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Trouble with P10
#11
hi mattmill,

First, congrats on the progress and reduced AHI. Hope you are feeling better.

I would be talking to the insurance company to determine what your options are.

My goal would be to return the rental to the DME and buy one from another DME if that is your preference. These arrogant crooks deserve to lose your business and their contract with your insurance company.

Knowledge is power in dealing with the DME. Find out from your insurance what is required to close the deal to buy the machine and go make it happen with a different DME. DMEs do not get to choose whether you rent or buy, your insurance does. You don't have to talk to insurance via a DME middleman. Call the insurance directly and find out precisely what is covered and what your options are for acquiring equipment and supplies. You might find that you can buy 3 months worth of supplies in one purchase and not get one pillow at a time from the DME.

Then take charge and tell the DME what you are willing to do. If they say that's not their policy then fire them. You have a policy, too, which is your insurance policy, and you have the latitude to do whatever your policy says.

One of the reasons all three sizes come with the P10 sealed in a retail package is for you to try them on for size. It is likely that you need to go up one size but you can't try that if you don't have the different sized pillows in the starter kit.

If your DME ordered all the pieces parts separately to jack up the price that seems unethical and prevents you from experimenting to find the best fit. If the DME open a sealed retail package your insurance paid for as a unit and sells you the parts separately or withholds certain pieces that your insurance has paid for, that seems like fraud and maybe criminal.

I would make sure the insurance company knows about all this. Don't make any assertions about fraud or criminal acts, but do tell them precisely what's going on here and let them draw their own conclusions. At a minimum you can express your dissatisfaction with the current DME when you ask for a referral to a different DME.

Your DME doesn't necessarily have to be in the same town where you live. Ask your insurance company about what DMEs are in network within driving distance, and also beyond driving distance and you may find some who are willing to ship products to you.

You may have more choices than the current DME wants you to believe. When you already know what you are buying, then going to the DME office is not a necessity. I have a DME I am happy with who are within driving distance and they routinely ship my supplies to me. I haven't been in their office since we first met.

Might also ask your insurance what out of network benefits you have. Maybe none, maybe more out of pocket, maybe there is no network to be concerned about. Won't know if you don't ask.

good luck and best wishes.

Saldus Miegas

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#12
(08-02-2016, 08:00 PM)OpalRose Wrote: Sleep position may have something to do with dislodging the pillow mask. Do you turn alot or sleep on your stomach? The pillow shouldn't slip out of place (maybe occasionaly) unless it might be the wrong size pillow. Have you tried the different sizes?

BTW...if your insurance is covering your supplies, you should be getting 2 pillow replacements a month. I know some here think that's overkill, but they do get soft and floppy.

Not all insurances supply 2 pillow replacements a month. I'm on a Blue Cross HMO plan, which normally covers an Awful Lot of Stuff ... but they only supply one pair of "pillows" per month. Since the pillows come as a pair, they say that counts as "2 per month". For me, that's plenty, as they last a bit longer than that.

Re: trying different sizes: my DME looked at me and said "small". 30 minutes after trying to sleep, I was suffocating, and tried "medium". That worked okay for a year, till I got accidentally sent the "For Him" kit, which *also* included a large. I had been wanting to try that, so I did. More air!!! It's great!

Some of the people here post that the pillows don't have to go IN the nostrils, but can merely sit below them. That's how the large size fits me (I'm female) but it works really well. The air pressure keeps them in place.

So, to the extent that some of your leaks may be related to "not enough air" and fidgeting with your mask .... it wouldn't hurt to try the large for a bit.

Yeah, more sizes should come in the "whole mask" kit, but not in the every month replacements. And if they totally refuse to supply more than the one size you are on till the next 6 months, it only costs about $20 to buy one outright. (Just the pillows, that is.) It might be worth it.
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#13
[quote='BadGoodDeb' pid='171318' dateline='1470348896']
Not all insurances supply 2 pillow replacements a month. I'm on a Blue Cross HMO plan, which normally covers an Awful Lot of Stuff ... but they only supply one pair of "pillows" per month. Since the pillows come as a pair, they say that counts as "2 per month". For me, that's plenty, as they last a bit longer than that.

Please let me clarify...I am aware that not all insurances cover the same things, so that is up to the patient to find out and not "believe" what your DME tells you. They don't always get it right. And I'm also aware that they call one nasal pillow for the P10 a pair, but it is still only one nasal pillow, so I guess I'm fortunate that my Insurance sends 2 nasal pillows a month, and the billing from my DME is worded as 2 nasal pillows, not pairs.





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#14
Contact your insurance they set the replacement schedule not your DME. Your insurance co also has a list of DME's that they will work with again check with them. Nobody here will know exactly what your insurance offers unless they live in your same state and have your exact insurance. I have only replaced my headgear on my P10 once in two years and my pillows only twice although I have atleast 3 complete masks on my shelf.
For free Medicare assistance for your state check out this page. http://www.seniorsresourceguide.com/dire...onal/SHIP/
or here http://www.medicareinteractive.org/
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#15
(08-04-2016, 06:14 PM)OpalRose Wrote:
(08-04-2016, 05:14 PM)BadGoodDeb Wrote: Not all insurances supply 2 pillow replacements a month. I'm on a Blue Cross HMO plan, which normally covers an Awful Lot of Stuff ... but they only supply one pair of "pillows" per month. Since the pillows come as a pair, they say that counts as "2 per month". For me, that's plenty, as they last a bit longer than that.

