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Permalink Reply by Melodie on January 4, 2009 at 2:58pm

Felicia,
It is easier if your physician has a DME (durable medical equipment) supplier that he/she prefers to use, and that way your insurance should most likely pay for your equipment with the prescription or "orders" from your physician.

That is what I do. I have my physician send the orders to my DME and then they bring me the equipment in person and explain it all to me while they are in my home. I have never had to pay out-of-pocket, except when I ordered something off of the internet from a supplier, like the mask wipes and Snuggle Fleece hose cover. But then, I usually meet my insurance deductible at the first of every year in January, as I have a lot of medical health issues.

Hope this is helpful to you!
Melodie

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Permalink Reply by Steven Y. Park, MD on January 4, 2009 at 5:57pm

To be honest, I'm not that up to date on the latest models. There are so many models from different companies. Mike's answer is correct—you can buy from whomever you want, as long as you have a prescription from your doctor. The DMEs usually handle the insurance part, as long as they participate.

Although what I'm finding is that in general, the counseling and support that my patients get is highly variable, so I have to fill in the gaps more and more often. I've recently interviewed a respiratory technician who is PASSIONATE about CPAP, as part of an expert teleseminar series that is available as a mp3 recording if anyone wants it. My main goal is to do everything possible to help the patient use their CPAP machines, regardless of which model it is or which mask they are using. Sometimes, it's the simple things that can help the most. Other times, you need the latest in technology and design. I always start from the simple and move on up to the more complex, technology-driven solutions.

For example, if someone has chronic nasal congestion, I address this first through conservative measures, then medical, and lastly using surgical options. Being able to breath well through your nose is a great benefit, and can also help CPAP use. Another aspect of CPAP use that many people don't address is good sleep hygiene. Doctors assume that if you just plop a mask on someone's face and get rid of the apneas, the person will wake up refreshed for the first time in years. It almost never happens that way (sometimes it does). There has to be a significant amount of counseling beforehand, implementation of desensitization techniques, and after the titration, there has to be an intensive and effective coordination between the sleep doctors, DME vendors and referring doctors like me. When I send patients to a sleep lab, I take full responsibility for the coordination and care of the patient, and not just "pass the buck" to another doctor.

One of my biggest gripes about this entire CPAP process is that because of the way the system is set up, no one takes any responsibility for the patient. The ENT thinks that the sleep doctor will handle everything, the sleep doctors think the DME vendors will handle the follow-up and support and the DME vendors have no vested interest in whether or not the patient is able to use his or her CPAP machine effectively. Everyone is so short on time and financial resources that no one is able to give intense, consistent follow-up and support that's needed for people to be able to benefit from CPAP as well as to obtain good compliance. There are some notable exceptions with regard to all the parts involved, but for the most part, the only person that loses is the patent.

Part of this problem is the fragmentation of the medical system, and the Stark regulations that prohibit sleep doctors from selling CPAP machines. These laws were set up with good intentions, but as always with everything, there are unintended consequences. Imagine if the sleep doctor could sell CPAP equipment, or better yet, a government run comprehensive interdisciplinary sleep apnea center (hypothetically!) that can pool all its' resources into one place where it's ultimate goal is to help patients use their CPAP machines, using multiple modalities. This can include regular follow-ups, desensitization methods, cognitive behavioral therapy for CPAP or insomnia, as well as in-house dentists, RTs, psychologists, social workers and surgeons working collaboratively together for the benefit of the patient.

The patients that do well are the ones that take responsibility for treating their sleep apnea, and not depend on the doctors to give then all the answers. People who participate on forums and blogs like this one tend to know more about their CPAP machines than their doctors.

Sorry for rambling and getting off topic, but sometimes I get so riled up about these issues.

Steven Park
http://www.doctorstevenpark.com

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Permalink Reply by Mike on March 29, 2009 at 1:16am

I like Dr. Park's message here, and wanted to bump this up so some of our newer members who haven't seen it yet can access it easily.

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Permalink Reply by Judy on March 29, 2009 at 8:59am

Wow! Dr Park said a mouthful! If only ALL sleep doctors were as involved and concerned w/the welfare of their patients!!!

Like Mike, I don't mean to ursurp Dr Park's response. If you want to use your insurance for purchase you will most likely be limited to purchase from the local DME suppliers they are contracted with which may mean a choice of just one or of several. Some insurances offer limited or no benefits if you buy out of network. Even if you have insurance you can opt to buy out of pocket any where you want if you can afford it.Your xPAP prescription is good for life from online DME suppliers. However, it usually must be renewed once a year to buy from local DME suppliers. You do NOT need a prescription to buy masks, hoses and other accessories online. You do when buying from local DME suppliers.

The most important decision in selecting an xPAP for purchase (in my not at all humble opinion) is that it be fully data capable. Just because it has a data card does NOT mean it is fully data capable. Those xPAPs capable of only compliance (usage) data are of absolutely NO value to you or your sleep sleep doctor, it's only value is to the local DME suppliers in order for them to receive reimbursement from insurances.

Insurances reimburse by HCPCS (code number) not by brand or model. All CPAPs and A-CPAPs (APAPs) are HCPCS code e0671. Bi-levels (Bi-PAPs and VPAPs) are an entirely different HCPCS code. You cannot buy a Bi-PAP or VPAP w/a CPAP prescription nor can you buy a CPAP w/a Bi-PAP or VPAP prescription.

Masks are an entirely individualistic matter. The perfect mask for me could be an entire disaster for you. Once they've determined the ideal pressure for you THE MASK is THE KEY to successful xPAP therapy.

In the forums, xPAP refers to ANY type of PAP device. APAP refers to auto-titrating CPAPs. Bi-PAP is Respironics' proprietary name for their bi-level models and VPAP is Resmed's proprietary name for their bi-level models. ST, SV, etc. refer to even more sophisticated xPAPs. Your sleep doctor determines which type of xPAP you need - keeping in mind an APAP is considered a CPAP.

My preference is for the fully data capable Resmed models, they are the leader in ease of access to and amount of data available to the patient via the LCD screen. Respironics is the leading xPAP manufacturer in the USA. DeVilBiss has just come out w/a fully data capable CPAP and APAP, the IntelliPAP Info and IntelliPAP AutoAdjust. In a recent comparison by 50 Respironics M Series Auto w/A-FLEX users w/use of the DeVilBiss IntellipPAP AutoAdjust, the majority preferred the IntelliPAP. Covidien produces the Sandman Auto which is fully data capable. I understand that Fisher & Paykel has just come out with or will shortly be releasing a fully data capable APAP. I believe it is GE that recently purchased a European xPAP manufacturer and introduced the Breas xPAPs to the USA and I believe I read at least one model was fully data capable and I think the headquarters are in Maryland.

The best xPAP model for you is the one that provides the most comfortable therapy for you and that is based mostly on finding the ideal PRESSURE for YOU.

Good luck!

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Permalink Reply by Anne Pf on March 29, 2009 at 5:20pm

Thanks Dr. Park for your very complete response to this. I would like to add:
It paid for me to ask around when choosing a DME. My doctor has one he usually sends his patients to, but I didn't go with that company. I asked at my local medical supply company (where I buy my anything my mom needs for her wheelchair, walker, commode, etc). They don't carry CPAP but they knew who did. I also looked at online reviews. I went with a small company, rather than a large, nation wide firm, and I am finding them very helpful.
Ask around in your area. There's probably a local sleep apnea support group, and their members might know where you should go for your supplies.
Anne

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