Buy machine to avoid DME's hidden pricing behavior I find odious?

[willo]

I'll start by saying that I think the whole system-- DMEs making secret pricing arrangements with insurance companies--is essentially fraudulent. Even a well-educated, careful "consumer" of healthcare is likely to find it difficult or impossible to comparison shop and try to make cost conscious decisions about getting a CPAP machine within the insurance/DME collusion model.

Two weeks ago,  I went to the local DME as referred by my family doctor and got my DreamStation setup. (Model: DSX500T11)

After a bit of use and becoming more and more alarmed about the size of the bill I should be expecting, I finally spent one hour and 20 minutes on the phone yesterday demanding hard figures for how much I owe these people and exactly what that money gets me. (There were no prices on any of the papers I signed; I would never buy anything else this way!) I spoke to four different departments, by the way...

So I am currently on the hook for $530 in for my "initial setup." To keep the DME's machine, I have to prove compliance for three months. Even after that, my "rent to own' insurance scam deal is for another 9 months at $85 per month, or $765 more or a total of $1295.

According to my "Delivery Ticket" with its part numbers but no costs, my only rentals are the CPAP itself (DSX500T11) and
the modem (which I've removed and sent back, agreeing to mail in SD cards instead.)

I asked the woman in billing, IF I GIVE EVERYTHING BACK AT THE END OF ONE MONTH, I return the rental equipment and owe nothing else? She said yes.

1) MOST IMPORTANT FUNCTIONAL QUESTION
So am I correct that I could just purchase the CPAP main unit (part DSX500S11) which I see online new for $623 (at Supplier10) and use that CPAP body with all my existing parts, including the humidifier the DME listed as a purchase?

2) Is that likely to be correct or an error by the DME? Is a humidifier usually bought, not rented? Because I found another typo where two part numbers were swapped on the form, so I know there were failures in paperwork.

3) If I'm going to purchase a machine, should I consider and research a different model? I'm new to CPAP use, but it seems manageable long term, except for travel... (I'm considering a used machine from Supplier2 to reduce my outlay to another $429 and allow me to keep one packed for travel long term.)

I've posted a little data and people here tell me I show more central apneas and hypopneas, so I may not need a lot of pressure or as many adjustments as the "best" machine offers. (Better to look at my other thread than trust how I'm explaining that here!) I'm barely into the "getting used to it" phase, so there's lots of room for experimentation.

I have to make a choice within a week or so, however, and the DreamStation is the devil that I know.

I would pay someone with clearly listed prices even slightly MORE than my local DME charges. I find the obfuscation disgusting.

Thanks!
--willo

[Sleeprider]

Also check with Supplier #33, and if you're paying out of pocket, get the better Resmed Airsense 10 Autoset For Her $628, and I think you can get another 3% off with a coupon code, EXTRA3%. http://www.apneaboard.com/forums/Thread-...#pid276783

[Walla Walla]

I think I'd hold off on buying a machine before you get your treatment sorted out. Your sleep test showed mixed apnea. It's possible that you may end up needing a different machine such as an ASV. I'd hate to see you waste money on a machine your not going to be able to use.

[SarcasticDave94]

I'll start by saying that I think the whole system-- DMEs making secret pricing arrangements with insurance companies--is essentially fraudulent. Even a well-educated, careful "consumer" of healthcare is likely to find it difficult or impossible to comparison shop and try to make cost conscious decisions about getting a CPAP machine within the insurance/DME collusion model.

Two weeks ago,  I went to the local DME as referred by my family doctor and got my DreamStation setup. (Model: DSX500T11)

After a bit of use and becoming more and more alarmed about the size of the bill I should be expecting, I finally spent one hour and 20 minutes on the phone yesterday demanding hard figures for how much I owe these people and exactly what that money gets me. (There were no prices on any of the papers I signed; I would never buy anything else this way!) I spoke to four different departments, by the way...

So I am currently on the hook for $530 in for my "initial setup." To keep the DME's machine, I have to prove compliance for three months. Even after that, my "rent to own' insurance scam deal is for another 9 months at $85 per month, or $765 more or a total of $1295.

According to my "Delivery Ticket" with its part numbers but no costs, my only rentals are the CPAP itself (DSX500T11) and
the modem (which I've removed and sent back, agreeing to mail in SD cards instead.)

I asked the woman in billing, IF I GIVE EVERYTHING BACK AT THE END OF ONE MONTH, I return the rental equipment and owe nothing else? She said yes.

1) MOST IMPORTANT FUNCTIONAL QUESTION
So am I correct that I could just purchase the CPAP main unit (part DSX500S11) which I see online new for $623 (at Supplier10) and use that CPAP body with all my existing parts, including the humidifier the DME listed as a purchase?

2) Is that likely to be correct or an error by the DME? Is a humidifier usually bought, not rented? Because I found another typo where two part numbers were swapped on the form, so I know there were failures in paperwork.

3) If I'm going to purchase a machine, should I consider and research a different model? I'm new to CPAP use, but it seems manageable long term, except for travel... (I'm considering a used machine from Supplier2 to reduce my outlay to another $429 and allow me to keep one packed for travel long term.)

