Recommendations on sleep machine

[ellenos]

I had a sleep study about 10 yrs ago and have used my Respironics Bipap Auto M daily since then with no problems.

My doctor moved and I do not have access to my sleep test but I was helped in this forum with getting the setup from my current machine.
I want to purchase a new machine and I really do not want another sleep study.  I did see a doctor who agreed to give me a prescription.

I am covered 70% with my insurance under DME coverage and would like to buy from SecondWind cpap.  They have a new open box Aircurve 10 VAuto for $1649.

Questions:

1)  Does this seem like the appropriate choice given my existing equipment?

2)  Will I be able to transfer the values myself from my current machine?

Values from the machine:

AHI = 0.5 (7 days)  0.7 (30 days
Biflex = 2
Ramp start  4.0
Mode: Bilevel
IPap 10.0
EPap  8.0

I remember originally the insurance company argued that I did not need a Bipap machine. 


My hope is to continue to sleep as well as I do now.   Thanks for any suggestions!

(and if the suggestion is that I should have a sleep study, I would do that)

-Ellen

[Sleeprider]

Your prescription can be matched on the Resmed Aircurve 10 Vauto, and on the lower priced Resmed Airsense 10 Autoset CPAP. Resmed CPAPs use a form of exhale pressure relief that allows up to 3 cm of pressure relief through exhale and a comfortable rise of pressure during inhale, just like a BiPAP. Both of those machines are auto-adjusting, so they have more capability and comfort than your former machine, as well as full data. So the choice is really yours. Be aware the Philips Respironics Dreamstation Auto CPAP will not match that pressure reduction on exhale, but the Dreamstation BiPAP-S or BiPAP auto can.

Your settings did not take advantage of the auto adjusting capability of your M-series. When your new machine is setup, you can set it for 10/8.0 at PS 2 (PS= pressure support), or you could start a bit lower at a minimum EPAP of 6.0 and let the machine adjust as high as you want, so your machine could start at 8/6 an it would be able to automatically provide 9/7, 10/8 and you can limit it to whatever you want. If you choose the Resmed Auto CPAP, then just set EPR to 2 and use a minimum pressure of 8 to simulate your current machine at 8/6. Or you could choose to set a minimum pressure of 6 and maximum pressure of 10 and it would again deliver 6/4, 7/5, 8/6, 9/7, 10/8. So you can choose to spend less and get the same results or better than you had before, even with auto CPAP (Autoset). Resmed machines also provide ramp at whatever pressure and time you choose; the interesting thing is, you could just let the pressure start at 6/4 in auto mode and ramp would not be needed.

The data either of these machines offer is better than a sleep study, especially if you have a computer that you can read the data on. Any current laptop or desk computer would work with #Sleepyhead to show you an amazing amount of information, and the forum can help you get dialed in.

[E.W.]

You may need to talk to your insurance company. I don't think
they will pay for anything bought from an online store especially
anything from SecondWind cpap. And a lot of insurance companies
follow Medicare guide lines. And at least with medicare unless you
have had regular contact with your Dr. at least once a year and
seen him recently they will not ok an new machine unless you
have another sleep study. Or at least that was what my DME told
me 2 months when I asked about a new machine and because I
had had continuous contact with my Dr. the last 10 years and had
seen him 2 months before I did't have to have another sleep study.

[Melman]

I just got a new machine and it is my understanding that Medicare will not pay for the purchase of a machine outright but that you need to get it on a lease to own basis so they can quit paying if you don't show compliance between 30 and 90 days after acquisition. At least that's what I was told by my DME and Medicare Addvantage insurance company. If that's really the case, and I'm sure someone will correct me if I'm wrong, you may have no choice but to go to a DME if your insurance follows Medicare guidelines.

[ellenos]

Thank you so much for this - its very helpful.

I don't understand why repeat sleep studies are required when it seems to me that the software on the current machines can show so much relevant data.  

-Ellen

[ellenos]

I was concerned about this and had a long discussion with someone from the insurance company.  She said that I could either go for a rental or purchase a machine myself which would be considered DME equipment and therefore covered 70%.  She said online purchase would not be an issue.  I am purchasing new (open box) - I would think used equipment might be a problem for reimbursement.

I did see a sleep doctor recently who agreed that unless my insurance company required it, I would not need a repeat study (since I was doing so well)  They do not require it.  

Thanks for your comments !
-Ellen

[trish6hundred]

Hi ellenos,
WELCOME! to the forum.!
Good luck to you on your machine decision and I hope you can get the one you really want.

[Mosquitobait]

yay Ellen!  It really helps when an insurance company lets YOU make the best deal you can and then reimburses you 70%.  Wish Medicare would do that.  It would save a lot of hassle and cost to Medicare for folks who have already been using their machines for 5 years.

[ellenos]

Double thank you on this ...  I called the insurance company again to confirm what they had told me.
She added an important detail - this has to be from a DME that is on their official DME list which is not Second wind.


I contacted Americare Respiratory, they are going to get back to me on what the rules are.  I selected them because somewhere on the list they were mentioned.

Is there a way to get a recommendation for a DME on this forum?  I see the list for suppliers, but that doesnt include DMEs.

Buying a machine outright does not seem like an easy process - I guess thats why so many opt for rental.

Sigh.

[Sleeprider]

Most of the online suppliers are DMEs but they may not be in-network to you. Supplier #30 does invoice insurance, and you could give them your details and see if they can help.

Please remember, you can duplicate your prescription on a Resmed Airsense 10 Autoset, which is half the price of an Aircurve 10 Vauto. It has up to 3 cm of exhale pressure relief, so a CPAP pressure of 10 with EPR at 2 will match your current M-Series in feel, for a lot less money.