Question About Severity

[kaiasgram]

Did you read this?
http://maskarrayed.wordpress.com/
Scroll down just a little ways till you see what Janknitze wrote about "Help, I have been given a brick".

I only read the first post. I didn't see the strategy section. Looks like a good approach. Thanks.

So the probability is that my current pulmonologist is "in on" the scam. I have to find out what my options are with the insurance co, and get my PCP to cooperate in writing a proper prescription. Hopefully I can get things straightened out. My PCP requested that he get a copy of the sleep study, and I requested that my pulmonologist send it to him. I'll have to make sure that's been done.

JQ, I skimmed this thread so forgive me if I'm repeating... If your insurance is covering the S9 Escape then it will cover the S9 Elite, which is the same machine except that it records all the important data that Pugsy mentioned. Your insurance would also cover the S9 Autoset which is an auto-adjusting CPAP -- pressures can vary as you need them to during the night. (Avoid the S9 "Escape Auto.") The Autoset can also run in straight CPAP mode (a single fixed pressure), and is a full data machine.

The thing is that insurance pays by the billing code and it's the same billing code for all the above-mentioned machines: E0601. So your doc may or may not be aware that the DME gave you the cheapest machine they could get away with, because more than likely the doc's prescription simply identified the machine by the insurance billing code.

[JQLewis]

The thing is that insurance pays by the billing code and it's the same billing code for all the above-mentioned machines: E0601. So your doc may or may not be aware that the DME gave you the cheapest machine they could get away with, because more than likely the doc's prescription simply identified the machine by the insurance billing code.

Could be. The question that occurs to me though is why the doctor wouldn't be specific in his prescription? He's the doctor, right, not the DME. Why leave such an important decision up to a company which has no medical responsibility and makes decisions based solely on their "bottom line"? He's supposed to be a "scientist", after all. Why would a doctor, a "scientist", not want data?

According to the research I did last night, my insurance would indeed cover any cpap machine my doctor deems necessary. If that does prove to be the case, then it seems to me that he's been irresponsible at best and part of some kind of kick-back scam at worst. Unless there's some sound medical reason to be unconcerned about the choice of machine.

[Bama Rambler]

Welcome to the wonderful world of sleep (or should I say non-sleep). The problem is that most docs don't even look at the data. Mine seemed surprised when I took the reports to him. Once he saw them he was interested, but he was perfectly asking the pat questions (how do you feel, are you feeling sleepy during the day, etc.) and not looking at the data. I think part of the problem is that they have a mind set that most people diagnosed with OSA aren't data savvy. That is changing by leaps and bounds now, and hopefully we'll see things get better in the future as more people realize that there are machines that can give them data so they can tell exactly how their therapy is working.

Don't be timid when facing the DME, doc or PT about replacing the brick you have for a full efficacy data machine.

[steeve]

I was given a brick to start with. Exchange went fairly easy when I insisted, didn't even have to tell them I had another DME that was willing to give me the machine I wanted. Do Not accept anything with Escape in the name.

For my part it seems the DME people know less than I do at this point. There I go painting with the broad brush. There are knowledgable, caring DME's; just luck of the draw finding one. And there isn't one who cares as much about your health as you do!!!

As for your Dr., who you will see for brief moments I feel if you can't communicate with him easily, it would definitely be advised to find one you can. Unless he is the only one in the area or a really great sleep Dr.

I know I would probably have given up on this whole mess without the help and information-support gained here.

[StuUnderPressure]

According to the research I did last night, my insurance would indeed cover any cpap machine my doctor deems necessary. If that does prove to be the case, then it seems to me that he's been irresponsible at best and part of some kind of kick-back scam at worst. Unless there's some sound medical reason to be unconcerned about the choice of machine.

Well, that definitely is a possiblility, - but maybe it is not the case.

The Sleep Doctor interprets the Sleep Study, determines that you do have Sleep Apnea & need a machine - so he writes you an Rx. At this point (at least in his mind), his responsibility stops & it is now the responsibility of the DME to supply you with a machine & teach you how to use it.

Based on how the Rx is written, the DME will definitely try to make the most money by giving you the cheapest machine because the insurance company will pay the DME the same amount no matter what machine the DME gives you.

And to add insult to injury, most Sleep Doctors just don't really care about having all of the extra data. Most never even look at it. When you go back to the Sleep Doctor for follow up visits, he wants to just ask you whether you are using your machine & for how many hours each night. The "brick" you got will give him that information.

Have some Doctor give you an Rx for a ResMed S9 AutoSet with a pressure range of X - Y.

Make sure you keep the "original", so you can make copies as you need to.

