I spent hours researching  prior to my first appointment at the DME. Walked in to what appeared to be a business office at one end of same space where my doctor's office is and where the sleep study had been performed -- although this was a separate address, separate entry. No sign of equipment anywhere. That made me a bit nervous.

I was ushered into a conference room. There was ONE machine on the table with all the components spread out: Devilbiss IntelliPAP. That wasn't one  I'd researched.

My first question: Do I have a choice? The answer: did you have a particular machine in mind? I mentioned RemStar Auto M w/A-Flex, but was told my doc didn't prescribe an Auto one. (I hadn't seen my prescription which had been sent directly to the DME.) I was completely out of water then, as I'd wanted an auto and not researched the others. No other machines were mentioned. I was simply told this one was the 'quietest on the market.' When I asked how much quieter than the RemStar M, say, the person couldn't say.

I asked if it was 'fully data capable' -- yes. But when I asked how I could review the events of the past night that didn't seem to be possible?!!!
I definitely want feedback! Even expressing that, I was not offered another machine, but  told that if I was unhappy with the machine I could change it out.

I did get the mask that I had liked during the sleep study (I'd had the opportunity to try on several before the study began) : the ResMed Swift for Her, and was given a thorough run-down of operation and care of mask and CPAP by the very pleasant representative.

But... I had wanted a machine with *feedback*. I also believe an auto would be more comfortable?  I was titrated at 13 and when I tried this machine at that pressure, it felt uncomfortable. I was told just to hit the ramp button (starts at 4) as often as I wanted and eventually I'd go to sleep. Wouldn't an auto A-flex take care of a lot of the discomfort on the exhale? Was told the A-flex was a lot noisier because of the changes of air pressure....(but I think I'd trade comfort for a bit of noise that I should get used to... )

When I mentioned again the RemStar M series (I like the look of those- others remind me of a pet fountain!) I was told they were not carrying them any longer due to the number sent back for repair! Is this true? that they are repair-prone?

I was desperate to get a machine as I'd waited a *month* for my prescription. I raised a ruckus finally and got a call that my prescription had been sent to this place, that I had an appointment the next day and was assured I'd walk out with my machine that day.  I really need the equipment -- was diagnosed with severe, long-term OSA-- so I will give this one a try. When I have a followup appointment with my doctor I will ask if I can get a prescription for a more sophisticated machine.

My advice newbie-to-newbie: research **prior to getting the prescription** rather than prior to the DME. I didn't know enough to ask for a more specific prescription. I am disappointed, but so desperate for my equipment that I accepted what was offered. I am newly on Medicare, did that make a difference it what was offered?

BonSleep. Insurances pay by HCPCS (insurance) code, NOT by brand or model. ALL straight CPAPs and auto CPAPs (APAPs) are reimbursed under HCPCS code e0601. Insurances pay ONE contracted amount for ANY HCPCS code e0601. Of course, the fully data capable APAPs cost the DME supplier more than a bare bone compliance data only capable CPAP. So it is understandable if the local DME suppliers prefer to pawn off a bare bone compliance data only capable CPAP than a fully data capable APAP on unsuspecting newbies.

I would suggest that you call your insurance company and ask them what local DME suppliers they are contracted with. No need to mention what type of CPAP you want. Hopefully you will have the option of more than just this current local DME supplier as that will give you more bargaining/negotiating room.

Then call your sleep lab and request a copy of 1] the doctor's dictated results (1-2 pages each) and 2] the full scored data summary report w/condensed graphs (5+ pages each) from BOTH your in-lab sleep evaulation PSG "and" your in-lab titration PSG "as well as" 3] a copy of your equipment order (script). These are part of your medical records and you have a legal right to those copies under HIPAA.

Then go shopping at these various local DME suppliers your insurance is contracted with. Ask them what brand and model CPAP they usually provide. Ask what other brand and/or model CPAP they can and will provide. Ask about their providing the brand and model that you would be happy with.

At least one online DME supplier sells the fully data capable DeVilBiss IntelliPAP AutoAdjust w/integrated heated humidifer as a bundle for $419 and the DeVilBiss IntelliPAP Standard (which sounds to be the one you have been provided) for $365 w/integrated, heated humidifier as a bundle.

