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LindafromNJ Offline

Members

Posts: 7
Joined: Sep 2015

Machine: resmed airsense 10 elite
Mask Type: Nasal mask
Mask Make & Model: Resmed Nano
Humidifier: unsure
CPAP Pressure: 6
CPAP Software: ResScan

Other Comments:

Sex: Female
Location:

Post: #1
Help
Have to go from CPAP to APAP. Found out from Medicare they will do a swap with my 10 month old machine. but will only pay up to 13 months. So medicare will only pay for 3 months since they have already paid for 10 and I have to pay for the rest. I have a Resmed cpap now. Should I go with another Resmed which is expensive? My supplier suggested 3B Luna 480 but read some reviews that says it is noisy. Any suggestions?

I am new to this site and it has been helpful. Also opinions is APAP
better than CPAP? I am a little upset doctor never gave me an APAP to begin with.
04-13-2016 04:07 PM
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JSL747 Offline

Preferred Members

Posts: 22
Joined: Feb 2016

Machine: ResMed S9 VPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: ResMed S9 H5i
CPAP Pressure: 17/12 PS1
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Female
Location: Oregon

Post: #2
RE: Help
Are you sure Medicare will not pay for the full price of a new machine?? Is this what the DME is telling you or have you checked it out for yourself? I switched machines 3 times, from a BRICK to n S9 autoset to a ResMed VPAP and Medicare paid for the whole thing.

Also I would go with the brad you are using, ResMed..if you like it. The other one that is good is a PR< Philips Resp. Both are good. You might look at lightly used, great prices. See the venders section
04-13-2016 04:18 PM
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OpalRose Offline

Monitors

Posts: 3,166
Joined: Nov 2014

Machine: PR System One REMstar Auto 560 with A Flex
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10 For Her
Humidifier: REMStar heated humidifier with heated hose
CPAP Pressure: Auto Cpap 10-13 AFLEX 1
CPAP Software: SleepyHead EncoreBasic

Other Comments: Started CPAP Therapy October 23, 2014

Sex: Female
Location: Northeast Ohio, USA

Post: #3
RE: Help
How much do you have to pay? I know you said 10 months, but how much?

I would not accept that 3B Luna from DME. And yes, your doctor should have perscribed an APAP.
Your DME has already made a hugh profit by giving you a Cpap verses APAP.

Insurance companies pay the same amount regardless if you get a Cpap or APAP, so the DME isn't going to advise you. Their priority is Profit, not you.

Here is a link to help you decide.
http://www.apneaboard.com/wiki/index.php...ne_Choices

Once you find out what you have to pay the DME out of pocket, you may want to check the suppliers list above. You can probably buy online cheaper, but check with your insurance first. Don't believe anything a DME says.

http://www.apneaboard.com/forums/Thread-CPAP-Supplier-List

OpalRose
(This post was last modified: 04-13-2016 04:29 PM by OpalRose.)
04-13-2016 04:25 PM
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robysue Offline
Wiki Editor
Advisory Members

Posts: 1,226
Joined: Oct 2013

Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #4
RE: Help
The PR System One Auto CPAPs and PR DreamStation Auto CPAPs are quite a bit cheaper than the Resmed ones are.

They are also just about as quiet as the Resmed AutoSets are.

Finally:
Quote: I am a little upset doctor never gave me an APAP to begin with.

The problem is not the doc. The problem is the DME (supplier). A script for CPAP at a specified level is enough to allow a DME to sell the patient an APAP and set the APAP up in CPAP mode. Most DMEs won't do this. But a few high quality DMEs will routinely set their new patient/customers up with APAPs even when the script reads "CPAP". Why? Well, first of all if the script changes to APAP early in the rental period, they don't have to swap the machine out. Next, if the patient runs into trouble and the doc wants to do a week or two of auto titration to check on the pressure setting, the DME doesn't have to deal with providing a loaner machine (usually for NO reimbursement) for the two week period.

Personally, I'm surprised the DME is saying that you have to foot 10 months of the bill for the new machine. It's not like you're going to keep the existing machine. My guess is that the DME's contract with your insurance company specifies what happens when the doc changes the script during the rental period. And my guess is that what's specified is that the original machine winds up back at the DME and the DME is under some obligation to provide the already paid rental fees to the new machine. That's what happened to me when I was changed from CPAP/APAP to BiPAP about 3.5 months into therapy. The first 3 months of "rent" on the original S9 AutoSet was applied the rent/purchase price of the PR System One BiPAP Auto. My copays did have to go up substantially since the new machine was twice as expensive and the negotiated amount my insurance company pays for a BiPAP is twice as much as they pay for a CPAP/APAP.

Personally, if I were you, I'd contact the insurance company and let them know the script has changes and ask them what the DME is responsible for doing under the contract between the DME and the insurance company. I'd be sure to tell them the DME is insisting that you pay 10 months of the rental fee OOP for the new machine.

Questions about SleepyHead?
See my Guide to SleepyHead
04-13-2016 04:26 PM
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Mike1953 Offline

Preferred Members-2

Posts: 134
Joined: Aug 2014

Machine: Resmed S9 Escape Auto
Mask Type: Nasal pillows
Mask Make & Model: Resmed P10
Humidifier: Resmed Hi5
CPAP Pressure: 12
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Kansas USA

Post: #5
RE: Help
(04-13-2016 04:07 PM)LindafromNJ Wrote:  Have to go from CPAP to APAP. Found out from Medicare they will do a swap with my 10 month old machine. but will only pay up to 13 months. So medicare will only pay for 3 months since they have already paid for 10 and I have to pay for the rest. I have a Resmed cpap now. Should I go with another Resmed which is expensive? My supplier suggested 3B Luna 480 but read some reviews that says it is noisy. Any suggestions?

I am new to this site and it has been helpful. Also opinions is APAP
better than CPAP? I am a little upset doctor never gave me an APAP to begin with.

Is the Apap dr orders or do you just want one now? If it is dr orderd and you have a new prescription for your dme then if all the paper work is done correctly Medicare will rent again for 13 months and you will have the usual co-pay.
If you just want to change its going to be your pocket that will take the hit.

For free Medicare assistance for your state check out this page. http://www.seniorsresourceguide.com/directories/National/SHIP/
or here http://www.medicareinteractive.org/
04-15-2016 04:06 PM
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