Feature differences in S9 models?

I am a Respiratory Therapist and I can explain why you may be given the S9 Escpae instead of the S9 Auto. First of all, your insurance is a determining factor because of the added cost and if they will pay for it or not. Also, some physicians want to see all data while others do not. It is not up to the Respiratory Therapist or the RT would give every patient a good CPAP machine that gave all clinical data possible. Every RT works for someone who tells them what products they can use due to companies having formulary guidelines. Let me also caution people purchasing the Resmed S9 CPAP of any version. It is a piece of junk. I receive a lot of them back with an ERROR message and it will not turn back on and has to be sent back to Resmed along with the CPAP and humidifier not staying together and that requiring the manufacturer to fix as well. Just because the new S9 model looks good doesn't mean it works. I have several physicians who are CPAP patients that have made me order in the Respironics Remstar Plus A-Flex or C-Flex CPAP for their personal use. The Fisher Paykel ICON is a good CPAP as well with added features including a clock, alarm clock, plays music, and is all one small compact unit including a built in humidifier.

sleepwellmylove wrote: ...We do travel internationally, and once toasted the fuses in an earlier generation CPAP brick while in Europe. We'd only used an adapter when what we should have used was a transformer to convert the voltage from 220 to 110. ...

Can the S9 Autoset be used overseas without a transformer. Page 6 of http://www.resmed.com/us/assets/documen ... er_eng.pdf implies to me that it can. Anyone actually done it?

Hey, uh, Guest12. I take it you have little to no experience w/the Respironics M Series or the newer PR SystemOne PAPs??? Stopping, and, MAYBE, starting again on their own during the night? Stopping and NOT being able to be restarted during the night? And other transgressions as well. The Resmeds enjoyed a jump in sales due to the Respironics M Series. Between these two manufacturers they control 80% of the USA CPAP market.

Compliance data only CPAPs, fully data capable CPAPs and auto-titrating CPAPs are ALL just CPAPs: HCPCS code e0601. Most all insurances contract w/local DME providers by HCPCS code, NOT by brand and model, so if your local DME company contracted w/an insurance to provide HCPCS code e0601 they should have factored in the cost of all 3 styles of e0601. You won't get any sympathy here for excuses to provide bottom of the barrel, compliance data only capable CPAPs. You're crying on the WRONG shoulders!!!

sleepwellmylove wrote: Is there a way we can determine the current EPR setting without having to contact the RT? I seem to recall a thread that dealt with a special menu on the S9 XPAP, available only to the RT--unless you know how to access it. Right now he has a S9 Escape Auto, but we plan to swap it for the AutoSet.

Yes. If you can't see EPR now viewing ability may have been turned off in the clinician menu.
To access the clinician menu to turn it on.
http://www.apneaboard.com/ResMed/ResMed ... Setup.html

If you don't have the clinician manual I would suggest that you also get it. It will show and explain things in more detail.
Do a forum search for member Uncle_Bob and look in his signature line for clinician manual download link along with software when you get a machine that gives you data.

A clinical manuel will give you that information. Send me a PM with an e-mail address or look for member Uncle-Bob. Under his signature is a download link for the clinical manuel and also for the ResScan software. If you guys are able to switch to the auto-set the software would help you a lot.

Slinky wrote:Hey, uh, Guest12. I take it you have little to no experience w/the Respironics M Series or the newer PR SystemOne PAPs??? Stopping, and, MAYBE, starting again on their own during the night? Stopping and NOT being able to be restarted during the night? And other transgressions as well. The Resmeds enjoyed a jump in sales due to the Respironics M Series. Between these two manufacturers they control 80% of the USA CPAP market.

Compliance data only CPAPs, fully data capable CPAPs and auto-titrating CPAPs are ALL just CPAPs: HCPCS code e0601. Most all insurances contract w/local DME providers by HCPCS code, NOT by brand and model, so if your local DME company contracted w/an insurance to provide HCPCS code e0601 they should have factored in the cost of all 3 styles of e0601. You won't get any sympathy here for excuses to provide bottom of the barrel, compliance data only capable CPAPs. You're crying on the WRONG shoulders!!!

First I am not crying about anything and secondly I know about all brands. I was simply stating the facts that sometimes your equipment is dictated by insurance and also what company a Respiratory Therapist works for as well as the ordering physicians choice. ALL brands make good and bad equipment, it happens. Bottom line ALL guidelines are set by Medicare and since we are not owners of companies or prescribing physicians we have to do what we are told. All insurance companies contract with all DME companies. Right now, United Healthcare will only allow their patients to get an old crappy Fisher Paykel Sleepstyle 200. That is not an RT's fault. I stopped by to be helpful not be put down and told I am crying. I don't even understand that "quote" but you obvisously are a very closed minded person. Get a Resmed S9 and see how long it lasts you. I was simply telling you that right now there is a major problem with this CPAP and that they are working to correct it. ALL brands make models that give AHI, leakage and if they are Auto the pressure as well. Resmed, Respironics, and Fisher Paykel ALL make these types of CPAP's and BIPAP's. You may just have to open up your pocket book to PAY for it.

