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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
MaskingtheNightAway
 
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Re: Why is it necessary to have a support team?

Postby MaskingtheNightAway on Sun Dec 27, 2015 6:24 pm

From reading the last post, it confirms my suspicions that Sleep Labs and DME's are just in it for the money.

I've got my own equipment and now I'm having trouble finding a DME that will sell me mask's and tanks thru my Employer's Insurance Plan.

There seems to be a code that if you go "Outside" the system or process, no one wants to help you.

Teaching me a lesson, EH?

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LSAT
 
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Re: Why is it necessary to have a support team?

Postby LSAT on Wed Dec 30, 2015 7:40 am

MaskingtheNightAway wrote:From reading the last post, it confirms my suspicions that Sleep Labs and DME's are just in it for the money.

I've got my own equipment and now I'm having trouble finding a DME that will sell me mask's and tanks thru my Employer's Insurance Plan.

There seems to be a code that if you go "Outside" the system or process, no one wants to help you.

Teaching me a lesson, EH?


Call your insurance company and ask which suppliers (DME) are in their network.....By the way....what business is not in it for money?

_________________
Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: S9 Autoset...APAP Settings 11-15
Last edited by LSAT on Sun Jan 03, 2016 10:12 pm, edited 1 time in total.


S9 Autoset
Back up mask is another Quattro FF and an F20
Buckwheat Hull Pillow (CPAPfit) from http://www.pur-sleep.com/

xxyzx thinks he knows far more than he does, beware his advice.


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Roman Hokie
 
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Re: Why is it necessary to have a support team?

Postby Roman Hokie on Fri Jan 01, 2016 6:32 am

LSAT wrote:
Call your insurance company and ask which suppliers (DME) are in their network.


Exactly. My new insurance provider has 3 levels of coverage. Affiliated (I work for a hospital), in network (non-affiliated), and out of network. So, I called the insurance company and they report that my Sleep Doc is affiliated (I can look that up on the hospital website) and they weren't sure about the DME because he's not a Doc. So, they had to call him to find out who his distributor is for the hardware. They are listed as being "in network" which is still 100% covered without copay/coinsurance/deductible.

However, they cannot complete a prior authorization with the patient; they have to confer with the DME provider. It's the DME's job to secure their prior authorization (agreement) that the item is covered. So, even if the DME is in the network, the DME will need to secure approval. Generally (and I have to do this at work at times for my own patients), it takes 1-3 days, sometimes as little as 20 minutes from the initiation of the phone call, but voicemails and whatnot..

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tlohse
 
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Re: Why is it necessary to have a support team?

Postby tlohse on Mon May 30, 2016 6:05 pm

A support team is very important. You need to have a team that supports you through this disorder other wise you will often fail. I have been a CPAP user since 2013. Im 38 and doing great with my machine. and my sleep doctor and family and DME support me all the way.

_________________
Mask: Mirage™ FX Nasal CPAP Mask with Headgear
Humidifier: PR System One 50 Series Heated Humidifier
Additional Comments: First became a cpapper June 11, 2013 pressure setting 10cmH20. DX: Severe Sleep Apnea with Hypersomnia. REF# 450P
Thomas Lohse
Cpap is 4 ever.

RonSchuster99
 
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Re: Why is it necessary to have a support team?

Postby RonSchuster99 on Wed Feb 01, 2017 4:48 pm

I have two CPAP machines, had two sleep studies, and had to go to local yokel to "set" the machines to a pressure level, and lock me out of the menu to set the pressure. The mfgrs tell me that I have to run back to the providers to make any adjustments to the machine pressure. Well, they aren't real good at their jobs, because one is set too weak, and one is set very high. I WANT TO BUY A MACHINE AND CONTROL THE SETTINGS MYSELF. I'm a user for over 6 years, and can control the settings better than the dumb ass techs who messed up the two machines I have. Where can I buy a machine ad have full access to the settings and menus?

RonSchuster@Gmail.com

HoseCrusher
 
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Re: Why is it necessary to have a support team?

Postby HoseCrusher on Wed Feb 01, 2017 10:56 pm

I believe all you need is the operators manual for your two machines. The manual will instruct you how to adjust settings. These manuals are available on line.

What units do you currently have?

_________________
Mask: Nuance & Nuance Pro Nasal Pillow CPAP Mask with Gel Nasal Pillows
Humidifier: HumidAire H4i™ Heated Humidifier
Additional Comments: Retired my Swift FX
Machine is an S8 Autoset II. SpO2 96+% and holding...

