DME mistreatment and can't get a Resmed UPDATE

I'm not sure if its lack of sleep or just sheer frustration, but I'm almost in tears.

Anyway, the original DME I had picked out, not only tried to talk me into a different machine than I was prescribed (Resmed S9 Autoset ), but decided since they couldn't get enough money from my insurance company, they wouldn't bother dealing with me. Not bothering to tell me of course.

So, on to a different DME. They seem helpful. However. They will not supply me with the Resmed S9 Autoset that I want. I kind of had my heart set on it. With its heated hose, its super quietness, to its nice LCD screen with lots of useful information like AHI and Leak, and an easily accessible clinicians menu to tweak settings. Apparently my insurance (BCBS) will only pay $800 to the machine. Which is not enough to cover the S9. They are not allowed to charge me an upgrade fee. They told me, the price I can get it from CPAP.com, is cheaper than they can get it direct from Resmed.

They are prepared to lend me a PR System One AutoPAP to see if I can get on with it. I don't know anything about how it works, ease of use, how easy it is to access menus, none of that information was available online when I went looking to compare the machines. But apparently, its a lot cheaper where I live because everyone uses Respironics. The DME also said they would give me a copy of the software to access the data on it. They said if I wanted to I can always buy the machine online, and they will be happy to service the machine and my supplies needs, because their out of pocket cost on the machine alone is $1800, so there's no way they can beat the price online.

Right now I'm so dejected, I feel like I'm being offered no choice at all. Is there anyone out there that can speak to how wonderful the PR machine is?

My reservations about the PR was that I keep my room at 60 degrees at night, and thought rainout would be an issue and I really don't want to have to add weight to the hose with a cover, also that it makes noises if you turn it on and off - worried about disturbing my husband, if I wake up in the night, also that it is difficult to access data on the machine, and it doesn't show leak data - you have to download the card every time you want to see that. Also that the software available, was just a viewer software, and cost money and that I'd have to go to the DME every time I wanted to change settings on the machine, (like going to Auto-titrate, or tweaking EPR, or ramp times).

Am I just sleep deprived and unreasonable, are there any PR users out there that can allay my fears?

Or should I just shell out of pocket for what I truly want?

Eva

I have a PR 1 auto and I love it. Its all a matter of personal preference though.

The clinicians menu is easily accessed and you can do it your self. The leak data and other important information is available through your computer using the standard SD memory card and the computer software. The on screen info is more limited than the S9, but with either machine the computer reports are far superior.

The PR1 has really good rain-out protection. I live in Alaska and my bedroom is usually pretty chilly and I almost never have a problem with it. When I had my old machine, I had to use a hose cover and with the PR1, I don't.

There are trade-offs with both machines, but I really like the PR1 and I wouldn't trade it for a S9 if someone offered it to me. There are other people on this forum that are exactly the opposite as me and love their S9s.

What would be great is if they would be willing to let you try it out for a while without obligation.

Also, you might want to contact your insurance company to see if you can buy the machine online and get reimbursed. I know cpap.com will do everything they can to provide you with the needed proof that you purchased it.

I have had both machines, the pr system one a flex and now the s 9

I never had a rain out issue with the system one either.
I loved how gently if followed every breath.
It was quiet but a hyper sensitive person might hear a little sound on it, nobody in the docs office heard it but me.
The screen is hard to read at night so keep a little pen light by your bed if you are curious to see your pressure if you
wake up for some reason, HOPE not!
You cant get the daily AHI, but it will give you the average weekly on the screen.. however it has a ton of information if
you download it.. I didnt want to really want to do that every day, so I thought the s nine would be just what I needed..

Also the PR system one aflex has a pre event feature, which sends a pressure pulse or puff of air thru the tube if you didnt
breath in time. If you have daytime hypopneas and dont breath properly while you are awake, you might notice this, nobody else
has but me, Im WEIRD!
I have enjoyed the s 9 in that I can see the nightly AHI average.. I thought that will really help me figure things out..
However, the Ahi nightly readings dont really match how I feel the next day, and I thought that would be a big help.
The screen is MUCH easier to read on the s9, and it does have a lot of bells and whistles, like a mask fit feature which brings
the machine up to your pressure for three minutes while you fit your mask. IF THAT is really important to you, its something
to consider..
I am waiting for my heated hose for the s9, Im hoping that will make things much nicer. I didnt need a heated hose on the system
one for some reason, it was always comfortable.
I loved my pr system one, and I would trade my s9 autoset back for it, if the system one didnt have the pressure pulses or that tone
I could hear.... I can live without seeing a nightly AHI average, I didnt think I could, but I can.. AND YOU CAN ALWAYS DOWNLOAD IT, if
youre curious.

