Veteren Hoseheads, please share your wisdom...
I'm scheduled for a titration study tonight with Alpha Sleep Diagnostics here in Denver and hope to get a machine in the next week. They're also a DME provider in my insurance network. There are many other DMEs in my provider network, in the area. It hasn't taken long reading messages on this board to develop some skepticism about DME providers.
Here's Alpha's deal:
They'll run the titration, send results to my doctor, who will then write a prescription for a machine etc.
Alpha is set up to give me a respironics Remstar M series machine w/ heated humidifier on a 3-month rent-to-buy program "so we can see if its what works and make sure the insurance company doesn't buy something that's not what you need."
Remstar M series: https://www.cpap.com/productpage-advanc ... nformation
I asked the head tech about getting an APAP and smart card, he stated that straight CPAP works in "99.9% of cases, & APAP is only needed if there are serious compliance issues, anticipated significant weight loss, etc."
Smart card, & software would be my own out of pocket $$ likely.
The head sleep tech recommends the Swift mask, says its the best thing since sliced bread, etc. and told me about how hard it is to get a good fit with the conventional masks. My concern is that I'll blow the air out my mouth and negate any benefit, so I'm interested in a full face mask. the one I tried during desensitization was fine for the hour I tried it, I think I actually dozed off wearing it. He said that if unhappy with whatever mask I get I can swap for another mask from same manufacturer within 1 week if I'm not happy with what I get to start with. Their main brands are Resmed and Respironics.
My questions:
Is he snowing me to avoid providing an APAP? Do I NEED an APAP and if so how do I make sure I get it? I also want something I can take up to high elevation when I visit friends in the mountains, a mile higher than Denver...
What's the consensus on the Swift mask?
Is it possible to get insurers to pay for Smart Card & Software? Are these REALLY worthwhile?
Basically, how do I avoid getting screwed by the health care system?
Thanks,
--Andy
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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, swift, Titration, CPAP, DME, Prescription, APAP, Smart Card
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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, resmed, humidifier, swift, Titration, CPAP, DME, Prescription, APAP, Smart Card
Question - getting the machine I want vs. what I need
Question - getting the machine I want vs. what I need
Last edited by ColoZZZ on Fri Dec 01, 2006 11:30 am, edited 1 time in total.
Whether DMEs actually believe that straight CPAP is best or are trying to feed you the cheapest machine is always a good question.
Based on some of the information my DME tried to tell me including setting my machine up wrongly, I could believe that they really believe that or are taught to believe that.
Some folks on this forum actually do better with straight pressure CPAP.
I for one am quite happy with my APAP.
Reasons I am an APAP lover.
Allows me to sleep at the pressure I actually need at that point in time.
I am 13 titrated and that can get to be a bit much. I use 10 much of the night and when I need more my machine gives it to me.
By using lower pressure much of the night it makes my CPAP experience much more comfortable, and less swallowing air as well as lower mask leaks.
I am not a person who maintains a regular weight so any gain or loss that might change my titration number is covered.
APAP can be used as straight CPAP if desired but not vice versa.
I want to avoid costly retitration studies (unpleasant too in my opinion).
Could I be treated with straight CPAP? Probably. But with APAP I personally am more comfortable.
If you doubt the accuracy of your titration study, performed under strange sleep conditions, one night then another good reason for APAP.
If you enjoy a beer or cocktail occasionally that affects your pressure needs
If you sleep in a variety of positions that also affects your pressure needs
In reality the APAP only costs $150 - $200 more than a straight CPAP. Check online prices at CPAP.com
You don't mention what M series machine they are going to try to give you.
One with data capabilities would be very useful. For example the Remstar M series Plus can't record usefull data and the Pro can. (in the classic line the pro doesn't but pro2 does)
Be aware that in the Resmed line, the APAP doesn't have exhale relief and the company has chosen to require on line vendors to increase their prices recently. Take that as you will.
On the interface. I have a swift. I love it. I will most likely move on when I use up all my pillows due to the pricing policy, but I will be sad. Great interface for me.
On the issue of nasal and mouth leakage. Yes, ff masks will prevent this and I have one. Loved it until I found swift. But many do use them as their favorite mask. If you like the Swift read about taping and chinstraps. Chinstrap alone is usually not enough. Paper tap on the mouth is what a lot of us do who want to use a nasal interface. Choice is yours.
