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* Get a copy of your Prescription
Most users do not need a BiPAP/BiLevel or an ASV machine. Thus most users need a CPAP machine (BiPAP/BiLevel or an ASV machines treat more advanced apneas)
Within these basic CPAP machines are many models with different capabilities. The machine of choice is an Auto CPAP. The most recommended Auto CPAP recommended on the Apnea Forums is the ResMed AirSense 10 AutoSet (best choice) (E0601) with heated hose (Fixed CPAP, Auto CPAP) (or the for her version)
Another good machine is Philips Respironics DreamStation Auto CPAP Machine (DSX500x11) (''Not all DreamStation Models, Check SN on the bottom, bricks look the same'') (Fixed CPAP, Auto CPAP) (best choice)
'''Why you want Auto CPAP.'''
* It may be used for home, or self-titration
* It provides full efficacy data (detailed data down to breath by breath info if necessary) that can be read and evaluated by doctors office to modify treatment or yourself for “info. This data can either eliminate the need for an additional sleep study or highlight the need for an additional study.
* You will be using this machine every night for about 5 years, It is likely that your treatment will change over this time. The autoset auto function will adjust pressure as required to meet changing circumstances (even mundane things like sleeping on your back or side)
* The "For Her" includes an extra algorithm which provides gentler pressure changes and is (apparently) more attuned to the patterns of [http://www.apneaboard.com/wiki/index.php?title=Beginner%27s_Guide_to_SleepyHead#Flow_Limitations flow-limitations] experienced by women
* The Resmed machines typically respond much faster to precursors, killing many apneas before they get a chance to develop
* These machines are supported by '''[https://sleepyheadsleepfiles.jedimark.netcom/OSCAR/ SleepyHeadOSCAR]''' software to allow you to monitor and optimize your own treatment.
'''Read this [[Prescription_-_CPAP_-_APAP_-_BIPAP#Prescription_APAP|APAP Prescription]]'''
You want to get a New machine. You will be using it for about 5 years and usage hours (not therapy hours) should be very low. (DME’s have been known to provide “used” machines as new.) So learn how to get to and read the usage hours for your machine.
Call the DME before you show up and let them know what you expect to get, specifically an '''AirSenseAirSense™ 10 AutoSet'''™ 10 AutoSet CPAP Machine with HumidAir™ Heated Humidifier and Heated Hose. Let them know that you are an INFORMED customer. When you jump into the clinician menu to check the total hours they will be surprised.
Most "customers", especially new ones, at a DME are not knowledgeable about the CPAP equipment and the treatment of apnea. Would you buy a car with an instrument panel that didn't work? Didn't think so. Why would you buy a CPAP machine that only provides Run hours? Let's keep with the car analogy for a bit. You just got married and you bought a sweet two seater. You decide to start your family, you need a bigger car. Your family continues to grow and you get an even bigger car. Wouldn't it be great if your car could change according to your needs? Well an Auto CPAP can do just that.
I would call your doctor's office and let them know that the DME they've referred you to is interfering with your ability to get treatment for your affliction. Make it a medical complaint rather than a service complaint because the staff is trained to deal with medical complaints in a much more structured manner. That is, you are more likely to get results that way. One call from the doctor's office to that DME may be enough to get them in gear.
For example, when I told my doctor that I needed my machine because a lack of sleep was having a serious effect on the quality of my life he had his nurse issue a "stat" order. The DME called me a couple of hours later and delivered a machine to my home that afternoon.
'''User 3'''
You can do a couple of things to make your experience better.
# Read the wiki on this site and know what you need to get (resmed airsense ResMed AirSense 10 autoAutoSet, mask off of choice, tubing, filters etc.) # Go ahead and call your insurance and get a Dme referalDME referral. They will give you a minimum of three as anything else would be kickback territory. # Then call the doctor and ask his assistant who they deal with. They will also give you a couple of choices.
# Then get the list and call them all. Ask about masks, exchanges, fittings, what machines they dispense, which doctors they work with everything you can think of.
