Can I buy my own CPAP machine? (USA)

[sarajane82]

I am new to this and so confused. I got my CPAP last week (Sleep Style 233 w/built in humidifier) and the Swift FX nasal pillow mask.

What I want/need to know is, can I purchase this stuff myself off https://www.cpap.com or do I have to get it through my doctor?

I am confused because I got my machine straight from my sleep doctor. There was no middle-man (DME) involved. He said, "well, because of your insurance we can just give you the machine here." I was, however, told that I would be "renting" it for 13 months before owning it.

I have not been billed for any of the equipment yet and the insurance hasn't received anything, either. I called the doctor's office and left a message to find out the billing code and also the Tax ID of whoever it is that will be billing for this so I could get an idea of the cost. I looked on CPAP.com and they have my machine for $399. At the doctor's office I was told that since my treatment overlaps the first of the year, I would have to pay my full deductible ($350) on it in January.

So what is the point of me renting it and paying monthly for something I can buy outright online for $399? If I have to pay the $350 deductible one of the 13 months, then the other months would have to be less than $4.08/mo for it to be equal to me just paying $399 out of my own pocket for the machine.

I haven't heard back from the doctor, but I have been lurking here today and I am hoping someone can shed some light onto this. Can I take this thing back to the doctor, demand a prescription, and just buy it online? Is this something I have to ask my insurance about, if they will let me do it that way?

Thanks everyone.

[Mary Z]

You can certainly get a prescription and buy on line. I don't know if you will get insurance reimbursement, but you might save money over monthly rental. You may want to talk to the machine provider and your insurance company.

[nanwilson]

You don't have to buy from your doctor or any DME. If the price works out better by just buying it online than going thru your insurance, you would be crazy not to do it. You MUST have a copy of your precription to buy online, just ask your doctor for a copy...........you should have a copy anyway, what if you had to buy something new while you were away from home on a vacation. At cpap.com they will request the prescription from your doc for you...no hassles that way. Do your homework, whatever comes out to the the most advantages for you is the way to go. If you buy online, tell us what your pressure is to be set at and one of the good folks here can explain how to go about it.
Good luck to you and welcome to the land of hoseheads.

[sarajane82]

Thanks so much for the quick replies. Do you happen to know if I am likely renting the mask, as well? It's probably something I need to ask the doctor.

I don't have a copy of the prescription! I didn't know I was supposed to ask for one! (Shoulda researched beforehand).

I have seen a lot of people on the forum say that you should get a machine with all these data capabilities. The one they gave me doesn't have all that. Is that something that I really need if I plan on seeing my doctor regularly?

Are these visits that i have to do at one month, 3 months, 6 months, etc. because of the insurance/machine rental? Or is that normal?

[chunkyfrog]

FYI: Cpap.com will contact your doctor free of charge, if you go on their site and provide his/her contact info,
and be sure to give the doc a 'heads-up' on the cpap.com request.
Your doctor cannot legally refuse to authorize your RX at the provider of your choice.
You can get masks locally (they should never be rental), and can be exchanged within 30 days that way-
-but confirm before you accept.

[jabman]

Thanks so much for the quick replies. Do you happen to know if I am likely renting the mask, as well? It's probably something I need to ask the doctor.

I don't have a copy of the prescription! I didn't know I was supposed to ask for one! (Shoulda researched beforehand).

I have seen a lot of people on the forum say that you should get a machine with all these data capabilities. The one they gave me doesn't have all that. Is that something that I really need if I plan on seeing my doctor regularly?

Are these visits that i have to do at one month, 3 months, 6 months, etc. because of the insurance/machine rental? Or is that normal?

No you are not renting the mask. ( at least I hope not).

The data capable machine is Important to be able to let YOU know how your treatment is going. It shows you your AHI avrage's for the week month ect..., it also shows you your leaks ( from your mask) among other data. The non data machines only show compliance data which is to say that it lets the insurance company ( and Doctor) know you are using the machine. Most people want to know how they are doing with thier treatment and the non data machines don't let you know that.

[sarajane82]

No you are not renting the mask. ( at least I hope not).

The data capable machine is Important to be able to let YOU know how your treatment is going. It shows you your AHI avrage's for the week month ect..., it also shows you your leaks ( from your mask) among other data. The non data machines only show compliance data which is to say that it lets the insurance company ( and Doctor) know you are using the machine. Most people want to know how they are doing with thier treatment and the non data machines don't let you know that.

What does AHI mean?

[Pugsy]

What does AHI mean?

Might as well start your reading.. Lots of new terminology.
wiki/index.php/Category:CPAP_Definitions

AHI
AHI (Apnea Hypopnea Index) is the number of apneas and hypopneas per hour.

