newbie needs help on the process

My understanding is that the one you are talking about is a very good machine. Docs and DMEs do have a lot of say along with what your insurance will cover. At least you are being smart and researching. I didn't although I can't say I'm dissatisfied with my machine. I do fine with my set up. I myself use a Phillips Respironics REMstar System One Cpap Pro with C-Flex. All c-flex is (or at least this is my understanding) is a feature that allows the machine to use your prescribed pressure when you inhale and then backs off to a much lower level when you exhale. For some, that makes no difference but the higher your pressure is, the harder it is to exhale against that pressure. I like it and it works well for me. Other than that, I have just a straight cpap.

However, depending on your needs you may want the autoset. I actually, if I'd really researched machines, would have wanted one of those. During my sleep study, I did fine at 10 cm on my sides but as soon as I flipped over to my back, I would become apnic and even with that pressure, my oxygen levels would drop to 80%. Because they didn't have time to titrate me any higher, he wrote the prescription for 12 which has worked well. However, if I had autoset, the machine would set according to how I was breathing so if I was on my side, it would drop down to 10 which would work fine but if I flip to my back and start with hypopnic or apnic events, it would raise the pressure to 12 or above.

Just be sure to do your best to get what will work for you. Don't just settle for whatever mask they can give you. Most DMEs will take a mask back and give you another if the first mask doesn't work. If you find that the one issued doesn't work, take it back til you find the right mask. You can try them on at the dme although it won't be entirely accurate until you are laying down.

Lastly, don't be afraid to ask questions here, of your dme or your doctor. That's what we are all here for. Hope things go well.

oldgeezer wrote:I just got diagnosed a week ago, and am awaiting for the approval of insurance. Here are my thoughts and questions regarding the process. I may be jumping the gun but am trying to figure out how much input I really have.
I haven't see the script, but I know the Doc. doesn't like auto CPAP machines. He says they are not reliable
He also mentioned Cflex, which I believe is a brand name rather than a feature
After some research, I decided I want the Resmed S9 elite or autoset with humidifier and climate tube. I don't know if its the best choice, but my feeling is that I'm going to have this machine hooked up to me for a third of my life, so I simply want the best.
So, can I get what I want, or does the Doc and DME decide? I'm sure they know better than me, but I don't want to be bullied into something just because it is more convenient for them.
Seems to me other brands have something like cflex, and even if the doc doesn't like auto machines, is it reasonable for me to insist on it, even if the auto setting is disabled at first. As I said, I'm going to have this thing on my face for a long time, why not get all the bells and whistles?
Any thoughts and comments are welcome

Ok. He is where I am at. The DME seems to be willing to get me Resmed S9, but not the Auto. They say since the Doc didn't specify auto, it is deemed not a 'medical necessity" and CareCentrix or the insurance company will reject it. Since the Doc prescribes a single, pressure, is the simple fix to just ask the Doc to write the script Auto with the pressure set at a single pressure. All I'm trying to do is give myself some flexibility for the future.
BTW, the DME said the auto version was $200 more, but it seems to me the online price is just $60 more.
For $60 I'll pay the freakin difference.

Your solution would be to go back to the doctor and talk to him about rewriting the prescription to meet what you feel you need. Wish I had.

oldgeezer wrote:Ok. He is where I am at. The DME seems to be willing to get me Resmed S9, but not the Auto. They say since the Doc didn't specify auto, it is deemed not a 'medical necessity" and CareCentrix or the insurance company will reject it. Since the Doc prescribes a single, pressure, is the simple fix to just ask the Doc to write the script Auto with the pressure set at a single pressure. All I'm trying to do is give myself some flexibility for the future.
BTW, the DME said the auto version was $200 more, but it seems to me the online price is just $60 more.
For $60 I'll pay the freakin difference.

oldgeezer wrote:The DME seems to be willing to get me Resmed S9, but not the Auto. They say since the Doc didn't specify auto, it is deemed not a 'medical necessity" and CareCentrix or the insurance company will reject it. Since the Doc prescribes a single, pressure, is the simple fix to just ask the Doc to write the script Auto with the pressure set at a single pressure. All I'm trying to do is give myself some flexibility for the future.

Check with your insurance company yourself, if you haven't already, regarding the DME statement that since the doctor didn't specify auto then your insurance won't pay. If you insurance company uses only billing codes they won't care because the billing code for a cpap and apap are the same. Billing codes don't change until you get into the Bilevel machines.

If your doctor doesn't "believe" in APAPs you may have trouble getting him to write RX for the specific model that is APAP (the S9 Autoset) even if you have it set to cpap mode and not apap mode. Doesn't hurt to ask though. He probably would need to add "Dispense as written" to the RX if he would even write for the Autoset at straight pressure.

