CPAPtalk.com

Hi,
I was diagnosed with OSA in early December. My doctor referrred me to a local DME company that provided me with an APAP machine, mask, etc. When I picked up my equipment, the RT told me I needed to have a titration study or my insurance wouldn't cover my equipment. My machine has an SD card, so she said to send in the card after two weeks and then see about scheduling the titration study. After much trial and error, I have been able to use my machine consistently for the past two weeks. I was supposed to send in my SD card this Friday (01-13-2012). Meanwhile, I decided to check what exactly my insurance (I have Medicare primary, plus supplemental) will cover regarding cpap. When I looked up my benefits on medicare.gov, I didn't see a thing about having to have a titration study. I thought I might be missing something, so I called Medicare and the person I spoke with told me the same thing, Medicare DOES NOT require a titration study. I decided to call the RT at the DME and give her this info. When I gave her the information, she wanted me to call Medicare again and get a name so she could put it in my chart in case the person gave me incorrect information. I really thought she should be the one doing that, but she didn't seem interested in calling Medicare and verifying my information. She then told me that after she gets my SD card results that she will need to swap my APAP for a CPAP. I asked her why and she said my insurance doesn't cover APAP machines. She had only given me the APAP as a test machine so she could know at what pressure to set the CPAP machine. I was very concerned, because I have read on the forum how difficult it is to get the CPAP set at the proper pressure; and I have done quite well with the APAP. I was concerned about her lack of desire to investigate whether Medicare requires a titration study and why she didn't tell me about the APAP swap to CPAP when I first signed the papers for the equipment in December.
I decided to call a local DME in my town, whom I deal with monthly for other supplies. I found out that she does CPAP equipment (after contracting with the other DME) and that she would tell me what was covered under Medicare. She told me that: #1. Medicare doesn't require a titration study, & #2. Medicare covers ALL types of CPAP machines, including APAP.
I am switching to my local DME and am going to send my machine back tomorrow. Has anyone ever had an experience like this? I'm just grateful I decided to dig into what my benefits were and what was covered, or I would be having a titration study and switching to a CPAP machine. Any thoughts or comments would be greatly appreciated.
Question #2: I am unconsciously taking my mask off in my middle of the night. Is there something I can try, so I can sleep the whole night through with my mask on?
Thank you,
porete

Unfortunately, these types of experiences are all too common. Good for you for standing up for yourself and advocating!

Wouldn't it be fun to see the expression on the DME's face when you return the APAP and 'fire them'? Good Job

I'm giving her phone call in the morning. It's sad that you have to verify everything yourself these days. Actually, she hasn't really been much help at all with getting adjusted to CPAP. I don't know if I would have adjusted this well without the treasure trove of information and help from all the kind folks on this forum.

You might also want to ask the new DME about giving you Resmed S9 autoset which is the latest machine that Resmed has out instead of S8 which is old technology.

I'll ask about the S9 tomorrow.

Definitely go for the S9. SD card makes it easier to use ResScan software and now SLeepyHead works great on ResMed S9 machines. The S8 Mahines have different data card and uses a very expensive card reader that is nearly impossible to find except on EBay from seller in Israel.

S9 AutoSet, not S9 Escape Auto. The Escape Auto doesn't collect data like the AutoSet does.

Philips Respironics System One (PRS1) Auto is on par with S9 AutoSet.

Do NOT accept any ResMed S8 or Respironics M Series machine. They collect less data and are harder to get data out of.

I just called canceled the DME. I talked to my local DME and asked about the S9, but she said they don't do Resmed products. She's ordered me the Respironics APAP. Does anyone use the Respironics APAP?

I'm glad you were so diligent. Somehow, I would say there was an ulterior money motive. Obviously, if you got another sleep study, it would have probvided more money to someone who probably tells them to tell you have to have the titration study for a fee. Money and not people's welfare and health seem to rule the world. It is always good to have options. So far, my current DME for cpap has done fine.

Kairosgrammy - I see you use a Respironics machine, my DME is switching me to a Respironics APAP. How do you like the Respironics? It it good machine?

You will want the PR system 1 Remstar auto with a flex...same machine Pugsy has in her sig. Respironics is a very good machine make sure its auto.

porete wrote: Does anyone use the Respironics APAP?

The PR System One Remstar Auto Cpap with AFlex. Otherwise known as the Respironics APAP.
Yep, lots of System One users here.

All machines have pros and cons.
The 2 main cons when comparing to ResMed S9 Autoset IMHO.

The ResMed S9 has the heated hose option.....Respironics doesn't but you can build your own or buy one if needed. I hear Respironics is releasing a heat hose machine soon but as far as I can tell, not available widely yet.

ResMed S9 has more data available on the LCD screen ...Respironics on screen data sucks and is limited to 7 and 30 day AHI averages not even broken down and a Large leak data point that is useless.
Good new is that there is easily available software that gives you huge amounts of data and the lack of on screen data is moot. I use PR S1 machine and never bother with on screen data...I just use software.

I have had a chance to use both brands of machines. I like them both pretty much the same. The ResMed might be a teeny tiny bit more quiet..extremely hard to notice the difference.
Both do a great job. I have used a Respironics machine since May of 2009. First started with M Series APAP and the PR S1 APAP since April 2011 and most recently a PR S1 BiPap Auto. I guess you can tell I am quite happy with Respironics. I recently had a chance to try a ResMed machine for the first time ever. Both machines give excellent therapy. I would have to say I like them equally.

They do have different algorithms..and some people might prefer one over the other but I think most people would say either would work for them if they had a chance to compare them.

PRS1 is a fine machine.

Your current DME not only lied about APAP coverage but also stuck you with an older, discontinued model. You did a good job being your own advocate!

Before you go to your new DME, read "what you need to know BEFORE you meet your DME in my signature line below.

At the outset back in 2008 I had a poor DME experience but not quite the
same as what you have gone through.

It is not difficult to set the CPAP pressure... the difficulty comes in determining
what that pressure should be. The APAP can help narrow down what the pressure
should be by adjusting the pressure to a range and then gradually narrowing that
range down while also looking at the nightly numbers.

It really bothers me that folks go through this nonsense with some DME's and
have such a hard time, most often at the outset of therapy, to get things sorted.
It is a testament to the determination and courage of those sleep deprived
individuals that they get it all sorted out... because those bad DME's sure don't
make it easy.

Regarding removing the mask... I too have gone through that. I found the
passage of time, getting used to the mask and setting myself up mentally
prior to sleeping resolved that issue. I would repeat to myself during the
day that I needed the therapy and removing the mask was not helpful.

I fired my DME back in 2008. Currently have no DME and no sleep doc.