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Introduction & newbie getting equipment tips
#1
Introduction & newbie getting equipment tips
Hi everyone,

First...thanks for contributing to this website.  I've found so much of the info to be helpful.  Anyway, I was diagnosed with mild OSA (6 AHI and 15 arousals/awakenings per hour) in February and am finally getting titration done this Thursday and will hopefully be on the road to treatment soon thereafter (I'm looking forward to not wanting to nap at 10 am after having 9 hours of "sleep").  I've read the WIKI pages about how to deal with insurance, DMEs and machine choice recommendations as well as many other posts and forum threads. 


I recently began calling potential DME suppliers and asking what models they carry and they all typically have Philips or Resmed device that are within the "not recommended" category on the "machine choices" post.  When I ask specifically about the Airsense 10 Autoset and Dreamstation Auto, they responded that the device I get would depend on the device type that is recommended by my doctor, i.e, if the doctor doesn't specify an auto cpap, they'll give me a fixed pressure cpap device.  

The problem is, I've never actually spoken to or met the doctor and I doubt I will this Thursday either.  So how can I have a doctor to make a specific recommendation on a prescription if I haven't met her?  If I don't meet her again this time, is it within my rights to specify to the DME that I only want one of those two devices or is it true that if she doesn't recommend an auto CPAP of some sort, then I can only get a fixed pressure device?  I felt like I had the ability to make specific requests, but the sheer consistency in response from the different supply companies has me questioning myself.

Thanks in advance for your assistance,

Chris
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#2
RE: Introduction & newbie getting equipment tips
Hi,

I'm in the same boat as you, though I've had my titration. Tonight I'm going back for another test, since my insurance has disregarded the first being over 6 months old and just has the titration of last week.

I'm serious about wanting an apap machine, and already, the techs in the office tell me its most likely not going to happen. At this point, I'll settle for the prescription, take whatever insurance will give me for free, and buy an auto machine after a couple of weeks from wallyworld, which was suggested on these boards. Though not a millionaire, I'd rather spend the bucks than have someone with a vested interest in me coming back every 3 months manage this.

Looking for answers as you are! Good luck to all Smile

Michelle
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#3
RE: Introduction & newbie getting equipment tips
You must have a prescription from a doctor to get a CPAP machine. You must have been referred by a doctor when you did your sleep study. You must have gotten the results from that same doctor. That is the doctor who will write the prescription. Insist that that doctor prescribe the ResMed AirSense 10 Autoset or something better. If the DME won't provide the Autoset tell them you'll shop around for a DME who will. That is usually enough to get them to provide the Autoset. It's a more expensive machine so it cuts into their profit, but they still make a huge profit and so will reluctantly provide it in most cases.
Sleepster
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#4
RE: Introduction & newbie getting equipment tips
Thanks Sleepster! I am writing it up and giving it to the tech at the sleep lab AGAIN tonight. I understand why he is reluctant to give me what I want, as they want you coming back more often for titration, but I will get whatever I feel works better - there are not enough nights to waste!

Your advice is appreciated!

Michelle

Thanks
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#5
RE: Introduction & newbie getting equipment tips
To the insurance company, everything with the same billing code is the same.  CPAPs, ans APAPs, both ResMed and PR all have the same billing code.  This means that the DME gets paid the same for all of them.

Consider these to be just another dress.  The DME is selling you a size 3, you are a size 8 (I really have no idea what these sizes are so bare with me).  Will you accept the size 3 dress. I doubt it would happen in a million years.  You want the size 8 simply because it fits you.

In other words let them know that the billing code for the ResMed AirSense 10 AutoSet for Her is the same as the machine that they are 'giving' you.  If they will not provide that machine you will get it elsewhere, That means no supplies from you for years to come.  Now which machine are you going to give me?
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#6
RE: Introduction & newbie getting equipment tips
(07-13-2020, 05:17 PM)bonjour Wrote: To the insurance company, everything with the same billing code is the same.  CPAPs, ans APAPs, both ResMed and PR all have the same billing code.  This means that the DME gets paid the same for all of them.

Consider these to be just another dress.  The DME is selling you a size 3, you are a size 8 (I really have no idea what these sizes are so bare with me).  Will you accept the size 3 dress. I doubt it would happen in a million years.  You want the size 8 simply because it fits you.

In other words let them know that the billing code for the ResMed AirSense 10 AutoSet for Her is the same as the machine that they are 'giving' you.  If they will not provide that machine you will get it elsewhere, That means no supplies from you for years to come.  Now which machine are you going to give me?

Great point, bonjour! Thanks Thanks   I'm off to "hopefully" the last sleep away clinic camp night of the pandemic season! Will be happy to report how everything went after I get the script and the call from/with the DME - basically you're saying they're dealing with me, not the script, and I'm a strong willed person (especially after a good night's rest?) Smile

Michelle
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#7
RE: Introduction & newbie getting equipment tips
Thank you for your responses. For me, part of my lack of understanding was that when I initially went for the study, I was asked to fill out a form declaring who my first and second choices would be for a DME. Because of this, I assumed that the office would deal directly with the DME's by faxing the prescription to them and there wasn't really any other way to approach the situation. However, It sounds like if I ask for the prescription and just do the "shopping around" and calling myself, then most DME's will agree to provide a requested device, with the implicit understanding that if they do that, they won't necessarily get as much profit off me at the outset as a typical CPAP customer, though the decision for them comes down to either some profit now and more profit later or none at all, so they'll usually oblige. Also, if I can have the doctor prescribe the preferred device, that'd be a done deal, no matter what.

So helpful.....THANKS!

Chris
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#8
RE: Introduction & newbie getting equipment tips
Ah well, after 2 weeks of no sleep over this junk, the sleep center doctor refuses to change my prescription to an "autoset" machine, and will only leave the script for a regular cpap. The suppliers are refusing to give me an auto machine based on the insurance parameters and my husband simply wants me to get this done and get better.

I am in afib and have been since my last sleep study a week ago, and am not going to be able to do anything about this until the apnea is addressed. What are the disadvantages to a "set" machine and is it worth going along with whatever they give me as long as they provide ongoing supplies, and shopping for the best possible machine on my own? Is the 30 days the limit of my need for compliance with their equipment? Apparently nobody cares if my size 12 body doesn't want to be stuffed into a size 8 dress Sad

Thanks in advance!

Michelle
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#9
RE: Introduction & newbie getting equipment tips
We can work with a ResMed Elite, which is a CPAP, or the ResMed AutoSet, which is a CPAP with an Auto feature.

Call your insurance and get a list of Suppliers, call them all, and get a copy of your prescription from your doctor.
You can get an AutoSet outside of the system on a CPAP only prescription. The AutoSet may be set in CPAP mode but that is not a problem, trust me.
The question is I want a new AutoSet!, no exceptions, no substitutions, it can be set in CPAP mode. Will you sell me an AutoSet or do you prefer not to sell me anything.

We can help you find a gently used Autoset for probally less that you will copay for the whatever they will give you.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#10
RE: Introduction & newbie getting equipment tips
I had a problem also and could not get the machine I needed. I went to Supplier #2 (under the cart symbol at the top). They had a "slightly used machine" regularly $1800 for $800. After figuring in the deductible and sleep study I did NOT come up very far behind and got what I wanted. It had 250 hours (that's 1 month) so about brand new. Great machine and great service. Mine was ResMed AirCurve 10 VAUTO. The one you are talking about is much less. Take a look and see if that might work.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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