Or you could bypass all the hassle and use the cpap RX to buy the APAP of your choice online. Do the math in regards to deductibles and co pays if you use your insurance. Often it is a wash and sometimes a savings...especially if your deductible is a calendar year deductible and just reset to zero. You can still use a DME for masks and supplies if you wish. They come in handy for mask trials. I bought my machine privately yet I use a DME for masks.

oldgeezer wrote:Ok. He is where I am at. The DME seems to be willing to get me Resmed S9, but not the Auto. They say since the Doc didn't specify auto, it is deemed not a 'medical necessity" and CareCentrix or the insurance company will reject it. Since the Doc prescribes a single, pressure, is the simple fix to just ask the Doc to write the script Auto with the pressure set at a single pressure. All I'm trying to do is give myself some flexibility for the future.
BTW, the DME said the auto version was $200 more, but it seems to me the online price is just $60 more.
For $60 I'll pay the freakin difference.

The DME CAN dispense an Auto CPAP if you have a prescription that specifies a manual pressure. He has to set it to manual CPAP mode, which all Auto CPAP machines will do. The insurance company probably will not care, only the DME.

Be SURE the DME is an "in network" provider for your insurance. It is probably against their contact with the insurance company, if not actually illegal, to do "balance billing," which is what the extra $200 is called.

You will often get better service if you go check with another local DME, tell him you're not happy with what his competitor is offering and ask him if he can do better.

Do NOT let them give you an S9 Escape Auto or S9 Escape. If it's an Auto, be sure to specify "AutoSet," not just "Auto," or they'll try to slip you the Escape Auto.

Philips Respironics PRS1 Auto and Pro are good machines, too.

Boy howdy! I wish I got this guidance early in my process. I am on my third machine, and its finally an "auto pressure setting" model. I was afraid of it as first, but I am refreshed more than the direct cpap for the reasons grammy says about rolling over etc, and the variable exhale pressure also. I have the software now, and will be connecting to the unit soon. Then I will have all the data, oxygen levels, apnea events, because it has the data connection. NOW is the time to fight for what you want, because once they get a lesser machine to you then it will be there for a LONG time. However, that being said, even cpap is better than "nopap" .

Still have not gotten a machine. Since the DME was being a bit difficult with the machine I wanted, asked the Doc to write the script specifically so I could get a Resmed S9 Autoset even though I am prescribed a pressure of 11. As I mentioned, I thought the Auto would buy some flexibility down the road.
The nurse practitioner who I'm dealing with at the docs office said, she never heard of such a request. But would nonetheless write a script for the Autoset with a pressure of 11.

Is everything so difficult? What am i missing here? what the heck does the doc's office care. I can't wait to hear what the DME has to say when they get the script. I did ask them doc's office to fax me a copy of the script.
Very frustrated so far.

Simple answer. Yes.

oldgeezer wrote: Is everything so difficult? What am i missing here? what the heck does the doc's office care. I can't wait to hear what the DME has to say when they get the script. I did ask them doc's office to fax me a copy of the script. Very frustrated so far.

oldgeezer wrote:The nurse practitioner who I'm dealing with at the docs office said, she never heard of such a request. But would nonetheless write a script for the Autoset with a pressure of 11.

Your odds will be better if the prescription specifies a pressure range, even something small like 10-12.

Finally got the script in my hands. The docs office specified the resmed s9 autoset with pressure set 4-20. ( I guess they are getting worn down with my involvement.)
When the DME called me, she said they would order the s9 AUTO. Because of all the info I get at the site, I said the AUTOSET. She said they were all the same. I didn't have time to check my copious notes I have taken at this site, but told them maybe so, but the doc specified AUTOSET.
Then believe it or not I told them I wanted the climate line hose. She said the doc didn't specify Climate Line it in the script and it might not be covered by insurance. UNBELIEVABLE! Stay tuned!

Sounds to me like they are just plain ticked. They may be right though about the hose but I really doubt it. Just a way to stick their tongue out at you and blow a raspberry.

oldgeezer wrote: Then believe it or not I told them I wanted the climate line hose. She said the doc didn't specify Climate Line it in the script and it might not be covered by insurance. UNBELIEVABLE! Stay tuned!

I'm picking up my machine Thursday. My most sincere thanks to all for your valuable information. Seems they got a Resmed S9 AutoSet with humidifier and climate line tube, just as I requested thanks to you all.
My next adventure begins.......effectively using the thing.

hot diggity!!!

oldgeezer wrote:I'm picking up my machine Thursday. My most sincere thanks to all for your valuable information. Seems they got a Resmed S9 AutoSet with humidifier and climate line tube, just as I requested thanks to you all.
My next adventure begins.......effectively using the thing.

Well, you have the hard part done. Adjusting to CPAP is different for each individual. I've been "using" for about a month now. I can get to sleep fine, I just have to figure our how to keep it on all night.

And if you have trouble, there are people here who can help with that as well. Good Luck.