Please let me clarify...I am aware that not all insurances cover the same things, so that is up to the patient to find out and not "believe" what your DME tells you. They don't always get it right. And I'm also aware that they call one nasal pillow for the P10 a pair, but it is still only one nasal pillow, so I guess I'm fortunate that my Insurance sends 2 nasal pillows a month, and the billing from my DME is worded as 2 nasal pillows, not pairs.

BadGoodDeb (and mattmill), I'm with OpalRose and Mike1953 on this ...

For example, here's what my DME wrote to me in an email regarding original packaging of P10 and re-ordering P10 supplies:

Quote:The packaging for the P10 will always come with the 3 sizes you mentioned, S-M-L. It is the way the manufacturer packages them.

As for changing supplies, it is usually recommended every 3-6 months and is covered by the insurance every 3 months. I can get extra pillows sent along with the supplies you requested. Those would only come with one size, Large in your case.

The pillows can indeed be replaced every 2 weeks from the insurance, the maximum allowance covered under insurance is 6 per 3 months, which we usually send all together instead of one every 2 weeks.


Insurance policies may vary on schedule for resupplies, but maybe not too drastically since they are mostly all based on medicare schedules (I think).

Regardless of replacement schedule, I submit that an honest, ethical DME will be truthful about the packaging of original and resupply orders.

Check this out... using a sample of prices from one of internet suppliers, here is a comparison of buying the P10 manufacturer kit versus the same parts separately priced:

18.99 Nasal Pillow - Small
18.99 Nasal Pillow - Medium
18.99 Nasal Pillow - Large
24.99 Head Gear
69.99 Mask Assembly
151.95 Total P10 Kit Priced separately

99.99 Total P10 Kit Priced as a package from manufacturer

113.97 P10 Kit with only one Pillow Priced Separately

The local DME is probably higher priced (my local DME is), because part of their contract cost to the insurance company includes training you to use the gear they provide.

But using the internet example, you can see the DME will make 14% more per kit while providing you with less gear if they simply price and order the same parts separately.

So, when you re-order your next P10 kit, tell the DME you want the manufacturer kit complete package. If they tell you they cannot do that, then tell them you will be forced to look for a different DME provider.

Most likely if you call them on it, they will do what you ask. Most people don't know what to ask, so some DMEs will work to their own advantage and your disadvantage.

hope this is useful info that will help you deal with your DME.

Saldus Miegas
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#16
For what it's worth (just cuz we're noting things here), the "For Her" kit includes sizes
extra-small
small
medium

Plus, the head strap is about 1/2 inch shorter. (And purple, rather than blue.)
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#17
(08-03-2016, 05:08 AM)mattmill Wrote: How's the exhaust from the Dreamwear? Is it as diffused as the P10?

Sorry for the delay..

Similar the P-10's there are some exhaust ports / pressure release ports on the face of the Dreamwear as well well as an escape port on the top of the head gear where the xpap's pressure tube connects to the mask.

I find the Dreamwear to be actually much quieter that the P-10's.

My sleep Technologist said the Dreamwear was supposed to be able to handle up to 30 cmH20 pressure but he's not seen that.

I used the Dreamwear on a fixed CPAP at 18 cmH20 and it seemed to handle the pressure much better than than the P-10's.

Now that I'm on a BiLevel at IPAP 20 and EPAP 12, with a PS of 8, things seem to be better... in about a month I'm going to need to ask some of those here for some help to figure out which knobs and buttons to twist and push to get this thing dialed in so my BiLevel and I are better friends than we are right now.

My sleep is generally really fractured... I get 30 mins, 45 Mins, 1 to 1.5 hrs, and the list goes on. Rarely 4 hrs but my cumulative hours in a 24 hr period is anywhere between 5 - 15... but nothing in a 6 to 8 hr contiguous block.

I won't be going back to the P 10's just because the Dreamwear is that much better for me.

OH.. BTW.. my sleep tech told me in no uncertain terms, to make sure I clean the pillows EVERY DAY ..

Of course, YMMV...



Warning: Eating chocolate may cause your clothes to shrink!
[Image: ry6XtE9.gif] <---- That's ME!
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#18
To answer the original question, my pillows last just under 2 months. After about a month, one side will start collapsing. Sometimes the whole pillow will slip out but it all starts with this collapsing. I presume it is my nose shape. In any case, I boil the pillow for 5 minutes after cleaning. Then, it works another 3 weeks or so. Then toss and use a new one.

Some folks get MONTHS of wear out of their pillows and some only a couple of weeks. There is a lot of variation in skin oil, nose and head shapes. My mask happens to fit a bit tightly, but the straps NEED to be cleaned periodically.

My main problem with the P10 is the exhaust ports. For some reason, that mesh has buildup that I can't see, but clearly, I'm not breathing as well 3 months down the road. I'm trying longer vinegar soaks (with higher vinegar solution) to see if that fixes it. I might just have to bite the bullet and ask local Lincare office to replace the frame part every 3 months (the warehouse doesn't seem to understand that Medicare pays for this).
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