upgrade to what machine

The machine and humidifier was $850 and then the rest of the equipment (head gear etc) was $100. Then there was $95.00 tax. I asked the DME to bill Blue Cross so that I could get my denial and appeal it. They said the insurance company won't allow them to bill unless I've had a sleep study. Maybe I should do the study, but I just hate to. I'll have to get a sitter to spend the night with my mom. I'm going to appeal based on the extreme blood pressure drop---that drop does worry me a little. I've never in my adult life had a blood pressure that low --- not normal at all for me.

jess wrote:ok - I looked at the bottom of the machine --- it says ref - 150 P. So guess I got the bottom of the line. I do want a data capable machine because maybe my apnea will change. I don't know if I need the flex options because this feels pretty comfortable, but then I'm at a 7. I do feel leaks when I first put on the mask at night. But then there have been times that I wake up in the middle of the night and don't even know I have the mask on. If my apnea gets worse and I need a higher pressure I'll need a flex -- right??? Sorry about my stupid questions, but I'm still very confused about all the terminology. I think that if a better machine just cost about $500.00 more than I should probably go for it. I'll stick with the Respronics -- Remstar. Would you tell me exactly what to get --- maybe you can give me one or two options --- then I'll price them in the morning. I won't be able to purchase online, because I've got to return this machine ---- I purchased it on 7/1/11 ---- not even sure if they'll take it back. I will have a better chance if I trade UP. Thanks again for all the help. Sure wish I had researched before purchase, but the doctor made me an appointment at this supply group because they were supposed to give me a discount. I don't think I got much of a discount. I paid $950.00 (excluding tax) for everything. Does that sound like a discount?

Yes, bingo. That's the PRS1 "DS150" or basic REMstar. No data, but it will do fine if you get the right pressure.

You haven't asked any stupid questions yet.

"Flex" makes you more comfortable, but I think that if you don't use it, you won't notice the difference after a week. All the good machines have it, so don't worry about it.

Unfortunately, $950 is a discount for a local DME. Prices are often a LOT higher, especially if you aren't buying under insurance.

Here's what I'd try for.

PRS1 Auto - best choice.
PRS1 Pro - Fine machine without autopressure.
PRS1 Plus - NO - no data.
PRS1 DS150 or Basic - NO - No data no flex.

There's a brand new PRS1 AutoIQ. For several reasons, I wouldn't buy one of these until we find out more about it.

Do not accept any of the older Respironics REMstar machines. The ones that look like yours and say Philips have a lot of improvements over the older models.

ResMed S9 models are good, too.

AutoSet is as good as PRS1 Auto
Elite is as good as PRS1 Pro.
Escape Auto - NO - Does not have good data.
Escape - NO does not have good data.

Don't accept any ResMed S8 machines. S9's are big improvement in several ways.

Shop on cpap.com. Be sure to click the links to get the sales price. Compare this to what you can get through the DME and insurance.

jess wrote:The machine and humidifier was $850 and then the rest of the equipment (head gear etc) was $100. Then there was $95.00 tax. I asked the DME to bill Blue Cross so that I could get my denial and appeal it. They said the insurance company won't allow them to bill unless I've had a sleep study. Maybe I should do the study, but I just hate to. I'll have to get a sitter to spend the night with my mom. I'm going to appeal based on the extreme blood pressure drop---that drop does worry me a little. I've never in my adult life had a blood pressure that low --- not normal at all for me.

Getting a sleep study is a good thing. Costs money, though. Sometimes lots of money. A well done study checks a lot of things you won't be able to check yourself even with the best CPAP machine.

Do you have any complicating factors other than blood pressure? 125/85 doesn't really seem terribly high. Did you have higher pressure before or without medication? Are you on blood pressure meds?

The amount of blood pressure drop you had is not at all surprising. Apnea does increase BP in many people.

the only thing about switching from Phillips Respironics to Resmed at this point archangle... is that she's already bought the humidifier.

Jess, in order to make the transition less costly... stick to the PR S1's... that way you'll use your current humidifer and not have to buy another one.

Some sites post retail prices and only show you the discount when you put it in the cart. Once it's in the cart, they also show you discounts on accessories, such as the humidifier and the monitoring software. Go with a site that advertises at least a 7 day price match. I found mine on sale two days after I received it and got a credit posted back to my card.

I bought the Devilbiss Intellipap Auto and I like it. I, too, was given a Remstar M100 plain CPAP at first and couldn't get the doctor to prescribe an auto. I should have refused what they gave my on the morning after my sleep study and demanded an auto. But, considering what they charged me for the 10 month rental on the fixed pressure CPAP, I would have been much better off shopping and doing some price checking online.

The Devilbiss, as someone said, has good monitoring features in the software, but does not feature a flow graph. The flow graph shows a sinusoidal representation of your breathing. This is valuable if you have apnea or hypopnea and want to see what happened at that time. The system one SW actually places icons where the issues were and you can see on the flow graph what the machine detected at that time. To me, this is priceless.

I wonder if I could get a credit and upgrade for my Intellipap and pay the difference to upgrade to the system one at this point. I know they wouldn't credit the software and the data module.

