Ever Changing Protocol of CPAP

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
MiLady56
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Re: Ever Changing Protocol of CPAP

Post by MiLady56 » Thu Apr 23, 2015 9:11 pm

Thx one and all! Well, sadly, this is pretty much how things go here in SC. I am a native. Traveled round the state. Bozo is a good ole boy. Obamacare(no politics here, just quoting them) made them mad, so them that can go boutique and the big practices just test ya penniless, unless you are a relative.
Great idea about the copy of Rx. May call insurance company, too.
But at least, you got to hear a crazy story!!
I love cpaptalk! Nite, ya'll!

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Re: Ever Changing Protocol of CPAP

Post by chunkyfrog » Fri Apr 24, 2015 6:32 am

All too often, the protocol gives way to a free-for-all!
--with the patient in the middle, not so much being helped, but getting poked and squeezed from all angles.
That is the time to be proactive, to stand up and say "ENOUGH!
Your health, and even your survival, depends on it!

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hyperlexis
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Re: Ever Changing Protocol of CPAP

Post by hyperlexis » Fri Apr 24, 2015 7:23 am

MiLady56 wrote:Thx one and all! Well, sadly, this is pretty much how things go here in SC. I am a native. Traveled round the state. Bozo is a good ole boy. Obamacare(no politics here, just quoting them) made them mad, so them that can go boutique and the big practices just test ya penniless, unless you are a relative.
Great idea about the copy of Rx. May call insurance company, too.
But at least, you got to hear a crazy story!!
I love cpaptalk! Nite, ya'll!
This whole thing sounds peculiar on so many levels.

I'm not sure where in SC you are or what insurance you have but I think there is either some miscommunication or misunderstanding or both.

First, with a modern, data capable xPAP machine, a DME or sleep MD, etc., should be able to monitor your compliance and effectiveness of therapy remotely -- without needing multiple repeat studies. With the new ResMed Air series machines, the doctor can even do it wirelessly over the internet. It couldn't be easier. Your MD would be able to see whether leaks were causing any problems by that alone. Absolutely no need for a full repeat sleep study, IMHO.

If you have an old 'brick' machine with no data, and are asking for changes in prescription or something like a new machine, then perhaps that is why they are asking for a new study. But in general, with data capable machines, like I said, this is not the norm.

In Illinois, a medical prescription is only legal for one year. Refills may go longer. But do people ignore the requirements and continue selling supplies, etc., regardless, yes. Although, my DME asked for an updated Rx after a year and my MD just faxed them one when needed. But I certainly wasn't asked to have an annual sleep study.

It is possible the law in your state is the same -- that an Rx expires in a year. But demanding repeat studies just does not seem normal, just to recheck for leaks. If the MD that is demanding a new sleep study, each year, has anything financial to do with a sleep lab he recommends, he may be getting unlawful kickbacks for referring patients to do to this. It could be a violation of federal Stark Laws (anti-kickback laws affecting medical labs). This is especially serious if you are a socialized medicine recipient (Medicare). If an MD is referring Medicare patients to a clinic or lab that he has a financial relationship with and gets paid for referrals, there could be very serious consequences.

Personally, I would just call around to other board certified sleep MDs or hospitals with MDs that do sleep medicine work, and see what they say.

UPDATE -- it seems you DO have a 'brick' machine, correct? You have a PR DS250 basic CPAP machine no? I didn't catch that initially.

This is the problem with these machines -- you have no data to determine the effectiveness of therapy, other than indirectly, by how you feel, etc. The basic brick machines store no therapy data other than hours of use.

People on this board constantly warn people to ask for better machines for the very reason that without data feedback, then yes, if you want to properly retitrate (re-test effectiveness and re-adjust pressures) you WILL need a new titration sleep study.

I'm sorry but your doctor, in part, may be correct to ask for a new study if changes need to be made to your machine. Annual titration tests, however, are ridiculous. A fully data capable machine would prevent the need for any of that.

With CPAP machines it's you either pay once or may have to pay multiple times -- a basic CPAP brick may save some money up front, but you may need to get repeat titrations over time to adjust therapy. A more advanced, data capable machine or auto machine may cost a bit more (very little compared to a repeat sleep study) up front, but it saves the need for repeat, or as many repeat sleep studies.

Perhaps what you need to discuss with the MD is simply if getting a better, data-capable auto machine would help, and prevent the need for a full follow-up sleep study.
Last edited by hyperlexis on Fri Apr 24, 2015 8:02 am, edited 3 times in total.

