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DME Provider Recos - cincysinner - 01-25-2024
Hi,
I got a ResMed S9 VAuto. It has served me quite well over the past 10 years or so. I have it tuned up and adjusted to keep my AHI under 1 pretty much everyday.
However, after having the "motor life exceeded warning" message for a year or 2 now, it's time to upgrade.
Naturally, I would like my insurance to cover it.... thus I must dive in to the hellish underworld of DME racketeers. My current DME has served me OK for my routine mask/supply needs but trying to get a new machine has been a nightmare and aggravation for the past 2 months.
I have an S9 VAuto thus I want to replace with an Aircurve 10 VAuto - simple enough eh? No.
I'll spare you all the details but suffice it to say I have all my ducks in a row, recent sleep study, prescription (annual sleep Dr visits), 100% compliance reports spanning a decade etc.
I am looking for a DME that is good work with. I am in the USA with United Healthcare. As we all are here, to one degree or another, are "power users" of our machines. We know how they work, when they are not working and probably a good sense when to call up the Dr for help.
I'm in a good place... some would probably be envious of my routine days of AHI of < .5 (with 35+ without therapy). I don't want to mess around experimenting with it. I have not only my pressure levels set precisely after much trial and error, I also have the trigger parameters precisely tuned (most people don't bother with).
I need the new machine simply shipped to my house and I will take it from there - including programming it as needed. That's probably not realistic but minimal amount of DME BS preferred.
Given all of that :-) - can you super/power CPAP users recommend some DMEs that are good and easy to work with?
Thanks!
RE: DME Provider Recos - Sleeprider - 01-25-2024
Your current machine is the S9 VPAP at pressure 13/8, and I'll assume that is fixed pressure. Your new machine should be the Resmed Aircurve 10 Vauto, and you should accept no substitutes. Normally the path to a new device is to visit your regular doctor rather than a specialist and ask for a prescription renewal, in this case the Rx can specify the Resmed Aircurve 10 Vauto in VPAP mode at IPAP 13.0, EPAP 8.0. Since you use ResScan, you can take a compliance report showing your use and efficacy for the last 90 days or so, or update to the new OSCAR and print a report from the statistics tab. You should discuss your use of the VPAP for the past 10 years and how you have benefited from the therapy, and that you wish to continue treatment using the updated machine and retire the "motor life exceeded" device. There is no requirement I'm aware of that you have a new sleep test or titration test. We cover some of this in the Dealing with a DME wiki https://www.apneaboard.com/wiki/index.php?title=Dealing_with_a_DME
The bad news is DMEs are almost universally bad, and your best defense is education and knowing your rights and coverage. Look for a DME that is in-network for you. When I changed DMEs last year, I actually walked into the local office and talked with the person that does the ordering and management of CPAP care. She was very helpful and encouraging and that gave me a point of contact at ROTECH to ensure she received the Rx from the doctor and any supporting documentation. I found it necessary to actually monitor communications between my doctor's office and the DME. You can't assume everyone will just do their job. What difficulties have you encountered up to now?
RE: DME Provider Recos - cincysinner - 01-25-2024
Thanks for the DME link, I'll definitely have a read through that.
My current issues are just dumb stuff... In Nov, I told them it's time for a new machine. I'll be seeing the Dr in Dec to get an official prescription (again, routine annual visit). I have S9 VAuto and I will want the same.
They're like OK no problem, just send us the script in December. Script gets sent, and they are like OK we have You Aircurve S ready... um no, need the VAuto... "we don't have any", fine, I don't want an S. Don't do anything. Start getting automated messages "your new machine is ready, and you take a training class"... it's an S. Um NO.... VAuto. "Do you have VAuto's now?", silence, no response for weeks... ask again what the status is, silence.
I went through this 10 years ago with my Resmed. I specifically wanted a Resmed. This DME I got referred to only sells Phillips, they tried to foist one upon me by shipping it to me (despite my explicit instruction not to do so), had to return it... blah. So nothing's changed.
Good news is, at this point, an Aircurve S 10 hasn't shown up at my door. I've given them explicit instructions to never ship me anything without my explicit permission (covers supplies also). But given the swarminess of the business, wouldn't be surprised to see one show up now they may suspect I'm shopping for a new DME.
BTW My settings are a little different than my profile (I'll update them). I should be good with this right? (see image attached) LOL.
I did experiment a few years back running my VAuto in S mode (straight BIPAP) for a week-ish. Didn't go well, AHI shot up over 5X.
If I had the option (or knew of one), I probably could get to the magic AHI of zero if I could program my machine to run in S mode for the 1st 2 hours of sleep then drop into VAuto after that. I need the pressure bump for the early phase of deep sleep but need the drop for later REM sleep. If I run straight BIPAP all night, central apenas go up big time in the second half. Just a few cmH20 makes ALL the difference for me.... but I digress... :-)
I don't why this stuff has to be so hard, it should be like buying a glucose monitor under insurance. I guess the idea is for the insurance companies to erect as many barriers as possible to discourage claims.
RE: DME Provider Recos - SarcasticDave94 - 01-25-2024
Something to consider, get you doctor to write specifically on the script
ResMed AirCurve 10 VAuto
Preferred settings xxxxxx
Mask patient choice
D.A.W. (and I think also to include number 1) so DAW 1
Here's why...
Dispense as Written Codes:
DAW codes are used by prescribers or pharmacies to indicate when a substitution is, or is not, permissible for the prescribed drug/product.
What are the dispense as written (DAW) codes and what do they mean?
- DAW 0 – No Product Selection Indicated
- DAW 1 – Substitution Not Allowed by Prescriber/Provider
- DAW 2 – Substitution Allowed – Patient Requested Product Dispensed
- DAW 3 – Substitution Allowed – Pharmacist Selected Product Dispensed
- DAW 4 – Substitution Allowed – Generic Drug Not in Stock
- DAW 5 – Substitution Allowed – Brand Drug Dispensed as a Generic
- DAW 6 – Override
- DAW 7 – Substitution Not Allowed – Brand Drug Mandated by Law
- DAW 8 – Substitution Allowed – Generic Drug Not Available in Marketplace
- DAW 9 – Substitution Allowed by Prescriber but Plan Requests Brand
RE: DME Provider Recos - Sleeprider - 01-25-2024
I think it may be worth calling around to the DMEs in-network. See who picks up the phone and will listen to this problem and offer to get you the machine you need. These are not in such short supply and you really should not have to put up with this crap. Anyway, it really helps to note the name of any person you talk to and keep in touch through the fulfillment process. I assume you don't have a name of an individual at your current DME and it just gets lost in the bureaucracy.
RE: DME Provider Recos - Deborah K. - 01-25-2024
I got new machines for both my husband and me from Easy Breathe. I found them online, and when I call I always get a live person and good advice.