Make a copy of the Rx for the DME, then politely tell your DME that you will NOT do business with them unless they give you what you want. And most importantly of all, MEAN IT.

The DME does NOT need the "original". A copy is sufficient. They will just scan it into their computer system & then shred the copy anyway.

[JQLewis]

The Sleep Doctor interprets the Sleep Study, determines that you do have Sleep Apnea & need a machine - so he writes you an Rx. At this point (at least in his mind), his responsibility stops & it is now the responsibility of the DME to supply you with a machine & teach you how to use it.

I can't speak to what goes on in the mind of a sleep doctor, but neither can I believe that a doctor's responsibility ends with diagnosis. I especially find it difficult to believe that a doctor can be justified in turning such responsibilities over to an equipment rental company. I decided to check into it, and according to the American Academy of Sleep Medicine the sleep doctor is very much responsible for making sure the therapy is effective. According to the guidelines they've established my sleep doctor has already been irresponsible in his handling of my case. The AASM guidelines say I should have been contacted by my doctor (not the equipment company) within a few days of receiving my equipment, and I should have had a follow-up office visit scheduled for no later than a month after beginning therapy. Instead I've been left entirely on my own, with no attempt to schedule a follow-up. And what would a follow-up reveal? What good would it do to tell the doctor my subjective perceptions? How does that prove or disprove the effectiveness of the therapy? Only objective data can do that.

[Judge Nap]

I can't speak to what goes on in the mind of a sleep doctor, but neither can I believe that a doctor's responsibility ends with diagnosis.

It's time to quit worrying about all these damn philosophical questions. "You ain't gonna change the field of sleep medicine in the next six months."

But you could get a full data machine, "become you own doctor" and change your health in a very big way in less than six weeks.

[Jay Aitchsee]

JQ, I'm afraid the Judge is right. I went through 4 sleep doctors before I found one that was interested in looking at my sleep data. (I'm not sure those first four knew it could be done.) In the meantime, I learned all I could about the therapy and was able to optimize it on my own. The one subjective perception that is important is how you feel. If your therapy is optimized (but you need a data capable machine to tell) and you still feel tired or fatigued, then it is time to look elsewhere for the problem. But before looking elsewhere, you must ensure your apnea is controlled. Therefore, you must have a data capable machine.

[JQLewis]

JQ, I'm afraid the Judge is right. I went through 4 sleep doctors before I found one that was interested in looking at my sleep data. (I'm not sure those first four knew it could be done.) In the meantime, I learned all I could about the therapy and was able to optimize it on my own. The one subjective perception that is important is how you feel. If your therapy is optimized (but you need a data capable machine to tell) and you still feel tired or fatigued, then it is time to look elsewhere for the problem. But before looking elsewhere, you must ensure your apnea is controlled. Therefore, you must have a data capable machine.

I certainly have no illusions about changing anything, but I'm not sure that building an effective support team is merely philosophical. Most people accept substandard care because they don't know what is and isn't acceptable behavior from their doctors. I guess you do, unless there was another reason for you to have gone to five different sleep docs? Now that you have succeeded in finding a sleep doc who is interested/aware of the importance of this data, was it worth the effort? I accept my primary responsibility in these matters, but that doesn't mean I'm willing to accept irresponsible behavior from my doctors.

As an example, I've been trying for three weeks, since my sleep studies, to get my pulmonologist to send my PCP a copy of my sleep studies. Yesterday they told me they'd tried to send it, but the fax wouldn't go through. Apparently it never occurred to them to print it out and mail it, or send it as an email attachment. They tried to fax it, failed, and gave up. That's not acceptable to me. I told them I would be coming by to pick up a copy of the reports in person, at which time they offered to email it to me. Ten minutes later I had the reports. They also, in response to my questions about why I was given a brick, replied with a bunch of incomprehensible nonsense. I will not be contacting them again.

I don't want to wait until I find a competent/responsible sleep doc to take charge of things, but I can't write my own prescription for a data capable machine. Hopefully next week, my PCP, sleep studies in hand, will be cooperative in this matter. If not, maybe my new sleep doc will cooperate a week after that. How did you get a data capable machine without a doctor who felt it was necessary?

[robysue]

How did you get a data capable machine without a doctor who felt it was necessary?

In my case, I got a Resmed S9 AutoSet when I first started PAPing in Sep. 2010 by calling a lot of DMEs and asking whether they'd set me up with an efficacy data machine even though my script only said CPAP at 9 cm. By doing the shopping before accepting a machine, I was able to find a small, specialized DME that sets all their new patients up with the patient's choice of a Resmed S9 AutoSet, a PR System One Auto CPAP, or an F&P Icon Auto right from the start.

