Can I buy my first CPAP online and set it up myself?

Hello - I'm new here and very appreciative of all the great info. I recently was diagnosed with moderate OSA (AHI of 18 and 83% min SpO2) in a sleep study. I was expecting an additional titration sleep study, but instead I got a call from the lab referred DME saying no more sleep studies were necessary and they wanted to set me up with a ResMed Autoset S9.

The DME claims my insurance company requires that I lease-to-own the unit at $325 per month for 12 months. In addition,checkups are required every 3 months to make sure I'm using the unit (I assume based on data from the S9). My insurance has a high deductible, so I would be responsible for a large portion of this cost (negotiated rates may be lower however).

My question: is it realistic for a CPAP newbie to buy their first machine/mask/etc online? The cost savings of buying online seem huge, even after including any insurance benefit (DME markup appears to be 300-400%). Does buying the machine online mean I don't get to use the cost towards my insurance deductible, and how does a new user go about choosing a mask when buying online?

I read the maskarrayed blog posts which I believe are written by Janknitz who posts here. It seems that this is certainly doable for experienced CPAP users. Would I be biting off more than I can chew as a first time CPAP user?

Sleep_Pirate wrote:Hello - I'm new here and very appreciative of all the great info. I recently was diagnosed with moderate OSA (AHI of 18 and 83% min SpO2) in a sleep study. I was expecting an additional titration sleep study, but instead I got a call from the lab referred DME saying no more sleep studies were necessary and they wanted to set me up with a ResMed Autoset S9.

The DME claims my insurance company requires that I lease-to-own the unit at $325 per month for 12 months. In addition,checkups are required every 3 months to make sure I'm using the unit (I assume based on data from the S9). My insurance has a high deductible, so I would be responsible for a large portion of this cost (negotiated rates may be lower however).

My question: is it realistic for a CPAP newbie to buy their first machine/mask/etc online? The cost savings of buying online seem huge, even after including any insurance benefit (DME markup appears to be 300-400%). Does buying the machine online mean I don't get to use the cost towards my insurance deductible, and how does a new user go about choosing a mask when buying online?

I read the maskarrayed blog posts which I believe are written by Janknitz who posts here. It seems that this is certainly doable for experienced CPAP users. Would I be biting off more than I can chew as a first time CPAP user?

You can have the doctor give you a copy of the prescription and then buy it online. But call your insurance company directly first. DMEs are known for lying. Some insurance companies do a rental period, and then it is yours. Some, like mine, do a rental for 1-2 months, and once you meet compliance for 30 days within the first 2 months, then they convert it to a full purchase. And some do a full purchase.

Some DMEs will tell you what they assume without actually confirm it. Some will outright lie in an effort to get more money from you. So, you really need to ask the insurance company.

Just make sure you get the autoset and not the escape auto. You will need the data, especially since you haven't had a titration.

Hi and welcome. At $325/month for 12 months your grand total would be $3900. This doesn't make sense. A fully data capable APAP (which you'd need since you didn't have an in-lab titration study), brand new, costs under one thousand.

I would first double check the rental terms with your insurance company. NOT the DME. Someone recently came on the forum with a similar story to yours, then when they called their insurance back it turned out they weren't given the complete information and the monthly rental price was not that high for that long.

If those really are the insurance terms I would do what zoocrew is suggesting, which is to get a copy of your prescription and purchase the machine yourself. To buy from a reputable online seller (like our forum host cpap.com) you do need a copy of your prescription. And yes, you could with some help figure out your ideal pressure range. Kaiser Permanente sends patients home for their titration as a matter of routine. Patients use an APAP for a week then bring the machine back and the prescription is issued.

It's pretty hard for most folks to get any insurance coverage for machines they puchase online, but to be sure call your insurance company and ask.

Masks: You can use your local DME for masks even if you haven't bought a machine from them. You can also buy online and purchase the Return Insurance -- and some masks actually come with free 30-day Return options. I did not have a local DME when I started so I bought online. I did buy and return several before I settled on the one that worked best for me. A little inconvenient but not bad.

To answer your main question...yes, you can set things up on your own. It isn't difficult.
http://www.apneuvereniging.nl/forum/pdf ... manual.pdf
Above link is the provider/clinical manual for the S9 machine. You can see how easy it is to get into the setup area and set the parameters.

Do try to find out the actual negotiated price that your insurance company says is the "allowable" amount that the monthly rental gets knocked down to. Sometimes it's a substantial reduction and sometimes not such a big reduction.

Or buy a used one and you won't need doctor's prescription. I only recommend this for somebody who is willing to learn about adjusting pressures etc.

VikingGnome wrote:Or buy a used one and you won't need doctor's prescription. I only recommend this for somebody who is willing to learn about adjusting pressures etc.

Unless the OP buys from an individual on Craigslist s/he will need a prescription. secondwindcpap.com is a trustworthy online seller of open box and gently used machines and they require a prescription. In any case, since the OP had a sleep study and a diagnosis it only makes sense to get a copy of the prescription. Masks will also require a prescription (unless you buy parts and assemble a mask yourself, but this isn't possible for all masks).

I agree that anyone doing self-titration should be willing to become educated about how to do it. Kaiser sets the APAP wide open (4-20 cm) when they send the patient home for titration week and then the prescription settings are based on where the pressure went during the titration week. When we do it ourselves, the 95% number usually is our starting point for narrowing the pressure range. I'm guessing in uncomplicated cases this is what the doctors reviewing the titration data do, too. They don't have any more information from the machines than we do except in cases where they attach a pulse oximeter to the machine for home titration. Even then I suspect that the AHI and pressure data are the basis for the prescription settings (again, barring unusual or complicated cases).

