DME Scams

[zeeser]

I've got a RedMed VPAP S which will be 4 years old in March. It has 9500 hours on it and some problems are telling me it needs a tune up. The Start/Stop button is getting difficult, and also the pressure plummets rapidly then slowly builds back up every now and then.

My DME is Lincare who I have never been pleased with and if it weren't for this forum I probably would have given up years ago.

So my question is this: What type of scams am I likely to run into as I try to get my machine tuned up?

Thanks for your help, Tom

[trish6hundred]

Hi zeeser and WELCOME! to the forum.
Hang in there and someone will be along to help you soon.
Best of luck to you.

[PaulaO2]

Is the machine saying it needs something or is Lincare telling you?

At just 4 yrs, you're not eligible for replacement according to Medicare (and a lot of ins. companies follow their guidelines).

If you have to pay for the repairs, then ask for a price up front. If they cannot give you one, then take your business elsewhere. If there's no where else to go (or no one else will touch it because you got it from elsewhere), then ask again for a repair price up front. If you get one, get it in writing.

Before you pay that, go to Supplier #2 in the supplier's list and compare their prices for other VPAP machines. It could be cheaper for you to get a new (or gently used) machine from them vs have these guys fix it. And they probably won't even be the ones fixing it, but send it off to the manufacturer instead.

If you have an insurance other than Medicare, or if you bought the one you have out of pocket, you may be able to get a new one. Call different DMEs in your area to get price ranges. Even if you have to go out of town, the peace of mind would be worth it vs staying with a company you don't trust.

[SuperSleeper]

Also, not sure if this would be viable, but if your doctor agrees, it might be possible to purchase a used ResMed S9 AutoSet or S9 Elite, given your pressure ranges of 18 inhale, 15 exhale. It's not exactly the same, but the 3 cmH2O difference can be handled by standard CPAP, by setting the S9 unit at 18 cmH20 of pressure and setting the C-Flex at level 3, giving you your 15 cmH20 exhalation pressure. On top of that, you'd have a newer machine.

To some of our more experienced members - do you see any problem with doing this?

If the doc agrees that's an option, check out the Supplier List that Paula talked about - it might be cheaper for you in the long run going that route.

Let us know what you find out.

[archangle]

At just 4 yrs, you're not eligible for replacement according to Medicare (and a lot of ins. companies follow their guidelines).

They may pay for repairs or replacement if it's broken, even if it's not "old enough."

[vsheline]

Also, not sure if this would be viable, but if your doctor agrees, it might be possible to purchase a used ResMed S9 AutoSet or S9 Elite, given your pressure ranges of 18 inhale, 15 exhale. It's not exactly the same, but the 3 cmH2O difference can be handled by standard CPAP, by setting the S9 unit at 18 cmH20 of pressure and setting the C-Flex at level 3, giving you your 15 cmH20 exhalation pressure. On top of that, you'd have a newer machine.

To some of our more experienced members - do you see any problem with doing this?

The ResMed terms are EPR (Expiration Pressure Relief, lowers pressure during exhalation) on their regular xPAP machines and PS (Pressure Support, boosts pressure during inhalation) on their VPAP (BiPAP) machines.

I think PS is more accurate than EPR because the blower is upgraded. On my old S8 AutoSet II, an EPR setting of "3" usually produced a pressure difference of only 2.2 cmH2O (or less). I think this might mean the blower couldn't support rapid pressure changes as well as the blower in a BiPAP machine.

Also, there are subtle differences in the shape of the pressure waveform for EPR versus PS. And PS has far more adjustability on how sensitive it is on changing from inhalation mode to exhalation mode (5 possible levels) and back again (5 additional possible levels). And has adjustability on minimum inhalation time, and maximum exhalation time. Please understand, however, that our run-of-the-mill sleep doctor or RT would probably never deviate from the typical settings. Probably only researchers, or enthusiasts such as ourselves on this forum, would ever consider taking the time to try the various settings. (OK, OK, so I might be the only one...)

If zeeser can get his doctor involved, he might try asking for a VPAP-Auto machine. It can be put in the VPAP S operating mode. Or it can be put in an Auto VPAP mode to allow the doctor to use the Auto mode to recheck the titration once in a while, or can be left in Auto mode all the time to allow a lower average pressure (lower Leak and lower discomfort when falling asleep).

[zimlich]

Good luck, Tom.
Mary

[zeeser]

Thanks