90 day checkup with DME

[Gparr]

So...I go yesterday for my 90 day checkup...this time I thought I might me a smart tale and bring my MacBook Air with Sleepyhead in it. She was totally at awe at what the program can show! She takes my card and I ask her to bring a copy of my report back to me. When she returns I get this piece of paper that only shows some median pressure, leaks and AHI. I think they look fairly good. Pressure 6.5. Leak 1.2. AHI 2.1...apnea index 1.6...central 1.0. I explain my concerns to her that overall I am feeling good (slowly but surely) however in the afternoon I hit a horrible brick wall and struggle to stay awake...yes I have fallen asleep at a stoplight...then it goes away and I am fine. She then says I need to raise my lower pressure from 5 to 8. I politely asked if she was a sleep doc and of course she said no. I then asked her to please get a prescription from the sleep doc and then let me know what to do.

Am I totally lost here or did I go overboard asking for the opinion of a sleep doc?

[CapnLoki]

So...I go yesterday for my 90 day checkup...this time I thought I might me a smart tale and bring my MacBook Air with Sleepyhead in it. She was totally at awe at what the program can show! She takes my card and I ask her to bring a copy of my report back to me. When she returns I get this piece of paper that only shows some median pressure, leaks and AHI. I think they look fairly good. Pressure 6.5. Leak 1.2. AHI 2.1...apnea index 1.6...central 1.0. I explain my concerns to her that overall I am feeling good (slowly but surely) however in the afternoon I hit a horrible brick wall and struggle to stay awake...yes I have fallen asleep at a stoplight...then it goes away and I am fine. She then says I need to raise my lower pressure from 5 to 8. I politely asked if she was a sleep doc and of course she said no. I then asked her to please get a prescription from the sleep doc and then let me know what to do.

Wow, I also had my 90 day yesterday, and it was almost an exact duplicate of yours! My doc also said to raise the min, from 5 to 9, but said that because I obviously had control of things he wouldn't bother telling the DME to do it. I'm trying 7.5 for now since 9 is the pressure where it starts to bother me; so far last night seemed to work pretty good.

Am I totally lost here or did I go overboard asking for the opinion of a sleep doc?

Not at all, although the MD or special certificate is not a guarantee of anything.

A question for Medicare users: does a special compliance letter have to go to Medicare, or does the doctor's billing satisfy that? Does the DME send in the compliance automagically because they have the modem data?

[Sheriff Buford]

Yes... you are overboard.

Sheriff

[oak]

She then says I need to raise my lower pressure from 5 to 8. I politely asked if she was a sleep doc and of course she said no. I then asked her to please get a prescription from the sleep doc and then let me know what to do.

Am I totally lost here or did I go overboard asking for the opinion of a sleep doc?

I am confused. Why did you go to this doctor/clinic if you wanted to see a sleep doc? Just make an appt on your own with a sleep doc if you want to see one for another opinion.
What am I missing? A sleep doc is NOT going to give you direction without seeing you. And why do you think the doc you did see was wrong about your pressure setting?

[Pugsy]

Who did you see for the 90 day follow up..was it the DME person who was a "she" or someone in the doctor's office?
DME personnel are not allowed to change anything without an order from a physician or similar person in the doctor's office.
Or is the DME person part of the doctor's office as such they also dispense equipment??
So I guess it depends on who "she" is and what her title/job description happens to be.
If you are still having extreme daytime sleepiness to the point you are falling asleep at traffic signals then you need to be following up with the doctor about it.

[Gparr]

Sorry...it is obvious that I did not explain well enough.

I have an HMO unfortunately so there is no Sleep doc that I see. My GP runs everything through Sleep Med. my visits are always with a DME as I have no direct access to a doc. They are the ones that are supposed t send the report to the main office so a doc can look at it and make suggestions.

Hopefully, his makes things a little more enlightening...why can't you folks learn to read my mind?

[chunkyfrog]

Only my DH can do that, but he says he only reads mine and our family.
I have an appointment next Friday with my PCP.
I will take my spiral notebook, and maybe a sleepyhead summary printout.
I will ask for the "face to face" documentation to be sent to Medicare,
so I can "stick" them and my part B supplement for my supplies.

[Pugsy]

Ahhh...I understand now.
If you are still consistently falling asleep at traffic lights....and you are sure that all the other stuff is well covered...
that your sleep is solid and not fragmented and you are getting sufficient hours of sleep and all other usual culprits have been ruled out...you need to be talking to the doctor....which one I don't know but I would be wanting sleep doctor.

[oak]

"I have no direct access to a doc"

Remind me not to join an HMO when I go on Medicare next June. Yikes! I don't know what I would do in your situation. Sounds like talking to a service desk instead of the mechanic about your car.

[eeckel]

"I have no direct access to a doc"

Remind me not to join an HMO when I go on Medicare next June. Yikes! I don't know what I would do in your situation. Sounds like talking to a service desk instead of the mechanic about your car.

What qualifies the DME to act as a doctor?!

[Gparr]

"I have no direct access to a doc"

Remind me not to join an HMO when I go on Medicare next June. Yikes! I don't know what I would do in your situation. Sounds like talking to a service desk instead of the mechanic about your car.

You know Oak...most of the time I have been extremely satisfied! I had 4 surgeries 3 years ago on nose and sinus, etc. This was done at the best hospital around. Cost me $150.00...insurance picked up the rest. Vasectomy - $10.00. In July, I had a large kidney stone (and hopefully the last one!!!) and my hospital stay cost me $150.00. Being a teacher, we simply cannot afford the other tier - PPO. With the OSA...this does honestly make me a bit nervous as I feel I am getting the HMO attention - which is NOTHING!!!

[Gparr]

"I have no direct access to a doc"

Remind me not to join an HMO when I go on Medicare next June. Yikes! I don't know what I would do in your situation. Sounds like talking to a service desk instead of the mechanic about your car.

What qualifies the DME to act as a doctor?!

Good point...IMHO it does NOT!!!

I have made a few calls...I should be able to have a face to face meeting regarding this situation. Hopefully I can get it resolved and be able to talk to a doc.

[Julie]

One thing to remind ourselves of - a high carb (? pasta) lunch will make anyone sleepy in the afternoon - used to happen to me all the time.

[Woody]

You had to remind me my 90 day check up is coming up too.
Well it's not so bad now but took a couple of years to convience
him if I was using my cpap every night it wasn't going to cure my
obesity. i only wish it had ....

[Janknitz]

With Kaiser HMO I've never seen a sleep doc either. The sleep lab has Respiratory Therapists as techs, and they do all the testing, patient teaching, troubleshooting etc. Supposedly your testing data is run by the sleep doctor who puts his rubber stamp on things, but for run of the mill OSA, I'll bet a doughnut that the techs are the ones who decide on your settings and machine.

As a matter of fact, when I had difficulties and needed setting changes, I saw only the RT/techs and they made all the changes without stopping to ask anybody else's recommendations or permissions. It's probably illegal, but that's how it was done.

I'm not complaining because they do know what they are doing and did well enough by me. I don't have complex apnea, though. Kirasgram has a more complex issue and she's with Kaiser. I think she actually got to see the DOCTOR.

I'm not sure if it's within an RT's scope of practice in California to prescribe CPAP pressures and settings or not.