That same online DME supplier sells the fully data capable Resmed S8 AutoSet II w/EPR and integrated humidifier as a bundle for $619 or the fully data capable Resmed S8 Elite II w/EPR and integrated, heated humidifier as a bundle for $490.

And the fully data capable Respironics REMstar M Series Auto w/A-Flex w/integrated, heated humidifier as a bundle for $699, the fully data capable Respironics REMstar M Series Auto w/C-Flex w/integrated, heated humidifier as a bundle for $649 or the fully data capable Respironics REMstar M Series Pro w/C-Flex w/integrated, heated humidifier as a bundle for $589. Shipping would be free.

Now, do NOT expect local DME suppliers to meet these prices. They can't. Online DME suppliers get their money immediately before they even ship the product to you. Local DME suppliers must have an inventory of CPAPs in stock for which they have laid out quite a bit of an investment of money BUT they only get reimbursed for most sales by monthly dribbles spread out for as long as 13 months. In addition they have to have a good size staff to handle just the many insurances and claims forms which adds to their cost. Online DME suppliers don't deal w/insurances.

But this does give you an idea of the cost differences between various brands and models of CPAPs/APAPs.

Now YOU are the one PAYING for this CPAP. YOU are the one who will have to live and sleep w/it for at least the next 5 years. Whether you are paying thru insurance or out of pocket is of no consequence. Unless you accept the equipment they don't get the sale. If the local DME supplier wants your business bad enough they will negotiate w/you. A good compromise on both sides, yours and theirs, would be a fully data capable CPAP, which is more important in my personal opinion than an APAP.

BUT - you only have 30 days to exchange this DeVilBiss IntelliPAP and get the equipment you want (w/in reason, of course). You do NOT need a script that specifies an APAP to get an APAP, a CPAP script is sufficient for an APAP. A CPAP can NOT be an APAP, "but" an APAP can be used as either a CPAP or an APAP.

Only you can decide if you want an APAP, or at least a fully data capable CPAP, bad enough to do the shopping and the negotiating to get what you want. Its totally up to you.

And by the way - the Resmed S8 Elite II w/EPR is sound rated at 24 dcb vs the 26 dcb quoted you for the DeVilViss IntelliPAP Standard.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

I can't give you current Medicare reimbursement fees. They've gone down since I got my Resmed S8 Elite w/EPR in 2006 and since I got my Resmed VPAP Auto (bi-level) in 2008 but it will give you some idea of what the local DME suppliers get reimbursed.

Medicare purchases CPAPs on a 13 month capped rental (accessories are paid when billed) so these are monthly payments (actually only paid Quarterly).

2006 CPAP
Billed:  $135.00 - Medicare allowed: $99.95 - Medicare paid: $79.96 - CoPay: $19.99

2008 VPAP (bi-level) which are CONSIDERABLY more expensive than CPAPs (also a 13 month capped rental)
Billed: $239.92 - Medicare allowed: $218.11 - Medicare paid: $174.49 - CoPay: $43.62

Just keep in mind: you ONLY HAVE 30 DAYS to return this DeVilBiss IntelliPAP if that is what you want to do AND you do NOT need a script specifically for an APAP, a CPAP script is sufficient for an APAP. Your doctor can write scripts until he is blue in the face, Medicare is ONLY going to make 13 payments for a CPAP or APAP. Once this local DME supplier bills Medicare (30 days after you receive it) you are STUCK w/it or w/making up any payments they've been billed up front w/another local DME supplier if one will even accept you as a client.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

Dear ChronieToo-

Loved your extensive and superbly helpful posts. Out of nowhere, a stranger, being so generous with your time and expertise -- I can't thank you enough!

I am astounded to learn the DME erroneously diverted me by saying I could not get an APAP with my CPAP script. This was not some newly-trained kid but a 50+ person claiming many years experience in the field.

I already have the several page print-outs you mentioned from both my sleepovers at the lab. And I also *now* have a copy of my prescription.

