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+--- Thread: New to CPAP - Need advice! (/Thread-New-to-CPAP-Need-advice)
RE: New to CPAP - Need advice! - avaholic - 11-30-2018
Well I've had some interesting and very frustrating news. I received a call from my new DME, a Lincare affiliate, in October. Even though they had contacted my insurance company and got 'pre-determination' for coverage of the new ResMed machine, AETNA is denying coverage for certain line items from their claim. For some ridiculous reason AETNA paid for the Philips Dreamstation humidifier in full (at the exorbitant price of $437) rather than renting it like they were with the actual Dreamsation AutoPAP machine. Now that the new DME has submitted a claim for a rental Resmed humidifier, AETNA is denying it with the claim note,'we previously considered this at purchase price.' I filed an appeal with AETNA and mentioned that I'd happily return the useless Dreamstation humidifier that I have in my possession but they denied the appeal as well. Why would the BUY the darn humidifier in the first place??
Now this new DME has 'placed my account on insurance hold.' They are threatening to swap my current unit with what I assume would be a heavily used unit without humidifier. I can't get supplies because my account is on insurance hold and now they're gonna take away this machine. I'm so frustrated! I know that the plastic humidifier chamber is fairly cheap but if they swap the machine out with one that doesn't come with a humidifier, do those units even have the metal plate on the bottom where the humidifier chamber sits?
I now have a Philips Dreamstation humidifier that I can't even use and now the new DME won't give me supplies and is threatening to take away my ResMed machine!
I hate this bureaucratic crap!
Any suggestions on what I can do?
RE: New to CPAP - Need advice! - Sleeprider - 11-30-2018
Consider the cost of a new unit from Supplier #33 and what your cost and frustration level will be. The DME probably only has $550 in capital costs into your original machine. The idea they split the humidifier, tubing, and filter just means the insurance allows that manipulation. You can have a complete new unit with heated tube for just over $625. Just another example of how Philips enables this BS by not integrating the humidifier.
RE: New to CPAP - Need advice! - avaholic - 11-30-2018
I'd love to just buy one but unfortunately that's not really an option at this time. I was hoping that someone would tell me to say 'x' to the DME or 'y' to the insurance company. Perhaps a state agency could assist me?
RE: New to CPAP - Need advice! - jaswilliams - 12-01-2018
The Resmed humidifier is integrated get the machine without the humidifier, remove the end plate and get your own water bin. You will need to buy a heated hose as well to prevent rainout
RE: New to CPAP - Need advice! - Fats Drywaller - 12-01-2018
(11-30-2018, 10:20 PM)avaholic Wrote: I'd love to just buy one but unfortunately that's not really an option at this time.
When you say "buy one", I assume you mean machine and not just humidifier?
If you did mean that buying a machine isn't an option, here's a suggestion: Take a look at the web site of the American Sleep Apnea Association, read the pages and application forms there, and see whether you quality for assistance:
https://www.sleepapnea.org/community/cpap-assistance-program/
ISTR finding out about that org here on AB a while ago, can't remember who suggested it. I don't know whether those web pages about applying to receive a donated machine are up to date or what the eligibility terms & conditions are, so this is only a suggestion. It could be that the org screens out anyone who already has insurance; I dunno.
If that's not feasible, then welcome to the large club of sleep-apnea patients who have been sent into Bureaucratic Runaround Hell by an incompetent and/or malevolent DME.
A lot of folks have bought inexpensive used machines from Craigslist, Letgo, ebay, etc. Just another suggestion for whatever it might be worth. If you badly need any CPAP machine for some number of months while you try to get the insurance/DME mess cleared up, then it doesn't matter whether the thing already has several thousand hours on it, and a much-used machine should be quite cheap.
That ASAA web page also mentions that the org has supplies of two kinds of full-face mask (Quattro FX and Amara Gel) and is selling those for $25 each.
RE: New to CPAP - Need advice! - Fats Drywaller - 12-01-2018
(11-30-2018, 09:40 PM)avaholic Wrote: I know that the plastic humidifier chamber is fairly cheap but if they swap the machine out with one that doesn't come with a humidifier, do those units even have the metal plate on the bottom where the humidifier chamber sits?
As jw said, if they give you an A10 with the Resmed side panel installed, you can just remove that side piece and plug in a humidifier tank that you have bought. Yes, the machine has the heater plate.
If they give you an S9 instead of an A10, the humidifier (model name H5i) is a separate, more expensive component.
Sorry if I'm in the dark here from not reading back in the thread, but do you really need humidification, can't get along without it? Does anything terrible happen when you use the machine without a humidifier? If you want to test this with your A10 that has the humidifier, just leave the tank empty and switch off the heater ("Humidity Level") in the settings. That has the same effect as using the side panel instead.
RE: New to CPAP - Need advice! - avaholic - 12-05-2018
I'm sick of dealing with insurance and the DME so I acquired a ResMed AirCurve 10 VAUTO with only 9 run hours for a mere pittance. I'm hopeful that I can use its upgraded technology to help me even more or at least keep me on the same path that I have been using the AUTOSET.
As you can see from a few days over the past week or so I'm fairly consistent around the 1-3 AHI range. My current settings on the AUTOSET are 13-19 with NO EPR. What would be a good place to start using the new technology on the VAUTO?
And Drywaller to answer your question, I am a mouth breather and without humidification my mouth feels like sandpaper in the AM.
Thanks again for all the help and support!
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RE: New to CPAP - Need advice! - Sleeprider - 12-05-2018
No promises, but since you have no OA currently I would start at Vauto mode, EPAP min 9.0, IPAP Max 16.0, P.S 3.0. We really need to see how you react to pressure support before going much further.
RE: New to CPAP - Need advice! - avaholic - 12-05-2018
Ok. If I've understood previous posts I've read correctly, sometimes pressure support on the VAUTO actually causes more central apneas and/or hyponeas. Is that why you think it may not work for me?
Is pressure support the same type of feature as EPR? Why does having no OAs make a difference? I thought that was a good thing.
Can the VAUTO function like a regular AUTOSET too, IE, 1 Min pressure setting and 1 Max pressure setting with no pressure support function?
RE: New to CPAP - Need advice! - Gideon - 12-05-2018
(12-05-2018, 10:06 PM)avaholic Wrote: Ok. If I've understood previous posts I've read correctly, sometimes pressure support on the VAUTO actually causes more central apneas and/or hyponeas. Is that why you think it may not work for me?
Is pressure support the same type of feature as EPR? Why does having no OAs make a difference? I thought that was a good thing.
Can the VAUTO function like a regular AUTOSET too, IE, 1 Min pressure setting and 1 Max pressure setting with no pressure support function?
IMHO yes, pressure changes, either from EPR or PS, as well as variation of pressure, especially pressure increases may, not definitely, cause increases in Central Apnea which you currently have at low levels. This means making changes with care.