I've posted a little data and people here tell me I show more central apneas and hypopneas, so I may not need a lot of pressure or as many adjustments as the "best" machine offers. (Better to look at my other thread than trust how I'm explaining that here!) I'm barely into the "getting used to it" phase, so there's lots of room for experimentation.

I have to make a choice within a week or so, however, and the DreamStation is the devil that I know.

I would pay someone with clearly listed prices even slightly MORE than my local DME charges. I find the obfuscation disgusting.

Thanks!
--willo

OK, let me say I agree with Walla Walla, keep renting until you have setting and chart gurus affirm what you're actually dealing with. By that I mean, of course, is it simple Obstructive Apnea or is it Mixed Apnea (AKA with Centrals). His reasoning is what I'd also agree with, you could buy a CPAP now for cheap and find you're needing an ASV like I have. Now you gotta buy another machine. OOPSIE!

Now on to your numbered questions, answered by virtual coffee drinker SD94

1. Yes you can do that. You can buy a Respironics Dreamstation that will work with what you've got now, humidifier, etc. Just DON'T actually buy one just yet.

2. My humidifier, was listed separate and was bought outright with payment 1 of the rental. Funny though, because ALL ResMed 10's have INTEGRATED humidifiers. It's not sold as a separate part like on the Respironics. But still, it's listed as a separate part and accompanying line with a price listed. I think it's part of the scam to skew the price even more IMO.

3. If it were me in your shoes, I personally like ResMed as a product line for CPAP equipment more than Respironics. Obviously, your humidifier won't work with ResMed, but sometime down the road, you may end up with a Respironics used backup. Now you've got a use for the humidifier.

And thinking of the possibility of a need being determined IF you need ASV, certainly I would even more strongly suggest choosing ResMed then.

Hope it helps some. And best to your treatment success. Oh, and get some Tylenol, Advil, whatever, because if you're dealing with a DME, guaranteed you'll get a headache.

[willo]

Given that my AHI has been "treated" (below 5) for 19/20 nights I've used the CPAP, is there any chance I would be prescribed the ASV, even though I'm showing many more hypopnea and CA than OA?


   

Or is the hard part insurance coverage as opposed to physician Rx?

Thanks as always. I really appreciate how generous everyone here is with help.

--willo

[SarcasticDave94]

IMO it's partially on you, in that an AHI of 5 or less is "treated" but are you benefiting? Well rested, yes or no? What else makes treatment less suitable to you?

Due to equal or more CA than OA, ASV machine is a maybe, but even if definite, you'd likely land in BPAP land next to try for compliance and a new maybe fail there too before ASV.

[mesenteria]

I haven't looked at your charts yet, but the comments suggest you have a mix of CA/OA.  If you were truly struggling during these times, and not feeling particularly happy or healthy, AND your reports each day say you are skirting into dangerous territory (i.e., with a reported AHI of 5 or more each, or most, night[s]), then you still have some learning and adjusting to do, and that may involve an ASV.  It may also END WITH an ASV...but we simply don't know unless you are certain your nightly reports are stable and that you are generally pleased with how you feel about the past month or so of 'rest'.

So, I agree with Dave's cautious approach to this, and also with yours.  When you begin to relax, and feel that at last you have this figured out, and that you are getting good and reasonably consistent reports with AHI less than 5, what you know works will be all you will need for the foreseeable future.  

This is why the self-control, the personal involvement, and the personal responsibility, are so critical when dealing with PAP as a novice.  You have to please yourself, in the end, and to have confidence in what the machine is providing you in the way of an enduring and sufficient benefit.

[jaswilliams]

I don’t think your numbers are bad enough to justify an ASV machine the number of CA’s have reduced since you first started, more minimum pressure will reduce the Hypopnoea as the Philips machine is slow to respond to your needs. I am sure your treatment can be optimised without needing to resorting to BiLevel/ASV

[SarcasticDave94]

Best thing I'd say is keep using, noting positives and negatives, making charts as needed as in occasional updates esp. if you change settings. So to speak, you'll give us a roadmap on where your therapy is headed for a few weeks I'd say. Certainly, if you've got high AHI or you're not sleeping well over time, shout info. Otherwise, you're attempting to build a long term consistent "sleeping well" status. Make infrequent to no changes unless really needed if you're doing OK.

[Gideon]

IMHO there is zero chance that you will be prescribed an ASV or other BiPAP machine based on your numbers. As stated above those say that you are treated. 
BUT. . . How do you feel?    

There are two portions to treatment, first is your numbers, you have apparently gotten them under control, BUT. . .  IF you are not feeling relief from your symptoms there is more to do.  You are on a PAP machine because it was proven that you have sleep apnea and very likely had other symptoms which you were in de-Nile denial about.  Daytime tiredness, overly grumpy, snored heavily, woke multiple times a night.  If your doctor feels these are severe enough he could justify a higher level (ASV) machine.  To do this he would need documented evidence. This is letting him know about all the issues that you are having.