You gave me some super advice.... and looked up all those comparisons, etc. Since, as you say, I'm paying for this one way or another, what's to prevent me from ordering my machine now, online, and just forgetting about Medicare & Supplemental and all that? If it means I can get what I want and be done with it? I suppose, though, there would be no recourse to returning it if something went wrong... and... I lack experience and am basing my wish-list on others' comments. It would cost me a bit more too, but I am not as concerned about the money. Don't have it to throw around, but this machine is going to be my nightly date now!  I want *THE Most Comfortable* one and a very responsive in terms of my keeping track of what is going on!

I see that data reporting is of great interest to *you* and that you have a REsMed VPAP. At first I'd dismissed ResMeds as looking like pet fountains, but I realize that's stupid. I also saw, elsewhere, your comments making me rethink the ResStar M series. So I looked at the ResMed site and am royally confused with the many models. Couldn't find a comparison chart, and many were described just as 'the next level'. Could I get VPAP on my prescription? If I paid out of pocket online? Tell me why you like yours. Also, what type of data is available on built-in screen (why don't they say on ResMEd site, or am I just not looking in the right place?)

I am concerned that my lowest blood-oxygen levels between my initial (untreated) overnight study and my second overnight (with mask) differed little: 83% vs 86%. Since I was almost event-free all night the second time, why wasn't the blood-oxygen higher?  Yes, I will ask my doc, but don't have an appt. for over a month and must decide on machine before that.  Would VPAP have any effect on this? (I have not been able to determine what type machine I was on for the second study: the report listed the exact make of mask, but not machine).

If I order a machine online, can I simply return my current one to the DME without repercussions if within the the 30 days? I imagine they'd not be at all happy.... Perhaps I should think of keeping it as a back-up machine?

I feel awful asking yet more questions when you have already given so freely of your time CrohnieToo.  Would so appreciate hearing from you (and others as well!) on these issues.

-B

A Resmed VPAP is a bi-level, just as a Respironics Bi-PAP is a bi-level, just different proprietary names. But no, you can NOT get a bi-level w/a CPAP script. Bi-levels are a much more sophisticated xPAP. Most insurances require that you "fail" CPAP before they will pay for a bi-level and even then only under certain specific circumstances. I have COPD which is the reason it was necessary to eventually be switched to a bi-level. Bi-levels are an entirely different HCPCS code.

Sometimes local DME supplier staff are "less than truthful", sometimes they are "dumber than rocks" and sometimes they are restrained by the policies of the management and then once in a while you get a local DME w/a great RRT, great staff and great management - and then there are those in-between.

There's absolutely no reason you can't buy your CPAP online and get exactly what you want. All you need is to provide a copy of your script. I'd stick w/a local DME supplier willing to work w/me for getting the mask and accessories other than the integrated, heated humidifier tho. Why pay for everything out of pocket ?? and you should be able to exchange a mask that doesn't work out for you w/the locals whereas the return insurance some online DME suppliers offer are too high to make it worth while in my opinion. I can't name names here but there are several very reputable online DME suppliers who honor the manufacturer's warranties.

Do you have any day time breathing difficulties? How low we desat isn't as important as how long we desat to that level and how often. The way it is usually reported, w/o seeing your specific report,  that could easily have been ONE desat to 86% that only lasted 11 seconds and nothing to be concerned about. There is no xPAP that measures 02. One would need to buy a recording oximeter w/software. And insurances don't pay for them, they are strictly out of pocket expenses.

The Resmed Elites are all fully data capable CPAPs regardless of the series. The S8s were new in 2006 and the S8 IIs came out in 2008. The Resmed S8 AutoSet Vantage and S8 AutoSet II are both fully data capable APAPs.

You can access the Efficacy and Usage data via the Resmed LCD screen w/a simple button push. That would be the 95th percentile Pressure and Leak, the AHI, AI and HI, the hours used that night, total hours used, number of nights used and number of nights since it was first used. The Pressure, Leak and AHI, AI, HI are available for that night, the previous week, month, six months and year (once you've used it that long). In order to get the previous night's data you need to access the LCD before noon as these xPAPs have an internal, 24 hour, noon to noon, clock and at noon the previous night's data is rolled over into the averages.  The 95th percentile is the leak or pressure AT OR BELOW which you spent 95% of the night.