# Go down the list... It won't take you long. If their customer service is crap on the phone you can rule out.
# One caveat is most of the equipment is usually dispensed by a respitory respiratory therapist and Dme DME sell a bunch of stuff usually.
# You'll be getting follow-ups with the doctor so getting your script is easy enough. I'm sure they can easily fax, email or send it you.
# It's best to have a Dme DME closer. You might go through 3-5 masks in the limited 30 day window they give you. # Best not to do that online honestly unless your deductible is huge. Most online places are selling things for just a bit more than medicare Medicare reimbursement. # The cpap CPAP machine is roughly $800 which is just a bit more than medicare Medicare pays them however your Dme DME will "bill" your insurance company 1200 or more so a 20% deductible "could" be more than the machine costs. # An unscrupulous dme DME will often try to get you set up supplies which come out of pocket that are not needed etc. Special cpap CPAP wipes, etc. # My Dme DME works directly with the doctor and was super easy to deal with. Gave me exactly what the doctor ordered. They didn't do much to help choose masks but they did show me how to use the machine and spent 20 minutes with me. They went over the manual on cleaning.
# It seems overwhelming but it's really going to go smoothly.
Today was the start of my therapy so drove 35 miles to my new DME to get my new ResMed AirSence 10 AutoSet.
There were several new boxes piled on the floor but he pulled one off a shelf that was in a travel bag. I checked the power cord and machine and it looked used. I asked him 3 times if the machine was new - he said yes. I asked him if he checked the clinical menu “about” for time and he pretended to not know what that was.
I needed a good mask fit so went through process testing under pressure with me ending up with ResMed P10 nasal pillow.
Went home plugged in the machine and went into the clinical menu and bingo machine had 1,359 hours on it. I immediately called and he said , “it should have been new, must have been a mix up with the machine in the backroom, he will bring me a new one.”
Hell with that I drove back and traded after verifying I had a brand new machine.
It was no mistake - he lied and tried to give me a used machine with lots of hours on it.
Thanks to this forum and help on my first post that gave me the knowledge to be educated and not allow fraudulent DME to cheat me & Medicare.
Thank you and warning to all new users.
I didn’t see a box. Sad But anyway, I used the machine for 6 weeks before finding this forum. That’s when I discovered how dishonest some DME’s can be.
Out of curiousitycuriosity, I looked at my machine hours and saw that that it had over 900 blower hours on it. Of course , they had erased the previous user hours. The machine/blower hours cannot be reset.
I called and told them what I found and that I would be in the next day for a new machine.
Patient has had a sleep test which meets Medicare Requirements that meets either of the following criteria:
* AHI/RDI3 is ≥ 15 events per hour with a minimum of 30 events; or,* AHI/RDI is ≥ 5 and ≤ 14 events per hour with a minimum of 10 events and documentation of excessive daytime sleepiness, impaired cognition, mood disorders, insomnia, hypertension, ischemic heart disease or history of stroke.
Resulting in
== Obtaining disposable supplies ==
For apnea patients, disposable supplies include but may not be limited to; masks, mask interfaces (cushions), headgear, chin straps, filters, hoses , and humidifier chambers. For patients obtaining disposable supplies through insurance (personal, employer provided, Medicare, Medicare Supplement, Medicare Advantage etc.) guidelines for replacement intervals vary. For patients that self pay, practically any provider will be happy to sell whatever is needed. Some will ask for a prescription, some will not.
For the patient obtaining disposable supplies through insurance , some DMEs will remind you when you become eligible for supplies and others will make no effort to remind their patients making it necessary for the patient to initiate the process. Recent changes appear to make it necessary for the DME to obtain a new prescription for each new supply order. This situation emphasizes the necessity of teamwork all around. More than ever the patient must be actively informed and at times involved in the process. If the doctor and the nurse are not on the same page as the DME the patient may need to add some diplomacy to the mix. It's not unusual for the doctor's nurse to be the key player.
Medicare prohibits auto fulfillment of replacement supplies. You MUST initiate the ordering of all replacement supplies with Medicare. How often can you replace disposable supplies? Look at the '''[[Prescription_-_CPAP_-_APAP_-_BIPAP#Medicare_Replacement_Schedule|Medicare Replacement Schedule]]'''.
