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[Equipment] Do I have a choice on which CPAP machine I get?
#1
I have had a ResMed Escape machine for almost six years and am needing a new one.  I would like to get the ResMed AirSense 10 Autoset.  Since
the insurance is covering the cost; do I have a say on which machine I accept?  Thanks
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#2
The best way to get what you want, is to ask your doctor to update your prescription to specify an auto machine, and preferably the brand and model, and to include in the prescription the heated humidifier, heated hose, mask and supplies. Under most insurance reimbursement, a CPAP machine, encompasses everything from the fixed pressure brick you received, up to the auto-titrating CPAP.

A persuasive discussion with your doctor, explaining you want to be more involved in your therapy, avoid future sleep studies and use an auto CPAP to optimize your results should be sufficient to get what you want. You already have a high CPAP prescription pressure. The autoset would allow you to use a lower minimum pressure of perhaps 12 cm, and maximum pressure of 20 and automatically adjust. This should be more comfortable than fixing the pressure at 16 all the time. Ask for a variable pressure prescription. "Plan B" would be to simply inform the DME or supplier of your choice, and refuse to accept anything else. You may have to identify additional in-network suppliers and be willing to go to someone else, if your current supplier is not cooperative. Most of them will comply with a request from an informed patient.
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#3
You can always buy your own. Or you can call your insurance co and ask what their coverage limits are.
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#4
Being "an informed patient" will go a long way particularly starting with your doctor. I had her put the exact model of machine I wanted on my prescription (Airsense for Her Autoset) and had a lot less argument with the DME who wanted me to have just a regular Airsense Autoset. I just pointed to the prescription.
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#5
Just to clarify, the only difference between an Airsense 10 Autoset, and the For Her model is external case cosmetics. There used be some data reporting differences and a soft-auto mode.
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#6
I just picked up a new machine monday.  My prescription just called
for a cpap set to 14  but my DME  surprised me and gave me a 
Resprodonix DreamStation Auto, heated humidifier and heated hose.
But because the prescription called for a cpap set to 14 that's what
they had to set it for before I picked it up.  Well it's now set to auto
instead of cpap.   Now what to do with that heated hose. I have been
using a cpap over 10 years  and never had rain out. If that's the case
is there any point using it.
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#7
Thank you to all who responded.  I just got off the phone with the local DME and they are telling me that my insurance will only pay for the
most basic machine AND only a full faced mask.  I informed him what mask I was using and worked for me and the machine I wanted based
on nearly six years of using a bricked machine.  His reply was to take my business elsewhere.  My current machine is about to go out and I am
back to step 1.  The things and hoops we jump through for a little sleep!  I will call my insurance company and try to get some clarification.
I will also try another DME and see what they say.  I may have to get my Dr. to amend his prescription, but that will be determined by what the
insurance company tells me.
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#8
By all means get a list of in-network providers from your insurance. That is a terrible attitude! Profit first, last and always. The amount the provider is reimbursed does not change when you get a better machine, but be assured, they don't lose money either. The idea they will only supply a full-face is really perplexing since those are generally more expensive. I certainly would not give that place my business.
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#9
Hi dfluss,
WELCOME! to the forum.!
Since that DME had such a bad attitude, I would find another one.
I wish you good luck with getting the machine you want and also with finding a more cooperative DME.
Hang in there for more responses to your post.
trish6hundred
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#10
If the ins co only pays up to $xxx, that might be the cost of the basic model the DME carries. You need to check your policy and call your ins co, don't take tge DME word for it. You might bd able to get them to reimburs that $xxx on a better machine if you pay the difference. And ordering online can get you a way better deal than a local DME.
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