Quick Question... is this TRUE??

[Orionstarr]

I was told today by the DME that an auto cpap (we were discussing in particular the M series auto cpap with aflex) will NOT adjust your pressure while you sleep? It will only adjust the pressure upwards until it finishes titration then will level off there and stay there static? In other words, if say you are on your back and you need very high pressure of say 18 and you roll over and require far less pressure (like 12 or 13) it will not ease up the pressure but instead stay at the highest pressure detected (18)... is that true?? Because I thought that auto's would continually adjust throughout the night according to your needs... they said apap is only used as a diagnostic tool never as a permanent machine, yet the majority of people here have auto adjusting machines. Would you guys set me straight on this? Thanks so much!

~Starr

[tattooyu]

That sounds totally wrong to me. My APAP machine adjusts all throughout the night up and down depending on if it sees flow limitations and such.

And I'm pretty sure AutoPAP is NOT just diagnostic!

[The Texan]

No, as usual the DME has no idea what they are talking about. I have the exact machine you were discussing and mine adjust up and down, depending on what it detects. Mine was set to operate between 8 and 12 and many times I woke up with it at 12 and then later woke up with it back to 8. Sorry but they are providing you with false information.

[Wulfman]

I was told today by the DME that an auto cpap (we were discussing in particular the M series auto cpap with aflex) will NOT adjust your pressure while you sleep? It will only adjust the pressure upwards until it finishes titration then will level off there and stay there static? In other words, if say you are on your back and you need very high pressure of say 18 and you roll over and require far less pressure (like 12 or 13) it will not ease up the pressure but instead stay at the highest pressure detected (18)... is that true?? Because I thought that auto's would continually adjust throughout the night according to your needs... they said apap is only used as a diagnostic tool never as a permanent machine, yet the majority of people here have auto adjusting machines. Would you guys set me straight on this? Thanks so much!

~Starr

You're dealing with an IDIOT.
It's amazing how some of those people just make stuff up if they don't know the answers.


Den

[Slinky]

The Texan is just being kind - some of these sheister local DME supplier RTs are "less than truthful" (I'm TRYING to be polite too). And even it your DME supplier's is just IGNORANT, there is NO EXCUSE for someone in that position to be THAT IGNORANT!! NONE!

[sleepisgood]

They are wrong. And if they don't know that an APAP titrates up and down they can't even be familiar with Encore Pro- the graphs clearly show pressure going up and down. Even amateur me can look at it and say "I snored... There was an obstructive event, and my pressure went up, then it went down.

I was running at a straight 15, then a straight 13, now I spend most of my night at 12 with bumps up to 15 a couple times a night. I'm more comfortable and sleeping better- thanks to an APAP that adjusts both ways. v

[Orionstarr]

I FREAKIN' KNEW IT!! They totally had me doubting myself, they are supposed to be the "PRO'S"... STILL you would think they would be more informed. (Though they seem to know more than my sleep study doctor.) Thanks guys!! I knew I could count on you for the facts. The DME people were actually very nice to me and were trying to be very helpful, I honestly believe they didn't know or have any idea. Still you would think that if they deal with the equipment they would know about it...

On the other hand... they could be saying that because of insurance... they did tell me that both auto and cpap have to be billed out under the same code and insurance companies will only pay a certain amount - the doctor's Rx was for Auto-pap as my permanent machine, but the DME was trying to give me a loaner as a home titration study so that they could get my pressure and try give me another standard cpap machine, they emphatically stated they will not and do not give auto machines out as perm machines ... even though that is what the doctors Rx was for... ( I ALREADY have a cpap and can not tolerate it...my Rx pressure is 13) I also think they can not bill BCBS until they prove compliance... I think they are not wanting to fill the Rx because of insurance billing - what do you guys suggest i do? Find another DME?

This is turning into a full time job for me - I wasted 4 hours driving down and back there today in the rain and Houston traffic only to go home empty handed because I did not want to take a used machine on a temp basis so they can give me exactly what I already have in 2 weeks time, that makes zero sense.

Since I do not have the cash to go out of pocket for the machine and file for reimbursement I have to get the machine from a DME so that they can bill the insurance. Otherwise I would just buy my machine from Cpap.com and submit a claim myself.

[Wulfman]

I FREAKIN' KNEW IT!! They totally had me doubting myself, they are supposed to be the "PRO'S"... STILL you would think they would be more informed. (Though they seem to know more than my sleep study doctor.) Thanks guys!! I knew I could count on you for the facts. The DME people were actually very nice to me and were trying to be very helpful, I honestly believe they didn't know or have any idea. Still you would think that if they deal with the equipment they would know about it...

One the other hand... they could be saying that because of insurance... -they did tell me that both auto and cpap have to be billed out under the same code and insurance companies will only pay a certain amount the doctor's Rx was for Auto-pap as my permanent machine, but the DME was trying to give me a loaner as a home titration study so that they could get my pressure and try give me another standard cpap machine, they emphatically stated they will not and do not give auto machines out as perm machines ... even though that is what the doctors Rx was for... ( I ALREADY have a cpap and can not tolerate it...my Rx pressure is 13) I also think they can not bill BCBS until they prove compliance... I think they are not wanting to fill the Rx because of insurance billing - what do you guys suggest i do? Find another DME?

This is turning into a full time job for me - I wasted 4 hours driving down and back there today in the rain and Houston traffic only to go home empty handed because I did not want to take a used machine on a temp basis so they can give me exactly what I already have in 2 weeks time, that makes zero sense.

