One month to get machine!

Sorry, to ask questions that have probably been answered, but I am on a tight schedule to get my machine and equipment, so I thought I would get recommendations first to get me started. I have great insurance with my co-pays all paid up - until the end of the year. Then I go on Medicaid. So I would like to get my machine in the next month so I can have more flexibility and say so in what I get.

I am on my second go around with CPAP. I just couldn't hack it about six years ago and finally my health problems are getting to the point, that I will do anything. Last time I had sleep surgery and it didn't help enough that I could do without mask. But I was just too uncomfortable to wear one.

So a month ago, I went to my first sleep study and I just finished my second. I guess there is a new thing now - CFLEX? But whatever they had me on last night seemed more comfortable than before. I gather I have average sleep apnea. So I think I need CFLEX?, heated humidifier & accessories. Of course I would like to be in control of my own sleep apnea and be able to see each day how the machine is doing. I'm not sure what will happen when Medicaid takes over.

I would love any suggestions on what to look at.

Start here: viewtopic/t88637/CPAP-Basics----Table-of-Contents.html, then check out this post viewtopic/t94095/viewtopic.php?f=1&t=94 ... 99#p868999. Actually, any post by Pugsy may help you in your search for answers. There are many others who have provided good information over the years - I don't want to mention names for fear of offending someone I inadvertently forgot! Happy reading, but feel free to ask specific questions.

Whether you need C-Flex is entirely a matter of personal preference - I have it and don't use it. Same with the humidifier (although I sometimes use pass-over humidification. What is your AHI, and what pressure is required to stop the events? Those are important pieces of information that will affect the advice that people can give you.

CFlex is Respironics form of exhale relief and yes, some people really like it. Nothing wrong with that. Anything to make this adjustment easier is fair game.
http://cflexplus.respironics.com/
Only Respironics machine offer this "Flex" form of exhale relief.
ResMed has a different form of exhale relief but it is just as good.

You will want a full data machine...see this blog
http://maskarrayed.wordpress.com/
To keep things simple and since you like CFlex...educated yourself on the Respironics machine...not all machines with CFlex offer full data...so avoid any model machine number less than 450 and you will have full data.

For ResMed S9 machines...avoid any machine with "Escape" in the model name.

Get it sorted out now...when Medicaid takes over you get bare bones everything. They only pay for the barest of necessities and they sure don't feel that data capabilities are a necessity and may not feel that exhale relief is a necessity.

Mention to everyone the tight schedule you are on.

In fact, I would shorten that schedule to no later than 12-15-13 to give you a little cushion in case something gets screwed up.

If you are organized & prepared & IMPRESS upon the DME up front what you will accept, that should decrease the time some.

But, if anyone plays any games with you (i.e trying to give you something less than what you need), you could easily get into 2014.

Your FIRST step should be to call your great insurance co to make sure they will BUY the machine outright for you. Most insurers require at least a few months rental first to make sure you're really going to use it. A 13 month rental period is common. Only a very few insurers will buy outright. Don't ask the DME what your insurer will do. Make sure you've spoken to the insurer yourself and know exactly what the insurer's policy is before you talk to the DME.

If they require a rental period first then you need to know what will happen on Medicaid. Medicaid may or may not cover the machine of your choice. You may be better off applying whatever would be your first month rental co-pay to buying your own machine on craigslist or secondwind.com. You can probably still get masks and supplies on Medicaid.

Janknitz wrote:Your FIRST step should be to call your great insurance co to make sure they will BUY the machine outright for you. Most insurers require at least a few months rental first to make sure you're really going to use it. A 13 month rental period is common. Only a very few insurers will buy outright. Don't ask the DME what your insurer will do. Make sure you've spoken to the insurer yourself and know exactly what the insurer's policy is before you talk to the DME.

GREAT POINT!

In my 16 years on CPAP, my BC/BS insurance has NEVER required a rental NOR even compliance - so I easily forget that is not always the case.