What do you need
* Mask (there is NO therapy without a mask)
* Cushions (tend to get soft and cause a leak)* Pillows (tend to get soft and cause a leak)
* Headgear (gets stretched)
* Hose (can get a hole in it (dog/cat bite mark))
* Humidifier Chamber (An integral part of many CPAPs, if broken - NO therapy)
Many of these supplies will last longer that than the replacement schedule offered by insurance.
== Obtaining a replacement machine ==
[https://www.resmed.com/us/dam/documents/articles/QualifyingmypatientforanewCPAPMachine.pdf Helping patients replace their current CPAP machines (2014)]
Less than five years The replacement of an item before its five-year life-time lifetime expires can only be done if the item is lost, is irreparably damaged, or the patient’s medical condition changes and the item no longer satisfies the medical needs of the patient.
* Loss or irreparable damage: – Irreparable damage is considered damage caused by a specific accident or natural disaster. – A physician’s order is needed to reaffirm the medical necessity of the item.
* If a PAP machine is replaced during the RUL because of loss, theft or irreparable damage due to a specific incident, there is no requirement for a new clinical evaluation, sleep test or trial period.
Secondly, if available, a copy of your sleep study will be requested by the new DME. Again, a copy of your sleep study should be on file with your current DME, since this too is a medical record, your prescribing doctor must make available a copy to you.
Third, a release of medical information document must be on file with the both the current DME and the new DME. This release of information document facilitates the legal transfer of information from your current DME to your new DME. You will sign a copy at the current DME and new DME. Usually you sign this document when you complete new patient intake for any medical services you receive and the document is specific to the medical provider.
Lastly, your current insurance documentation is required for transfer. The new DME will request this from you as a potential new patient.
Once your current DME releases you from their care and insurance has given their approval, your new DME will setup an appointment to do a new patient intake. This intake process is performed anytime you receive medical care by a service provider that has never seen you as a patient before. A medical history questionnaire, personal information questionnaire, current medical needs questionnaire, vital statistics questionnaire and any other information needed to care for you as a medical patient will be obtained.
When changing DME providers, if you currently own your machine, the new DME will ask for you to bring your machine in to into their office when they schedule an appointment for you to begin receiving supplies. Assuming that insurance is covering your supplies, the DME will record the serial number from your machine and modem (if equipped), and collect your sleep data from your machine. This is for compliance monitoring. The DME will record the supply types and sizes you require (mask type and size, hose type, filters…) and according to your insurance policy, the DME will create your supply schedule.
It is common practice that an insurance company will rent the machine you are provided by your DME. During the rental period your DME is responsible for the collection of compliance records and reporting your usage statistics. If you fail to report compliance or do not meet minimum usage for compliance, your insurance may stop payment to your DME and the DME will stop issuing supplies. If the machine is still in the rental period, the DME will require you to return your machine.
The typical rental period will be 10 consecutive months. After the rental period and you have met minimum compliance requirements, the machine will become your property. The contract is similar to a “rent to own” contract with you being the consumer. If you change DME providers during your rental period, the insurance company reserves the right to deny the issue of a new machine. Therefore, it is recommended that you maintain your DME provider during the entirety of your rental period. After the rental period has been fulfilled and you own your machine, selecting a new DME is, in essence, only selecting who will fulfill your supply needs.
## ResMed AirSense 10 AutoSet (or “AutoSet for her” model)
## Philips Respironics DreamStation Auto CPAP Machine (DSX500x11 on bottom of machine)
## Go to the '''[http://www.apneaboard.com/adjust-cpap-pressure/change-cpap-pressure-settings-adjusting-your-machine-with-a-clinician-setup-manual CPAP Manuals Page]''' to get instructions (or a manual) that tells you how to get into the "Setup", "Clinician", or "Provider" Mode on your make & model of CPAP. (you wanht want to know before you pickup your machine)
#Let your doctor know what machine you want. Ask your doctor to write a prescription for the machine you want.
#Call DME before you arrive to pick up your machine. Let them know what you are expecting.
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