then be honest with them about what you plan to do and hope they are honest with you, but get it in writing and make sure insurance is on board with what you plan to do, if they are involved. Otherwise, you could have trouble down the road with finances, ethics, and your health.

At least, that's how I see the larger issues.

jeff

secret agent girl wrote:

For various reasons, I have to wait until next month to buy the machine I want. My husband wants me to go to a DME, rent for one month, and then return everything and buy it elsewhere. I feel uncomfortable about that, like I'd be burning bridges. In particular, I was kind of counting on the DME to be able to try several masks, if needed, to find one or 2 that would work well for me.

I know they're a business and some people have had bad experiences with bad DMEs, but this seems like a rather shabby for me to treat them, esp. when they seem knowledgeable, helpful, and well-equipped.

Your thoughts?

Let me give you an opinion from the business owner's perspective. If I make an offer to potential customers (for example, to rent a machine temporarily or to test samples), I know the sale is not complete until you purchase. I make such an offer knowing some people will eventually purchase and some won't. I am doing this because my experience or research has told me in the long run my sales will increase. So it is a good thing for me if people feel free to rent or sample expecting that they will never purchase. Even some that don't purchase will tell others of their good experience and some of the others will try and eventually purchase.


As a business owner one of the best things is to have foot traffic and activity in my store. This will generate sales even though not everyone who comes in will buy.

As far as burning bridges, I never want to burn a bridge with a potential customer and I am also careful not to put the customer in a position that he feels like he has burnt a bridge.

So if your DME makes offers for you to rent or trial equipment without an obligation, then by all means don't feel guilty to do so. Be aware that you may run into a snarly employee who doesn't understand or share the owner's philosophy. You can then choose to ignore the employee, report them to the owners, or burn the bridge.

rooster wrote:

secret agent girl wrote:

For various reasons, I have to wait until next month to buy the machine I want. My husband wants me to go to a DME, rent for one month, and then return everything and buy it elsewhere. I feel uncomfortable about that, like I'd be burning bridges. In particular, I was kind of counting on the DME to be able to try several masks, if needed, to find one or 2 that would work well for me.

I know they're a business and some people have had bad experiences with bad DMEs, but this seems like a rather shabby for me to treat them, esp. when they seem knowledgeable, helpful, and well-equipped.

Your thoughts?

Let me give you an opinion from the business owner's perspective. If I make an offer to potential customers (for example, to rent a machine temporarily or to test samples), I know the sale is not complete until you purchase. I make such an offer knowing some people will eventually purchase and some won't. I am doing this because my experience or research has told me in the long run my sales will increase. So it is a good thing for me if people feel free to rent or sample expecting that they will never purchase. Even some that don't purchase will tell others of their good experience and some of the others will try and eventually purchase.


As a business owner one of the best things is to have foot traffic and activity in my store. This will generate sales even though not everyone who comes in will buy.

As far as burning bridges, I never want to burn a bridge with a potential customer and I am also careful not to put the customer in a position that he feels like he has burnt a bridge.

So if your DME makes offers for you to rent or trial equipment without an obligation, then by all means don't feel guilty to do so. Be aware that you may run into a snarly employee who doesn't understand or share the owner's philosophy. You can then choose to ignore the employee, report them to the owners, or burn the bridge.

In general, though, the arrangement for renting the machine the first month is not done for the customer--it is done for insurance purposes, as I understand it. The doc and DME have to "prove" to insurance that the patient is "benefiting" from the use of the machine and is "compliant" before insurance agrees to pay. So the one-month rental period is generally for a different purpose from those you mention.

jnk wrote:
In general, though, the arrangement for renting the machine the first month is not done for the customer--it is done for insurance purposes, as I understand it. The doc and DME have to "prove" to insurance that the patient is "benefiting" from the use of the machine and is "compliant" before insurance agrees to pay. So the one-month rental period is generally for a different purpose from those you mention.

If insurance is involved, I would not change my argument. The business owner still "makes such an offer knowing some people will eventually purchase and some won't. He is doing this because his experience or research has told him in the long run his sales will increase. (If insurance is involved and he doesn't do it his sales may go to zero.) " The DME owner still wants foot traffic in his store.

I assumed from the OP that insurance is not involved. If this is the case I would caution secret agent to understand exactly what she signs, how much it will cost, and what the residual costs are.

jnk wrote:In general, though, the arrangement for renting the machine the first month is not done for the customer--it is done for insurance purposes, as I understand it. The doc and DME have to "prove" to insurance that the patient is "benefiting" from the use of the machine and is "compliant" before insurance agrees to pay. So the one-month rental period is generally for a different purpose from those you mention.

This may be very true, but why should the reasons for DME provider policies and practices matter to us, the end-user? We are not bound by the priorities of the insurance company or the DME provider. They use the system to suit their wishes; in fact they invented the system. There is absolutely no reason we cannot benefit from their system when it suits us. We pay them for that opportunity.

Rent your machine for a month. Use that month to figure out which mask(s) suit you best. If it is your choice, then return the machine after the month and purchase the machine you want from another seller of your choosing. If you paid them rent for one month, then you are entitled to use it for one month. If you did not agree to rent or purchase your machine for any longer, then you have a choice - rent for another month, or return the machine.

Tony

Secret agent girl, I would feel bad doing that, too. And my husband would think I was crazy to feel that way. If I definitely knew I had no intention of buying anything from the DME ever, I wouldn't do it. If I thought I might buy something from them at some point (seriously thought I might), but knew I wasn't going to buy the machine I'm renting from them, I might do it.

I understand the need to have a DME help fit the mask, and maybe even possibly demonstrating the machine. BUT, not all DME's are good with that kind of thing, so make sure if you go that route--like someone else suggested--interview the DME and ask questions to make sure you'll get what you need from them.

For what it's worth. The mask I ended up using as "the" mask is not one I was ever fitted for at the DME; bought it through cpap.com. I still have the ones they fitted me with, but they just don't work as well for me. What may have helped that, though, is that my mask--the Hybrid--comes will all sizes. My DME is pretty good and is there if I need them. They call every now and then to see how I'm doing. Nothing against cpap.com--they're great--but if my DME was even close to the same price as cpap.com, I would use my DME because of the service I've received from them when I had insurance and did use them. I wouldn't mind paying a little more to get their service, but not the $75 a mask more I'd have to pay as someone without insurance.

Pam