[Equipment] ASV Acquisition Guidance Requested

[Ventura Bill]

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,

I recently (about 4 weeks ago) purchased an Aircurve S10 ASV machine from a supplier in Minnesota. My local DME said they would not sell me one, rental only. My sleep Doctor gave me a copy of my last sleep study and a copy of the prescription for the ASV machine. The price was less than 3 grand new.

I am very happy with the new machine and sleeping better than in years. I have complex Apnea issues and Cheyne/Stokes breathing issues. I had to go to a Full Face Mask to control leakage because I would mouth breathe after falling asleep. Good luck on getting your situation resolved to your liking.

Regards,

Bill

[Ventura Bill]

To CT Centrals,

You said:
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,

Sounds like my own experience! My same DME (*ria) with rental policy. Also, the outside source you mentioned sounds like the same as my source in MN, price, shipping, etc. I took a chance and paid by check and had a very good experience. Two year warranty and free overnight shipping. They were not the cheapest but all things considered, I was comfortable with their price and deal. They were straight shooters. Hope that is helpful.

Bill

[ajack]

Bill, The death rate using an ASV can be 5 times higher with CHF and cheyne stokes can be an indicator, ..did you have an echocardiogram and check that the left ventricular ejection fraction is 45% or more
http://www.aasmnet.org/articles.aspx?id=5562

[DeepBreathing]

The death rate using an ASV can be 5 times higher with CHF

The article you quote does not support this view, nor does any other documentation I have seen. To say there is a five times higher chance of death is a gross exaggeration. To quote from the article:

Based upon the early results of the randomized controlled SERVE-HF study, for this particular at risk population, there is a 33.5% increased risk of cardiovascular death, compared to control patients who are not on ASV therapy (absolute annual risk: 10% in ASV patients vs. 7.5% in control group).

That is a 33% increase on a fairly low base - not insignificant but not an enormous absolute risk. Resmed's current guidance states that the contraindication applies to:

patients with symptomatic, chronic heart failure (NYHA 2-4) with reduced left ventricular ejection fraction (LVEF ≤ 45%) and moderate to severe predominant central sleep apnea.

I think we can assume that any properly qualified sleep doctor who writes a prescription for an ASV is aware of the precautions, though it is of course always wise to confirm this.

Resmed's recall notice: https://www.google.com.au/url?sa=t&rct=j...v4ndpB2j9A

NEJM paper: http://www.nejm.org/doi/full/10.1056/NEJ...#t=article

[ajack]

no, the 5 times came for a symposium and I guess a later study? They also talk about a current study underway
https://youtu.be/Nr08K5IfzzY?t=2250

[DeepBreathing]

Interesting - I'd like to see the paper rather than just the panel discussion.  More research needed.

Edit: I didn't have time to watch the whole thing which runs for two hours, nor did I get the full context of the higher risk profile. I'll try to make time over the weekend to sit through the whole thing. However I did get the impression from the parts of the conversation I did see that the higher risk rate applies to a specific sub-set of patients who were already extremely ill before they went onto the trial.

[jerrydaw]

Amazon has a new ResMed AirCurve ASV for sale for $ 2,500. Commerical Link Removed. Sounds like that beats $ 5,000+.

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[Sleeprider]

Fantastic news that these are showing up on Amazon. Should save someone a lot of grief.

[CTcentrals]

Thanks so much for all the support, guidance, and valuable information.

I ordered the gently used (398 hours) ResMed S10 AirCurve ASV with heated humidifier, climateline tubing, from Supplier #2 for $1749 including free shipping and one year warranty. I used the chat function to get the process started and talked for seven minutes on the phone to complete it. They said it would take about two days for administrative processing and 4-6 days for shipping. 

I clearly don't have the technical knowledge to pay it back or forward in kind, but if I can be of any assistance in some way, please let me know.

[Sleeprider]

Thanks so much for all the support, guidance, and valuable information.

I ordered the gently used (398 hours) ResMed S10 AirCurve ASV with heated humidifier, climateline tubing, from Supplier #2 for $1749 including free shipping and one year warranty. I used the chat function to get the process started and talked for seven minutes on the phone to complete it. They said it would take about two days for administrative processing and 4-6 days for shipping. 

I clearly don't have the technical knowledge to pay it back or forward in kind, but if I can be of any assistance in some way, please let me know.

Your personal experience is the most valuable asset you can bring in helping others.  If you hang around a while, you will find we get many new members that can relate to your experience and advise that comes from it.   I'm sure everything will work out well with your new ASV, and it's good to know you will save a lot of money, and will get good support from Supplier #2. With all that money you'll be saving you could lease a new luxury performance car.