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Just getting started, Need help!
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murf2499 Offline

Members

Posts: 6
Joined: Sep 2012

Machine: Resmed S9 Elite
Mask Type: Nasal pillows
Mask Make & Model:
Humidifier: Resmed H5i
CPAP Pressure: 12
CPAP Software: Not using software

Other Comments:

Sex: Male
Location: Albany NY

Post: #1
Ohmy Just getting started, Need help!
Hello! I am diagnosed with OSA, AHI score 83 and saturations as low as 70%. I had my titration study last week and was told I will have the results in 7-10 days........Very tired of waiting, just want to start feeling better!!
I am looking for advice on selecting a DME supplier and equipment. My insurance will pay for 80% of one machine, so I want the first one to be the right one. I dont mind paying additional out of pocket to have a successful thearpy. APAP makes alot of sense to be. I travel for work 80-90 nights a year and every night sleep is a little different, some better than others. It also makes sense from a compliance standpoint to have an auto-adjust. I'm not sure if the lab will write a script for auto adjust however, when I mentioned it to the sleep tech she said they only write apap scripts for patients who fail on cpap. Any advice?

I also need to select a HME provider. The first place I called today said I have no input on selecting my cpap unit. Is this the norm? The Resmed S9 seems to be my choice. Do I have any choice, even if I am willing to pay extra? I like to Resmed S9 because I'd like to be able to see my AHI to know I'm getting effective thearapy, also the heated tubing makes alot of sense to me.

Thanks in advance for your opinions!!
09-04-2012 09:44 AM
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jdireton Offline

Preferred Members-2

Posts: 149
Joined: Feb 2012

Machine: Resmed S9 Elite
Mask Type: Nasal mask
Mask Make & Model: Resmed Mirage FX
Humidifier: Resmed H5i
CPAP Pressure: 12
CPAP Software: ResScan

Other Comments: ClimateLine Hose

Sex: Male
Location: Florida

Post: #2
RE: Just getting started, Need help!
Murf,

Welcome!

You're in the same boat many of us have been in. I wish I could tell you specific things to do, but each of us have a unique combination of doctors, DME's, insurance, etc. Some general recommendations below.

1. Get agressive! Any DME who tells you that you have to take the machine they offer is basically lying to you. That doesn't mean they won't do it. We also had people supplied with used and obsolete machines. In one case, the "new" machine the DME provided had not been manufactured in over eight years.

When you get your machine, check the hours. It should have no more than 20 hours, QA testing at the manufacturer. Any more than that and it is USED.

2. Don't let your doctor dictate to you. Most good doctors will listen to their patients, and if you can communicate in an educated and empowered manner, your doctor will likely help you. It's a partnership! If your doctor refuses to listen to you, consider getting another. That said, my doctor declined to provide an APAP prescription for me, stating the sleep study showed a clear "step resolution" of symptoms. Looking at the sleep study, I couldn't dispute this. Now, why he would care if I got a machine that cost maybe $100 more, who knows. Maybe if I had been firmer I would have gotten the auto. I did get a fully data capable, modern, and brand new machine. Not bad.

3. Call your insurance company. Find out exactly what your coverage is, what the consumable (mask, hose, humidifier tub, etc.) replacement schedules are. Don't believe anyone that there is a "normal" coverage. A lot of people on Medicare think all insurances have the exact same coverage. When I called cross/shield, they even told me coverage changes by your account status and what state you live in. The insurance company should tell you your exact coverage, including if rental is required or an option. Sounds like you've already made contact with them. Don't let your DME tell you what your coverage is!

4. As far as machines, Resmed and Respironics are the most popular. Make sure it is data capable. Again, make sure it is data capable, not just compliance data, but apnea event tracking, flow, etc. Before you accept any machine, check back here with us. The Resmed S9 Elite or Autoset are great machines. The Resmed Escape or Escape Auto are not data capable and should be avoided.

