First Post (looking for advice)

Hello,

At the end of last year I had a sleep study, which confirmed that I have "severe" sleep apnea. I've known my entire life that I've had it. Anyway, just before I was to return to do the second study which would fit equipment to me they cancelled. It was the end of the year and they couldn't get me back in until the start of this year. To make a long story short, because of the costs and with my insurance resetting for the year I didn't go back.

I've now moved to a different state and saw a doctor here who analyzed their test and prescribed me a cpap machine that he said could likely achieve what that second study would have as far as titration. He was kind enough to work with me on this understanding the costs associated.

I've been contacted by the company that is going to be providing equipment and they're charging me $85 a month, plus the accessories I will need. This monthly amount goes towards my deductible and after its met I only would pay a smaller amount.

So, my thoughts are: if I'm going to spend nearly $1,000 for 10 month in "lease" fees, why wouldn't I just buy my own equipment and be done with it? I am sure my doctor would support whichever decision I made. What is the benefit of leasing the equipment? It certainly isn't less money!

I really appreciate the help! I am supposed to go in for the appt to pick up the equipment in a week, and I would like to be informed before I decide to go that route.

And so far it looks like I should be insisting on the S9. Right?

Welcome!

Just a word to the wise if you havent already thought of this: your deductibles and out of pocket will reset at the beginning of the year and you might be stuck all over again. Check with your insurance company to be sure. I did, and I learned the DME was just doing the rental thing out of "habit." My insurance company said they would pay outright. I had to call the DME to tell them to convert the "rental" to "purchase."

Good luck on your new adventure in hose head land

oak wrote:Welcome!

Just a word to the wise if you havent already thought of this: your deductibles and out of pocket will reset at the beginning of the year and you might be stuck all over again. Check with your insurance company to be sure. I did, and I learned the DME was just doing the rental thing out of "habit." My insurance company said they would pay outright. I had to call the DME to tell them to convert the "rental" to "purchase."

Good luck on your new adventure in hose head land

Yeah the deductibles definitely reset each year. I never thought to ask the equipment company if I was required to lease rather than purchase. Thank you!

My DME didnt know and assumed otherwise because thats what alot of insurers require. I contacted the insurance company directly.

And so far it looks like I should be insisting on the S9. Right?

No!

You want the Resmed S9 Autoset.

https://www.cpap.com/cpap-machines/resmed.php

Hey Steve, Welcome aboard.

The benefit as I see it is to the insurance company to do the rental . If they paid for the whole machine at the start (if you had no deductible) and you did not stick with it, then they would be out the total cost of the machine. If you rent the machine and the insurance pays monthly rentals for you, and you stop after a month, the insurance company is only out the one month rental. Yes in most cases it is cheaper to pay for the machine up front, however your insurance company may not be willing to do that. If you are paying the total of the machine out of pocket, or if it all goes towards your deductible thereby you are paying the total cost, then it may make more sense for you to not put it toward your deductible but just pay out of pocket for it. I hope this makes some sense.

If the insurance company rents the machine, then they will insist on proof that you are still using it. This is called compliance or adherence depending on to whom you speak.

I wish you well and a quick adjustment to the therapy.

Karen

Pad A Cheek wrote:Hey Steve, Welcome aboard.

The benefit as I see it is to the insurance company to do the rental . If they paid for the whole machine at the start (if you had no deductible) and you did not stick with it, then they would be out the total cost of the machine. If you rent the machine and the insurance pays monthly rentals for you, and you stop after a month, the insurance company is only out the one month rental. Yes in most cases it is cheaper to pay for the machine up front, however your insurance company may not be willing to do that. If you are paying the total of the machine out of pocket, or if it all goes towards your deductible thereby you are paying the total cost, then it may make more sense for you to not put it toward your deductible but just pay out of pocket for it. I hope this makes some sense.

