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contracted DME will be paid the exact same number of $$$ regardless of whether the insured patient is set up with an out-of-date compliance-only CPAP that's been sitting on the shelf for a year or a brand, spanking new APAP with all the whistles.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.