You need to find out WHICH M series they want to give you. If it is the Plus, negotiate or call the next DME on your list. Data is very useful for many of us. And in that case, if they want to give you a Plus, I say they are probably trying to maximize profit.
Also check your beneifts (directly with your insurance company, don't believe what the DME tells you). See how much out of pocket your copay will be vs cash onine purchase. Don't forget the Deductable(annual) and figure if you will meet some or all of it on other things next year to determine how much you will be using just for the CPAP.
And above all get the doc to give you the prescription and copies of the sleep studies. You can go anywhere you want that insurance accepts or anywhere you want at all if you are willing to pay cash or figure out that there is very little difference in cash vs insurance copays.
Good luck, and decide what YOU need/want and go for it. Be strong.
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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, cpap.com, swift, Titration, CPAP, DME, Prescription, APAP
Based on some of the information my DME tried to tell me including setting my machine up wrongly, I could believe that they really believe that or are taught to believe that.
Some folks on this forum actually do better with straight pressure CPAP.
I for one am quite happy with my APAP.
Reasons I am an APAP lover.
Allows me to sleep at the pressure I actually need at that point in time.
I am 13 titrated and that can get to be a bit much. I use 10 much of the night and when I need more my machine gives it to me.
By using lower pressure much of the night it makes my CPAP experience much more comfortable, and less swallowing air as well as lower mask leaks.
I am not a person who maintains a regular weight so any gain or loss that might change my titration number is covered.
APAP can be used as straight CPAP if desired but not vice versa.
I want to avoid costly retitration studies (unpleasant too in my opinion).
Could I be treated with straight CPAP? Probably. But with APAP I personally am more comfortable.
If you doubt the accuracy of your titration study, performed under strange sleep conditions, one night then another good reason for APAP.
If you enjoy a beer or cocktail occasionally that affects your pressure needs
If you sleep in a variety of positions that also affects your pressure needs
In reality the APAP only costs $150 - $200 more than a straight CPAP. Check online prices at CPAP.com
You don't mention what M series machine they are going to try to give you.
One with data capabilities would be very useful. For example the Remstar M series Plus can't record usefull data and the Pro can. (in the classic line the pro doesn't but pro2 does)
Be aware that in the Resmed line, the APAP doesn't have exhale relief and the company has chosen to require on line vendors to increase their prices recently. Take that as you will.
On the interface. I have a swift. I love it. I will most likely move on when I use up all my pillows due to the pricing policy, but I will be sad. Great interface for me.
On the issue of nasal and mouth leakage. Yes, ff masks will prevent this and I have one. Loved it until I found swift. But many do use them as their favorite mask. If you like the Swift read about taping and chinstraps. Chinstrap alone is usually not enough. Paper tap on the mouth is what a lot of us do who want to use a nasal interface. Choice is yours.
You need to find out WHICH M series they want to give you. If it is the Plus, negotiate or call the next DME on your list. Data is very useful for many of us. And in that case, if they want to give you a Plus, I say they are probably trying to maximize profit.
Also check your beneifts (directly with your insurance company, don't believe what the DME tells you). See how much out of pocket your copay will be vs cash onine purchase. Don't forget the Deductable(annual) and figure if you will meet some or all of it on other things next year to determine how much you will be using just for the CPAP.
And above all get the doc to give you the prescription and copies of the sleep studies. You can go anywhere you want that insurance accepts or anywhere you want at all if you are willing to pay cash or figure out that there is very little difference in cash vs insurance copays.
Good luck, and decide what YOU need/want and go for it. Be strong.
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, cpap.com, swift, Titration, CPAP, DME, Prescription, APAP
Last edited by snoregirl on Fri Dec 01, 2006 11:32 am, edited 1 time in total.
Ask if the sleep tech has OSA and uses the Swift? I doubt it, that interface is cold, noisy and even uncomfortable if you don't like walking around with your fingers stuck in your nose. IF you have difficulty falling asleep due to noise, the Swift is not what you want. Consider a much quieter mask such as a Somnotech Soyala. The Resmed UltraMirage Full Face is not bad, it is much quieter than the Swift. Somnotech is coming out with a Full Face version this month which is supposed to be even quieter and if like their others will seal better, but we won't know that for sure until it gets tried.and the head sleep tech is recommending the Swift mask, says its the best thing since sliced bread, blah blah blah. My concern is that I'll blow the air out my mouth and negate any benefit so I'm interested in a full face mask - the one I tried during desensitization was fine for the hour I tried it, I think I actually dozed off. He said that I can swap for another mask from same manufacturer within 1 week if I'm not happy with what I get to start with.
