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[Equipment] Appt tommorow for study review & new machine
#1
Hello all & i just joined.

I've had my a Resmed S8 Escape II (i think it's an S8) since 2006. The on/off button started to go bad in 2009/10 or so and i was given another machine (same make & model) as a loaner. My bad machine was supposed to get fixed & returned, but my national DME never called me or mailed it. Oh well. I have 17,800 hours of usage on the replacement and it still runs nicely, although the on/off button on this machine has started to go bad.

I talked with a sleep study group who performs sleep study's and is also a DME. This regional provider has 5-6 offices. When i scheduled the appointments for the 2 consults, split-night & equipment pickup, i asked if they provide AirSense10 and they do. I had a new split-night titration study last week. Tommorow, I have my study review consult & i am supposed to pickup my new machine w/ supplies. When i talked with the dme dept earlier today, the lady said i am scheduled to get a Respironics cpap machine (i forgot to ask for the model name). I said that i preferred to get a Resmed AirSense 10 AutoPAP. She came back with 'the Respironics CPAP is what the doctor has prescribed'. I again said, i like the Resmed brand and do not want the Respironics CPAP and that i want a fully data capable machine and want an A10 APAP. She said the doctor prescribed the CPAP machine and i would have to discuss it with the doctor.

I will have to persuade the doctor tomorrow. He already prescribed a CPAP, so it might be an uphill battle. Even if i go to another DME, they will just prescribe what the doctor writes on the prescription. If agrees to prescribe the A10 AutoPAP, i am good. But, if he doesn't agree on the better machine, going to another DME won't matter. My insurance plan already sent me an approval letter for billing codes E0601 - cpap device & E0562 -humidifer.

During my split-night, while already on the cpap machine, i noticed (or think i did) that the presurre was higher after putting thepillows back on after a bathroom break. I will use the previous posted advice with my higher presurre (maybe) and insurance cpap approval to get the AutoPAP. I guess i can settle for an AirSense10 Elite.

Oneeyedrifter
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#2
You don't have to settle for a machine you don't want.

It starts with your doctor. Since you are seeing him, ask to have your perscription revised to name the machine you want. He/she shouldn't care unless there is a financial interest on his part.

Actually, the script should say: fully data capable auto cpap and supplies, patient choice.
Get a copy of the script. Go to another DME if they are not cooperating.

Your insurance could care less what brand you get, and those insurance codes are good for a cpap, auto cpap any brand. Go in there with knowledge, and dont take their crap.

Now with that said, the DreamStation is as good a machine as the Airsense. The Airsense is a little more aggressive in raising pressure to treat events than the DreamStation, but you should be fine with either.
OpalRose
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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.




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#3
And after my experience of getting a slightly used machine that was used, which I learned from this fine forum, I would suggest that you have them show you the machines total run hours.
Tom
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#4
Good suggestions. I'll give it a shot.
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#5
Oneeyedrifter: You never have more power over a DME than before you accept their equipment.
As OpalRose said, the E0601 code covers both CPAP and APAP.
If you like ResMed (and there is much to like) the Airsense 10 Autoset is the machine to shoot for.
Try to get your doc to specify the machine and add "Dispense as Written".

If one DME will not fill it; there are others who will.

Your insurance will likely be provided on a rental basis. You must show compliance and have a followup visit with the doc to meet insurance requirements.

Important Ask for and get copies of your Rx and you sleep study reports. You have a right to the reports.
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.
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#6
Of the fixed CPAP machines out there, the Dreamstation Pro and Auto have data, the CPAP does not. Resmed Airsense 10 CPAP is also a brick. The Elite is the fixed CPAP with data, and the autoset is of course your machine of choice.

The doctor simply needs to know you want to be engaged in your treatment and see tangible evidence of its benefit. The Autoset can be setup as a CPAP or as an Auto CPAP with a range. It is the most versatile of the units, and can accommodate changes in your health, sleep position, sleep stage and lots of other variables. It lets you be independent of having more studies.

As long as your doctor does not have a conflict of interest, he should have no problem prescribing the auto cpap.
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#7
Doctor and dme irritating funny business.

