Newly diagnosed with some concerns...

I have been lurking here for some time and decided it would be mandatory to join since this is going to be a new way of life.

Have recently had an in-home ARES sleep test that was read and reported by Watermark Medical. In short I was diagnosed with moderate obstructive sleep apnea. My GP has written a prescription for an Auto CPAP (E0601).

I am currently on an HMO - Anthem Healthkeepers. What kind of advice can you offer me so I am up to date and somewhat knowledgable when it becomes time to speak with a DME? Also what questions should I be asking them?

Thank you all for what you do here to make the "beginner" feel somewhat as ease when facing this huge change...I'm sure my wife will be thanking you when the snoring ceases!!!

I am new to the world of CPAP but not nee to the insurance game. I would advise that you pull out all the coverage plan documents you have (or go obtain them) abd review your terms to be familiar with them before you deal with the DME and ins co. Different plans vary greatly.

Good luck and welcome aboard (from a guy who just got his machine yesterday)

Check out the "CPAP Basics" threads at the top of the home page. There is a chapter on insurance/reimbursement, as well as a chapter on dealing with DMEs.

In a nutshell, if the DME will sell you a full data machine you are "in like Flint".
If they will only dispense a brick, you need to either get your doctor to specify exact name and model
or leak, Ahi, and waveform in your RX.
Failing that you need to compare your in network co-pay with the full price at an online DME (our hosts, for example)
We paid the upcharge on my hubby's Autoset because it was less than going out of network-(but not by much)

Well...my face to face meeting is tomorrow at 11:00...although I am very exited to find out what it feels like to get a good night's sleep...I do face concerns as I am claustrophobic and worry I will not be able to do it.

I guess time will tell...

+1

A DME is a lot like a used car salesman....They'll sell you whatever they have that gets them the most profit.

You need to be fully informed about your medical coverage, before you go in to see them.

caffeinatedcfo wrote:Check out the "CPAP Basics" threads at the top of the home page. There is a chapter on insurance/reimbursement, as well as a chapter on dealing with DMEs.

Welcome & here is a link that has some very helpful info. Remember the most important thing when choosing a machine is that it is a Data Capable machine. Also, just from my personal experience I would stay away from the F&P Icon. That leaves you with the Phillips Respironics or the ResMed machines as the most popular machines among forum members. That's not to say other machines aren't just as adequate, just that to get the most help getting one of these is easier to get help from forum members.

http://maskarrayed.wordpress.com/

Make sure when you visit the DME and you get the mask you determine the DME's mask policy - can you return the mask & exchange for another with 30 days & how many times can you exchange in that 30 days. Here is good info on dealing with the DME the first time.

http://maskarrayed.wordpress.com/what-y ... me-part-i/

Once you have your mask & machine, list it here under the User Control Panel. It helps to know what your equipment is when you need questions answers & advice on any problems you may have.

Good luck on your visit.

Jen

Denial Dave wrote:+1

A DME is a lot like a used car salesman....They'll sell you whatever they have that gets them the most profit.

Sir - you insult the profession of ..... used car sales people! They at least know their products.

I have spoken with my insurance provider - unfortunately it is an HMO!!!

I will have a 20% copay up to $2000.00 out of pocket per calendar year.

After reading some stickies please respond that I have this correct:

Since I have a prescription for an APAP (E0601) I should only get a ResMed Elite or Autoset or Phillips System One Pro w/ C-Flex Plus or System Auto w/ A-Flex. I understand that Data Capable is a MUST and I need to check to Mask Policy.

Whew...this newbie's head is SPINNING!!!

Gparr wrote:Whew...this newbie's head is SPINNING!!!

The spinning will ease soon. It did for me. I've been using my machine for a whole week now, and those other friendly folks asnwering above have helped me a lot.

Gparr wrote: After reading some stickies please respond that I have this correct:

Since I have a prescription for an APAP (E0601) I should only get a ResMed Elite or Autoset or Phillips System One Pro w/ C-Flex Plus or System Auto w/ A-Flex. I understand that Data Capable is a MUST and I need to check to Mask Policy.

Whew...this newbie's head is SPINNING!!!

E0601 covers both CPAP and APAP devices. As far as the HMO is concerned, a 2 year old Respironics M-series with 3000 hours on it is the same as an Autoset Elite S9 with 0 hours.

Gparr wrote:Since I have a prescription for an APAP (E0601) I should only get a ResMed Elite or Autoset or Phillips System One Pro w/ C-Flex Plus or System Auto w/ A-Flex. I understand that Data Capable is a MUST and I need to check to Mask Policy.

Whew...this newbie's head is SPINNING!!!

I would make my decision as to EXACTLY what I want BEFORE I go to the DME.

Then tell the DME you want THIS setup & that it must be new with zero "Run" Hours. And with the latest internal software for ResMed (SX474-0907) or latest firmware for Phillips Respironics (I don't know what that currently is).

Learn how to check that you got what you requested BEFORE you go to pick up your machine. Do not accept it if anything is not what you requested.

The S9 Escape Auto will technically meet the RX requirement for APAP E0601 but the only data that it gathers is hours of use, general overall AHI and pressure average (either that or 95% pressure used).
So make sure you know your models and know what they do.
In general avoid any ResMed S9 with the word "Escape" in the model name.
Phillips Respironics...avoid any model number below 450 because any model number below that only gathers hours of use.

If sticking with the APAP part of the RX..
S9 AutoSet or the PR System One Auto CPAP (model 550 or 560) would be the way to go. The 560 has the heated hose option and is the newest.

I would avoid the F & P machines even if full data machine because the software is a PITA to obtain and use.
The Devilbiss machines..great machines but I don't care for their software reports and they don't gather flow rate at all.
Personally....I would zero in on ResMed S9 or the Phillips Respironics System One machines and learn the model differences.
More comprehensive data available and software is easy to find and use.

I would also shop the DME vs. CPAP.com regarding what they will charge you based on your insurance coverage. They have contracted rates with each insurance carrier and these may vary as well as the DME's billing practices.