First Post (looking for advice)

Steve99 wrote: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.

Ask your Dr for a copy of your sleep study and your RX. You're entitled to them for your personal records. Good luck and keep us posted.

It is my understanding that insurance companies reimburse a set dollar amount on a PAP machine, regardless of the brand or features. I opted for ResMed's S9 Autoset, but I had to pay extra over and above the "member responsibility" amount. I wanted all the bells and whistles because I figured I'd be spending approx. 1/3 of my life with this thing hooked up to my head. I think (but not sure) that some insurance companies may require you to have your data from the machine downloaded (the DME company or doctor generally does this) after 3 months to see if you've been compliant with therapy. Also, in checking compliance with therapy, your therapy can be adjusted to maximize your CPAP therapy if needed.

I think most people don't necessarily need all the bells and whistles. You can always get a copy of your sleep study and prescription and use whichever DME company you choose or order online. With my insurance company, it is cheaper for me to use a preferred provider DME company. I am planning however, to order extra supplies online here pretty soon-- after I get a new mask from the DME company, I plan to order mask parts for my previous mask.

If you happen to be a veteran, the VA may help with your machine and supplies.

As a nurse, I'd say you need to start therapy ASAP. As a patient on a budget, I'd hate to meet my $1K deductible so late in the year. But, on the other hand, your health in way more important than money.

Now that I think about it, when I told the DME company that I wanted the S9 Autoset, they offered me two choices; a gently used machine with less than 200 hours on it or pay more for a new one. I assumed the one they were offering was one that had been previously rented. It would have probably served me just as well as the new one I spent more money for.

DoriC wrote:
Ask your Dr for a copy of your sleep study and your RX. You're entitled to them for your personal records. Good luck and keep us posted.

+1

I ended up buying my machine on cpap.com because it was so much less than going through the DME and paying for it outright. My BCBS also wanted me to rent to own, and it would have cost me out of pocket over $2400. If I bought it outright from the DME it was going to be around $1800, and on cpap.com it was about 1/2 that price. I am lucky, and don't have any other medical expenses, so I probably (hopefully) am not going to meet the deductible. I can still file what I have with BCBS and they will apply what I have paid towards my deductible, just in case I do have something come up (knock on wood). As long as your Dr prescribes a S9, you can order any S9 you want, and you can get the autoset. My Dr wrote the Rx for an S9 elite, but I ordered the autoset and got it. If you really want to get it through a local DME, call them all to get prices. Insurance companies contract with each company what they will pay for things. I found a $250 ish variance between the highest and lowest price I got from the 4 DMEs in my small town. Along with these fine people here, my insurance company suggested I buy online to save me money, since I probably wouldn't meet deductible.

I am new also Steven, only 6 days in and doing well so far. Good Luck!

I really appreciate everyone's suggestions! I spoke with my insurance company today and they said after 10 months I will own the equipment, so it's basically a wash if I bought it outright right away.

Can't wait to see what impact this has on my life!

I will report back

Another explantation of what the insurer is doing.

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

I do not see how it is more convenient to make your whole co payment in a single payment, unless you have a lot of money just laying around.

I am pretty sure that for Medicare, and a lot of other insurances, they will not pay for supplies; masks, hoses, filters, if a person does not have a prescription from a doctor.

Despite the fact Pugsy knows lots more than I do, and so on. I feel that a person is more likely to stick with treatment if they have the nearly right pressures when they start with treatment. Trying to go it on one's own, by finding pressure using a machine set to auto, and not having a helpful DME who can help you to find the right mask, makes sticking with treatment that much harder. Do I not recall someone saying that almost fifty percent of those who get through a sleep study, and get a machine with doctor prescribed settings and a mask quit using the machine.

This goes against the grain of a lot of people here who have had really unhappy results from sleep studies, and DME's who were not helpful at all. So that group tends to say, the heck with the establishment, just get a machine with auto, and full data capability, then sort it out on your own. There are some sleep issues which can not be solved this way. And some sleep studies which do not find those problems/issues eithe.

purple wrote:Despite the fact Pugsy knows lots more than I do, and so on. I feel that a person is more likely to stick with treatment if they have the nearly right pressures when they start with treatment. Trying to go it on one's own, by finding pressure using a machine set to auto, and not having a helpful DME who can help you to find the right mask, makes sticking with treatment that much harder. Do I not recall someone saying that almost fifty percent of those who get through a sleep study, and get a machine with doctor prescribed settings and a mask quit using the machine.

FWIW...I usually encourage people to go the "regular" way when at all possible...use the doctor and the prescribed pressure and let the DME help you sort out mask issues. That's the "ideal" way...that is of course assuming that the titration study was spot on with their suggestion on pressure and that the DME actually will help with keeping on trying numerous masks until the right mask is found.
Unfortunately not everyone gets the "ideal" package for any variety of reasons.
Those who don't get "ideal" are sort of left out in the cold to fend for themselves.
If someone can't go the "ideal" way for whatever reason that doesn't mean that they should be left out in the cold with no help nor does it mean that they can't manage to sort out issues on their own. It really isn't all that difficult to do when there are no complicating factors.

How much help were your DME and your doctor able to offer you when you needed and wanted a bilevel machine?
They kept telling you that you didn't meet Medicare criteria so they told you they couldn't do anything despite the fact that aerophagia normally is considered a good enough reason to warrant a bilevel machine and have Medicare okay it.

Steve, I just want to remind you to be really really careful when dealing with a DME. 99% of the time, whether you are private pay or insurance funded, they are going to try to talk you into the equipment they make the most profit on. Take a look at this to get an idea: http://maskarrayed.wordpress.com/what-y ... me-part-i/

I called today to find out what machine they have planned on providing me with friday. They told me I am set up for a RemStar Auto A-Flex. I asked if I would be able to change it if I would like and she told me I would have to talk to the respiratory therapist on friday once I go see them.

I have read a bunch of great reviews on the machine. Anyone have feedback on that model specifically?

thanks for everything!!!

Steve99 wrote:They told me I am set up for a RemStar Auto A-Flex.

Most likely this model because as far as I know it is the only Respironics model with AFlex exhale relief.
This would be model 560...full data machine and software is easily available and easy to use....works with SleepyHead and Encore.
https://www.cpap.com/productpage/pr-sys ... -tube.html

The 560 is the latest model...now they might offer the 550 which is essentially one model older and doesn't have the heated hose option available.. as far as data...it is still full data.

Model numbers are easily seen on a sticker on the bottom of the blower unit...3 digit number with maybe DS or REF in front of it.
Some machines have a 561..with the 1 being there instead of 0 as third digit. That's no big deal.

It's a great machine. If they are dispensing those models...can't complain.

Well night 1 did not go well!

The full face mask is very uncomfortable for me, I will be requesting a nose only one monday. I tried to talk a few times and breathe through my mouth a few times with it on and I mist have swallowed a bunch of air....very uncomfortable.

I don't think I slept more than an hour

its going to be a long day, then hopefully better success tonight!