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New to the board - distantdreamer - 03-10-2015
Hi, I am new to the board but have been using my cpap for about 6 years. After reading through the board a lot the last few days I find that I know basically nothing about this stuff. I have had the same machine (a Resmed S8 Elite) that was given to me by the sleep study place 6 yrs ago. They showed me that it could hold an SD card but never what could be done with that, so I didn't bother. I have no idea if this old beast can give me info or not and if it can, how to go about getting it. Only tonight did I figure out how to even see what my setting was. I am at 9.0. I have had no clue for 6 yrs. I did not like the sleep study place I got the machine from so I never went back to them. In fact I didn't even know I probably should have changed my mask at some point, or at many points. I have only been replacing the tubing and pillows on it and trying to clean it really well. There really was lack of communication on all sides as I had no clue what to even ask about back then. And I really had no interest in learning, the experience left a bad taste in my mouth so I just kind of blew off learning anything about it, which is terrible on my part.
But I am ready to start over, last month I asked my PCP for a referral to have a new study done because I don't think my settings are doing me as much good. I have gained a significant amount of weight in the last few years and I know that can affect SA. He said it was a good idea and sent me to the study center of my choosing. I went Friday night and now have a follow up with my PCP for the results this coming Friday. I guess I just have some questions going forward from here. I have different insurance than the last time I had a study done and was given a machine, (that the study center overpriced). What is the likelihood that my current insurance will allow me to get a new machine and let me get it from where I want to? I am a bit fearful of the DME people, I haven't read many great stories. What are pros and cons of going through the DME vs ordering online? I have been looking at all the different machines available and would want to ask my doctor if he would write the Rx for what I chose - I am pretty sure he will, but I don't have the slightest idea what coverage BCBS offers for a machine. I have a high deductible so I know it will still be pricey out of pocket, only getting a "contracted" price break. Are there specific questions I should ask at my upcoming appointment?
Thanks for reading my long winded post and I appreciate any feedback.
RE: New to the board - OpalRose - 03-10-2015
Welcome distantcreamer,
Yes, it is probably time to upgrade your equipment. The best thing for you to do is call your insurance company to see what they cover. They reimburse the DME company the same set amount no matter what machine you get, so don't let the DME buffalo you. You need to be one up on them!
The two top of the line machines right now are the PR System One 60 Series AutoSet or the ResMed Airsense 10 AutoSet for Her. Do your research on them.
Once you deceide, ask your Doc. to write a script for the machine by name. Make sure it says Auto Titrating machine. Ask for Heated Humidifier with Heated Hose.
As far as mask goes, it is the hardest to adapt. Try one of the nasal pillows mask to start. You've been on CPAP for awhile now, so you probably will adapt easily enough. The DME should allow a 30 day trial period.
As far as deductible verses an online supplier....that is something you will have to research to see what is best decision. At least with insurance coverage, they will replace mask, hoses, etc. every three to six months.
OpalRose
RE: New to the board - justMongo - 03-10-2015
BTW -- the S8 series does not use an SD card. There is a proprietary data card that is inserted into a slot on the back. Unlike the S9 and 10 series, the card is not in place during use. A special reader is required to read the card; and there is no high rate flow or pressure data.
I ordered one of those card readers in 2013 -- I had to get it from Israel.
distantdreamer: You must first know what type of apnea is being treated before deciding on a machine.
Central apnea usually requires a different machine known as an ASV.
The best advice I can offer is to get a copy of the sleep report.
You will need a written Rx to buy a machine and for masks. (US law.)
Since you have high deductible insurance, you might find that an online purchase from the supplier list (top of page) beats your out-of-pocket expense using your insurance.
RE: New to the board - Sleeprider - 03-10-2015
A new sleep study will be quite expensive. Depending on your insurance that may not be a problem. With modern auto-titrating CPAP machines and feedback from data, you can frequently self-titrate and find the optimal therapy. If your doctor simply writes a prescription for the auto-cpap with humidification and heated hose, then you can choose the best option from your insurance, or direct purchase. If you need the technical support of a DME, choose wisely. The quality of service varies widely.
Headgear and masks have come a long way. If you tolerate nasal therapy, the new Resmed Airfit P10 is a real delight since it has no strong cold exhaust stream, and is light and comfortable. Best of luck in getting back on track with modern equipment. I think you will notice a big difference.
RE: New to the board - trish6hundred - 03-10-2015
Hi distantdreamer,
WELCOME! to the forum.!
