+- Apnea Board Forum - CPAP | Sleep Apnea (https://www.apneaboard.com/forums)
+-- Forum: Public Area (https://www.apneaboard.com/forums/Forum-Public-Area)
+--- Forum: Main Apnea Board Forum (https://www.apneaboard.com/forums/Forum-Main-Apnea-Board-Forum)
+--- Thread: Resmed Airsense 11 Availability Issues (/Thread-Resmed-Airsense-11-Availability-Issues)
Resmed Airsense 11 Availability Issues - geno71 - 03-23-2022
Hi all. I'm new to the board and new to CPAP. I just was diagnosed with OSA in Feb. off a home study. PCP was going to prescribe an APAP. After reading up here, I realized that the Resmed Airsense 11 Autoset is the machine that I want. I asked the PCP to write the Rx for the Resmed Airsense 10 or 11 Autoset which he agreed to do. The problem is that it seems none of the local DMEs have these Resmed machines due to the Philips recall. At least one DME said they were still filling orders for Rxes from Nov 2021 and they were using what I assume are Chinese off brand machines. I'm supposed to go to another DME next week but they have been noncommittal on whether they have the Resmed or not. My guess is they don't and will try to get me to accept a lesser machine. Our insurance plan is really good and in talking with them, they will cover whatever whatever is prescribed. Being a new user with insurance, my preference is to work with somebody local but not sure how to approach this situation. Thoughts?
RE: Resmed Airsense 11 Availability Issues - Gideon - 03-23-2022
Get hold of a patient advocate for your insurance. State the facts, you have a prescription, the prescribed machine is NOT available from any DME you can find without a delay of months. As for an exception to go to an out-of-network online source that can deliver a machine in less than a week and you would like them to cover it. You can provide a receipt with billing codes etc but these online sources do not deal directly with insurance. Will they reimburse you for an out-of-pocket purchase (please) and how much will they reimburse you.
I'm getting a replacement ResMed VAuto with a 12-week wait from my DME today. Fortunately, my current matching an over 5 weeks still works and I wasn't in a hurry.
RE: Resmed Airsense 11 Availability Issues - geno71 - 03-23-2022
(03-23-2022, 11:47 AM)Gideon Wrote: Get hold of a patient advocate for your insurance. State the facts, you have a prescription, the prescribed machine is NOT available from any DME you can find without a delay of months. As for an exception to go to an out-of-network online source that can deliver a machine in less than a week and you would like them to cover it. You can provide a receipt with billing codes etc but these online sources do not deal directly with insurance. Will they reimburse you for an out-of-pocket purchase (please) and how much will they reimburse you.
I'm getting a replacement ResMed VAuto with a 12-week wait from my DME today. Fortunately, my current matching an over 5 weeks still works and I wasn't in a hurry.
Thanks for your reply! I've thought about going with an online vendor but how does that work from a mask/accessories perspective? Do you just get everything through the online vendor? Will they allow for mask exchanges if they don't work out? I wasn't sure how important it is to work with a local DME who may have a therapist to help with those sorts of things.
RE: Resmed Airsense 11 Availability Issues - Gideon - 03-23-2022
Masks are the most important consumable. Going online for masks and accessories is just a choice.
The DME will hound you that it's too soon to order a new mask.
As long as insurance is good and covers it let them pay the high DME prices. Otherwise go online.
Supplier#1 offers a mask insurance. Contact them about terms .
You can ask your E to come in for mask fitting as you are having issues. Try them in as close to your sleeping position as possible as your facial geometry changes when you lay down. And read the Mask Primer