"Do you have any complicating factors other than blood pressure? 125/85 doesn't really seem terribly high. Did you have higher pressure before or without medication? Are you on blood pressure meds? " No, I've never been on blood pressure medication -- blood pressure has never been a worry for me. That's why this drop of 15 points in just two weeks has been a concern. The only medicine I'm on is for low thyroid. I'm going to post a new threat on what I learned from the doctor today.
I called the medical supply people today --- they will trade up, but I didn't get a price because I didn't know what to ask for without coming back to this tread. I will start price shopping in the morning. I'll let y'all know what I end up with. Thanks again

jess wrote: No, I've never been on blood pressure medication -- blood pressure has never been a worry for me. That's why this drop of 15 points in just two weeks has been a concern. The only medicine I'm on is for low thyroid. I'm going to post a new threat on what I learned from the doctor today.
I called the medical supply people today --- they will trade up, but I didn't get a price because I didn't know what to ask for without coming back to this tread. I will start price shopping in the morning. I'll let y'all know what I end up with. Thanks again

Re: Low BP

Ask your doctor, but I think , in general, they don't worry about low BP unless it drops below 90/60. Or if you have some problems like dizziness that may be a sign of low BP.

Re: "I'm going to post a new threat".

Please don't post "threats" on this board.

Good luck. Let us know how things work out.

Sorry I meant to say "thread" not "threat" ----

jess wrote:Sorry I meant to say "thread" not "threat" ----

Many of us want to post threats after dealing with our DMEs.

I called cpap today and the model I purchased for $950 through my DME (at a discount) would have cost me approx. $445.00 through cpap. That's the machine, humidifier and mask. I then called my DME to ask for an upgrade to either the prsi auto or prsi pro. They agreed, but quoted me a price of $2,500 for either of them. I'm speechless!!! I guess all I can do is review them on Angie's list..

jess wrote:They agreed, but quoted me a price of $2,500 for either of them. I'm speechless!!!

Holy crap. I am speechless also except for a few words that are rather blue. Talk about getting screwed...

I know what I would do and tell them. Wouldn't be nice. I wouldn't even use them to buy a filter.

Get a copy of your RX and watch the cpapauction.

jess wrote:I called cpap today and the model I purchased for $950 through my DME (at a discount) would have cost me approx. $445.00 through cpap. That's the machine, humidifier and mask. I then called my DME to ask for an upgrade to either the prsi auto or prsi pro. They agreed, but quoted me a price of $2,500 for either of them. I'm speechless!!! I guess all I can do is review them on Angie's list..

Unfortunately, that's not at all unusual. Most local DMEs do charge that kind of money. Maybe you do want to post some threats now. I guess Angie's list is sort of a threat.

However, for the extra $2000 to your local DME vs. online, you get more of the same quality service the local DME has already given you.

Is it any wonder we can't afford healthcare in this country?

jess wrote:I called cpap today and the model I purchased for $950 through my DME (at a discount) would have cost me approx. $445.00 through cpap. That's the machine, humidifier and mask. I then called my DME to ask for an upgrade to either the prsi auto or prsi pro. They agreed, but quoted me a price of $2,500 for either of them. I'm speechless!!! I guess all I can do is review them on Angie's list..

That's the price they bill insurance companies, however, it is not the price insurance companies usually pay. Insurance will negotiate this down, sometimes to below the online retail rate.

Try haggling a bit. Of course, you'd be in a much better position to do this if you hadn't already bought a machine from them, but it won't hurt to try. A polite, "I'd really like to give you a good review on Angie's List, but you're charging more than twice what some of your competitors do," might help, but don't waste your breath unless you're talking to someone with some authority.

You should discuss this "discount" with your doctor next time you see him. If he doesn't have a financial interest in the DME, he might suggest the next self-pay patient buy the machine online and only get the mask from the local robbers.

That is a good idea. Today I'm going to call all the other DME's in my town to compare prices. I'll also call BCBS to see what they pay for the machine. Then I'll call the manager back. I just feel so taken advantage of. I probably should just let this go and move on, but now I'm curious just how bad I was scammed. If the other DME's are priced in the same range I'll let this go and write it off to brick and mortar mark up. However, I WILL write the doctor a letter since I'm not supposed to see him again for another year.

Unfortunately, that's the way our healthcare system works.

The DME wants to make money, which is understandable. It does cost him money to run his business.

The insurance companies feel compelled to pretend to be controlling costs. They want to always "negotiate" below the "retail" cost. For instance, the insurance company may say, "we will only pay $1500 for a CPAP machine."

Now, here comes one of the scams involved. The insurance companies insist on paying below retail. If the DME is willing to sell to anyone at $1500, the insurance company will insist on getting a lower price. If the DME will sell for $1500 to a person off the street without insurance, the insurance company will say, "we'll only pay $1000 or you won't get any of our business."

Most of the DME business comes from insurance claims. If the DME charges an honest price to the non-insurance customer, he goes out of business.

It's part of the medical mafia. Insurance companies, doctors, clinics, etc. force you to buy insurance or you'll pay a lot of extra money.

There's also the scam where you have some procedure done. The clinic bills you $2000 for the doctor, and $2000 for the room the procedure is done in. The insurance company says "The negotiated price is $1000 for the procedure. You can't submit additional bills for the room, so the total bill is $1000." The uninsured person pays the $4000.

In the case of CPAP machines, the manufacturers set "minimum advertised prices." A brick and mortar DME has to charge a certain price or they won't be allowed to be an authorized dealer any more. Online retailers have a different minimum price. Either one may actually sell for less, but they sort of have to keep it quiet, or they may find they don't meet the "quality standards" of the manufacturer when it's time to renew their status as a dealer.

By the way, jess, I've done pretty good watching Craigslist and finding good deals. There are a lot of people who try to sell based on what the DME charged them, and end up being more expensive than a new machine with a warranty online. You occasionally find a good deal. I got a PRS1 Auto with humidifier for $225, but I had to watch the ads for 3 months. Right now, someone local to me is selling the same for $300.

Online retailers are a good way to go in a lot of cases. Be sure to get your own prescription on paper from the doctor. Get your prescription on file at cpap.com and some other places and you can keep buying there.