I asked the head tech about APAP and smart card, he stated that straight CPAP works in "99.9% of cases, is only needed if there are serious compliance issues, anticipated significant weight loss, etc."
Smart card, etc. would be my own out of pocket $$ likely.
APAP vs CPAP. Again the sleep tech is full of BS in my opinion. He is trying to save his job. With the autopap version you don't have to run back to the sleep lab to find your pressure needs changed, you can also run with an overall lower pressure. This means greater comfort, greater compliance, you will only use the machine if you can tolerate its comfort level.
DME's like the one you are dealing with like to push straight cpap because they get paid exactly the same money for a cheap cpap machine as they do a more expensive costing autopap, the code they bill insurance with is the same. If your doctor writes the script for autopap (recommendation) they have to give it to you.
My suggestions:
1. Important: Get a copy of the PSG from your doctor and the prescription (don't let them fax it to DME, you keep original they fax a copy).
2. Request from your doctor for long term purposes you want a autopap, all autopaps can run in cpap mode so that argument of 99.9% doesn't cut it. The REAL reason they want you on cpap is you have to come back and spend thou$ands with them on additional titration studies should you have a problem with therapy or find you need your pressure changed. With an autopap you never have to worry about that, it will automatically adjust on a hourly basis only supplying the pressure you need.
3. If you have difficulty with nasal congestion consider a full face mask, chin straps don't work. Full face masks cost more than full face, let insurance pay for the expensive full face masks, if you want to experiment with others you can buy those on-line for much cheaper than your DME sells them for.
Don't think a one-stop shop (doctor, sleep lab, DME) is always your best option, usually they are not, they are biased with one vendor or another.
Lastly, if you take that machine rafting or hiking you want the autopap, it has automatic altitude adjustment, the cheapo cpap doesn't.
Last edited by Snoredog on Fri Dec 01, 2006 11:34 am, edited 1 time in total.
Yes....a light dusting of snow. The simple fact is that APAPs are more expensive than straight CPAP's, and you are being provided with the least sophisticated CPAP in Respironics line. DME's get the same payment from an insurance company whether they provide you with a CPAP or an APAP, so it is in their interest to provide you with the cheapest machine, thus maximizing their profits.
Do you need an APAP? Very hard to tell prior to your sleep study/titration. Since all APAP's can run as straight CPAPs, an APAP would cover nearly all your bases (unless you have an extremely high titration pressure, indicating the need for a Bi-PAP). APAP's will adjust to your changing needs w/o having to return to the sleep doc/lab/DME for a new setting if something changes, i.e. weight gain or loss, stress at work or home, even positional changes while sleeping. In addition, APAP's as a class usually have more recording/reporting capabilities than straight CPAPs do, although there are CPAPs that provide pretty comprehensive reports. Those machines are usually at the high end of the CPAP line in cost , and thus would not maximize the DME's profits.
Personally, I would hold out for an APAP. Its a more flexible machine, and is likely to cover more of your changing needs with greater convenience to you. It will likely be a fight, but worth it, IMHO.
All the usual disclaimers apply.
Good luck![/i]
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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, Titration, CPAP, DME, APAP
Do you need an APAP? Very hard to tell prior to your sleep study/titration. Since all APAP's can run as straight CPAPs, an APAP would cover nearly all your bases (unless you have an extremely high titration pressure, indicating the need for a Bi-PAP). APAP's will adjust to your changing needs w/o having to return to the sleep doc/lab/DME for a new setting if something changes, i.e. weight gain or loss, stress at work or home, even positional changes while sleeping. In addition, APAP's as a class usually have more recording/reporting capabilities than straight CPAPs do, although there are CPAPs that provide pretty comprehensive reports. Those machines are usually at the high end of the CPAP line in cost , and thus would not maximize the DME's profits.
Personally, I would hold out for an APAP. Its a more flexible machine, and is likely to cover more of your changing needs with greater convenience to you. It will likely be a fight, but worth it, IMHO.
All the usual disclaimers apply.
Good luck![/i]
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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, Titration, CPAP, DME, APAP
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| Additional Comments: Avg. AHI .4 | ||||
Getting old doesn't make you 'forgetful'. Having too damn many things to remember makes you 'forgetful'.
