First appointment with my DME today

Ok, so I finally get to meet my DME today and get my equipment (they are actually coming to my apartment). I am looking forward to finally trying to get my tiredness under control but a little nervous due to hearing many of the horror stories people have with DME's. I am hoping my experience is one of the good ones and I am determined not to get stuck with a brick! Wish me luck.

Scooter,
I wish you the very best getting started with this DME. I wanted to go to the facility when I was set up because then I knew they would have any number of masks and sizes for me to try on as well as all the different machines to compare. (they may not have all the different types in their car/van) That was when I knew very little about the masks or the machines.

Knowledge is your strength in the case of getting the right equipment. If you know the machine you want and you have a script for it, insist that it is the exact one on the script. I am assuming you have researched here and know which ones are data capable. I love my APAP but not everyone likes to use and APAP, just remember if you get an APAP they can also be used in CPAP mode.
Now I am just rambling.

I wish you well, and let us know if you got a caring, helpful DME. They are out there, I have seen a few.

Karen

Thanks! I got my machine today and think I did ok. Its a PR One REMstar Pro with C-Flex+. It's full data compliant and I already downloaded sleepyhead as from what I could see, their software for it sucked. While not an APAP, it does seem like I have a few different settings available to make it easier to use and all. Still have to call the main insurer to see what this is all costing me as this is just a local contingent of a national company based in California. Guess I will just see how it goes and I am sure I will be posting more on this board as I deal with CPAP on a nightly basis now.

Also not sure why but my machine doesn't show up on the bottom and I did edit it in. Weird.

Look on the bottom of your blower unit for a 3 digit number.
If 450...that would be the PR System One Remstar Pro CPAP with CFlex and it has been discontinued...and that's likely why it won't show up in your profile. It seems like discontinued items (all this profile equipment stuff is tied to cpap.com inventory) have broken links now. So we just add it in the comments section manually.

If it is a 460 model then you have the PR System One 60 series Pro CPAP and that link should work...and your humidifier would also be the 60 series humidifier.
The heated hose is an option available for the 60 series..

It's been over a year now that the 60 series machines have been released.
On the same sticker where the model number is you will see an 8 digit number. That's the manufacture date in year/month/day format.
You might want to check blower run hours to make sure that the machine hasn't been used. Therapy hours can be reset to zero but blower hours can't.
How to get to the menu to find out blower hours...see here
http://www.apneaboard.com/pr-system-one ... structions

The biggest things to know are that you have complete choice on what equipment you have (though if your RX says a specific machine or mask, the DME is required to give you that machine/mask). The mask if the big thing to think about, because you want one that;s comfortable and doesn't leak. Those are literally the only two things the mask has to do to work. If you're confused about anything, ask questions, and ask them to show you how your insurance breaks down the pricing (this is assuming you pay some amount for it). Also, ask if they have an exchange policy on their masks. Some DMEs allow a 30-day period where if you don't like the mask you picked, you can exchange it for another mask for free.

Thanks! I did check and see I have the 460 model (I really would be suspect if they tried selling me a discontinued model!). Basically for machine with the visit, that's all I had to choose. For me, I am happy with it as it's fully data capable and really quiet when running. I'm sure as I use it more often I will find things I love (and hate) about it, but for now it's good. As far as mask options I went for the same exact one that felt good during the study. Supposedly I should be able to get a new mask after three months and the guy said I could try a different style if I wanted. Dang, do you only get 3 months out of a mask? I will need to follow up more with the main DME company as I haven't heard anything about costs and all.

I did go today and get a copy of my prescription (it says Certificate of Medical Necessity, is that the same thing) and second sleep study using the CPAP. It was nice to know that at the prescribed pressure I was at 0.0 AHI. I didn't sleep all that much that night but it at least it is pointing in a positive direction!

Scooter32 wrote:Thanks! I did check and see I have the 460 model (I really would be suspect if they tried selling me a discontinued model!). Basically for machine with the visit, that's all I had to choose. For me, I am happy with it as it's fully data capable and really quiet when running. I'm sure as I use it more often I will find things I love (and hate) about it, but for now it's good. As far as mask options I went for the same exact one that felt good during the study. Supposedly I should be able to get a new mask after three months and the guy said I could try a different style if I wanted. Dang, do you only get 3 months out of a mask? I will need to follow up more with the main DME company as I haven't heard anything about costs and all.