[JQLewis]

An update: I called the DME, to ask about switching the escape for an autoset, and was told that the prescription had specified an escape. So I did call back my sleep doc (never say never), to ask why they'd done that, and to request a change. They said the escape was the better model, and why would I want to switch? I replied that I wanted to know about leaks and ahi info. I was told the doctor would call me back, as he was not in the office until tomorrow. We'll see what he's got to say. Is there any justification in considering the escape superior? The Resmed page describes it as an "entry" level machine, it's the choice of only 3% of patients, and it seems to be the cheapest machine they have. Doesn't sound superior to me, but maybe there's something I'm missing. I would like to have a counter for any arguments the doctor might make.

[Pugsy]

Is there any justification in considering the escape superior?

None....nada...zilch. Not one thing better than the Elite or the AutoSet except wholesale price to whomever sells it to you so they make more money.

Does your doctor or his staff, have any financial interest in the equipment supplier? Did they steer you to this particular DME or did you pick it out on your own?
I would be shopping for a different DME...and I would want to see a copy of that RX that says specifically "Escape" and if it does...get a new script. Doctors rarely specify brand names..much less model names unless they have a financial interest in the equipment supplied aspect of things.
If you were Medicare patient...that's against the law for a doctor or any member of his staff or family to have any sort of financial interest in DME equipment.

[JQLewis]

OK, things are looking pretty good right now. According to the DME the cpap machine is a rental item and can be returned at any time during the rental period. There may be a gap between the return of the machine and the arrival of the new machine, but apparently that can't be helped, Hopefully it will be only a day or two. I need to get a new script specifying the elite or autoset machine, and that has to be approved. Once it's approved I can return the old one and get the new one. Approval for the first machine took a couple of weeks, so none of this will be immediate, but I should, with persistence, be able to get things straightened out.

As far as the relationship between the doctor and the DME goes, I've always assumed, cynic that I am, that all such relationships involve some kind of kickback scheme. Under the table no doubt, so there's no record to trip them up, but there's a definite quid pro quo involved. I could be wrong, of course, but in this case it seems the logical explanation. I'm very glad I found this site. I'm sure most people who have inferior equipment foisted on them have no idea there's anything wrong.

[Jay Aitchsee]

..unless there was another reason for you to have gone to five different sleep docs? Now that you have succeeded in finding a sleep doc who is interested/aware of the importance of this data, was it worth the effort? I accept my primary responsibility in these matters, but that doesn't mean I'm willing to accept irresponsible behavior from my doctors.

Was it worth it? Yes.
I got my data capable machine by a fluke. After my initial sleep study, my sleep doctor prescribed a machine and mask. I don't know what kind of machine it was. After a few weeks of trying to use it, with no help from the doctor or DME, I took it back, told the DME I didn't want it, couldn't use it. After some time went by, I saw another Dr. who thought EPR was great and prescribed a cpap machine that had that feature. Well, that turned out to be the S8 elite, which was data capable. I used that machine about a year while working with this doctor, keeping a hand written log of the LED readout of my overnight sleep results. Then I discovered, maybe by visiting this forum, that the machine provided all kinds of useful information that could be downloaded into a computer program. Wow! I was a little angry that my doctor hadn't told me this, but honestly, I don't think he knew it. Fact of the matter is, after I became proficient in ResScan, I showed my DME how to use it. About all he knew how to do was retrieve compliance data.
So, off I went looking for another Dr that could help me. Through Doctors 3 and 4, whose treatment suggestions were, "try this and come back in 6 months". So far, no doctor had shown any interest in the results of my therapy as reported by my machine. I had my apnea under control but I still wasn't getting restorative sleep. Then Dr number 5. When I walked in with my charts and graphs, IR video recordings, Pulse-Ox reports, Zeo Reports, etc. and she wanted to see all of them, I knew she was a keeper.
The first thing this Doctor did was order a complete blood work-up. Duh. No one had thought to do that before. She did find I had several deficiencies, D3, thyroid, B12, etc. and we've been working to overcome them and uncover any other reasons I may not be obtaining optimal sleep. Since seeing her my sleep has improved. It's not as good as I'd like it, but it is a lot better than it was 6 years ago when I started on this journey, at least I can function now. So yes, it was worth it.
I just read that you'll be getting a new machine. That's great! Good job!

[NachtWürger]

As far as the relationship between the doctor and the DME goes, I've always assumed, cynic that I am, that all such relationships involve some kind of kickback scheme. Under the table no doubt, so there's no record to trip them up, but there's a definite quid pro quo involved.

Ridiculous, childish ramblings.

Most DMEs don't make enough profit to offer anyone a kickback.

Most doctors are backbones of the community and highly ethical.