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Advice for new users wanting to "tweak" settings
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jackazz76 Offline

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Posts: 25
Joined: Aug 2012

Machine: S9 Escape Auto
Mask Type: Full face mask
Mask Make & Model: Quattro FX
Humidifier: H5i
CPAP Pressure: 5-7 tentatively
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: North Eastern US

Post: #41
RE: Advice for new users wanting to "tweak" settings
(10-13-2012 09:57 PM)Sleepster Wrote:  Those things do tend to affect the pressure, but the machine is designed to maintain the correct pressure despite them. But if your leak rate is exceptionally high the machine can't maintain the correct pressure. That's why it's so important to have a data-capable machine that lets you know when your leak rate is unacceptably high.

I know, I pushed for the S9 auto (non-escape), but the insurance wouldn't allow the DME to give me one. I might be able to exchange the escape and pay a small amount out of pocket, but I've had this machine for 3 months now. No leak data Sad . My DME is pretty awesome, they GAVE me a quattro FX mask without even charging my insurance... small towns and good people are great. I thought with the "Cadillac" of masks all would be good in Oz... unfortunately I get a leak that hits my eye when I put my hand under my head (thinking a memory foam pillow might help). Have been compensating by seriously overtightening the straps, looks like someone has been whipping my nose with a wet noodle in the morning.
10-19-2012 09:20 AM
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Sleepster Offline
Wiki Editor
Moderators

Posts: 4,993
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #42
RE: Advice for new users wanting to "tweak" settings
[/quote]
(10-19-2012 09:20 AM)jackazz76 Wrote:  I know, I pushed for the S9 auto (non-escape), but the insurance wouldn't allow the DME to give me one. I might be able to exchange the escape and pay a small amount out of pocket, but I've had this machine for 3 months now. No leak data Sad .

They should have offered that option to you 3 months ago when your machine was new.

Quote:My DME is pretty awesome, they GAVE me a quattro FX mask without even charging my insurance... small towns and good people are great.

Sorry to burst your bubble, but the DME has contracted with your insurance company to provide you with an array of equipment options and a replacement schedule. They probably have to give you the option of a mask switch during your first month, and every six months thereafter.

Quote:I thought with the "Cadillac" of masks all would be good in Oz... unfortunately I get a leak that hits my eye when I put my hand under my head (thinking a memory foam pillow might help). Have been compensating by seriously overtightening the straps, looks like someone has been whipping my nose with a wet noodle in the morning.

Call your DME and report this problem immediately. I've heard that problems like that can lead to seroius issues with your eyes, not to mention the negative impact it's having on your therapy.

Note to all readers: Don't let your DME stick it to you with a brick.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
10-19-2012 11:05 AM
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archangle Offline
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Advisory Members

Posts: 3,159
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed S9 H5i
CPAP Pressure: 16-20
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments: Happy PAPper

Sex: Undisclosed
Location: USA

Post: #43
RE: Advice for new users wanting to "tweak" settings
(10-19-2012 09:20 AM)jackazz76 Wrote:  I know, I pushed for the S9 auto (non-escape), but the insurance wouldn't allow the DME to give me one. I might be able to exchange the escape and pay a small amount out of pocket, but I've had this machine for 3 months now.

Did the insurance company tell you that, or did the DME tell you that?

Most insurance companies don't care. They simply contract with the DME to supply any CPAP machine for $x. Many DMEs will lie to you to get you to accept the cheaper machine so they make more money.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
10-19-2012 12:34 PM
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SuperSleeper Offline

Administrators

Posts: 9,967
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #44
RE: Advice for new users wanting to "tweak" settings
To add to what Archangle said, please note that insurance companies in the U.S. operate their plans under Medicare authority and regulation (http://www.cms.gov), and under those rules, they pay the DME a flat fee for CPAP - doesn't matter to them that it's a CPAP or APAP... both have the exact same reimbursement codes, whether you're on private, corporate or Medicare insurance.

Either way, insurance and/or Medicare pays the exact same amount out to the DME either way... usually around $1500. So, if the DME can "con" a patient into taking a low-end straight CPAP that costs the DME $700, they make $800 profit. If the patient insists upon an APAP that costs the DME $900, they only make $600 profit.

I'd be willing to bet dollars-to-donuts that it was your DME that told you "the insurance company won't approve the Auto-CPAP". If so, they probably lied to your face. Insurance and Medicare pays the DME with with exact same billing code for both--

DME's have been doing this for years and years. As a patient, you must insist that you know how the system works and that you're not just another sucker who takes their word for everything.