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Pugsy
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Re: Ever Changing Protocol of CPAP

Post by Pugsy » Fri Apr 24, 2015 7:39 am

OP has a brick....so no way to verify that the mask is fitted/sealed well.
The doc says that taking Lunesta can kill you if the cpap mask isn't fitted right if someone has AFib...I don't know where he is getting that from but right or wrong that is what he says. There's some medical history going on here that we are probably missing but that's really neither her nor there because.....
With the brick there is no way to tell if a mask fits without (in his mind) a sleep study...which is of course idiotic and unneeded if someone had a full data machine...but of course then no one gets the extra revenue that a sleep study produces.

Having to bring in a broken cpap mask to the doctor for him to do whatever or not....totally insane, I bet he didn't have a clue how to even put the damn thing on..if he ever looked at it.
That's the DMEs job anyway.

A doctor that balks at writing a simple RX for CPAP Masks and/or cpap supplies so the patient can get what they want....I would be finding a new doc if at all possible. That's ridiculous. Sounds like serious God complex/control freak or really stupid and lacking serious common sense to me and any of those warrants getting fired by me if I could find someone else at all.

If the OP had a full data machine the bulk of all this drama could have been avoided.

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chunkyfrog
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Re: Ever Changing Protocol of CPAP

Post by chunkyfrog » Fri Apr 24, 2015 9:12 am

Or the doc has a wild hair up his behind that the OP wants to abuse/sell Lunesta.
Definitely time to look for a different doctor!

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Re: Ever Changing Protocol of CPAP

Post by BlackSpinner » Fri Apr 24, 2015 10:14 am

I am still trying to figure out how that doctor was going to tell if the mask leaked without her having it on and the machine running! Dropping it off would have told him absolutely NOTHING other then it is a mask.

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Re: Ever Changing Protocol of CPAP

Post by chunkyfrog » Fri Apr 24, 2015 10:47 am

Why ON EARTH would anyone in a doctor's office, especially the DOCTOR,
have a patient leave their ONLY MASK in the office for longer than a few minutes?
RUN! ---FOR YOUR LIFE!
I would expect better care in a CASINO!

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Re: Ever Changing Protocol of CPAP

Post by JohnO » Fri Apr 24, 2015 11:48 am

chunkyfrog wrote:I would expect better care in a CASINO!
That made me LOL. Of course, the casino can clearly see the benefits of increasing the life of their customers -- more so than some in the medical profession, sadly.

Just to add another data point. I had my initial sleep study in the summer of 2012. As a pilot, the FAA requires me to show a note from my sleep doc every year. I have a form letter than my doctor reviews and makes any changes, as required, looks at my data, (again, you need the fully data capable machine for this to be practical), gives me a quick check with the stethoscope, and I'm out the door. If I didn't have the FAA requirement, I would not go in unless I were having issues. I usually check my data once every couple of weeks or so using the Respironics software.

I get most of my supplies and masks from cpap.com, but I have visited the DME a couple of times over the last couple of years to try different masks. With my insurance, it is still cheaper to use cpap.com, so I don't expect I'll be visiting the local DME again.

My sleep doc is a specialist, and not my family practice doctor. They are both "in network" for my health care provider, so I'm not sure how that would compare to health care in SC.

John

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Re: Ever Changing Protocol of CPAP

Post by Janknitz » Fri Apr 24, 2015 4:40 pm

My sleep doc is a specialist, and not my family practice doctor. They are both "in network" for my health care provider, so I'm not sure how that would compare to health care in SC.
I certainly hope that this bozo doctor is the exception and not the rule in South Carolina. Otherwise, it's time to MOVE!
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Re: Ever Changing Protocol of CPAP

Post by greatunclebill » Fri Apr 24, 2015 11:11 pm

to the OP, in looking for a new doc, it might work to go to the dme and ask them the names of the good doctors they deal with. they know which docs are a pain in the axx and which ones aren't.

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Re: Ever Changing Protocol of CPAP

Post by MiLady56 » Thu Apr 30, 2015 7:04 am

An Update...not much to tell, but continuing saga interesting.
My hubby talked to a dr friend and to his urologist. Dr friend used to the term "breach of ethics", as he felt that my dr was trying to blackmail me with Pubertal withholding. He added that he has treated many patients with CPAP and sleep meds, not lost one yet.
Urologist (really smart guy, also lawyer) knows my GP and was taken aback. Recommended new dr.
Oh, my GP, is back from vacation since Monday. Still has not returned my message.
I am gone from this guy. Again, thanks for your support.