Guest 12 wrote: First I am not crying about anything and secondly I know about all brands. I was simply stating the facts that sometimes your equipment is dictated by insurance and also what company a Respiratory Therapist works for as well as the ordering physicians choice. ALL brands make good and bad equipment, it happens. Bottom line ALL guidelines are set by Medicare and since we are not owners of companies or prescribing physicians we have to do what we are told. All insurance companies contract with all DME companies. Right now, United Healthcare will only allow their patients to get an old crappy Fisher Paykel Sleepstyle 200. That is not an RT's fault. I stopped by to be helpful not be put down and told I am crying. I don't even understand that "quote" but you obvisously are a very closed minded person. Get a Resmed S9 and see how long it lasts you. I was simply telling you that right now there is a major problem with this CPAP and that they are working to correct it. ALL brands make models that give AHI, leakage and if they are Auto the pressure as well. Resmed, Respironics, and Fisher Paykel ALL make these types of CPAP's and BIPAP's. You may just have to open up your pocket book to PAY for it.

Sounds like the real problem is the company that YOU work for. My DME standardly issues Resmed S9 autosets to all CPAP patients. And I know plenty of people with united healthcare as well as BCBS and CIGNA. My DME prefers to use Resmed S9 series when at all possible. Makes it easier for them as well as for the patients. They don't even carry the older models of machines.

Guest 12 wrote: I was simply stating the facts that sometimes your equipment is dictated by insurance and also what company a Respiratory Therapist works for as well as the ordering physicians choice.

We have excellent insurance (Blue Cross Blue Shield) and it is my understanding that we are not limited to working with the DME suggested by his MD or the RT they sent us, although she seems quite lovely and flexible, so I don't anticipate we'll be looking for another RT or DME.

Guest 12 wrote:Bottom line ALL guidelines are set by Medicare and since we are not owners of companies or prescribing physicians we have to do what we are told.

I don't think this applies to us because we are not on Medicare. But we're still learning about how this works, so I could be wrong.

Guest 12 wrote:Right now, United Healthcare will only allow their patients to get an old crappy Fisher Paykel Sleepstyle 200. That is not an RT's fault.

This is not our situation. We have BCBS and have our choice of any MD, any DME, any RT.

Guest 12 wrote:You may just have to open up your pocket book to PAY for it.

I know you said you were trying to be helpful, and if that's the case, please refrain from shouting in all caps. If I did not know you were being helpful, I would think that you are insinuating that we do not pay for what we get. Au contraire! The insurance premiums, deductibles, and co-pays we pay each year are enough to pay full tuition at an Ivy League university. And on top of that, we are willing to pay full fare, if need be, in order to receive the necessary medical treatment and DME. So please don't assume otherwise.

Bobby269 wrote:A clinical manuel will give you that information. Send me a PM with an e-mail address or look for member Uncle-Bob. Under his signature is a download link for the clinical manuel and also for the ResScan software. If you guys are able to switch to the auto-set the software would help you a lot.

Thank you. I just downloaded the clinical guide and the software, but it looks like the software only runs on PC OS, and we have converted all our systems to Macs. Does anyone know if there is a Mac version available?

Guest 12 wrote:I was simply stating the facts that sometimes your equipment is dictated by insurance and also what company a Respiratory Therapist works for as well as the ordering physicians choice. ALL brands make good and bad equipment, it happens. Bottom line ALL guidelines are set by Medicare and since we are not owners of companies or prescribing physicians we have to do what we are told. All insurance companies contract with all DME companies. Right now, United Healthcare will only allow their patients to get an old crappy Fisher Paykel Sleepstyle 200.

Any insurance company that pays by HCPCS code and MEDICARE do NOT care what CPAP/APAP machine a DME provides as long as it is billed under HCPCS code e0601 and collects at least the minumum compliance data. Moreover a generic prescription for "CPAP @ n cm pressure" is enough to allow a DME to provide the patient with any CPAP/APAP machine that is billed under HCPCS code e0601.