Stand up for your rights - you paid for the insurance (either through premiums or Medicare tax) and they pay the Durable Medical Equipment supplier the same amount whether you get an S9 AutoSet or an S9 Escape Auto or S9 Elite or S9 Excape.

Like Arch's sig line says, "If it's midnight and a DME tells you it's dark outside, go and check it yourself.".

DMEs lie all the time to make more money. It's the unfortunate truth. Oh-jeez

Now... that said, it is possible that insurance company has a specific policy on how to obtain an APAP over a CPAP... for instance they may require the doctor to write a specific prescription for APAP in order for you to obtain one (that's pretty easy to obtain if your doctor is reasonable, since APAPs can be set up to operate in straight CPAP mode or in Auto mode). But the issue is not a financial one for the insurance company at all - they pay the same for both CPAP and APAP. 95% of the time when a DME gives you trouble like this, it's because they're trying to make more money.

Good luck to you! Coffee

SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.

10-19-2012 07:22 PM
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Sleepster Offline
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Moderators

Posts: 4,993
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #45
RE: Advice for new users wanting to "tweak" settings
(10-19-2012 07:22 PM)SuperSleeper Wrote:  To add to what Archangle said, please note that insurance companies in the U.S. operate their plans under Medicare authority and regulation (http://www.cms.gov), and under those rules, they pay the DME a flat fee for CPAP - doesn't matter to them that it's a CPAP or APAP... both have the exact same reimbursement codes, whether you're on private, corporate or Medicare insurance.

According to my insurance company I have to pay a certain percentage of the cost of the machine to the DME. Other than that they do seem to follow the medicare equipment replacement schedule.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
10-19-2012 07:26 PM
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SuperSleeper Offline

Administrators

Posts: 9,967
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #46
RE: Advice for new users wanting to "tweak" settings
(10-19-2012 07:26 PM)Sleepster Wrote:  According to my insurance company I have to pay a certain percentage of the cost of the machine to the DME.

Right, but that's probably your out-of-pocket costs, correct? That out-of-pocket expense you must pay applies whether or not you get APAP or CPAP I'm pretty sure.

But for the DME to say that you must pay more out-of-pocket for an APAP over a CPAP, that is not true, unless the APAP costs more than the $1500 or so that Medicare and/or insurance reimburses them for.

And, an unscrupulous DME might simply "jack up" their APAP price to an inflated $2000 so that the patient would have to pay the $500 overage.... and if that happens, it's time to tell that greedy DME straight to their face that you're leaving to find a DME who will not screw their customers. It's ridiculous that a brick and mortar DME will charge you $2000 for an APAP machine that you can purchase online for $900. Faced with you walking out the door, many DMEs will give in and admit that they can "do something for you" and give you an APAP with no additional out-of-pockets costs to you. (Less profit is better than no profit, after all). I'd recommend talking to the manager of the DME if it gets to that point. And if they still don't budge, walk out and go to another DME.

And for them to say that "insurance won't allow the DME to give a patient an APAP" is just not true. They can and they will if you put enough pressure on them... and we have many members here who have gotten APAPs completely paid for by their insurance company or Medicare... so this is not just some theory.

With most DMEs, it's all about the money. The faster patients realize that, the better off they'll be. Yep, they'll make you feel all "warm and fuzzy" about "how much they are helping you" or some such nonsense. I hear people tell me all the time, "Oh, my DME is owned by a really nice man - he would never do something like that!". Hmmm... okay, wanna bet? You have to look past what they say and look into the facts for yourself.

Coffee

Disclaimer: The above statement was brought to you by your cynical, realistic and sceptical Apnea Board Admin and is not intended to be an all-encompassing indictment upon every single DME on the face of the earth.

Too-funny

SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.

10-19-2012 07:34 PM
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jackazz76 Offline

Preferred Members

Posts: 25
Joined: Aug 2012

Machine: S9 Escape Auto
Mask Type: Full face mask
Mask Make & Model: Quattro FX
Humidifier: H5i
CPAP Pressure: 5-7 tentatively
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: North Eastern US

Post: #47
RE: Advice for new users wanting to "tweak" settings
Hey guys, I hear what you are saying... honestly though in my case I do have the 1% DME that really is kind and decent folk. Two good friends work in fairly higher level positions there. I'm on medicaid, which doesn't like to pay too much being that it's for us poor folk who can't work. Exactly what he said was, "we don't order the autoset unless they can sell them"... he could have given me a bottom of the barrel CPAP as that is what the prescription called for and "made" an extra 4 or 500 off my insurance. He also had no obligation to GIVE me a 150 dollar mask, I say give because he didn't bill my insurance for it, I have to sign a "receipt of merchandise" if he is to bill them. He just handed it over and let me walk out with it. He also offered to GIVE me a climate line tube, which I declined after he explained what his secretaries have to go through to be paid by insurance (filling out a monthly request for payment until compliance is proven and machine paid off). He told me when he combines the time and effort involved in getting reimbursed from medicaid it is almost not worth the trouble.

