New Member!

Hello to everyone........I have been recently diagnosed with moderate/severe obstructive sleep apnea. I completed my two night sleep study earlier this month and I received the bad news yesterday from my doctor. The study went very well both nights and I had no trouble sleeping the second night with the mask on. My doctors comments were "you slept exceptionally well" the second night and most patients dont because they struggle with the mask. Only woke once to make a trip to the bathroom and had no trouble falling back asleep.

Here is the interesting part........I dont exhibit any of the classic 'symptoms' like sleepiness during the day, fatigue, memory or concentration problems, etc. I did feel much better the next morning and throughout the day. I have known for years that I snored and that is the reason I went for the study. What a shocker when he told me!

Anyway I have been reading some posts here for a couple days and I have learned a lot so far!! I used the C-flex technology during my study (and it worked very well) so I know that I am going to get a Respironics device. I called my insurance company and I am very fortunate that everything will be covered 100% no deductable or copay. I am now waiting for the sleep center to contact my insurance with the 'codes' so they can refer me to a DME.

The interesting part with my insurance is that my employer is a large worldwide company with several US locations and even though I live in Ohio my insurance is Blue Cross/Blue Shield of Michigan since we have a sister company there. So when I asked my insurance company about the DME she told me that since I am 'technically' out of the Michigan network I am not penalized and I can use any DME provider in my area and they will cover me 100%. And I can also use CPAP.com and they will reimburse me 100%. My choice.

What do some of you think I should consider given my unique insurance situation? The only down side I see with CPAP.com is that I can not 'try' several masks before settling on one. I buy it and its mine even if I dont like it.

Look forward to your advice!! Thanks in advance!!

MARK

Welcome, Mark!! Sounds like you're off to a good start. I too have good insurance but know lots of folks don't so you're situation is great. To those who don't---it would be like a kid in a candy store!! I've gone through a few masks and basically what I did was keep reading on this site to see the kind that folks like the most. Of course 2 of the 3 that I initally tried, some like alot and they didn't work for me, but you just have to keep trying until you find one that works for you. But if your insurance will pay, you're out nothing so you can afford to try several. Best of luck to you ---keep posting and let everyone know how you're doing.
Kathy

Mark,

Welcome to the forum.

I've purchased from cpap.com many time and have never regretted it. It will save your insurance company oodles of money if you buy online. It sounds like you are looking at getting a good machine. I would suggest you look at getting the REMstar auto w/ c-flex, it will give you a lot of flexibility in making sure you are getting the right treatment an will only be a couple hundred dollars more (actually if you buy online the auto will be much cheaper than the most basic cpap from a local DME).

As far as trying the masks.. with most local DMEs you won't get to choose from a wide variety of masks and unfortunately a DME that will sell you a REMstar machine will probably only carry the Respironics line of masks which are on the poor end of the success scale. I think you will find if you read enough on the forum that the ResMed Mirage Activa is the most recommended first mask. From there I would suggest trying a nasal pillow interface like the AEIOMed Headrest (aura) or the ResMed Mirage Swift.

I think you will find you will get much better customer service from cpap.com. They have phone support till late in the evening 6 days per week. This forum is also a great place to get some feedback regarding any questions you might have.

Good Luck.

Mark83 wrote:...I can use any DME provider in my area and they will cover me 100%. And I can also use CPAP.com and they will reimburse me 100%. My choice.

I suggest you read the following link to a thread on this very subject. 2 pages of very interesting discussion.

I Just dont get it...

As far as masks go, it's really just a crap shoot. What works for someone else may not work for you. It depends on the shape/size of your head, the shape/size of your face, the shape/size of your cheeks, the shape/size of your nose, etc. It seems general consensus is that the Respironics masks aren't as well-liked as ResMed.

Maybe you could try on the masks at a DME and tell them you'll think about it. Then go home and order online from cpap.com.

I haven't heard anyone who regrets bypassing the expensive, time-consuming, often uninformed DME in favor of online purchasing. I have heard a LOT of regrets from those who used a DME.

Hi Mark83,

What kind of a mask did you use at the sleep study? Was is good for you?

Wader has given you good advice and he has a lot of experience. My first and so far only mask has been the Activa which works well for me. I do intend to get a nasal mask but have not yet made any decision - the one I have works well.

I think you need to confirm if you are a mouth breather or not as this may dictate the kind of mask you need.

My suggestion is to get a quote from a local DME for a machine and several masks. Then get the same quote from CPAP.COM. For sure they will be much cheaper at least by half. Then approach your insurance company with the comparison cost of the the machine and one mask and demonstrate that CPAP.COM will give you at least 2 or 3 additional masks for a lower price then the cheapest local DME. Don't forgrt to mention the "package deal". Who knows, you may be able to fanagle a couple of extra masks going this route.