What the insurance company negotiates with the DMEs is how many $$$ the DME is allowed to charge a covered patient for any CPAP/APAP that is billed under HCPCS code e0601: In other words, the contracted DME will be paid the exact same number of $$$ regardless of whether the insured patient is set up with an out-of-date compliance-only CPAP that's been sitting on the shelf for a year or a brand, spanking new APAP with all the whistles. And the fact that $$$ are at stake explains why the DMEs may well tell their customers lies such as "Full data machines don't exist", "Your insurance company won't pay for anything beyond a basic CPAP", "Full data machines require a special prescription", "The (Resmed Escape, PR Plus, Icon Novo) is a full data machine---see here's its chip", and more, all in an effort to minimize their immediate profit by getting the unsuspecting new hosehead to accept a machine that does not provide enough data for anybody (the patient, the RT, or the sleep doc) to determine whether therapy is working appropriately if/when the patient runs into difficulties.

In my own case, I know that the $$$ negotiated by my insurance company as payment for an xPAP billable under HCPCS code e0601 was enough to generously cover the cost of either the Resmed S9 AutoSet or the PR System One Auto. In the process of looking for a DME, I called many local DMEs that were "in network" as far as my insurance company goes. Every single DME I called quoted me the exact same price for my equipment with the exact same breakdown between the insurance company's share of the bill and mine. And all but one of the DMEs told me the lies and said they had no choice but to set me up with an S9 Escape or a System One Plus. But I eventually found the DME which I now use. It is an excellent one: They stock S9 AutoSets, PR S1 Autos, and F&P Icon Premos as their default machines and allow new customers to chose between them. Now, my DME will make more money if a customer covered by my insurance chooses the Icon or the System One over the S9, but they don't push you towards any brand. Rather they let you actually have a chance to listen to and breathe with a demo model of each machine first so you're not picking the machine blind. And the RT makes sure you know about all the bells and whistles for each machine and also makes sure you know how to access the on-line data.

So if you are working for a DME that claims a particular insurance company will only authorize a particularly bad, out-of-date, compliance only data machine, then in my not-so-humble opinion, you really ought to ask the manager to prove that statement to you and show you the exact language in the contract because you are doing the patients covered by that insurance company no favors setting them up with a machine that maximizes their chances of becoming noncompliant well before the first year is over. Because I wouldn't put it past a shady DME owner to tell their employees the same kind of lies they insist on telling us patients.

Get a Resmed S9 and see how long it lasts you. I was simply telling you that right now there is a major problem with this CPAP and that they are working to correct it. ALL brands make models that give AHI, leakage and if they are Auto the pressure as well. Resmed, Respironics, and Fisher Paykel ALL make these types of CPAP's and BIPAP's. You may just have to open up your pocket book to PAY for it.

As for quality issues: Yes, both Resmed and PR have quality issues if you read the posts carefully on this board. My own small data points are based using both a Resmed S9 AutoSet (for three months) and a pair of PR System One BiPAP Autos (for a total of five months). I experienced no manufacturing defects with the S9, although the Slimline hose did develop small tears within 6 weeks. Not promising for a piece of equipment that, according to my insurance, only needs to be replaced every six months. Duct tape took care of the leaks well enough. But the first PR S1 BiPAP proved unreliable in that I had clear evidence that it had turned itself off at night more than one and only sometimes turned itself back on. It was exchanged for a new S1 BiPAP before it was 4 months old. The same thing may have happened with the new one-month old machine, but I cannot be 100% certain that it was the machine (and not a human or a pet) that turned it off one night about 2 1/2 weeks ago. All in all, I'd rather deal with crappy hoses than unreliable firmware in the blower unit.

But (and this is an important but) for both Resmed and Resprionics, the relative number of complaints to happy customers is SMALL---provided the customers have a machine that provides them with the data they need to be actively involved in managing their OSA.

And do why the Resmed S9 and the PR System One get more airtime around here? The easy answer is that we---the USERS of these machines---can readily get our hands on appropriate software for analyzing the data gathered by the S9 and the System One. But to the best of my recollection, no Icon user has been able to successfully get their hands on the software needed to do a more detailed analysis of the data. And that software really does help us determine when we have problems with therapy and what the fix for the problem might be. In particular, it's the only way we---the USERS of these machines can really determine whether leaks and mouth breathing are issues or whether the pressure setting determined by the titration might need some adjusting. And for those of us unlucky enough to have long, drawn-out, and difficult adjustment periods, that data is critical in keeping us willing to do our lonely battle to make CPAP work each and every night when we go to bed without a friendly RT or sleep doc around to see what's happening in our troubled sleep.

robysue wrote:I experienced no manufacturing defects with the S9, although the Slimline hose did develop small tears within 6 weeks. Not promising for a piece of equipment that, according to my insurance, only needs to be replaced every six months. Duct tape took care of the leaks well enough.

@robysue, this is interesting info about your Slimline hose. In your opinion, did these tears happen because the material used to construct the hose is not durable enough to survive the tosses and turns one makes at night while sleeping, or because of a design flaw, or because of a defect in the material of your particular hose?