I could be wrong and he could be a shark, but my intuition tells me otherwise and is usually right. Sleepster, thanks for the concern about my eyes... I would take partial blindness to feel semi-decent at this point, but it is of concern... which is why I sacrifice my beautiful nose to save my eye from having air blasting it all night... haven't tried the gecko pads with this new mask yet, that's my next step... they didn't work well with the other mask, instead causing leaks. Have kept the machine to prescribed setting and AHI is pretty dang low, but I don't FEEL as good as I did with a few weeks at higher level. I have to convince the doc to let me put it up that .8 cm based on how I feel and not numbers. Sitting up 7 feels pretty significant, but when I lay down I feel almost like I can't get enough air into my lungs at that rate... would like to pick up a oximeter at some point to see if o2 sat is better.

You guys are fantastic, I appreciate you all! Smile
10-25-2012 07:56 AM
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SuperSleeper Offline

Administrators

Posts: 9,967
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #48
RE: Advice for new users wanting to "tweak" settings
(10-25-2012 07:56 AM)jackazz76 Wrote:  He also had no obligation to GIVE me a 150 dollar mask, I say give because he didn't bill my insurance for it, I have to sign a "receipt of merchandise" if he is to bill them.

Who knows, you could be right that this DME is handing out free equipment to you. I suspect otherwise, or perhaps that this particular person (lower level employee) doesn't even know if the folks in the DMEs billing department are billing for it or not. One thing I do know, and that is that a DME won't stay in business very long if they continually hand out a bunch of "free equipment" to patients. The folks in the DME's billing department work 8 hours a day, 5 days a week to try to get money out of insurance, Medicare & Medicaid, etc. I seriously doubt that they will simply "let it go" and not attempt to get reimbursement for a mask that retails for $150.

From what I've heard, DMEs don't need a "receipt of merchandise" to bill insurance, Medicare or Medicaid. They simply bill it without that backup documentation. From what I understand, Medicare or Medicaid requires backup documentation during an audit (rare) or a specific request for the documentation when they think something "fishy" is going on (again rare). And backup documentation to prove that the patient received the item usually isn't asked for on smaller stuff like CPAP masks. If they're going to go to all the problems associated with challenging a DME's billing, they usually ask for documentation on the larger more expensive items like CPAP machines, O2 generators, etc., where the cost/benefit ratio is better.

Your mileage may vary. All I'm saying is that I do know for a hard fact that in many, many cases... DMEs are like politicians: How do you know then they're lying to you? Answer: their mouth is moving. SHa_biggrin5

Again, all of this is simply my personal opinion based on what several folks have told me. It's just a good idea to keep in mind that DMEs are there to make money, not act as a charity. I could be wrong and in no way wish to falsely accuse any possible altruistic DMEs out there.... all 3 of them. Bigwink

Coffee

SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.

10-25-2012 09:07 AM
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koala Offline

Members

Posts: 12
Joined: Sep 2012

Machine: Resmed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: SleepWeaver fabric
Humidifier: H5i
CPAP Pressure: Auto
CPAP Software: ResScan

Other Comments: Sleepy Koala

Sex: Male
Location: Taiwan

Post: #49
RE: Advice for new users wanting to "tweak" settings
CSA is much of brain lacks of activity to control breething process while sleeping, OSA is caused by blockage. Still, not a good idea to mess around your machine's settings.
10-25-2012 09:21 AM
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Sleepster Offline
Wiki Editor
Moderators

Posts: 4,993
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #50
RE: Advice for new users wanting to "tweak" settings
(10-25-2012 07:56 AM)jackazz76 Wrote:  Hey guys, I hear what you are saying... honestly though in my case I do have the 1% DME that really is kind and decent folk.

I'm sure he is. Mine is too. But he's also in business to make money. I would be too, if I were a DME.

All I'm saying is that he's providing the service he's contracted to provide. I don't think they bill the insurance company for every device they give you, but they are under contract to provide you with certain things, like a new mask if you're a newbie and don't like the original mask.

True they make more money if they violate the contract and don't provide the new mask. But just because they honor the contract doesn't mean they're losing money. They're just playing by the rules, making money, and making a good impression on you for their honesty and good service.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
10-25-2012 08:07 PM
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