HELP! DME vs Online

I found a DME I'd be willing to work with. He was very straight forward about how insurance works and what script he needs in order to get me a machine with full efficacy data. He also stated that, depending on where the machine lands in the price range, he might be able to wave the %20 coinsurance.

All that said, I don't know if I should go that route. I have a $2500 deductible of which I will have paid about $1500 when my titration study is complete. I know that BCBS (insurance) usually pays $1600 for a machine so I'd end up reaching my deductible this year.

It looks like I could get a decent machine for around $500 online plus ~ $150 for hose / mask. But that doesn't include mask trials and all that. That's a potential savings of $300-$400... but that doesn't include trying several masks if I don't get one I like right off the bat.

Another thought I've had is that if I go through the DME then if I have further medical issues this year (coverage resets Jan1) I'd have already met my deductible...

I know that this is a decision I have to make myself but I'd appreciate your feedback... why go one route over another, is there something I haven't considered, etc.

Talking with the wife I realized that I could technically skip the titration study and save that much more money.... thoughts?

This would be your first machine?

If it's a wash financially, and you trust the DME I think I'd go that route.

Can't speak for BCBS but my insurance would not pay for a device until I proved compliance. I had to rent the machine for two month first and show minimum 4 hours utilization 70% of the time. In addition, I really needed ASV instead of xPAP but had to go through the motions with two machines (APAP, Bi-level). Once I proved necessity and compliance, I got authorization to acquire the ASV.

With the insurance discounts, my DME prices were actually comparable to online so given the hassle of returning devices (and uncomfortable masks), staying local was the best choice for me. Your mileage may vary.

- Flappy

Uncle Flapp wrote:Can't speak for BCBS but my insurance would not pay for a device until I proved compliance. I had to rent the machine for two month first and show minimum 4 hours utilization 70% of the time. In addition, I really needed ASV instead of xPAP but had to go through the motions with two machines (APAP, Bi-level). Once I proved necessity and compliance, I got authorization to acquire the ASV.

With the insurance discounts, my DME prices were actually comparable to online so given the hassle of returning devices (and uncomfortable masks), staying local was the best choice for me. Your mileage may vary.

- Flappy

What are your thoughts on skipping the titration study and buying outright? I could buy a machine outright just for what the titration study costs.... if it's not "necessary"

The nice thing about buying from local DME is if something goes wrong with the machine most of them will give a loaner if the
machine has to be shipped back to the factory. The local Dme does have advantages.

If you get auto adjusting machine then you could probably skip the titration study. What does the first study say your settings should be?

Bill44133 wrote:The nice thing about buying from local DME is if something goes wrong with the machine most of them will give a loaner if the
machine has to be shipped back to the factory. The local Dme does have advantages.

If you get auto adjusting machine then you could probably skip the titration study. What does the first study say your settings should be?

They didn't put me on a pap during the first study.. .just the sensors. They didn't recommend a pressure setting.

stratapastor wrote:What are your thoughts on skipping the titration study and buying outright? I could buy a machine outright just for what the titration study costs.... if it's not "necessary"

Do you have an Rx? It is required to buy an xPAP and usually granted only after a titration study. I believe there are home kits although I am not familiar with them.

Others will chime-in but from my perspective, a titration study will grant you a starting point for the best pressures which is better than going in blind. If you already have an Rx and a history of settings that work, online may be right for you. If you are new to xPAP, I wouldn't cut corners when investing in your health.

- Flappy

I never had a titration study. My 'script calls for an APAP machine with pressures in the 5 - 17 cm water range. I dialed it in from there by reviewing the data. It took a couple of weeks to do this but it wasn't all that bad.

If you are willing to stay on top of it and make small adjustments you should be able to dial it in as well. If you have difficulties we may be able to offer some assistance.