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Re: Ever Changing Protocol of CPAP

Post by chunkyfrog » Thu Apr 30, 2015 7:31 am

(High five!).

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Re: Ever Changing Protocol of CPAP

Post by hyperlexis » Thu Apr 30, 2015 10:09 am

MiLady56 wrote:An Update...not much to tell, but continuing saga interesting.
My hubby talked to a dr friend and to his urologist. Dr friend used to the term "breach of ethics", as he felt that my dr was trying to blackmail me with Pubertal withholding. He added that he has treated many patients with CPAP and sleep meds, not lost one yet.
Urologist (really smart guy, also lawyer) knows my GP and was taken aback. Recommended new dr.
Oh, my GP, is back from vacation since Monday. Still has not returned my message.
I am gone from this guy. Again, thanks for your support.

The MD is a GP, which could mean he has a sub-specialization in anything from family practice to rheumatology. It's not completely fair to run to a rural GP and demand specialized equipment and things better suited to seek from a knowledgeable sleep medicine specialist or an ENT or a pulmonologist -- and then get angry when the GP gets confused or requests testing. He just plain doesn't know, but, frankly, he's not a specialist in the field anyway. It's hard if he's the only MD in a hundred miles to deal with, but well, life isn't fair in many ways.

Simple fix, rather than threatening nonsense or talking to urologists of all people -- pick up the yellow pages and find a sleep medicine doctor or a pulmonologist. Go to that person instead of some country doctor generalist. And sell the brick CPAP machine and get a full-data, modern auto pap machine. That way whatever doctor you do go to will at least know what the data says and not need to require repeat sleep studies be done because you have a non-data, brick machine.

Good luck with whatever you do!

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Re: Ever Changing Protocol of CPAP

Post by archangle » Thu Apr 30, 2015 10:55 pm

Janknitz wrote:Your doctor is an IDIOT!
You're being too kind.
hyperlexis wrote:
The MD is a GP, which could mean he has a sub-specialization in anything from family practice to rheumatology. It's not completely fair to run to a rural GP and demand specialized equipment and things better suited to seek from a knowledgeable sleep medicine specialist or an ENT or a pulmonologist -- and then get angry when the GP gets confused or requests testing. He just plain doesn't know, but, frankly, he's not a specialist in the field anyway. It's hard if he's the only MD in a hundred miles to deal with, but well, life isn't fair in many ways.

Simple fix, rather than threatening nonsense or talking to urologists of all people -- pick up the yellow pages and find a sleep medicine doctor or a pulmonologist. Go to that person instead of some country doctor generalist. And sell the brick CPAP machine and get a full-data, modern auto pap machine. That way whatever doctor you do go to will at least know what the data says and not need to require repeat sleep studies be done because you have a non-data, brick machine.
You don't need a sleep doctor or pulmonologist, unless you have special problems, although that might help. Many of them are idiots, too. However, there's a good chance any new doctor will want to screw you by requiring a new sleep test. That's the way the medical mafia works.

If all the things you said are really what he meant, MiLady, you need a new doctor at a new clinic before this one kills you, CPAP related or not. Unfortunately, you will probably have to start all over again, and fight to get your Lunesta and CPAP prescriptions again.

If the doctor is too incompetent to rewrite a prescription for a REPLACEMENT mask, he should have referred this patient to someone with a clue.

If he's worried that Lunesta and a poorly fitting mask equals death, he needs his medical license revoked.

If he believes that Lunesta and a poorly fitting mask equals death, and he didn't specify a fully data capable CPAP machine with wireless monitoring, he needs his license revoked.

If he believes that Lunesta and a poorly fitting mask equals death, he shouldn't be prescribing Lunesta, even with monitoring. Even a mask that fits correctly every night for a year might have the straps slip and not fit tomorrow night.

If he really believes CPAP causes AF, he probably doesn't really have a medical degree, but untreated apnea might cause AF. Have you ever had an AF or some other serious problems before you started CPAP?

You definitely need a data capable CPAP machine if you're having any kind of CPAP problems. Buying one outright online will probably cost less than your copay for unnecessary sleep tests.

Hint: Send a copy of your prescription to cpap.com or some other online sellers and you will probably be able to buy replacement masks forever.

Some people buy their mask a part at a time from eBay or Amazon or elsewhere to get around the prescription requirement.

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Re: Ever Changing Protocol of CPAP

Post by cathyf » Fri May 01, 2015 10:40 pm

I'm thinking I misunderstood you... You dropped off your mask at the doctor's office, and then you left the office taking your face with you? How can the doctor check how the mask fits on your face without YOUR FACE?!?!?