If the insurance company rents the machine, then they will insist on proof that you are still using it. This is called compliance or adherence depending on to whom you speak.

I wish you well and a quick adjustment to the therapy.

Karen

I really appreciate it. Yeah I haven't used any of my $1k deductible, so I can either buy the machine out of pocket and own it or pay the monthly fee (which will cost the same in the end) and keep paying that fee forever. It's looking like owning my own equipment makes sense!

Steve99,

I have a high deductible policy and it is even true with some lower deductible policies, that you have to check each case and calculate if it is cheaper to pay on your own.

I had one case where I paid for my own surgery and it was less than the deductible.

Good luck,

Am I doing myself a major disservice by not having the titration study and letting the auto unit figure these things out for me?

Hello Steve, I have been on bi-level cpap since April 30 of this year. I was told by the sleep center where I had my sleep study and I also called my Health Insurance Company they told me the Insurance companies don't want to buy these machines because most people get the machines and then don't use them for whatever reason. The insurance companies want you to pay for rental first and if you aren't going to use it you would send the machine back and that saves everyone money.

Steve99 wrote:Am I doing myself a major disservice by not having the titration study and letting the auto unit figure these things out for me?

No, not at all. Titration studies in a sleep lab aren't always perfect either.
Unless you have some unusual complicating factors to your OSA and/or therapy there's no reason that letting the auto unit find a suitable pressure would be less desirable or less effective for that matter.
Should a problem arise a titration study can always be revisited later if need be.

Kaiser routinely uses APAP machines to find appropriate pressures for all their OSA patients and only uses sleep labs when problems arise. So it can be done and be done quite effectively as long as people understand how the auto adjusting machines work.

Problems can pop up but they aren't very common and if they do then there are ways to address them.

There's no reason why a person shouldn't try the simple way first. Odds are things will go smoothly and in about a week you will have a real good idea what pressure works well for you. Might even get lucky and figure it out in just a couple of nights.

Steve99 wrote:Am I doing myself a major disservice by not having the titration study and letting the auto unit figure these things out for me?

It is a risk either way.

I personally am a fan of a knowledgeable patient doing his own titration in his own bed at home. Two titration studies did not get it right for me. I eventually worked it out on my own by observing the data, tweaking the machine settings, ... repeat.

I am assuming you have obstructive sleep apnea and that there was not a significant amount of central apneas during your diagnosis study.

Sheffey wrote:

Steve99 wrote:Am I doing myself a major disservice by not having the titration study and letting the auto unit figure these things out for me?

It is a risk either way.

I personally am a fan of a knowledgeable patient doing his own titration in his own bed at home. Two titration studies did not get it right for me. I eventually worked it out on my own by observing the data, tweaking the machine settings, ... repeat.

I am assuming you have obstructive sleep apnea and that there was not a significant amount of central apneas during your diagnosis study.

I really don't know. The office who conducted the study never discussed the results with me. Just we rate you as severe and said at its worst my oxygen level hit 71%. My current doctor is going to be reviewing those results with me. But he was comfortable prescribing the cpap for me with what he has seen from the results.

Just a reminder - the severity (# of events/hr) of your OSA is not in proportion to titration - e.g. the amount of pressure required to help prop open your airway may be very small in relation to how mild or severe your events are - sort of apples and oranges, so while you might find e.g. 8-12 is a great pressure range to address your apnea, it (or an even lower range) may well be all you need - what provokes events has little bearing if any on how many times your breathing's obstructed.

Steve99 wrote:

Pad A Cheek wrote:
I really appreciate it. Yeah I haven't used any of my $1k deductible, so I can either buy the machine out of pocket and own it or pay the monthly fee (which will cost the same in the end) and keep paying that fee forever. It's looking like owning my own equipment makes sense!

If you rent the machine it would be for 12-13 months then you own it.
If you do choose to purchase the machine out of pocket I wouldn't buy from the DME, much cheaper to buy online like form CPAP.coom