Finding out what the policy actually states is a smart move.
But, I am not sure that I would rely on only what I was told on the telephone.
You can usually find your exact policy on the insuror's website & then find those details yourself.

Remember, one can always refuse to accept the machine if it turns out to be a rental & the insurance company will only be paying for the 1st month.

The "exact policy" is rarely on the insurers website. The real contract between you and the insurer is called the "evidence of coverage" and you have to SPECIFICALLY request it in writing. Then the insurer has 10 or more days to provide it in writing via snail mail. (Length of time varies by state law). Meanwhile, the clock is ticking. . .

Use the telephone, but it's a good idea to ALSO request the EOC for backup.

Thanks everyone for all the great advice. You confirmed my dire expectations of Medicaid. I have BC/BSand they paid for me to purchase my machine last time. I think I will go ahead and start the process to get what I can from BC/BS.

I'm not sure when my dr will receive second sleep study. The holidays will delay that. I was going to see if there was a local DME in my area to help me learn how to use the machine and masks. But I did not find one in my area that specialized in sleep therapy. My dr is about an hours drive, so I've got to get a plan.

I'm going to delve into researching machines. Thanks for all the site references. This is a great support community!

Well, I have to made decisions fast, so I was looking at the S9 Autoset CPAP Machine with H5i Heated Humidifier for her. I tried a Resperonics in Sleep Study and they gave me a nasal pillow entitled Nuance. Seemed easy enough. I know ResMed has something (Mirage FX)?

I was thinking of ordering it online. My only concern is that I would like someone to help me get started. I feel overwhelmed by it all! There is a store in Houston I can go to and maybe that might be best as far as getting a good fit.

I'm not sure about the software. Do you buy that separately? I don't want in depth info. At least until my brain refires from sleep deprivation. I just want to know and my doctors are never good at telling me things.

I have NO money. I have said that before when I got low on funds before pay day. But I am really out of money. So all I can order is what my insurance will pay. I guess I can leave ordering things to the supply house in Houston.

I would appreciate any feedback!

jshuler43 wrote:I tried a Resperonics in Sleep Study and they gave me a nasal pillow entitled Nuance. Seemed easy enough. I know ResMed has something (Mirage FX)?

The Respironics Nuance is a nasal pillow mask...a similar mask is the Swift FX nasal pillow...the Mirage FX is an over the nose mask with a plastic shell. So not the same type of mask as the Nuance.
If you did well with the Nuance you most likely will do well with the Swift FX nasal pillow mask..it was my favorite mask until displaced by a newcomer last spring. So I used it for well over 2 years. Great mask.

Our forum host cpap.com has a brick and mortar store in the Houston area.
Stafford, TX I think it is.
https://www.cpap.com/cpap-store-location.php
I don't know if they file insurance or not. They don't for online sells. Never hurts to ask though.

jshuler43 wrote:I'm not sure about the software. Do you buy that separately?

No need to buy the software...SleepyHead will work with either the S9 AutoSet (that you seem to want and it's a great machine) or the Respironics equivalent PR System One Auto.
It probably will give you more data than you want initially but you don't need to worry about understanding all that stuff right away (or ever really).
Main things to understand initially....AHI and leak. That's it. Not hard at all.
See the link in my signature to the SleepyHead tutorial. I go into more than AHI and leak but you don't need to worry about understand all that right now.

Janknitz wrote:The "exact policy" is rarely on the insurers website. The real contract between you and the insurer is called the "evidence of coverage" and you have to SPECIFICALLY request it in writing. Then the insurer has 10 or more days to provide it in writing via snail mail. (Length of time varies by state law). Meanwhile, the clock is ticking. . .

Use the telephone, but it's a good idea to ALSO request the EOC for backup.

EVERYTHING for my previous BC/BS policy was online (if you set up an account). In fact, even though BC/BS is now only my "secondary", all of that information is still available to me online.

And that has been the case for years now.

I do realize that may not be the case for all insurors or policies, but "I" would take the time to find out.

In this age of technology & the insurance companies' desire to keep their customers from constantly calling them, I would assume that more & more of this will be online today.

