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Newbie - Should I consider changing doctors? Help?!?
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OpalRose Offline

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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: #11
RE: Newbie - Should I consider changing doctors? Help?!?
(11-17-2015 11:53 AM)Hollyboop Wrote:  I spoke with the DME and they are claiming that I simply need to "get used to the equipment" and don't believe that the machine is malfunctioning. I am going to the DOE's office before going to my doctor tomorrow morning to get a report printed from the SD card. They said that they will also evaluate the machine. My insurance only covers a CPAP machine (not an auto) and the DME told me as a favor to my doctor they gave me the auto machine with no extra charge. I checked with my insurance (Oxford United Healthcare) and they only list CPAP as covered. So if I want to change the DME I am working with, I might be stuck with a CPAP, not auto machine. GR-r-r-r. Hopefully, they will change out the machine and at least I won't have one that malfunctions. Any suggestions on what I should ask and discuss with my doctor tomorrow? Thanks so much!


Hollyboop,
First of all, most DME's don't tell you the truth. Their bottom line is $$$$$$$$$$.
That is why they will give you a Cpap and not an Auto Cpap.

You need to understand that insurance companies pay under the same billing code for Cpap or Auto Cpap. If your doctor writes a script for an Auto Cpap, the DME has no choice but to dispense as written.

Tell your doctor you want an Auto Cpap, and get a copy of the perscription.
Call your insurance, tell them you have a script for an Auto Cpap, and ask what your coverage is.

OpalRose
11-17-2015 01:54 PM
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Sleeprider Online
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Machine: Resmed Aircurve 10 Vauto
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Post: #12
RE: Newbie - Should I consider changing doctors? Help?!?
I'm curious to know what DME you are working with. A number of them have a bad reputation.

As mentioned, there is only one billing code for CPAP and that includes bricks or top tier autosets. There is plenty of money in the insurance reimbursement to cover the costs of the Autoset, but obviously there is more profit if they can stick you with the Escape brick.

Look at the blower hours on your machine. If it is clear that they gave you a used machine, you have a right to complain. You should be entitled to the current model rather than a discontinued one. To view the clinical menu, press the down and right buttons simultaneously. Once in the menu scroll using the up and down menu. You will find used hours and usage hours and motor hours. You want to record all of those, but motor hours is the total use of the machine.

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11-17-2015 02:19 PM
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DeepBreathing Offline
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Post: #13
RE: Newbie - Should I consider changing doctors? Help?!?
(11-17-2015 02:19 PM)Sleeprider Wrote:  To view the clinical menu, press the down and right buttons simultaneously. Once in the menu scroll using the up and down menu. You will find used hours and usage hours and motor hours. You want to record all of those, but motor hours is the total use of the machine.

It's a bit different on an S9 - there are no down and right arrows. Press the silver info (i) button. That will bring up the information menu. Scroll down to the spanner symbol, and you will see a number for "run hours". This should be a little bit in excess of the number of hours you've actually used the machine (it goes through a cool-down cycle after use). If you've had it a month and the run hours are in excess of around 300, then they've sold you a used machine.

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11-18-2015 02:12 AM
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Shastzi Offline

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Posts: 1,174
Joined: Dec 2012

Machine: ResMed S9 Autoset
Mask Type: Full face mask
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Post: #14
RE: Newbie - Should I consider changing doctors? Help?!?
I think the mob is running your DME.
Sounds like they are trying to unload a worn out-high time machine on you.
Make them get you the right machine! (as listed above)
You doctor can specify the machine with a Dispense As Written, prescription.
Then they have to get you the one prescribed.

Good luck and don't give up!

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"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

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11-18-2015 04:33 PM
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Tacoma Droner Offline

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Post: #15
RE: Newbie - Should I consider changing doctors? Help?!?
(11-17-2015 04:10 AM)Hollyboop Wrote:  I noticed that the machine "snorted" 3 times and stopped working. Completely. I had to turn the machine on again to get it going. This happened two different times before and I reported this to the DME and they sent someone to look at the machine and he reported that it is fine. Has anyone had their machine quit? Does this mean the machine is defective?

I've had something similar to this happen with one of my machines, but only after it had over 8000 hours of use. It was just plain worn out. Shouldn't happen with a new machine.
11-18-2015 10:17 PM
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