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I have been diagnosed with OSA recently. My AHI is 76. I asked my sleep doctor to write a prescription for S9 Autoset. He would not write for Autoset, but instead he wrote for S9 Elite. He sent me to a local DME. This DME is only willing to give me S9 Escape, which I don't want as it is a BRICK. If I want Elite or Autoset, they want me to pay $250 upgrade fee. They claim that AETNA is only paying $39 per month for the machine. Secondly, I wanted to get ClimateLine tubing. The DME wants me to pay $15 upgrade fee. I don't want to pay any upgrade fee. As I am fully educated on this process by reading through this wonderful forum and after going through the blog of maskarrayed, I am unwilling to pay the upgrade fee.

I called Apria and they are willing to do without an upgrade fee. I see many negative reviews of Apria. I spoke with a patient who got good customer service from Apria. He deals with a different local office than mine. Is Apria universally bad or does it depend on local office? Do you guys recommend me going to Apria or keep looking for local DME's?

I use apria. They were good at getting me my machine and setting me up. My advise is to use them. My issues are when I need to re-order supplies. I have to initiate the order and I may get the order in several shipments. When I call to see what the shipment status is... apria says they are waiting on insurance approval. Then I'll get the shipment the next day via UPS. It's aggravating, but so is a lot of other things in life. The funny part is when some gets on this forum and starts defending them.

After you get your initial shipment from your local apria store, call 1-800-310-3363 to reorder supplies (masks, filters hoses) at whatever interval your insurance will provide it. The local apria will defer to the 1-800 number anyway. If you do it, you will cut out the middle man.

Sheriff

PS: try and get the autoset. You can obviously use the autoset in the autoset mode (duh!!) but also in the straight cpap mode. The Elite is only a cpap mode capable machine. Do not accept anything that says "Escape".

Sheriff

Thanks Sheriff.

I also want an Autoset, but the lady at local office says that she can only give what is written on the prescription. The Dr. wrote "S9 Elite", so she would only give that. I don't know how to convince her that Autoset is exactly like Elite when it is programmed to do a straight CPAP.

BTW, the pressure prescribed for me is 8 cm.

Apria really varies by office it appears. I was hyped on them because the central office for the state was really helpful when I called, and previously had provided me (through my doc's request) some home testing equipment at no charge other than the data processing. But they made the appointment for me with the local office nearest me, and it was a dingy room in a warehouse for the delivery trucks, and the rep sucked. Turns out the central office is only 20 miles away, so if I ever do deal with them again, I'd try there.

Did your doc say why he wouldn't write the script for what you requested? That seems strange. Another consideration is that you could take your study results to your family MD and ask him to write the xpap script for you. That's who wrote them for me, and for both machine and mask he wrote "patient's choice". My last visit to him he wrote me 2 more undated scripts for masks the same way, in case I want to try something different, and that way can shop for best price.

My doctor originally wrote a prescription for a CPAP for 9cm H2O. The DME wouldn't give me an Auto without an Auto prescription. I went back to me doctor and requested an Auto prescription. She wrote an Auto prescription. The DME didn't accept this because a range wasn't specified. The general practitioner doctor was unable to do this because it was outside of her expertise. She offered another titration study. Instead, I went to a sleep specialist. The sleep specialist wrote a prescription for 6 to 10cm H2O. The DME accepted this. Between the two doctors they have written additional prescriptions for a full face mask, heated tubing, a 12V power cord, and a washable humidifier chamber. Good thing the doctors are cooperative.

BTW, this DME is actually pretty good. They never tried to unload a brick on me. They allowed me to exchange the machine two times to try out different machines. After all this, it looks like the PR System One - 60 with heated hose is the one.

Be persistent and get needed prescriptions. You'll be living with this for years.

I'm glad you found another DME willing to provide the Elite without an upcharge. We bash Apria a lot, but sometimes certain local offices do a good job--it's just we see many reports of terribe interactions with Apria here which have earned them the nickname "Crapria". I think that when people have a good experience with Apria they should report it as well. If enough good reports accumulate, we may have to retire the nickname. I'm open to that if they earn it.

Unfortunately, if your script says "Elite" that's what the DME has to provide. So what I want to know is how that first DME can decide to give you an Escape instead? Sounds like it should be reported to the state agency that regulates DME's in your state--the provider is refusing to fill the prescription as written.

For the benefit of others who may have a similar experience but they are not able to find another provider:

What is your insurance? If it's Medicare and the first DME wants to charge you $250 more, it has to issue a written notice called an "Advance Beneficiary Notice" (ABN). And you are free to go elsewhere to find another DME who will accept assignment as you have. If the DME doesn't issue the ABN, additional charges are illegal and should be reported to Medicare's Fraud unit.