ICantBreath
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Re: Why is it necessary to have a support team?

Postby ICantBreath on Thu Apr 13, 2017 7:44 pm

Hello Everyone
I'm new to the forum & have had my CPAP since Sept. 2016 but I need a support group. I'm ready to throw my DreamStation in the trash. I have had issues since the beginning and I can't tell you when I dreamed last. I have been through several nasal pillow type masks, I now have a Amara View full face & sometimes it works, but mostly it don't. I have tried mask liners, now I make my own. I have panic smothering attacks with the mask sometimes & then sometimes I'm fine, I also have asthma & a chronic cough. I have a CPAP pillow and a hose cover. I rip the mask off & don't know unless I wake up at night or the next morning. My AHI is over 5 almost every night. I'm trying to get a copy of my sleep study, but at this time I don't have it
I'm in the process of finding a new primary care doctor that hopefully can help with my sleep apnea. Unfortunately, there is only one O2 supplier in my area & I've been waiting well over a month just to get my DreamStation turned to the AUTO setting. I got great support for the first 90 days, until Medicaid paid for the machine. Now I get transferred to Tennessee from my local Colorado office. They refuse to communicate with my doctor or me, unless I call them and the call the doctor. I have never had such problems with any home health company. It's like they speak two different languages. I apologize for my rant, but I had to talk to somebody.

DreamStation; AmaraView Full Face mask, Sleepyhead

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LSAT
 
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Re: Why is it necessary to have a support team?

Postby LSAT on Thu Apr 20, 2017 3:49 pm

ICantBreath wrote:Hello Everyone
I'm new to the forum & have had my CPAP since Sept. 2016 but I need a support group. I'm ready to throw my DreamStation in the trash. I have had issues since the beginning and I can't tell you when I dreamed last. I have been through several nasal pillow type masks, I now have a Amara View full face & sometimes it works, but mostly it don't. I have tried mask liners, now I make my own. I have panic smothering attacks with the mask sometimes & then sometimes I'm fine, I also have asthma & a chronic cough. I have a CPAP pillow and a hose cover. I rip the mask off & don't know unless I wake up at night or the next morning. My AHI is over 5 almost every night. I'm trying to get a copy of my sleep study, but at this time I don't have it
I'm in the process of finding a new primary care doctor that hopefully can help with my sleep apnea. Unfortunately, there is only one O2 supplier in my area & I've been waiting well over a month just to get my DreamStation turned to the AUTO setting. I got great support for the first 90 days, until Medicaid paid for the machine. Now I get transferred to Tennessee from my local Colorado office. They refuse to communicate with my doctor or me, unless I call them and the call the doctor. I have never had such problems with any home health company. It's like they speak two different languages. I apologize for my rant, but I had to talk to somebody.

DreamStation; AmaraView Full Face mask, Sleepyhead


It takes about 30 seconds to make that change Request the Clinical Manual at the apnea board. Control your own therapy.
http://apneaboard.com/

_________________
Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: S9 Autoset...APAP Settings 11-15


S9 Autoset
Back up mask is another Quattro FF and an F20
Buckwheat Hull Pillow (CPAPfit) from http://www.pur-sleep.com/

xxyzx thinks he knows far more than he does, beware his advice.


HannaJ
 
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Re: Why is it necessary to have a support team?

Postby HannaJ on Sat May 13, 2017 2:03 am

Interesting thread. When I see "support team" I think of professionals, but in our current health care environment, putting together a team of people with enough time, frequent enough availability for appointments, sufficient skill, and insurance coverage can present major obstacles. I live alone; I don't have many close friends, and those that I do have are very busy. My sister does CPAP, so that is good, but she lives 3000 mi. away. Because I know about apnea and CPAP, I knew I'd have to adjust to the machine. I've had some problems with that, but I think they are surmountable. My biggest problems have been with the health industrial complex:

1) I am insured by an HMO that approves treatment only by physicians in the local network, or selected distant locations. I had to fight to get a visit with a top expert clinician in Los Angeles approved.
2) My local specialist is hard to see, because he wears several hats. You can't just call and schedule an appointment in the next couple weeks. The next couple months counts as success.
3) Communicating with the clinic my sleep specialist works with is a huge nuisance. Call, go through several menus, maybe talk to a machine, wait and hope for a call back. Or talk to PA, who garbles your message to the doctor. Sort it all out with another call--menus, messages, wait, more garble.
4) Coordination among sleep specialist, sleep study center, and equipment supply store is cumbersome, and involves yet more wait times for appointments and approvals from the HMO/physician group, and more garble.
5) The doctors themselves can be a problem. My sleep specialist is great, but my pulmonologist (I started there because I had heart-related breathing problems) can be rather blasé. After a sleep study that continued into the next day, he blithely informed me that I had REM behavior disorder, and sort of left it at that. Upon web research, I learned to my terror that, of people with full-on RBD, 45% experience onset of a serious neurodegenerative disorder within 5 years, and 60% within ten years. The medical literature emphasizes that this is correlation without clear causation, but those stats scared me out of my socks. We're talking Parkinson's disease, MS, multiple system atrophy (don't ever read about it), and such like. As a woman, I was less likely to have full RBD, but my age (early 60s) is correct, and the sleep study showed lack of atonia during REM sleep. Hence the fight to see the guy in LA.

I had my first sleep studies last June; I started CPAP in July; it has taken me a year to get to the point of seeing the REM specialist in LA. Even that was disheartening. When I called to set up the appointment, I was told that there was no guarantee I would see the specialist; I might see one of his residents (i.e., trainee doctors). After all that work getting the visit approved!! Without approval, a visit would cost between $600 and $1500 (at a state institution, not a private clinic). Finally, I secured a June 6 appointment. But, lo! They made that appointment without checking with the doctor. Pushed back to June 26. I had to impress upon several people that ***my brain was on the line here***. This wasn't poison oak or a head cold.

I have very good health coverage through my job; probably better than very large numbers of people. So I shudder to think of what less-fortunate people have to go through. All this is/was extremely discouraging and infuriating. And, of course, I go through it all in a state of sleep deprivation.

Sorry to write this long diatribe, but I think it's important that people share stories of dealing with the medical industrial complex, share tips, and give each other emotional support. I've found this forum very practical so far, but also a bit on the emotionally chilly side. What I would like to tell people who are struggling with getting the care they need is this: Stick up for yourself! Keep calling. Go as far up the chain of command as you can. Use all the resources your providers make available, e.g., patient portals you can use to send messages to your doctor between visits. Use the internet for research, but take what you find with a grain of salt and vet your sources carefully (many medical studies reported in journals are financed by pharmaceutical companies or other corporations in the health care business). The lower ranks of the medical practices I use probably hate me. But, hell, I'm going to be seen by the man who literally wrote the book. And I did that by sticking up for myself and not giving up.

_________________
Machine: DreamStation Auto CPAP Machine
Mask: AirFit™ F10 For Her Full Face Mask with Headgear
Humidifier: DreamStation Heated Humidifier
Additional Comments: Pressure 16; heat 2-4 dep. on room temp. I've tried FP Simplus masks and PR nasal pillow mask with chin strap and mouth tape.
HannaJ

HannaJ
 
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Re: Why is it necessary to have a support team?

Postby HannaJ on Sun May 14, 2017 2:30 am

For ICan'tBreathe: I sympathize with your difficulties. Isn't Medicaid administered by the state? Why would you be referred to a different state? That's worth looking into.

Social programs like Medicare and Medicaid can be roadblocks. My sister needed new filters for her machine, just as she was transitioning to Medicare. She went two months without therapy because of all of the miscommunications she experienced, as well as red tape. She cares for my very elderly Mom around the clock, and never gets a full night's sleep. Medicare was giving her trouble about covering her needs because she wasn't compliant enough! As if she had a choice.

I don't find it particularly supportive to say things like "aren't all businesses in it for the money." What the poster obviously meant was that these businesses that are supposed to care for sick people are in it **only** or mainly for the money. There's nothing wrong with making a profit, but an ethical health care business needs to care about its customers. People who care only about money should find some other kind of business to run.

Saying that a good support team is essential can be very discouraging for the many people who are not able to find or form one. It's also discouraging to realize that you are on your own and responsible for managing everything from dealing with healthcare providers to researching your medical conditions to shopping for and trying out equipment. It's very hard to find the time, energy, and resources to do it all. Under the guise of encouraging people to be "informed consumers," care providers shunt work onto sick people, not all of whom have the education or resources to read complicated medical and pharmaceutical research, or the assertiveness to demand what they deserve from providers. A forum like this is very important in helping people in such situations.

_________________
Machine: DreamStation Auto CPAP Machine
Mask: AirFit™ F10 For Her Full Face Mask with Headgear
Humidifier: DreamStation Heated Humidifier
Additional Comments: Pressure 16; heat 2-4 dep. on room temp. I've tried FP Simplus masks and PR nasal pillow mask with chin strap and mouth tape.
HannaJ

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