[sarajane82]

You all are so awesome. Thank you so much. I was told I only have "mild" apnea (7.5-8 AHI I guess is how you say it) but that the CPAP should eliminate it altogether. I'm willing to try it considering how awful I have been feeling for so long.

I'm playing phone tag with the doctor's office now about the billing for the CPAP machine. They never seem to call me back, but I am going to call everyday until I get an answer because if I can get one cheaper out of my own pocket, I will be doing that ASAP.

[sarajane82]

The data capable machine is Important to be able to let YOU know how your treatment is going. It shows you your AHI avrage's for the week month ect..., it also shows you your leaks ( from your mask) among other data.

This might sound totally ignorant, but...does it matter if I track all that, as long as I feel better?

[archangle]

Many doctors treat a patient who wants to buy his own CPAP machine the same way a priest treats a heretic. Be prepared for a bad reaction.

Stand your ground.

Buy a good, full data capable machine. I'll recommend a PRS1 Auto like mine or a ResMed S9 AutoSet. The Auto machine is a little more expensive than a non-auto machine, but it can be operated in non-auto mode. You can easily set either machine to whatever pressure your doctor or you want.

Many doctors consider auto CPAP machines to be another form of heresy. Once again, you can always operate it in manual CPAP mode.

Both of the machines I recommend are among the easiest to extract the data from to go to your computer.

[Pugsy]

This might sound totally ignorant, but...does it matter if I track all that, as long as I feel better?

Lots of people don't care about data. You don't have to track it if you don't want to but what are you going to do if you don't feel better? Wait for doctor to order another costly sleep study? Make blind adjustments to the machine?

Insurance companies usually pay by code and not brand and model. Supplier gets same amount of money for a bare bones machine as a machine that offers full data..Guess which one he makes the greater profit on?

Get a full data machine..if you feel great and don't want to mess with following data.. fine.. but if for some reason you don't feel so great you will at least have the option to see what might be going on that is making you feel not so great.

[archangle]

The data capable machine is Important to be able to let YOU know how your treatment is going. It shows you your AHI avrage's for the week month ect..., it also shows you your leaks ( from your mask) among other data.

This might sound totally ignorant, but...does it matter if I track all that, as long as I feel better?

It's not an ignorant question.

Yes, it matters.

Feeling better is really important. However, you might feel better but still have some apnea events that are damaging to your long term health. By buying and using a CPAP machine, you've done 90% of the work to be able to monitor your progress and watch for problems and make adjustments. Maybe you can feel even better if you adjust your machine to eliminate these problems.

Your apnea can creep back on you slowly enough that you don't notice it or make the connection between feeling bad and CPAP. Checking your data will help prevent this.

What if you're not feeling that much better after a while? With the right machine, you can check and maybe see if your CPAP is the problem and how to fix it. If you don't have a good machine, you might need to get another expensive sleep study that you wouldn't need if you got a good machine. Even then, a good CPAP machine will tell you how you're doing every night sleeping in your own bed, with your CPAP machine, without extra wires, technicians poking you, sleeping at a different time than your usual schedule, etc.

A good CPAP machine is like having a "free" mini-sleep study every time you put on the mask.

[sarajane82]

Thanks, everyone. I see where you are coming from. I am going to talk to the doctor's office about what I am paying to "rent" the machine and perhaps I can rent a better model if I don't decide to buy one. I'm having a little trouble (due to my math-challenged brain!) figuring out if it really WOULD make sense to buy one because now that I think about it, if I am going to met the deductible ANYWAY (which I will due to my other health problems), wouldn't meeting it immediately in January actually make the remainder of my health expenses immediately go into the co-insurance category, which means I would start paying less for them right off the bat?

I really appreciate all the help and I look forward to sleeping well soon!!

[purple]

Might consider that if you get your machine from cpap.com, then your insurance company might not ever pay for any of your future treatment. Today insurance companies look for any reason to ditch their responsibility, and your buying online, and not use a DME, which should provide some (supposedly competent) person work with you, set the machine, might be all they need. That might include future trips to your sleep doc, to Including masks. I know with Medicare, if my current machine suddenly stopped working would immediately spring for me to have a new machine. I am pretty sure that if it was before noon, then an Respiratory Therapist would deliver to my front door a loaner machine, and set it up for me. When my doc got around to writing a script for a new machine, and he is of the same mind as I, it should be a fully data capable, top of the line APAP, then my DME will also deliver that to my door. My RT works long shifts in the hospital working with Respiratory patients, most of whom use a Vent and many with oxygen as well, Meaning the lady knows her stuff, and is quite good natured as well. Then the DME would, sometime in the future, mail me a bill. While your current DME wants cash up front, and Medicare may make my co-pay like that soon, I value being able to get a new machine without my having to pay for a whole new machine out of my pocket.

But do what you want.