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question and no time - Marc615 - 08-04-2015
Hope someone might offer anything helpful very fast. I have stumbled upon this site and I have questions and I have an appt with DME in 3 hours.
So i get a call yesterday stating that they have an appt to see me today after work. say it is going to cost me $70 up front and $10 a month for something like 10 months for a cpap machine, plus any consumables would be extra.
I have BCBS and I have already met my $500 deductible for the year. but not reached my $2,000 yearly out of pocket maximum co-pay.
I just got off the phone with my insurance and they state that they cant tell the DME what to charge in office but I shouldn't have to pay anything up front as the copay has been met. They should bill BCBS and then BCBS pays 90% and I should get a bill for the remaining 10% co-pay.
The DME on the phone yesterday sated remstar auto 560.
Is this a good machine? I have been told I need an auto set i think 8-14.
I want to be able to track this and see results in something like sleepyhead or some other tracking software.
I don't want to be pushed into something crummy and have them bill my insurance an arm and leg. I want a quality machine with decent features and software capabilities.
any suggestions on what to look for? i have a beard so nasal pillows?
I had 7 years ago received a remstar m series with full mask and I could never seem to wear it so in a corner it sat, its almost new except my dog ate the mask.
I know I need to finally get this under control and before my ins paid 100% of everything so I didn't bother looking into any of this stuff.
should I see if they can set my older m series to a preasure in the middle range of the auto and use the older gear with a more comfortable nasal pillow mask?
also does it seem right to be charged up front if my deductible has been met?
I see 560 series online for 650ish and masks etc and all could be had to bring total to $1000.
if so it seems high that if I am only suppose to be paying 10% that I get charged $70 up front and 10 months rental at $10. on a thousand dollars worth of gear.
whats the best 3 machines and masks, quality, features, and ease of use?
RE: question and no time - AndyB - 08-04-2015
Marc,
Along with many others here I use a ResMed AirSense 10 Autoset, which is ResMed's latest APAP. I like it -- convenient and easy to use and understand. There are many others on this site who use Respironics APAPs and swear by them -- I'll defer to them to provide guidance on Respironics' machines. When I was in your shoes several months ago I was steered away from Fisher & Paykel APAP machines.
Masks are so highly personal that it's tough to say which 3 are "the best." I've gone through 5 masks in less than 3 months, all of which are highly-regarded masks. I'm currently using Respironics "Amara View" and like it. There's a big group here who like ResMed's P10 pillows mask, if you can keep from mouth-breathing (I haven't figured out how to avoid that yet, but I'd love to use a pillows mask).
I'm sure you'll get some additional suggestions. Good luck!
RE: question and no time - DariaVader - 08-04-2015
im on resmed as well, but afaik the respironics 560 is a good machine with full data and auto capabilities. It is the one I am recommending to my son, since it is better than resmed if you need a battery, and it is less expensive for a similar feature set.
as for mask, I am one of the P10 cadre. My father is on one, and my son will soon be giving one a try.
RE: question and no time - Sleeprider - 08-04-2015
You should be dispensed a machine and the DME should bill BCBS. The DME will be paid the agreed amount for the machine and equipment billed, and they may not lawfully charge you any extra above that amount. You may however be billed for any deductible or copay.
Do not accept a machine on a rental basis. There are two billing codes for CPAP including any Auto CPAP
EO601 RR is CPAP rental
E0601 NU is CPAP purchase
Be SURE the insurance is billed for E0601NU for a purchase. Most insurance does not require rent-to-own, although you may have to demonstrate compliance. Rental is a way to lose a lot of money. If the DME wont' do this, change DMEs. You have a choice.
The PRS1 560 is the Philips respironics auto CPAP and it is capable of being equipped with a heated hose. You will like the heated hose, so ask for it. The machine is equal to the Resmed Airsense 10 Autoset and can do everything the Resmed machine does with some subtle differences. It is less expensive than the Resmed machine. No matter what they dispense, they get reimbursed the same from insurance, so they have incentive to give you the cheapest item that complies with prescription spec.
You have a beard, get Resmed Airfit P10 nasal pillows if you don't breath through your mouth. If you have that problem, you'll need a full face mask of some kind, and most will be tough to seal.
If this DME is Apria, call your insurer and ask what DME alternatives are available to you. Don't go to Apria (Crapria).
RE: question and no time - lmoretti - 08-04-2015
What Sleeprider said!