Hmmm... secondwindcpap didn't ask me for a prescription when I bought a used machine (about a month ago). In any event, most states require the physician to give you a copy of the prescription if you request it.

Nick Danger wrote:Hmmm... secondwindcpap didn't ask me for a prescription when I bought a used machine (about a month ago).

Secondwind doesn't require a prescription if they're shipping outside the United States. Otherwise, it was likely an oversight because their policy is to require the Rx.

I'm in US. I suspect you are correct - I was surprised they didn't ask for a prescription.

Sleep_Pirate wrote:Hello - I'm new here and very appreciative of all the great info. I recently was diagnosed with moderate OSA (AHI of 18 and 83% min SpO2) in a sleep study. I was expecting an additional titration sleep study, but instead I got a call from the lab referred DME saying no more sleep studies were necessary and they wanted to set me up with a ResMed Autoset S9.

The DME claims my insurance company requires that I lease-to-own the unit at $325 per month for 12 months. In addition,checkups are required every 3 months to make sure I'm using the unit (I assume based on data from the S9). My insurance has a high deductible, so I would be responsible for a large portion of this cost (negotiated rates may be lower however).

My question: is it realistic for a CPAP newbie to buy their first machine/mask/etc online? The cost savings of buying online seem huge, even after including any insurance benefit (DME markup appears to be 300-400%). Does buying the machine online mean I don't get to use the cost towards my insurance deductible, and how does a new user go about choosing a mask when buying online?

I read the maskarrayed blog posts which I believe are written by Janknitz who posts here. It seems that this is certainly doable for experienced CPAP users. Would I be biting off more than I can chew as a first time CPAP user?

All things being equal........
Yes, you can do it without a local DME. I did it nine years ago and have never regretted it. I bought all my gear out-of-pocket from CPAP(dot)COM and then billed my insurance provider. My insurance provider DID reimburse me for 80% of my purchase because they considered me to be "in-network". I just used my invoice from CPAP(dot)COM and created one of my own to bill my insurance provider. I had previously discussed doing it this way with them, but if they hadn't, I would have paid for everything out-of-pocket because I wanted to avoid the local DMEs.

It would help if you can get a prescription (especially for buying online), but it's doable without one. Most any medical doctor can write a prescription.

I'm still using the very same mask I picked as my first choice......the ResMed Ultra Mirage Full Face. I did lots of research on the masks available (there are more to choose from now than there were then). I knew I wanted a full face mask (even before my sleep study) and once I selected that category, I started looking at the ones available. I selected one that had all replaceable parts. I did the measurements from their mask sizing criteria and it has worked out well. CPAP(dot)COM includes all the provider setup instructions with their machines, so if you can read, you can set one up.

If you do the math, you'll probably find that buying one online comes out about the same as going through insurance with the deductibles and co-pays. However, if your deductible is quite high, you'll definitely be money ahead by going out-of-pocket from an online seller.


Den

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I would advise agianst doing it yourself. DME's and your sleep specialist are the best way to get things done properly.

As far as I see, the only financial downside to getting one online is if you get it and decide within the first month or so that you aren't going to use it. Even then, I think you are probably better off buying online and selling if you don't stick with it. A used low-hour ResMed S9 autoset can be had for between $500 and $600 including the humidifier. CPAP.COM has new ones for under $1,000. The equivalent Respironics machine would be a little cheaper and is spoken highly of by those who use them. If you are doing this yourself, you definitely want to get some sort of autoset machine with full data capabilities.

One thing that would change this would be if you expect to have substantial additional medical charges later this year. If so, it might be to your advantage to go ahead and begin burning through the deductible.

As far as a DME being a big advantage - some people have found good DMEs, but many of us have horror stories.

Nick

Hi guys - thanks for all the input. I still need to call my insurance, but I'm leaning towards getting an Autoset S9 online. Part of the reason I'm leaning this way is I'm a tinkerer, and am thinking I may end up (like many here) buying many masks, reviewing data, adjusting settings, and even possibly buying multiple machines. It just doesn't seem like the insurance/DME route is set up for that. FWIW, my deductible is $1500, then most things are covered at 80%, so I think it's still much cheaper to pay cash outside of insurance, but I need to call to verify.

I'm not clear on who writes the prescription for the device and when. Is it your primary care physician, or a doctor associated with the sleep study lab, or someone affiliated with the DME? Also, does the prescription usually include the machine type and recommended pressure? This seems like a bit of a catch 22 - I don't know the pressure I need, but yet I can't get a machine to establish the pressure I need without a prescription.

Any licensed physician, nurse practitioner or dentist can write the Rx. If you have a copy of your sleep study you could ask any of these health care providers for the Rx. The prescription should include the insurance billing code E0601 even if you don't go through your insurance. The insurance billing code is the same for CPAP and APAP. If you're buying online you can choose either type of machine with that billing code. As for the pressure settings on the Rx, typically if someone hasn't had an in-lab titration, the prescription will be for APAP with settings wide open, minimum pressure 4 cm and maximum presssure 20 cm.

Our forum host cpap.com has a prescription form that you can download and take to your doctor. This form shows you what needs to be on the Rx:

http://c0149421.cdn.cloudfiles.rackspac ... on-LMN.pdf