The reason I'm asking is because DH's RT left him with a Resperonics hose for the S9 instead of the Slimline. The RT didn't say why and I only noticed it after she left. I was going to ask for a Slimline hose when we swapped out the Escape for an AutoSet because I thought we should have the hose that was designed to go with the S9 unit (plus the Slimline is a bit smaller for traveling). Now I am wondering if we should leave good enough alone and keep the Resperonics hose.

Speaking of traveling, since DH does not use a humidifier, is there an alternate XPAP carrying bag we might buy? The ResMed S9 bag is very nice but since his is only half full I feel the unit may be more susceptible to damage.

Another S9 question I have is, are people who opt out of the S9 humidifier billed out at the same price for their S9 as those with respirators, or is there a corresponding price reduction? Because if DH is being billed out at full S9 fare, perhaps he should go ahead and take the humidifier anyway, in case he has a need for it in the future. He does use nasal pillows, but insists his nose does not dry out (we do live in a very humid environment year round, so perhaps that is enough to compensate. Any thoughts?

sleepwellmylove wrote: This is not our situation. We have BCBS and have our choice of any MD, any DME, any RT.

Are you SURE? That's what I thought, too. While they'll pay for an MD out of network, they will refuse to cover costs for equipment purchased from a DME that they're not contracted with. Phone the number on the back of your card and ask for a list of DMEs in your zip code that they are contracted with. Or you can do like I did and just pay out of pocket to avoid the hassles.

billbolton wrote:

SleepyHound wrote:And I can hear the water in the humidifier "bubbling" when I take a deep breath

You may have over-filled the humidifier then........

Cheers,

Bill

That sounds more like water in the hose. It will collect at a bend in the hose, and then as you breathe hard, it will bubble. When it happens, try to not move the hose too much, then unplug the hose at the machine and hold the end up a little. Then disconnect the hose at the mask end and hold the two ends up together. Now see if you can pour any water out of the hose. Start at one end of the hose, holding it higher than the rest of the hose, and work your way down to the other end, seeing if any water comes out the other end. You may also be able to see the water in the hose, depending on the hose.

This is what we call rainout, and it's usually due to room temperature and humidity level in the hose. It isn't usually from overfilling the water tank. However, you shouldn't overfill the water tank.

sleepwellmylove wrote:

robysue wrote:I experienced no manufacturing defects with the S9, although the Slimline hose did develop small tears within 6 weeks. Not promising for a piece of equipment that, according to my insurance, only needs to be replaced every six months. Duct tape took care of the leaks well enough.

@robysue, this is interesting info about your Slimline hose. In your opinion, did these tears happen because the material used to construct the hose is not durable enough to survive the tosses and turns one makes at night while sleeping, or because of a design flaw, or because of a defect in the material of your particular hose?

Given where the small tears were (right at the couplings), I'm sure the problem was not that the hose wasn't tough enough to survive the tossing and turning at night. The problem might have been caused by the fact that the hose attaches to the back side of the S9 humidifier, and that forced a pretty sharp bend in the hose with where I had the machine on my xPAP table. The PR S1's hose is attached to a rotating outlet on the top of the humdifier. So the hose is under much less stress on the S1.

However, I do think the hose material on the Slimline might not be quite as tough as my 15mm Resprionics Performance hose. And that could have resulted in it not standing up quite as well to my "Annie Oakley" routine (as my husband refers to it) for drying the hose after its weekly soaking in a vinegar-hot water bath.

Another S9 question I have is, are people who opt out of the S9 humidifier billed out at the same price for their S9 as those with respirators, or is there a corresponding price reduction? Because if DH is being billed out at full S9 fare, perhaps he should go ahead and take the humidifier anyway, in case he has a need for it in the future. He does use nasal pillows, but insists his nose does not dry out (we do live in a very humid environment year round, so perhaps that is enough to compensate. Any thoughts?

My humidifier was an extra one-time purchase charge; the blower unit was a monthly rent-to-own deal because of the insurance.

robysue wrote: However, I do think the hose material on the Slimline might not be quite as tough as my 15mm Resprionics Performance hose. And that could have resulted in it not standing up quite as well to my "Annie Oakley" routine (as my husband refers to it) for drying the hose after its weekly soaking in a vinegar-hot water bath.

@robysue: Do you use the 15mm Resperonics Performance hose with your XPAP? If so, do you prefer it to the Slimline because it is sturdier? Any difference in the effectiveness and/or noise level of your XPAP set-up with the Resperonics hose?

Do other people mix and match hoses? If so, what qualities are desirable?

Also, I'd like to hear more about that weekly bath. DH never rinses or cleans any of his components, and I think I may assist in that regard.