[Equipment] ASV Acquisition Guidance Requested

[CTcentrals]

Hello, All,

First, a thank you for all the information so many of you share and help that you give.  Second, I'm also posting this to another xpaptalk forum (hoping that's not against the rules to say or do, apologies, and let me know, if so).

My old 2011 Respironics bipap auto sv advanced went toes up last month and I had to go see my sleep doc for a new patient visit and prescription because it had been so long since I'd been back.  Everything went well and I received a Resmed Aircurve 10 ASV that night from a local DME.  The machine is working very well and doing everything that I think it's supposed to be doing.

Then comes the sticker shock.  I was expecting it to be high, of course, but apparently the billing company would like me to rent the darn thing for ten months at $516 a month, the negotiated cap with my insurance company (hope it's ok to use real numbers). I've talked with the billing company and my insurance carrier but haven't been able to find the actual purchase price and the DME is always experiencing an unusually high amount of calls, so I haven't been able to talk with them.  However, the billing company was able to give me a payoff date of April 2018, so I'm guesstimating around $5,160, more or less. I'm nowhere near meeting my insurance deductible this year, so whatever it will be will be out of pocket, total or payments.

My insurance company said that they negotiate different rates with each of the DME's in network but can't tell me what they are.  However, they did give me a list so I can call and get quotes and assume the contracted rate would be lower.  None of these DME's are online retailers.  So, I'm trying to figure out the best way to get the most affordable machine. I'm seeing three options right now: 1) Stay with existing DME and try to negotiate a payment plan, 2) Call the other DME's to find a better purchase price, 3) Buy outright from an online dealer that offers lower purchase price.  The concerns I have are which DME's to stay away from (e.g., xincare, xpria?) and which might be be good and what online dealers are credible.  For instance, I found one clinical supply online dealer offering my model for $2,865 and free shipping. I'm no math whiz but I know there's a big difference between $5,160 and $2,865, and I've learned all about things that seem too good to be true.

So, I'm looking for any feedback, guidance, thoughts that you all think might be helpful in making a decision, more quickly than not, since I'm on a rather expensive clock (to me, anyway).

Thanks in advance,

[chill]

OUCH!  See the Supplier List at the top of the page. Those are all known trustworthy businesses that members here have dealt with.  Supplier #2 has a "gently used" ResMed S10 AirCurve ASV w/ Heated Humidifier for $1,800.  They give the list price for new as $5K.  So $516 a month seems a little steep after insurance.  Looks like you will be effectively paying for it out of pocket with the DME making a very healthy profit from the insurer.

[ajack]

if you are getting warranty with the $2,875 for the 10 asv, that would obviously be the choice.
You can also pick up new s9 adapt auto asv run out models, without warranty at very good prices on craigslist, I paid $600 for one recently and a s9 st-a with 20 hours for $400

[DeepBreathing]

It sounds like your insurance and DME are having a good time screwing you over! Time to find another insurance company I think. As Chill mentioned, try any of the suppliers listed at the link at the top of this page.

[CTcentrals]

Thanks chill, ajack, and DeepBreathing for your timely feedback. Will definitely check out all of your sources.

ajack: would need to learn more about s9 adapt asv.  Thanks for suggestions.

[ajack]

the s9 and the 10 are very similar, I'm not going as far as saying it's the same algorithm, but I haven't seen it said that it's much different. In any case the same titration principals apply to all ASV. Just something to consider when you adjust your machine to suit you when you get it.

[Sleeprider]

The S9 VPAP Adapt is the predecessor to the Aircurve 10 ASV. It is nearly identical in treatment, but the form factor is more dated. Both can provide good treatment, and I know you can get the VPAP Adapt from Supplier 2 at $1249 (slightly used) with warranty. The Aircurve 10 ASV is available for $3000 through the listed suppliers. If you're risk tolerant there is an Aircurve 10 VPAP ASV on on the Raleigh Craigslist new in box for $1200. Do your diligence if you go that route.

[trish6hundred]

Hi CTcentrals,
WELCOME! to the forum.!
I have heard lots of good things about Supplier #2.
I wish you good luck on your acquisition of an Adapt Serbo Ventalator, (ASV) machine and also with CPAP therapy.

[klv329]

A warranty for a first machine, even if lightly used, would be a good start.  

Not sure what your deductible is or if the rental payments apply to the deductible, $5k is way out of line, unless it comes with a really nice sleep tech. 

[CTcentrals]

So, it looks like Supplier #2 has a gently used S9 VPAP Adapt for about $1300 w/one year warranty and a gently used S10 Aircurve ASV for about $1800 w/one year warranty. To me, $500 is $500 and I'm already down $500 for the first month of my current Aircurve, but I also know that I like the Aircurve and it has worked well, better than the Respironics bipap auto sv advanced I had (could be because it was on a downward spiral for who knows how long or just just didn't suit me well).  Supplier #2 gets good feedback here and the BBB. 

I haven't been able to discern any significant differences that we know (e.g., algorithm) from what I've heard and read in this short time, other than pressure transition is comparatively uncomfortable for some with S9, pressure changes aren't as responsive for some, and it's not clear to me about auto adjusting EPAP. My understanding is that the S9 is the predecessor of the S10, platform is similar, treatment should be similar, and titration principals are the same for ASV's (thanks to ajack and Sleeprider).

Do you all think there is anything I'm missing or else I should consider?  My dx is severe CSA/Neuromuscular Disease in cervical spine if that makes any difference.