They told me, the price I can get it from CPAP.com, is cheaper than they can get it direct from Resmed.

Soooooo........buy whatever you want from CPAP.COM.
In the long run, you'll probably pay about the same (or more) to your DME (depending on deductibles and co-pays.
You don't NEED a local DME to do this therapy.

How much is your frustration worth?


Den

beadedbiker wrote:I'm not sure if its lack of sleep or just sheer frustration, but I'm almost in tears.

Anyway, the original DME I had picked out, not only tried to talk me into a different machine than I was prescribed (Resmed S9 Autoset ), but decided since they couldn't get enough money from my insurance company, they wouldn't bother dealing with me. Not bothering to tell me of course.

So, on to a different DME. They seem helpful. However. They will not supply me with the Resmed S9 Autoset that I want. I kind of had my heart set on it...

I am sorry to hear (but not surprised) that you have been lied to and mislead by your DME.

So that future readers can understand how this journey starts out... check this link -
viewtopic.php?f=1&t=51876&p=478402#p478402

Here is part of it - He is the doc here.

beadedbiker wrote:He asked me what DME I wanted - and actually I want to use a DME from a different town, because they have an awesome RT, and the Doc knew him, said he was indeed probably one of the best RTs around and called him right then and there to put in the equipment order to make sure I got the exact right machine.

So I'm one of the the lucky ones. Apparently I do have a great sleep doc and I'm soon to be the happy owner of a Resmed S9 Autoset, just like I wanted. Yay.

It's just too bad that life has to be this way. But if you are new and searching for info take note that they can turn sour if they figure out they can't get a boat payment from you. They being both the docs and DME's. So be warned.

I hope things get better for you. Maybe you should take them up on buying online. I just can't believe that they can NOT buy the machine for what cpap.com is selling it for, just can't.

My insurance rents for 3 months and buys it on the 4th. My first DME gave me and my wife base model System Ones that did not have C-flex or data. They were not even willing to discuss a data capable machine.

We had a sense of urgency because our insurance is going to end after the last day of that 4th month. Our DME provider list is listed alphabetically by city, with wheelchair companies lumped-in with respiratory supply companies. I started calling every DME on the list until I found one that would provide a pair of S9s and pick it up on the 2nd month. I almost gave up. The one I found was almost at the end of the alphabet.

They charged us $250 more than the insurance would pay for each machine. I do not know if the DME can do that within the terms of their contract with the insurance company. Truth is, I didn't ask. I just wanted that particular machine.

If you already have a prescription for a S9 you are ahead of the game. My sleep doctor was un-cooperative. I had to talk my regular MD into re-writing my prescription.

I suggest you do what I did. Call your insurance company and find out the terms of your policy. Then call every DME provider that is contracted with them, and tell them what you want.

Good luck in your search.

If money is not an issue for you, buy the S9 online, by all means. Maybe your insurance will even cover it???

But if it is an issue, the PR S1, while not as great as the S9 sounds, is not a bad machine. Let's see if I can clear up some of your concerns:

My reservations about the PR was that I keep my room at 60 degrees at night, and thought rainout would be an issue and I really don't want to have to add weight to the hose with a cover

The humidification system on the PR S1 works really WELL. I have NEVER had any rainout in my hose and we keep our bedroom quite cool in the winter (and as much as possible in the summer). I have had rainout issues in my nasal pillows, but I am told this is a problem with the design of the pillows (Swift LT for Her), NOT the PR S1.

also that it makes noises if you turn it on and off - worried about disturbing my husband, if I wake up in the night,

Yes, there is a beep that cannot be disabled without voiding the warranty that sounds when the machine is turned on. It is one short and not too loud beep. As long as you don't keep turning the machine off and on (I do this sometimes when I'm having mask issues) it should not bother your partner. Otherwise, it the machine overall is VERY quiet.

also that it is difficult to access data on the machine, and it doesn't show leak data - you have to download the card every time you want to see that.

Basic information (AHI averages over 7 and 30 days and 90% pressure) are easily accessible. You do have to download your card to access more detailed data, but--hey--if your DME is willing to throw in the software for free (it currently retails for $99 to $199), that's a good deal. If you have a 64 bit PC, my understanding is that it is not too difficult to get the data. It uses a standard SD card, very easy to remove and replace from both machine and reader.

Also that the software available, was just a viewer software, and cost money and that I'd have to go to the DME every time I wanted to change settings on the machine, (like going to Auto-titrate, or tweaking EPR, or ramp times).