I did go today and get a copy of my prescription (it says Certificate of Medical Necessity, is that the same thing) and second sleep study using the CPAP. It was nice to know that at the prescribed pressure I was at 0.0 AHI. I didn't sleep all that much that night but it at least it is pointing in a positive direction!

Different insurance companies mark you as "eligible" for a mask after a certain amount of time (for instance with Blue Cross Blue Shield, it's every six months, with Medicare it's every three months, and so on). There are a couple important things to keep in mind with this. First, "Eligible" doesn't necessarily mean it's free - it means it can be billed through your insurance. If you have a deductible that's not met, you still pay the full price (so long as it's less than the deductible), and that amount just gets billed to your deductible. If your insurance covers everything at 100%, or you have multiple insurances that effectively do the same, then score; go ahead and get it as soon as you can, because why not.

Second, just because you're eligible for new supplies doesn't mean you NEED new supplies. Many masks last on average around a year or so in my experience, and technically, you only really need to replace the cushion and headgear. These are things to keep in mind if you have a deductible, since that's the scenario in which you'd be paying. Again, if you have no deductible, you can always get it when you're eligible, because why not, but just because you're eligible doesn't mean you have to get them. It's always better to get supplies when they're cheap and you don't need them than when they're expensive and you do need them.

Secondly, a CMN (Certificate of Medical Necessity) and a prescription are different things (despite that a prescription is, by definition, a certificate of medical necessity... yes, it's very stupid). A CMN is required by some insurances in order for your supplies to be billed through the insurance. Some doctors have their prescription also state "Certificate of Medical Necessity" on the paper, which allows it to be used in both purposes, but that's somewhat rare. Basically, if your prescription didn't say that, the DME would have to fill out a CMN form, fax it over for your doctor to sign, and then include it in your file if the insurance ever requested it. It's typically not something you'd ever see or need to worry about, it's just a stupid quirk of the medical legalities involved in getting the insurance company to pay out on a machine.

Thanks again. My deductible is only $100 a year which will get met this time around for the machine and everything. I just called and it sounds like it may be $158 out of pocket and $7.58 per month for the rental (my insurance pays 90%). I hear what you say, if it's free it's best to get! Also thanks for clearing up the certificate thing. I guess that should be good enough to have to just keep with things should someone need to see it (traveling perhaps).

Scooter32 wrote:Thanks again. My deductible is only $100 a year which will get met this time around for the machine and everything. I just called and it sounds like it may be $158 out of pocket and $7.58 per month for the rental (my insurance pays 90%). I hear what you say, if it's free it's best to get! Also thanks for clearing up the certificate thing. I guess that should be good enough to have to just keep with things should someone need to see it (traveling perhaps).

Also, if you order from cpap.com or other provider of products, they will need a copy of the prescription, too. I carry a copy in my travel bag, though I haven't needed to produce it yet.

Scooter32 wrote:Thanks! I did check and see I have the 460 model (I really would be suspect if they tried selling me a discontinued model!). Basically for machine with the visit, that's all I had to choose. !

just a couple of weeks ago, Mine tried to First stick me with a Long discontinued unit and when i refused delivery, they then tried to stick me with an old model of a unit still in use, when i said i only wanted the model with the most up to date features, they refused to order it, so i had to find a new DME that would give me the most up to date unit - luckily my MD, while knowing less than nothing about the machines - even though board certified in sleep medicine - is really nice and will write for whatever i want. I still haven't received it yet, supposedly next week - we will see

Man, that's just awful! I immediately went online and punched up the machine they gave me to check to make sure it wasn't an old brick. I was really worried hearing these and other horror stories but my guy was all business but at least I felt I knew what I wanted. I mean, he went through the machine so quick and the book doesn't show much so glad I can look up what I need on the computer, I feel bad for older folks who don't know anymore then what they get told by the DME's. It at least sounds like I just order my replacement supplies and I really don't have to deal with them all to much again.

Hope you get your machine soon!