I would not be at all concerned with dealing on line with CPAP.COM vs. a local DME. After reading many, many posts from individuals here and their first time experiences with local DME's you are sure to get much better service and professional advice from CPAP.com.

I am glad you found this forum as it has so much to offer. In return, you can help the rest of us and other first timers by keeping us informed of your progress, both the highs and the lows as well as any glitches or innovations you encounter.

Thanks for posting and wishing you well!

Bob F

Mark,

Welcome & you are off to a big head start. Your attitude is a winner.

Re machines

1) RemStar AUTO with cflex + h/h + software & card reader
equal
1) PB420E with h/h + software

I can personally vouch for the quietness of the RemStar - others here swear by the PB420E but one or two felt the noise was a problem.

As for ResMed - I will leave it for others who have tried the S8 Vantage to comment - I only have an S8 Escape & I have learned the hard way that what an AUTO will do noise wise is *not* the same as a similar CPAP only family model.

Cheers

DSM

Wader......Thanks for the feedback....a question......will I get to 'choose' the Respironics model with C-flex (Plus, Pro, Auto) or is this something that is 'prescribed' by my doctor and I will be told that the Auto is not 'medically' necessary by my insurance co.? Just kind of curious how this works??

Bob....I am going to call my technician that did my study and ask her which mask I used. I honestly dont remember. She let me try a couple on and I picked the one that seemed to fit the best. It was similar to the Respironics Comfort Gel mask. It was a little uncomfortable but I did sleep well with it. I had a leak around my eyes early on but she came right in and adjusted it. No leaks after. I was afraid that I would breathe through my mouth as well but I guess I didnt because I slept like a baby!

DSM........I do like the card reader option but how do you use it at home and would it really be a benefit for me?

Thanks to everyone for the feedback. I am actually excited to get started! Believe it or not. I have researched the masks fairly well and I like the 'looks' (havent tried them yet) of the Respironics Comfort Lite, Mirage Swift, Breeze, Comfort Gel and profile lite.

I will keep everyone posted as to my progress!!

MARK

Today I talked with the DME I was referred to for the first time. We had a little discussion about machines, masks, etc. and she quickly realized that I had done my research on the subjects. She had my prescription and I asked her what machine she would provide me. She told me the Remstar Plus with C-Flex. After reading so much on this site about the raves for an Auto machine I told her that I wanted a Remstar Auto with C-Flex. She told me that since an 'Auto' machine was not prescribed by the doctor that she could not provide me with that model and she went on to try and explain that I was prescribed a 'fixed' pressure and not a 'variable' one and therefore that machine was not an option for me.

Since this is the first time I am going thru this I dont know how accurate her assessment was??? Is that true that since the doctor didnt prescribe an 'Auto' machine that she 'technically' cant give me one? I told her my insurance is paying for it so what is the difference 'what' machine I get?? She didnt have a good answer.

Any help would be appreciated since I will be talking again to her tomorrow.

Thanks Guys and Gals!!!!


MARK

Hi Mark,
Tell your DME to take a hike and buy the machine you want from CPAP.com. You get get what you want instead of what they want to give you. The DME gets reimbursed the same rate for ths apap as they do foer a cpap. You get the less expensive machine and they make more money. Guess who loses in that deal! You have a good situation with your insurance, so take advantage of it. New machines aren't easy to get out of them, so choose carefully, and get what YOU want, not what they tell you you can have. I've bought several things from CPAP.com, and have received excellent support. Best of luck!

Hi Mark83,

The Auto can be used as a straight CPAP as well. It just gives you more options for your treatment and is a more advanced technology. That's why I chose the auto.

As it turned out, I am glad I did choose the Auto as I needed a slightly higher pressure than what I was titrated for. In addition, your's and everyone's sleep test is done under specific conditions the most important of which is your particular health and congestion level at the time. Well guess what, things change - and so do your particular pressure needs at any given time based on your personal health status. An Auto titrating unit is the latest step in attempting to meet your personal needs on a night to night as well as a breath to breath basis.

Kind of like cars, computers, TV's etc, every year they come up with new and improved products. My theory is to get the most up to date product you can as long as you can afford it. When it comes to your own health, why skimp especially if your insurance is paying for it? Don't settle for less! So go ahead and get the best money can buy from CPAP.com even if it does cost 60% less than the older model with fewer features and soon to be replaced that your DME is insisting on.

Good luck and keep posting. I just love these DME stories!