I'll stop rambling now, but encourage you to come back here with more questions. It's not an easy transition but it is worth it. We have all been there and hope we can help make it a little easier.
09-04-2012 11:04 AM
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PaulaO2 Offline
Wiki Editor
Moderators

Posts: 8,068
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #3
RE: Just getting started, Need help!
First, you say both DME and HME. Those initials usually mean the same. Durable Medical Equipment and Home Medical Equipment. Although Home Medical Equipment is probably more accurate as it refers to the supplier but most folks use DME for both the supplier and the devices.
http://www.apneaboard.com/wiki/index.php?title=Acronyms

Second, call your insurance company and find out their policy. Most insurance groups pay the same amount, no matter which machine or version. DMEs like to then push the cheapest one so they make the most profit. If your insurance doesn't care which machine you get as long as you use it, then tell your doctor you want a data capable auto-PAP. You are right in that they are the most versatile. However, APAPs are not for those who "fail" CPAP. BiPAPs, yes. They're more expensive. Your insurance will pay the same whether it is APAP or CPAP.

Third, when looking for a supplier, ask about their mask policy. Many allow you to choose and trial a mask for anywhere from two weeks to 30 days. If it doesn't work, you then return it and try another. This gives you the chance to find the right mask. A data capable top of the line machine is worthless if you hate the mask or it doesn't fit right and leaks. Then ask which APAP brand they carry. Both Respironics and Resmed are the most popular right now. Just not a Respironics with Plus in the name nor a Resmed with Escape in the name. Many DMEs sell Resmed for CPAPs (cheaper) and Respironics for APAPs (cheaper). It's all about profit margin. Each brand has their own quirks, bells, and whistles. You may find this thread useful: http://www.apneaboard.com/forums/Thread-...vs-S9-Auto

Fourth, ask what your 20% will be. Don't let them tell you "we have to first order a machine". If your 20% is going to be high (over $400), you may consider buying out of pocket. Try Supplier #2 in the Suppliers List.
http://www.apneaboard.com/forums/Thread-CPAP-Supplier-List

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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.
09-04-2012 11:07 AM
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Sleepster Offline
Wiki Editor
Moderators

Posts: 4,995
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: #4
RE: Just getting started, Need help!
(09-04-2012 09:44 AM)murf2499 Wrote:  The first place I called today said I have no input on selecting my cpap unit. Is this the norm?

It occurs all too often, but no, it is not the norm. Call your insurance company. If you can't get a APAP such as the ResMed S9 Autoset, get a fully data-capable CPAP such as the ResMed S9 Elite. Do not get any other ResMed machine.

Philips Respironics makes some good machines, too, but the same advice applies there as well.

Take a look at our Supplier List and familiarize yourself with the different machines.

Do NOT let them give you a machine that is not fully data capable.

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.
(This post was last modified: 09-04-2012 12:23 PM by Sleepster.)
09-04-2012 12:07 PM
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Dawei Offline

Preferred Members-2

Posts: 342
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Other
Mask Make & Model: Respironics "FitLife"
Humidifier: H5i
CPAP Pressure: 10-20
CPAP Software: ResScan SleepyHead

Other Comments: Began CPAP in 2006; spent the first 6 years with a "brick"

Sex: Male
Location: Western North Carolina

Post: #5
RE: Just getting started, Need help!
Hi, Murf and welcome to the board. I'm not positive you're located in the U.S., but if so, I can share my experiences with my sleep doc and my DME. Perhaps this may clarify a little more. The sleep lab that conducts sleep studies I have had does not write ANY scripts! Only a sleep doc writes scripts. The sleep lab runs the sleep studies and supplies the sleep docs with the results. Then, the sleep doc writes the script for a machine and its pressure settings, and that script is sent to a DME. My sleep docs have always asked me which DME I would prefer. Then, the DME receives the script from the doc and fills it, supplying a machine to me that is set to the pressure(s) named on the script. A sleep doc I have been seeing for about a year now confided to me that his primary concern about writing a script for an APAP (auto pressure) machine, such as the ResMed Autoset, is his concern for excessive pressures that can lead to Central apnea events which can be dangerous. When I was finally able to get him to consider writing a Rx for an Autoset for me, he said he would, adding that he'd have to decide on the pressure range, with which I had no problem. My DME confided to me that most docs in my area are reluctant to write for APAP machines. It could be for this same reason, but I don't know for sure. If you can get a machine that records AHI and other data, as others have suggested, that's the most important. As jdireton mentioned, a machine such as the ResMed Elite is a fully data capable machine, even though it's a straight CPAP machine. I recently learned from my DME that the doc must fill out some medical necessity form for the DME to justify my autoset for insurance purposes (in my case, Medicare).You might consider the argument for your doc that a ResMed Autoset can function as either an auto or straight CPAP. If you can get him/her to write for an auto machine, he/she will be able to confirm later that the pressures were unchanged in the event the doc wants you to start on straight CPAP. Printouts from the Autoset will show that it was used in CPAP mode and that you had not changed pressure during an initial trial period.
09-04-2012 12:15 PM
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trish6hundred Offline