I'm on a 560 Auto and it's a wonderful machine. I didn't get the heated hose and haven't had any issues yet (haven't had it through winter though). I use the P10 nasal pillows and it worked great when I had my beard. Shaved it for other reasons, and it still works great. I do have some mouth leak issues and I don't like the Philips Respironics chinstrap they gave me: too bulky. Going to get a strip of cotton cloth and try that (probably look like Marley from A Christmas Carol)
RE: question and no time - PoolQ - 08-04-2015
So here is what I know, I also have BCBS and have already spend my annual requirement.
1. I got my unit for nothing out of pocket
2. I don't pay any monthly fee
3. BCBS requires my DME to provide the unit as a rental, in case I return it or am not compliant, this converts to owned after the compliant period
4. for the rest of this year all required consumables are covered by BCBS, these are the things that need replacement as per the prescription. I don't need anything else
5. I have a mustache and beard and use a full face mask, Simplus by F&P, my nose pillow that I am going to try arrives today, bought from [commercial DME link removed, please refer to "Supplier #1]
Others here can tell you about the machines. Make sure it is fully data capable and not just summary data. make sure it has a min AND max pressure setting. I suggest looking at the machines at [commercial DME link removed, please refer to "Supplier #1] and write down the models (full model number) of what you want and DON'T want, I think there are several models of the 560 available.
What I would do? Contact BCBS and find another DME if you can. Your DME is trying to get you to pay out of pocket for supporting you in your medical needs.
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RE: question and no time - Marc615 - 08-04-2015
(08-04-2015, 03:49 PM)Sleeprider Wrote: You should be dispensed a machine and the DME should bill BCBS. The DME will be paid the agreed amount for the machine and equipment billed, and they may not lawfully charge you any extra above that amount. You may however be billed for any deductible or copay.
Do not accept a machine on a rental basis. There are two billing codes for CPAP including any Auto CPAP
EO601 RR is CPAP rental
E0601 NU is CPAP purchase
Be SURE the insurance is billed for E0601NU for a purchase. Most insurance does not require rent-to-own, although you may have to demonstrate compliance. Rental is a way to lose a lot of money. If the DME wont' do this, change DMEs. You have a choice.
The PRS1 560 is the Philips respironics auto CPAP and it is capable of being equipped with a heated hose. You will like the heated hose, so ask for it. The machine is equal to the Resmed Airsense 10 Autoset and can do everything the Resmed machine does with some subtle differences. It is less expensive than the Resmed machine. No matter what they dispense, they get reimbursed the same from insurance, so they have incentive to give you the cheapest item that complies with prescription spec.
You have a beard, get Resmed Airfit P10 nasal pillows if you don't breath through your mouth. If you have that problem, you'll need a full face mask of some kind, and most will be tough to seal.
If this DME is Apria, call your insurer and ask what DME alternatives are available to you. Don't go to Apria (Crapria).
thank you all for the quick replies.
so the PRS1 560 is equivelant to the airsense 10?
good to know. they mentioned the name yesterday and then I started looking at the horror stories of DME putting you on a crummy machine and charging a lot for it and thought this was what they were trying with me.
I am just liking the look of the sleepyhead software and would like to make sure that whatever I get is capable of SD card/reading it from my PC.
RE: question and no time - lmoretti - 08-04-2015
The PRS1 560 Auto is equivalent to the Airsense 10 Autoset. Since you have a variable prescription, the cannot give you a dumb brick.
Also:
DO NOT give them credit card/banking information. Tell them BCBS said since you met your deductible there was no CoPay.
RE: question and no time - AshSF - 08-04-2015
Just to add to the valuable advice from Sleeprider and poolQ:
1) the headline names of the machines don't tell everything. All Philips Respironics 69 series machines have same faceplate on top but the model nos tell the whole story.
Don't get any machine unless it says 560 in its wording. The best machine is 560TS. This has a humidifier and a heated hose. Since the DME gets paid the same amount, get this one.
Do not accept any machine with nos 160,460 or any previous 50 series machines.
2) For Resmed Airsense 10 is the headline name. The models are
1) cpap: Avoid at all costs.
2) Elite: straight pressure machine, avoid
3) Autoset: Minimum you should accept
4) Autoset for Her: the best machine (even for guys).
Hope this helps. Since it will be a lot of information at the DME, make sure you are prepared.
Also, start with nasal pillows type mask. I highly recommend the Resmed P10. It's the best out there. And as our spiritual leader said: eventually, everyone will be clamoring for the P10. Resistance is Futile!
RE: question and no time - trish6hundred - 08-04-2015
Hi Marc615,
WELCOME! to the forum.!
Good luck to you at your DME apointment and much success to you as you start your CPAP journey.