Awake In Philly

   Mark Bristow, RRT, with Miller Medical and Respiratory, 3200 Kensington Ave., Philadelphia was the speaker for this meeting. He has been a respiratory technician for more than 25 years, and came to the meeting to present information on CPAP or BiPAP mask selection, fitting, and to offer advice and information on insurance reimbursement.

   Mark provided a lot of insight on what Home Healthcare Providers or Durable Medical Equipment (DME) providers go through when providing for people with xPAP machines. Many insurance companies in the local area expect the DME to provide a mask to the patient, included with the cost of the CPAP or BiPAP machine during the initial setup. Some insurance companies also expect the DME to provide a second mask ("replacement") to the patient with a second payment if the initial mask proves to be uncomfortable, breaks, or any other problem. Some insurance companies will also not pay for specific masks, even if that specific mask is the only one the apneic could benefit from using, which would lead to the person being compliant with CPAP or BiPAP therapy. One example is a group member who is allergic to several types of medical grade plastics. Because insurance companies are skewing payment for certain items pertaining to CPAP or BiPAP equipment, Mark and others in the DME industry are forced to make difficult choices involving patient care and managing a business on a tight budget.

   Another point Mark brought up was how insurance companies make rental payments on CPAP or BiPAP equipment. The DME is paid a monthly fee from the insurance company for 10 months. At the end of 10 months, the machine is then considered property of the apneic. The payments are small, based on negotiated, contract rates under insurance company policies. For that reason, Mark indicated, many DMEs are getting out of the CPAP or BiPAP business, as the DMEs are having to tie up too much money in purchasing the equipment from manufacturers, pay for it within 30 days, but being paid for it, at reduced rates, over a 10 month period.

   Mark also noted that some apneics have problems with DMEs, and are unaware, and often uneducated by the insurance companies, that the care given to the selection of a physician or dry cleaner should also be applied to the company supplying your respiratory care equipment. "You don't have to live with 'less than satisfactory' care or treatment," Mark told the group.

    Speaking frankly about profit margins, Mark offered specifics about how much income he could expect to see from one patient, and explained the costs he had to incur, as well as offset against the payments that will be made by the insurance companies. DMEs have a lot of expenses, including the RRT's salary, purchase of a vehicle, fuel, insurance, replacement parts, and multiple visits to a patient, among other items. He also noted that the DMEs cost to purchase the CPAP or BiPAP equipment, before a physician orders it, must also be calculated into the equation. Sure, it's the cost of doing business, he explained, but business is still expected to turn a profit - or at least that should be the goal.

   When setting up an CPAP or BiPAP, the biggest challenge Mark has identified is mask selection and fitting. In addressing these issues, Mark explained that masks must be available in a larger size range. He expressed frustration that some newer masks being marketed may offer more comfort, but are not made to fit people with wide noses, large noses, or large bone structure. On the other side of the mask issue are people with small and very small nose structure and size.

   Mark also displayed various masks, explained how to fit the mask for best performance, addressed the need to inspect the CPAP or BiPAP equipment, check the hoses for small holes and leaks, and to be pro-active in self-care.

   Some of the information Mark presented on masks included:

As of October 1, 2002 at 11:27:08 AM EDT (-0500), the U.S. population was 
288,181,442. With estimates that about five percent of the population suffers from

obstructive sleep apnea, that means there are potentially

14,409,072 apneics in the U.S.

As of October 1, 2002 at 11:27:08 AM EDT (-0500), the world population was 
6,253,616,576. With estimates that about five percent of the population suffers 
from obstructive sleep apnea, that means there are potentially

312,680,829 apneics in the world.

Awake In Philly is a support group for individuals who have been diagnosed with at least one of the recognized sleep disorders, as well as anyone else impacted by those with sleep disorders. The information on the Awake In Philly website is not intended to replace medical advice, nor is any information to be misinterpreted as an attempt to diagnose, treat, cure, or prevent any disease. 

If you have questions about any of the medical conditions mentioned on this website, especially if you suspect that you (or someone you know) has sleep apnea, please contact a qualified medical professional immediately. The information is intended to provide support, guidance, and encouragement to others contending with the many challenges of sleep disorders. The goals of Awake In Philly are to support, educate, and inform those who feel the impact of sleep disorders, as well as the general public. Medical advice should only come from qualified, licensed, and trained health-care professionals.