If you have a private insurer, not Medicare, that upcharge may be illegal under state law or a breach of the DME's contract with your insurance provider. You should contact your insurer to see what they say about the upcharge.

Sometimes a polite letter reminding the DME that "balance billing practices" are prohibited by your insurer or state law, cc'd to the insurer and to the state regulating agency, have done the trick.

You know should you ever decide that you want a backup machine...and are willing and able to go to the secondary market then you could pick up an Autoset then and use it with your existing humidifier.
There are sources out there and even here on the forum from time to time. I bought a used S9 Autoset with humidifier for my step sister from a forum member. Price was super fair at $250. It had some hours of use on it but that didn't hurt a thing.

Your doctor stating the word Elite on the RX pretty much seals the deal on that one because he has already stated "no APAP". If he has said "CPAP" without model name you had a better chance.
Unless you have another "friendly" doctor willing to write for APAP or the Autoset you are pretty much stuck.

I urge you to get the autoset machine. Dont go for anything else. If you have to change dr's do it. I had a regular cpap machine and now that I upgraded to an auto machine and it is a big difference in my mood. Or buy one on craiglist like me.

Thank you for your valuable replies. I just spoke with the person from Apria. The RT will come home tomorrow morning. I convinced them to give me a S9 Autoset. I will know only when I see tomorrow. How do I make sure that Apria is giving me a brand new machine not a used one? Is there a setting on the machine to see how many hours it ran?

The service from this Apria office (Suburb of Philly) hasn't been that bad. The prescription was faxed by the local DME to Apria yesterday and hopefully tomorrow I will get my machine.

My doctor has written the following in the prescription:

8 cm pressure
15 min ramp
EPR @ 2

I bet the RT is going to set it up with a constant pressure of 8 cm. Since this will be my first day, should I put it in APAP mode or leave it at 8 cm for a while and see how it goes.

Thanks again for your help. This forum has been a great help to me.

I would suggest starting out using the machine at the prescribed settings. Gotta start somewhere and just because you can change to APAP mode doesn't mean you should do it right away. There is quite a bit of adjusting to do initially and why add auto adjusting pressures into the mix straight away. There is plenty of time for that later.

Yes, there is a way to check for hours of use..
You have to go into the clinical manual though.
Explained here with pictures...http://www.apneaboard.com/resmed-s9-cpap-setup

and if you go all the way down to the bottom on this page you will find the instructions on how to acquire the provider/clinical manual which explains all sorts of things that you can have in pdf format.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

When you receive the machine, BEFORE the DME leaves you with it, check it over very carefully for the model name.

Right above the STart/Stop Button it should say "AutoSet". If you see the word "Escape" or "Escape Auto" you've been hoodwinked. Tell the DME to take it right back where it came from because you were promised the AutoSet and no matter how much they try to convince you the Escape Auto is just as good it is NOT.

I'm sorry to say we've seen DME's pull this enough times that you must be vigilant. Let them earn your trust, don't give it to them for free.

I can give you the contact info for our rep in Philly if you like. He will assign an RT to come to your house and get you all taken care of, no drop shipping! The auto and elite code the same for insurance purposes. The DME can get you an auto if they really wanted to retain your business. Sad

DME can get you an auto if they really wanted to retain your business. Sad

Ryan, Welcome! Sorry that this is going to be a bit of a threadjack (the OP, BTW, has a DME who promised her the Autoset, I'm just warning her to watch out for the bait and switch).

Your statement is refreshing!

So why is it that SO MANY DME's don't seem to want to retain our business??? If you read through these boards you will see story after story of DME's that will only supply bricks (machines with no EFFICACY data), or they will try to upcharge people $250 to $350 for a machine with EFFICACY data--even when it is clearly illegal and in breach of contracts DME's have with insurers. What has become evident to me from all this is that DME's could really care less about the CPAP users long-term business. They act like there is a huge difference in price between the bricks and the EFFICACY data machines, which--judging by the differences in retail prices--can't be very much at all. They treat CPAP users like they are stupid and a nuisance, instead of cultivating a loyal customer base. Why???

Thanks Janknitz for the tips.

RT from Apria came home to setup the machine earlier this afternoon. I got the S9 Autoset with H5i humidifier and Swift FX nasal pillow. I got standard tubing as well ClimatLine tubing. The RT also installed the modem on the unit. I was told that I could use the data card along with the data modem. She recommended me to use the standard tubing now as it is not that cold this time of the year.

Could you please answer the following questions:
1) Should I use the ClimateLine or Standard? The temperature swings between 50 and 75 F around here.
2) The Apria guide tells me to clean the tubing and the humidifier chamber once a week. Is that good enough or should I do it every day?
3) I believe I got the standard chamber not the Dishwasher safe one. Should I buy a dishwasher safe chamber online?
4) How often should I change the filters?

Hopefully in the next few days, I will get used to the CPAP.