I met with the Doctor earlier this morning. I was able to get my doctor to prescribe AirSense 10 Auto. He initially said they would put me on a trail device for a month that is an autopap then put me on a fixed cpap machine. I said i would like the A10 auto from the start, if i would have a trail machine that can perform autopap functions. Why get one machine then switch a other machine after the data is reviewed. He said I'd have to wait for them to order one. The Doctor said they didn't have an A10 auto available, but someone would check in their storage area and they had one.

I then waited for the billing rep. She discussed my insurance would bill me for the machine as a rental over 4 months. I am switching insurance carriers for next year, which was an issue. Even though, i have a authorization for the machine under this year's insurance, i would have to wait for my new 2017 insurance carrier to issue their authorization. I could get the A10 auto today, but it wouldn't be under next year's insurance until they authorized it and there probably be many issues when the autopap is still under rental when i switched ins. carriers. A little billing hassle for me (unspoken but lots of hastle for them) and i would have to cover the rental fee for months 2-4 after 12/31. I already use a cpap machine, so why my new ins. carrier wouldn't pick it up, i don't know. I had to have the billing manager explain it to me as well.

I picked up a heated hose and a new nasal pillow. After i got to the receptionist desk, i realized i was given a Respironics nasal pillow. Back with the dme rep and tested the fit of a medium ResMed P10. I got the box with only the medium pillow attached in the box. I asked about the small and large pillows and the rep said they give the one i need. If they gave me the other 2 pillows they would be counted against my future new pillows by insurance. Okaaay. I let that slide. I've been using a ResMed Swift LT medium for many years, so i assume the sizing is the same. When i pick up my machine next week i might ask about the missing size pillows, if the medium pillows seem off. Of course, i can't notice the leaks while I'm sleeping with my brick S8 Escape II.

I will get my prescription when i pickup my machine. I asked about getting my prescription and the dme rep said it's not needed as they know that i want the A10 and will hold it for me. Mmmmm, more interesting slight of the mouth. I get a copy of my prescription when i pick up the machine. I'll also ask to see the machine's usage hours. Hope it's new.

The dme advice in previous posts is spot on.

Oneeyedrifter
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#8
Since the new year is only a day away, its best all around to get your machine billed under the new insurance, even if that means you wait a few more days for your machine.

Your DME sounds a bit dishonest. Well, maybe I'm being too harsh. They are all about profit first. The mask should come with all 3 size pillows. Some DME's will break up the pillows and sell separately. What they should do at the very least is give you two medium size nasal pillows.

Here is a suggestion. Call your "new" insurance company first business day of the new year.
Get the facts from them as to how they bill for the machine, and if they require a rental, and find out exactly what you will pay. The coverage may be different than your current insurance. Don't take the word of your DME!

Also get a list of approved DME providers from your new insurance company, just in case you want to change.

One more thing. Get a copy of your script. Let them know you will take your business elsewhere.

Most of us have been through this nonsense with DME's. Its very frustrating!



OpalRose
Apnea Board Moderator
www.ApneaBoard.com

How to Organize and Post ScreenShots

http://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

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.




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#9
Sounds like your doctor is a bit too tightly connected to the sales of equipment. Not a great situation since he is aware that the same billing code is used, and the same amount reimbursed Whether you get a brick or top-of the line auto-CPAP they are the same device under the billing code.

It's common to use a size larger pillow with the P10. Find a way to get one on Ebay or Amazon. Under insurance, the supplier can bill by item, and it is the only way their business model works. My supplier does the same thing.

Good advise by OpalRose. Find out if the new insurer will require a rental period. Not all of them do.

Get copies of your sleep study, prescription and other relevant records and make sure Auto-CPAP is specified. Your prescription is yours and should be portable to any in-network DME. Let these guys know you have choices.
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#10
Hi oneeyedrifter,
WELCOME! to the forum.!
Hopefully, after you switch insurance, you can get the machine you want.
Good luck to you as you continue your CPAP therapy.
trish6hundred
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