Since I do not have the cash to go out of pocket for the machine and file for reimbursement I have to get the machine from a DME so that they can bill the insurance. Otherwise I would just buy my machine from Cpap.com and submit a claim myself.

They don't want to give you an Auto because they would not make as much profit.
I would emphatically tell them that if they do not fill your prescription as written, then you will take your business elsewhere.

You may want to get your doctor involved and have him make a phone call to them to get the point across.
Find out from your insurance provider if there are other in-network DMEs that you could go to.

Den

[Slinky]

As long as your insurance allows you to go elsewhere I'd tell them that if they can't supply the xPAP you need and THAT YOUR DOCTOR SCRIPTED you will have to take your business elsewhere. You may or may not want to go to the trouble of shopping your other local DME supplier options first to find out if they will fill the script as written. Are you flexible about whether you get a Respironics or a Resmed? I ask only because some DME suppliers do the bulk of their business w/one manufacturer and thus have more leeway when watching their profit margin because they get bulk prices. Maybe you would want to consider the new DeVilBiss IntelliPAP Auto? Or even Covidien's Sandman Auto? It does sound from what you've said that this person really just doesn't know any better about the APAPs. So I guess I would give them the benefit of the doubt and at least be pleasant and civil when giving them the option to provide what you want or you will have no choice but to go elsewhere.

[jnk]

Far be it from me to play DME's advocate, but there are kernels of truth in the DME's falsehoods, in my opinion.

Manufacturer's advertise their auto machines as working for most people beautifully set up wide open, 4 to 20. So to most DMEs, that's what it means to "use an auto." I believe from the experiences I've read on this board that autos don't always work quite that way as advertised for all patients, and often give lower AHI when the minimum is raised from the preset. A DME doesn't think in those terms, though, since DMEs don't feel patients should be adjusting their own machines and putting them out of a job. (Oops, did I say that out loud?) So, from their standpoint, autos don't always work that well, when used as advertised to them.

It is also true that some patients experience runaway pressures--their auto keeps going higher and higher and doesn't come down. It doesn't happen with everyone, but I understand it does happen for some. When that happens, the maximum may need to be lowered to keep it from happening. We patients who self-titrate understand that, but, again, from a DME's standpoint, patients shouldn't be adjusting machines.

I may be just bending over backward to give the statements from the DME the benefit of the doubt, as far as motives. But sometimes what they say does make sense to them in the world they live in, even though it is pure stupidity to us. And that principle works both ways.

jeff

[wlenz]

This situation bogles the mind. You have a doctor, he writes a prescription for you. You go to the DME and he chooses NOT to fill the prescription as it is written. Suppose you were sick and went to your general practitioner, and he gives you a prescription. Then you go to your local pharmacy and the pharmacist decides to change it. Says the doctor is wrong. I have had prescriptions from MD's that were a little confusing to the pharmacist. In this situation, the pharmacist immediately calls the doctor and gets the scrip corrected, if needed. I would never walk out of the pharmacy with different meds than what was prescribed. Perhaps you can not equate the DME to a pharmacist, but the DME is filling a scrip, written by a doctor. If this DME refuses to give you the machine prescribed, I would consider filing a complaint.
Bill

[Gerald]

Star.....

There's a "tug-of-war" going on here...........

The DME wants to make more money.....and he will destroy your ability to take charge of your own therapy....in order to achieve his goal. He cares nothing about your well-being. You're pulling one way....and your DME is pulling in the other. Your health hangs in the balance.

What the Wulfman says is "right on the money correct".....Don't settle for anything less than a "M" series Auto with AFLEX.

Gerald

[sleepisgood]

They were surprisingly honest with you when they told you the machines are billed under the same codes and they don't want to give you a machine that you can be involved with. That's not praise- it means they think you're an idiot.

They can not override the specifics of the prescription. The RTs can call the doc for clarification or make suggestions, but they can not just say no. (Pharmacists can substitute equivilant drugs as well, but what the RT is offering is not equivilant. Especially since you've already failed therapy with what they want to give you.).

Honestly, I couldn't trust them myself. I'd find another DME to go through and tell your doc about it- they may lose a lot more patients if the doc referrs elsewhere. And money seems to be the only thing they care about.

[Marietjie]

Don't settle for anything less than a "M" series Auto with AFLEX

Hi, Gerald - When I read all the wrong answers some doctors and DME's give us, I, for sure will rather first consult Cpaptalk.com's members in future. Gerald, so you recommend 'M' series Auto with Aflex? I made a note of that.
The problem with the doctors and DMEs is that none of them are on CpapTherapy ! ? ! - so how will they ever know what to sell to a patient ? I say, they must refer patients to a hosehead to explain all the do's and don'ts ! (We can make money!)Greetings

[fuzzy96]

i read it over and over agian on this forum and just don't understand it--------"my prescrition was for an auto and they (tried or) gave me a standard cpap"

it is a violation of federal law to fill a prescription with anything other than what is prescribed. although the law alows for equivalents as, in the case of generic over proprietary drugs, those generics are tested and approved as substiutes. there is a difference between the cpap and the apap. apap's can be substituted for cpap since they can be run in cpap mode . but the vice - versa is not true.

this is why it is so important to have (the original preferred) (or) a copy of your prescription.

from there it is simple - they either fill the script as written or you'll report them to the state medical board , the state's attourney general , and the food and drug administration.

leave then no alternatives.

just remember you have to play by the rules too. you may have to show compliance and medical need but this can also be handled through any dr.s office.
good luck