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Picking a DME -- What is Best
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PaytonA Offline
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Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: H5i(distilled-top up)
CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Orange County,California

Post: #21
RE: Picking a DME -- What is Best
I have no problems dealing with Apria but then I avoid their RTs as much as possible. The thing that I found difficult with Apria was their Respiratory Therapists who are supposed to be there for the patients benefit (?). My problem was first that I could never get hold of one and I could not find the person in charge to complain to. I finally let go on some poor unfortunate order taker. I prefaced all of my comments with the fact that I was not irritated with her. She apparently got my comments to someone in charge because I got a call from the RT supervisor. He gave me a bunch of shuck and jive but the one positive thing that came out of it is that apparently he assigned a specific RT to me who gave me his direct dial number and some other information about how to get hold of him. Anyway since I joined this forum, I have not felt the need to contact a respiratory therapist for information about dealing with the mechanical aspects of my therapy.

As far as what to look for in a Respiratory Therapist, my thoughts are as follows. I will tell you that I think that it is important that the RT has first hand experience with CPAP. In other words, he is a hosehead like the rest of us. The more problems that he has had getting acclimated to CPAP, the better he will be able to help you. This does not guarantee anything all by itself. I had a hosehead RT supervisor give me a bunch of BS concerning dry mouth. I do not know if he was just trying to get me out of his hair or actually believed what he told me. What I have subsequently found out is that he was wrong. Another thing that I feel is important is what percentage of his/her time is spent on OSA patients. My gut feeling is that it should be at least 40%. He/she should listen to what you are saying and give considered responses.

These are some of my thoughts.

Best Regards,

PaytonA
05-31-2015 03:59 PM
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2PAPs Offline

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Joined: May 2015

Machine: PR System One 750p
Mask Type: Full face mask
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CPAP Pressure: 8-20
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Sex: Undisclosed
Location: California

Post: #22
RE: Picking a DME -- What is Best
I'm sure that with Apria, the patient is the only one paying on retail basis. Either Medicare is paying full reimbursement or the HMO is getting a discount.
(This post was last modified: 05-31-2015 06:01 PM by 2PAPs.)
05-31-2015 05:59 PM
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me50 Offline

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Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

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Sex: Undisclosed
Location: USA

Post: #23
RE: Picking a DME -- What is Best
with DME's, etc., and insurance companies: There is a contracted amount that the insurance pays for each machine, each supply, etc. Then, depending on the coverage you have (whether insurance pays 100%, 80%, etc.), the insurance pays their portion of the allowed or contracted amount and the customer pays the rest of the allowed amount. Ex: If the allowed amount is $100, insurance pays 80% of that (or $80.00) and the customer pays 20% (or $20). No insurance company or their insured pays 100% of the retail cost that the DME charges to a customer without insurance. The above information is based on the DME being in network. If it is out of network, insurance will pay less. Currently, my insurance only pays 50% of out of network supplies (I was told it was 40% but that was not accurate or they changed it mid-year).
(This post was last modified: 05-31-2015 06:35 PM by me50.)
05-31-2015 06:33 PM
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Adoniscmj Offline

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Posts: 168
Joined: May 2015

Machine: Resmed AirSense10 Autoset for her
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Integrated
CPAP Pressure: 6 to 9
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Everett, Washington

Post: #24
RE: Picking a DME -- What is Best
Welcome, I must say from my own experience as a new user, I have found that bad DME'S are plentiful. Try to shop around if possible and do some research on the CPAP machines so you know going in what you want because if you don't they will try to stick you with the machine that they have the highest profit margin on. If there is one that you really want and your scrip is fairly general make sure that you tell them up front that you want this machine and mask or you will be sorry. My DME had a brick of a machine waiting for me and I told her if that is my choice I will buy one some where else. I was wanting a smart auto cpap that is quiet and small in size. They offered me the complete opposite. Her response was ," well you seem to have been doing some research on these" . Remember the DME's are trying to make a big profit so they want to sell you stuff that their margin is the highest. I told her that since I am ultimately buying this machine and I have to live with it for several years that I will only buy what I want or go some where else. She did sell me the machine I wanted.
05-31-2015 07:43 PM
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2PAPs Offline

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Posts: 58
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Machine: PR System One 750p
Mask Type: Full face mask
Mask Make & Model: ResMed Ultra Mirage
Humidifier: PR System ONe
CPAP Pressure: 8-20
CPAP Software: Not using software

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Sex: Undisclosed
Location: California

Post: #25
RE: Picking a DME -- What is Best
My HMO is the largest health maintenance organization in the US. They are my insurance, provider, pharmacist, and DME. I will be getting another Philips Respironics. I'll probably pay rental for 13 months, although I will have use of it, I won't own it. Actual ownership will remain with the HMO. The trade off is there will probably be no hoops. I had no problems with the current system for pre-Medicare. Five years ago, I had a take home test. After evaluation, I was assessed for the proper equipment, and an Rx issued. No compliance other than when ordering from Apria, to say "Yes, I use the machine each night."
05-31-2015 09:02 PM
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me50 Offline

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Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

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Sex: Undisclosed
Location: USA