"I" "personally" just think that any information you get by telephone is pretty much next to useless. They just don't know every policy & often say things that are "general" statements & then you find out later it just does not apply to your policy.

Pugsy wrote:Our forum host cpap.com has a brick and mortar store in the Houston area.
Stafford, TX I think it is.
https://www.cpap.com/cpap-store-location.php
I don't know if they file insurance or not. They don't for online sells. Never hurts to ask though.

If the Houston store jshuler43 referenced "IS" the cpap.com brick & mortar store, then he is in good shape.

The brick & mortar stores of cpap.com ARE DMEs & they DO accept "many" insurances (BC/BS is 1 of them). But, you do have to look at the "specific" insurance they accept at each separate location.

The website for those brick & mortar DME locations is https://www.hmssleep.com/main.php

Click on the green "Insurance We Accept" tab at the top middle of the page.

Cpap.com and hmssleep.com are not the same AFAIK. Cpap.com lists one location (Stafford, TX). Hmssleep lists several States, but not TX. Shame there is no cpap.com location in my town, but the costs of licensing in multiple States are probably prohibitive.

SleepyToo2 wrote:Cpap.com and hmssleep.com are not the same AFAIK. Cpap.com lists one location (Stafford, TX). Hmssleep lists several States, but not TX. Shame there is no cpap.com location in my town, but the costs of licensing in multiple States are probably prohibitive.

They ARE definitely the SAME!

And Texas IS 1 of the states listed.
And their Texas locations DO accept BC/BS
Their 2 Texas locations are Houston & Dallas (See their location listing below that I copied from their website).

Pennsylvania, however, is NOT a state they seem to be in.


Our Locations
Texas
9100 Southwest Fwy, Suite 114
Houston, TX 77074
Phone: 713-541-2727
Fax: 832-201-0196
get directions » General
Manager

District
Manager Lisa Stovall
lisa@hmssleep.com

Lisa Krolczyk
lisa.krolczyk@hmssleep.com
12810 Hillcrest Road, Suite B123
Dallas, TX 75230
Phone: 972-991-6262
Fax:972-991-6464
get directions » District
Manager Shari Hilterbran
shari@hmssleep.com

Louisiana
Sleep Apnea Store
69164 Highway 59, Suite 5
Mandeville, LA 70471
Phone:985-249-6410
Fax:985-249-6412
get directions » District
Manager Alyce Friloux
alyce.friloux@hmssleep.com
Sleep Apnea Store
3828 Veterans Memorial Blvd
Metairie,LA 70002
Phone: 504-888-4449
Fax: 504-888-1534
get directions » District
Manager Alyce Friloux
alyce.friloux@hmssleep.com
Sleep Apnea Store
5215 Essen Lane,Suite 10
Baton Rouge, LA 70809
Phone: 225-766-9352
Fax:225-766-7416
get directions » District
Manager Dina Pate
dina@hmssleep.com
2014 W.Pinhook Road,Suite 500
Lafayette,LA 70508
Phone: 337-981-0888
Fax: 337-981-0877
get directions » District
Manager Donna Fontenot
donna@hmssleep.com

Illinois
DBA Health Management, Inc.
2090 Larkin Ave Suite 5A #2
Elgin, IL 60123
Phone: 847-882-2516
Fax: 847-882-2584
get directions » District
Manager Diane Jones
diane@hmssleep.com

Virginia
6767 Forest Hill Avenue,Suite 105
Richmond,VA 23225-1852
Phone: 804-272-6780
Fax:804-272-7262
get directions » District
Manager Judy Moss
judy@hmssleep.com
Mississippi
499 Gloster Creek Village,Suite F-7
Tupelo, MS 38801-6739
Phone: 662-840-1089
Fax: 662-840-4011
get directions » District
Manager
Rita Curbow
rita@hmssleep.com

Puerto Rico (Sleep Apnea Store)
165A Winston Churchill Ave
San Juan, PR 00926
Phone: 787-771-2500
Fax:787-771-2600