It's good to hear that you want to start over with your CPAP therapy.
If you can swing it, you would be much better served by a newer fully data-capable machine.
Here is a link for you to check out which has lots of good information on good choices for machines: http://www.apneaboard.com/wiki/index.php?title=Archangle:Machine_Choices
Hang in there for more responses to your post and much success to you as you start over with your CPAP therapy.
RE: New to the board - distantdreamer - 03-10-2015
Thanks all. I am pretty sure I lost my results from my first study so long ago. I will find out Friday I guess where I am now. Even with insurance my study was $650...ewe. I did use the P10 mask at my recent study and it was so much better than the archaic mask I have. So I know that is what I want mask wise. I think I will see what my PCP has to say about available DMEs in the area and go from there. I think it will cost me the same no matter what with my insurance, but do plan calling them today just to check. I actually cant wait to get a new machine and mask.
RE: New to the board - TheManseHen - 03-11-2015
Greetings Distant Dreamer,
It's great you are starting afresh in this process and you've come to the right place. Things have way way improved in machines and gear since your last discouraging start.
Re: Dme's. You will likely find your insurance will work with a couple or three at least, in your area. When I got such a list, I went on yelp (if your area has any yelpers, tend to be more in the cities) and see what reviews they have gotten there. If no yelp, go online and check the better business bureau for your area, and see what their ratings have been. Even non-members will often have a record of complaints made and settled, on the BBB site. You can usually find their listing by name or phone number. I chose the only DME in my area with a BBB membership. This doesn't guarantee they are good/helpful/kind, but it does mean I have a bit more annoyance to them if I place a complaint with the BBB.
All of these places seem to be the most solicitous before you get your machine/sign contract, so get all the things you want from them, before you get to that point. If they don't have what you want it, wait for them to get said in, don't accept substitutions.
It is also most helpful, all things being equal, if you are going with a DME for starters (vs online) to get one who's office is easy to get to, to pick up your supplies at, do exchanges at etc.
Best wishes. With your strong desire and good info from the boards, you will I think, have a better experience going in this time.
The Manse Hen
RE: New to the board - distantdreamer - 03-13-2015
I just got home from my follow up with the PCP. He had just gotten a copy of my results today and hadn't even had a chance to look at them so he looked over it with me and he gave me a copy of my study to take home as well. There are 5 pages, one includes a graph that I couldn't even begin to understand. I had a sleep efficiency of 94.2%. I will try to scan in the actual numbers sheet after dinner in case anyone wouldn't mind helping me understand some of the terminology in normal terms. Basically it said they recommend a setting of 10 and EPR of 1 with a heated humidifier and heated tube. I talked to him about the different types of machines available and he wrote the Rx for the "ResMed AirSense 10 AutoSet for Her" set in auto between 6-12 and for the mask he put the "Airfit P10 or per patients preference".
He said it was up to me if I wanted to take charge and find a DME in my network or he could have his assistant do it next week (lol he said he will be on vacation so she wont be busy anyways). I told him I could do the leg work on that or I could even go online and he said "ok". He gave me the original Rx and kept a copy in case anyone needs it faxed on his letterhead.
Of course BCBS customer service closed at 430pm so I couldn't call and say "hey I have an Rx for xyz, what is my coverage for that?". I am wondering if I should bother waiting till Monday when I can call and get info or not because I actually found an online retailer that has the machine for $750 for a two day sale....pretty much over $100 less than I have seen everywhere else.
RE: New to the board - truetopath - 03-13-2015
That's great that your doc handled the study like he did. I'd wait to talk to insurance before ordering, ya never know it may work out cheaper. Just my 2 cents. Good luck on your search.
RE: New to the board - Sleeprider - 03-13-2015
Most BCBS organizations have web sites that will let you look up DME coverage and providers. If you have an online account, you can probably find this information for yourself. Anyway you won't be able to talk to anyone until after the weekend, but you might as well have a list handy.
Working through a conventional DME will likely be a bewildering experience and will take weeks to be dispensed your equipment. It will be very hard to get a straight answer how much your cost will be for the equipment, because they have their list prices (wish price), and allowed price under your insurance contract. Most likely you will ultimately save money staying in-network if you have good insurance. Going out of network to online sources, will get you equipped faster and with less hassle, but the copay will be higher, and you will have to buy the full amount out of pocket, then be reimbursed.