Post: #26
RE: Picking a DME -- What is Best
(05-31-2015 09:02 PM)2PAPs Wrote:  My HMO is the largest health maintenance organization in the US. They are my insurance, provider, pharmacist, and DME. I will be getting another Philips Respironics. I'll probably pay rental for 13 months, although I will have use of it, I won't own it. Actual ownership will remain with the HMO. The trade off is there will probably be no hoops. I had no problems with the current system for pre-Medicare. Five years ago, I had a take home test. After evaluation, I was assessed for the proper equipment, and an Rx issued. No compliance other than when ordering from Apria, to say "Yes, I use the machine each night."

yep, I had the 13 month rental with medicare but my previous machine, before medicare, was purchased outright so there was no compliance issues. With Apria, I had to provide my SD card to them to see if I was compliant and since I was the first 30 days, that was all I had to do (you only have to use the machine 4 hours for 70% of the time to be compliant) but at first, Apria RT told me that I had to start over with compliance because I didn't use my machine one night while I was having a sleep study. This is another reason I left them. They should have known that one night of no use would not make me have to start over. If Medicare asks to see the documentation (and that doesn't mean a very confirmation from the customer) then they may have some splaning to do. Are you using a medicare advantage plan?
05-31-2015 11:29 PM
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2PAPs Offline

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Posts: 58
Joined: May 2015

Machine: PR System One 750p
Mask Type: Full face mask
Mask Make & Model: ResMed Ultra Mirage
Humidifier: PR System ONe
CPAP Pressure: 8-20
CPAP Software: Not using software

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Sex: Undisclosed
Location: California

Post: #27
RE: Picking a DME -- What is Best
I have been a member of Kaiser Permanente for almost 50 years, except once when it was not offered by my employer and times when I didn't have insurance. I now have my Medicare Advantage through Kaiser.

I got my first BiPAP without any hassle through Kaiser with a 20% copay on the retail price. The only compliance I have encountered is when I reorder CPAP supplies. I am asked, "Do you use your CPAP every night?"

In July, it will be five years and I will request a new BiPAP, which will be a Philips as that's on the formulary. I'm not sure of the conditions. With some rented DME, the ownership remains with Kaiser. I might only pay 13 rentals, but the ownership might remain with Kaiser. I don't know what the compliance issues might be.

The only reason I'm a bit concerned about compliance is that I split my time between two places and I don't want to have to lug the machine around, as I take public transit. Right now, I'm using a CPAP that someone gave me in one of the places. It seems to work good enough, although the BiPAP seems to be more comfortable.
06-01-2015 07:15 AM
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me50 Offline

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Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

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Sex: Undisclosed
Location: USA

Post: #28
RE: Picking a DME -- What is Best
(06-01-2015 07:15 AM)2PAPs Wrote:  I have been a member of Kaiser Permanente for almost 50 years, except once when it was not offered by my employer and times when I didn't have insurance. I now have my Medicare Advantage through Kaiser.

I got my first BiPAP without any hassle through Kaiser with a 20% copay on the retail price. The only compliance I have encountered is when I reorder CPAP supplies. I am asked, "Do you use your CPAP every night?"

In July, it will be five years and I will request a new BiPAP, which will be a Philips as that's on the formulary. I'm not sure of the conditions. With some rented DME, the ownership remains with Kaiser. I might only pay 13 rentals, but the ownership might remain with Kaiser. I don't know what the compliance issues might be.

The only reason I'm a bit concerned about compliance is that I split my time between two places and I don't want to have to lug the machine around, as I take public transit. Right now, I'm using a CPAP that someone gave me in one of the places. It seems to work good enough, although the BiPAP seems to be more comfortable.

Kaiser must be different than most insurance companies because I don't know of any insurance companies that pay a DME their retail price. Are you sure that what you are calling retail price is actually the contracted/allowed amount agreement between Kaiser and the DME?

Apria could get in some hot water if they are not requiring their customers to provide 30 days of usage either via their modem or by providing the SD card to Apria so they can download the information so they can document compliance which they have to provide to the medicare advantage provider or to medicare if the person is on straight medicare.

If you do have to show compliance with your new machine, maybe the 2nd residence you split your time with can, for 30 days, come to your residence or you will have to lug it with you for 30 days.

Best of luck with your new machine, etc.
06-01-2015 12:18 PM
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2PAPs Offline

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Post: #29
RE: Picking a DME -- What is Best
All I really know at this point is that I will be getting a Philips Respironics machine, as that's the only brand on the Kaiser formulary and that I will be purchasing it with a 20% copay from Apria. That I know more about what's going on now, I won't be snookered by Apria with a used machine, etc.
06-01-2015 03:47 PM
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me50 Offline

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Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #30
RE: Picking a DME -- What is Best
(06-01-2015 03:47 PM)2PAPs Wrote:  All I really know at this point is that I will be getting a Philips Respironics machine, as that's the only brand on the Kaiser formulary and that I will be purchasing it with a 20% copay from Apria. That I know more about what's going on now, I won't be snookered by Apria with a used machine, etc.

I didn't know that insurance companies had a formulary for CPAP machines.Learned something new today. So glad that mine wasn't that way. Anyway, just watch Apria like a hawk or two and let us know how it goes.
(This post was last modified: 06-02-2015 01:25 AM by me50.)
06-01-2015 08:46 PM
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