You do NOT have to go to the DME every time you want to change these settings. You can access them through the clinician’s menu and take care of them yourself. If you do a bit of digging here on the forum (it’s not hard) you can easily find out how to access the clinician’s menu.

I would much rather have a Resmed 9, but with an HMO which also acts as my DME provider that’s not an option and I cannot afford one on my own. But the PR S1 is really OK. It does the job, I feel better, and while it doesn’t have all the bells and whistles of the S9, it will be just fine. Maybe you can rent one for a month and see for yourself.

I'm sorry that you're having such a difficult time getting your equipment, beadedbiker. You're certainly not the only one who's gone through this wringer with the DMEs! As I recall, you stated in a previous thread that your doctor specified "S9 Autoset set 4-20cm" on the prescription. Is that correct?

If so, then the DME needs to fill the prescription as written. I think they're just playing hardball with you. I suggest that you contact your doctor. Ask him if he can intervene so you can get the machine as prescribed. He may be willing to contact the DME for you. The DME doesn't want to lose potential doctor referrals, so they'll probably do as he asks. Or you could call other DMEs and see if there's another one that will be more cooperative.

You're going to be living with this machine every night for a long time. I know that you're probably very tired and discouraged, but be persistent and get what you really want.

I hope you'll let us know how it goes.

ADDED LATER - I wanted to comment on this:

beadedbiker wrote: Apparently my insurance (BCBS) will only pay $800 to the machine. Which is not enough to cover the S9. They are not allowed to charge me an upgrade fee. They told me, the price I can get it from CPAP.com, is cheaper than they can get it direct from Resmed.

The CPAP/APAP machine is billed separately from the humidifier. They are two different billing codes. They told you that BCBS will only pay $800 for the machine. Well, the ResMed S9 Autoset machine sells for $853 at cpap.com. I know that some of the higher-volume sellers can get products at a lower price, but I believe they were trying to mislead you. I'm sure they'd still make some money on the deal, just not as much as they would selling you the Respironics machine.

If the doctor prescribes a particular machine, can the DME refuse to give that machine??

DreamOn wrote: You're going to be living with this machine every night for a long time. I know that you're probably very tired and discouraged, but be persistent and get what you really want.

I hope you'll let us know how it goes.

Get what you want.
Fight the fight.

Yes, you're tired.
Most of us have been down this particular road....
and when you're tired and fatigued,
you just want some relief.

Fight the fight.
It will be worth it, for years to come.

....and somewhere down the road, you will
be a different person because of it.

All part of the cpap experience.

Be strong!

SleepingUgly wrote:If the doctor prescribes a particular machine, can the DME refuse to give that machine??

yes -

jules wrote:

SleepingUgly wrote:If the doctor prescribes a particular machine, can the DME refuse to give that machine??

yes -

But the DME has a contract to accept that particular insurance and has agreed to allowed amounts for coverage, no? That would be like going to a doctor who takes Blue Cross Blue Shield (or whatever) and the doctor says, "You know what, I'll do a flex sig on you, but not a colonoscopy because I don't like the reimbursement I get from your insurance for that procedure".

The DME has a contract to issue machine suitable for therapy (according to the insurance company's guidelines) to their victims - it has no obligation to issue the bells and whistles Mercedes if the motorcycle version would provide adequate therapy even if the Rx is for the Mercedes. Some DME's will absorb the cost; others won't. Some DME's have contracts with insurance to allow upcharges.

The CPAP isn't like big boxes of Coke sold below cost at the grocery store to entice you to come in and spend all your grocery money there.

SleepingUgly wrote:If the doctor prescribes a particular machine, can the DME refuse to give that machine??

My DME had to call my doc's office to get approval for an apap when my prescription was for a cpap. When I told the tech I knew I could use the cpap prescription to buy an apap online, he said their accreditation requires an exact fill. Since he was happy to call the doc's office and the doc's office gave approval I had no problem. My prescription was not for a particular model though it did specify leak and AHI data download.

I had trouble getting the S9 at first, but my doctor intervened and I found a provider who would buy the S9 for me and he sent them a prescription to them and it's coming FRIDAY! The kind people on this list told me to stand my ground and I did and hallelujah, it's happening. I like the ResMed they gave me at first, but it had no data reporting. I'm on a Mac, so that may not be helpful to me, but the DME can show me how to use the daily report at least until someone writes a program for the Mac.

Meanwhile, keep the faith and fight for your rights. I think your doctor is your KING, so go to him for help.

Good luck.