Advisory Members

Posts: 6,453
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #6
RE: Just getting started, Need help!
Hi murf2499, First of all, WELCOME! to the forum.! I echo what everyone so far has said. I understand how tired of waiting you are, I thought I would NEVER get my machine back a few years ago when I first got started on my CPAP journey, but, though it seems like you'll NEVER get yours, you will before you know it. Best of luck to you.

trish6hundred
09-04-2012 02:49 PM
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murf2499 Offline

Members

Posts: 6
Joined: Sep 2012

Machine: Resmed S9 Elite
Mask Type: Nasal pillows
Mask Make & Model:
Humidifier: Resmed H5i
CPAP Pressure: 12
CPAP Software: Not using software

Other Comments:

Sex: Male
Location: Albany NY

Post: #7
RE: Just getting started, Need help!
Thanks for all the great advice!! I called around to several DME suppliers, and found one to be particularly helpful. The first word out of the person's mouth when I said "I was calling with CPAP questions" was let me have out RT call you right back, you deserve to speak to an expert. Within 20 minutes the RT called me, explained there services and assured me I would have a Resmed S9 Elite.

It was re-assuring to talk to a true expert and feel confident they are truly concerned with my comfort and compliance! The lab I went to is owned by a group of pulminary physicians, now just waiting for my script!! Looking forward to feeling better>>>>so are my wife and kids!!
09-04-2012 03:35 PM
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archangle Offline
Wiki Editor
Advisory Members

Posts: 3,163
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: #8
RE: Just getting started, Need help!
You need to tell us where you're located. Assuming you're in the US:

You may not be able to choose your machine, but you can choose who to buy it from . The doctor cannot force you to go to his preferred supplier. Get your prescription in writing to help you shop around. If the doctor is reluctant, tell him you want it to take with you when you travel in case you need emergency replacement. Once you have the prescription, you can buy online, but don't tell the doctor that. Most insurance won't pay for online purchase, but prices are lower.

Your insurance may only pay if you buy from certain suppliers. Or pay a reduced amount for other suppliers. Find out who is "in network" for your insurance. "In network" DMEs usually have to sell at a fixed, "reduced" price, and cannot charge extra for certain units.

DO NOT pay extra for the machine you want. This is usually a violation of the DME's contract, if not a violation of law.

If one DME won't give you what you want, shop around for another DME. They do NOT have to give you the machine you want, but you are free to take your business elsewhere.

Do NOT accept a ResMed Escape or Escape Auto or PRS1 (Philips Respironics) Plus machine. They record much less data than the better machines. DMEs will show you the data card and say they collect data, but that's a bit of a lie. They collect very limited data.

Resmed S9 Elite or PRS1 Pro are the minimum acceptable models. ResMed S9 AutoSet (Not escape auto) or PRS1 Auto are better.

There is no such thing as an S9 "Auto" machine, only AutoSet (good) and Escape Auto (do not accept.)

If it's midnight and a DME tells you it's dark outside, go check for yourself.

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.
09-04-2012 03:42 PM
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trish6hundred Offline

Advisory Members

Posts: 6,453
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #9
RE: Just getting started, Need help!
Hi murf2499, That's GREAT to hear, hopefully you get the machine you really want,, best of luck to you on your CPAP therapy journey.

trish6hundred
(This post was last modified: 09-04-2012 03:50 PM by trish6hundred.)
09-04-2012 03:46 PM
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zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #10
RE: Just getting started, Need help!
(09-04-2012 03:35 PM)murf2499 Wrote:  The lab I went to is owned by a group of pulminary physicians, now just waiting for my script!!
Ask for the script to specify the machine for example:
S9 AutoSet, pressure range 6-10, humidifier, ClimateLine, washable water chamber (sometimes its optional), mask of choice and "DISPENSE AS WRITTEN". To avoid any confusion and DME is under legal obligation to give you exactly what the doctor written.
09-04-2012 03:46 PM
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