Bob F

PS- It's not rocket science, it's common sense. Many DME's think it is rocket science and the sky is unlimited! ( Their sky, your bucks.)

What was your doctor like? Was he/she someone who was very specific about your machine and stuff? Mine knew nothing...I had to tell her how to write out the prescription properly (an internal medicine doc, not sleep doc). If you've got that type, call them and ask if you could get an Autopap from your insurance because then you would own a machine more likely to meet your needs as they change through the years...remind the doc that it is simply a CPAP machine with more options if you were to need those options. But that, whoops, your prescription has to specify APAP...

BUT the prescription only has to say APAP if you are using a local DME...if you buy it from CPAP.com, they will take your CPAP prescriiption and allow you to buy the machine you want, CPAP or APAP.

Good luck. Oh, by the way, one bit of advice I learned from this forum is that, in general, stay away from any mask that has "comfort" in the name. I always remember that advice because it is so funny...

Jan in Colo.

Mark83 wrote: She told me that since an 'Auto' machine was not prescribed by the doctor that she could not provide me with that model and she went on to try and explain that I was prescribed a 'fixed' pressure and not a 'variable' one and therefore that machine was not an option for me.

Jan is absolutely right!
This must be your DME's rule. It is not the case for ordering online. The insurance billing code for a straight CPAP is exactly the same as the billing code for an APAP! Tell them you want the prescription and fax it in to cpap.com and order whatever machine YOU choose.

Here's a link to a pertinent thread: Auto Cpap question

Just another two sense worth - my doc prescribed CPAP at 10cm with heated humidifier; that's all. I was fortunate in that my insurance didn't get hung up on the terminology and my DME (BMI) filled the prescription with an auto machine. As it turns out, at least in my case, the use of CPAP is kind of a generic name now, like aspirin, and in most cases they are referring to the technology itself in a gereral way, not a specific machine. Calling one machine a CPAP and another APAP is slightly incorrect as a APAP is still CPAP technology. The fact that it may be Variable Continuous...... makes no difference.

New readers should note that they may need to educate their sleep doc as to what you've learned and ask for the auto as it broadens your capabilites down the road and gives you more options for different scenarios depending on how you react to the treatment. BE PROACTIVE, it pays off! Be sure to ask why they want you to only have ONE pressure available. Its odd that the industry is hung up on terminology and it is getting in the way in many cases of getting effective treatment.

JimK

One more thing.....Unless your doctor is a bonafide SLEEP DOCTOR, he/she probably doesn't really know what the heck he/she is talking about. ENT's prescribe sleep studies and subsequent CPAP for example, as do internal medicine doctors, GP's, family care docs, etc....and I'm betting unless you find one who is a personal user of the equipemnt, they don't know as much terminology as we do, they don't know the brands of machines, etc., etc., etc. They write out a basic script and depend on the DME's knowledge from there on in. So give them a little nudge as to how you want your prescription written.....they probably won't mind at all.

Jan in Colo.

First, thanks to everyone for their replies and advice!! I appreciate it very much.

Jan, My Doctor is actually a Neurologist with his specialty in Sleep Medicine. He is a very well known and respected physician in my area in the field of sleep medicine. As such, my time with him was about 10 minutes during the follow-up visit. He answered all my questions that I had at the time and told me to call his office with any questions as his staff is exceptionallly well educated and trained in sleep medicine.

I just called and spoke to one his staff members about my initial call to the DME and her response to the Auto CPAP inquiry that I had. She was VERY knowledgeable and helpful!!! She told me Mark if you want an Auto CPAP I will change your prescription right now!! She educated me more on the Auto CPAP topic and told me she agreed it is 'state of the art' and it isnt an issue at all to change my prescription!

We continued to discuss the Pros and Cons of DME and using CPAP.com. She agreed that she could not give me ANY benefit that the DME could provide me!! She also told me the DME would NOT let me 'borrow' or 'try' masks. I get what I get from them. BUT she told me that I can stop by my doctors sleep clinic and I can try ANY mask that I want and keep it until my insurance would pay for a new one!! WOW! Now that is SERVICE!! She even called the DME back for me to cancel my appointment!!! It's funny that in the last hour I have two voice mails from the DME!!! NOW, all of a sudden they have openings tomorrow!!!

Long story short, I will be contacting Billmyinsurance.com and buying from CPAP.com!!! She already faxed me my prescription with Auto CPAP and she recommended the Swift to start with. She told me if I have ANY problems or questions to contact HER!

Only question I have is how long does the process take with Billmyinsurance.com until I receive my equipment???

Thanks again!!!

MARK