If you can afford it and want to do so there is no reason why you can't buy exactly what you want online, let Medicare and your secondary purchase the DeVilBiss IntelliPAP for you and once you have established compliance on the IntelliPAP for insurance reimbursement for the DME supplier, that IntelliPAP would make a great backup and travel CPAP for you! Use your APAP or fully data capable CPAP at home and the IntelliPAP for travel. No need to dismantle and pack when leaving home, its all packed and ready to go, and no need to unpack and setup when you get home and just want to hit the hay. Just remember you do HAVE to establish compliance w/that Medicare paid for xPAP in order to keep it.

Other than this current local DME supplier not being happy at losing the sale or begrudgingly providing a fully data capable CPAP that you want, there are no repercussions for returning the IntelliPAP. YOU are the one paying for it, YOU are the one who must use, sleep and live w/it for at least the next 5 years.

And I'm just passing on the many favors, advice, etc. that I received from those who started CPAP therapy and went thru this before me.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

You might try SleepQuest in Redwood City.  I used them and they have the Remstar Pro M.  I also asked for an auto machine but my RX didn't allow it.  I complained to my doctor and he's changing my RX to an APAP (I'm getting the one you mentioned.

You'll have to call Sleepquest if they accept Medicare, I don't know.  Fortunately, they do allow changes to machines, but I don't the time limits.

BonSleep. I would contact the manager and tell the manager that the staff person you talked to was "less than truthful", that you SPECIFICALLY asked if the CPAP you were being offered was fully data capable and that staff person told you that it was. Had you known it was fully data capable you would have refused it and would have gone elsewhere if necessary to be sure that you did get a fully data capable CPAP. You might still get lucky if the manager wants to keep your business AND your good graces. If necessary, not at first, but before ending your conversation w/the manager, tell the manager that you will be sure to mention to your sleep doctor and anyone else who will listen how "less than truthful" this DME supplier is.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

Hi Everyone.
I finally did what I should've done a few days ago... I dug out the actual prescription. I cannot blame my DME provider! Although the number is the same there are check boxes for the phyisician and he did NOT check off 'auto'. There are these boxes to check off:
-CPAP - E0601
-Leak-AHI-Compliance
-Pressure Relief
-APAP as Comfort Feature
-APAP as Clinical Tool
and
-heated Humidification
[Also serveral items to check off re mask and other supplies which I won't list here]
Since the doc did NOT check off anything but the first item + humidification, the DME *was* being truthful in saying I couldn't get an auto machine with this prescription!
....so.... I put in a call to the doc's office and asked for a new prescription, saying that I thought I needed an auto machine as I am having so many problems with the pressure. Can't say they are exactly nightmares, as I haven't gotten to the point of any dreams as yet, but the emotional anguish of the memories of the childhood nightmares of suffocation are extremely bothersome and, I believe, contributing to lack of sleep with the machine. The office person on the phone didn't think there would be a problem in getting a new prescription. Hope that's true.
It is true, however, that I was told the machine was 'fully data compatible' ... and all it does is track usage.
Thanks for the input everyone!

Bonsleep...even though your DR did not check off APAP, insurance pays the same..as Chronie too explained...doesn't matter if your Dr scripted it or not.  What does matter is that even if you DO get an APAP..your Dr's script is for regular pressure and the APAP will be set accordingly...as if it is a regular CPAP.

Keep in mind, an APAP itself is not always the best for everyday therapy..yes, it is good to have one for fututre use if the Dr deems it needed to retitrate you at home...or the Dr finds you are in need for an auto machine due to health reasons..but the therapy of a regular CPAP is 'typically' superior in 'most' cases.

Best of luck in your new journey...Please keep us posted.


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I am A ZOMBIE! 20 years+ undx'd. BiPAP Auto M 14/9. Nasal Swift&F&P Flex Fit 431 Full Face. RLS/PLMD, Primary CNS Hypersomnia, Sleep Paralysis, Parasomnia, Degenerative Disc Disease, Clinical MS, Fibromyalgia, COPD plus other past dx's..what's next?