Snoredog says......
Ask if the sleep tech has OSA and uses the Swift? I doubt it, that interface is cold, noisy and even uncomfortable if you don't like walking around with your fingers stuck in your nose.
I am dying laughing.... I really enjoyed this visual picture, you made my day Snoredog.
Just goes to show that all interfaces are not good for alll people.. They are a very personal thing.
I totally agree about letting the DME pay for the more expensive interface. You will most likely end up trying more than one anyway. I did this -- got the Ultra Mirage ff mask from the DME. $40 more than the Swift I bought myself. I keep the ff for colds and stuffy noses.
Good point on the altitude comment. I agree totally. Make sure you research any machine you are looking at online and check for that feature.
Remstar Auto classic that I have does indeed have the auto alt adj.
Ask if the sleep tech has OSA and uses the Swift? I doubt it, that interface is cold, noisy and even uncomfortable if you don't like walking around with your fingers stuck in your nose.
I am dying laughing.... I really enjoyed this visual picture, you made my day Snoredog.
Just goes to show that all interfaces are not good for alll people.. They are a very personal thing.
I totally agree about letting the DME pay for the more expensive interface. You will most likely end up trying more than one anyway. I did this -- got the Ultra Mirage ff mask from the DME. $40 more than the Swift I bought myself. I keep the ff for colds and stuffy noses.
Good point on the altitude comment. I agree totally. Make sure you research any machine you are looking at online and check for that feature.
Remstar Auto classic that I have does indeed have the auto alt adj.
In addition to what the others said......
Check with your insurance provider and see if they'll reimburse you for an out-of-pocket purchase. If they will (and many do/will), get your prescription, buy what you want at CPAP.COM and submit a bill from yourself to your insurance provider and (depending on the co-pays and deductibles) they'll send you a check for most of your out-of-pocket purchase. In my case it was 80%.
Tell your insurance provider you'll save them LOTS of money by doing it this way.
Best wishes,
Den
Check with your insurance provider and see if they'll reimburse you for an out-of-pocket purchase. If they will (and many do/will), get your prescription, buy what you want at CPAP.COM and submit a bill from yourself to your insurance provider and (depending on the co-pays and deductibles) they'll send you a check for most of your out-of-pocket purchase. In my case it was 80%.
Tell your insurance provider you'll save them LOTS of money by doing it this way.
Best wishes,
Den
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05
I'll post one other opinion as well.
Do you NEED an auto-pap? This is impossible for anyone to answer just yet. Most people do not NEED one. Obviously they are a very nice convenience. Some people absolutely do NEED them.
The Swift is a great mask that a very large number of people like. As has been said though, there simply will never be one mask that works for everyone. I happen to love my comfort classic. Lots of people hate them. It's a very personal choice. However, for a mask to start with - you can do a lot worse than the Swift.
If you are concerned about changes - one thing to think about would be to simply get a CPAP with a smart card. You can occasionally either take the card to your DME or have them mail you a replacement and mail yours back to them. They can check everything and adjust treatment if it's needed. This would be something they do for free. It's what I do. So far in 7 months my AHI has been less than 2 and I haven't needed to change a thing from the pressure set during my titration.
This could also help avoid the cost of purchasing the card reader and software. Again, these are very nice convenience items that for MOST people aren't needed. Just as before too, there are some people who certainly can use them. There are just way too many variables to even make an educated guess if you would NEED them. Personally and in my opinion, I don't too much care if my AHI goes up now and again. I'm more interested in week or even month long trends which I get just fine by dropping my card off every couple months and having it read. So what if my AHI shoots up one night? I'm not going to freak out over it. If the other 29 nights it's less than 2, I don't care. If something ever shows up wierd I'll talk to my doctor about it and fix it.
If you are concerned about mouth leaks, take them on the offer to try one mask and switch out during the week long trail period. That sounds like a very generous offer and something that would be extremly useful.
mattman
Do you NEED an auto-pap? This is impossible for anyone to answer just yet. Most people do not NEED one. Obviously they are a very nice convenience. Some people absolutely do NEED them.
The Swift is a great mask that a very large number of people like. As has been said though, there simply will never be one mask that works for everyone. I happen to love my comfort classic. Lots of people hate them. It's a very personal choice. However, for a mask to start with - you can do a lot worse than the Swift.
If you are concerned about changes - one thing to think about would be to simply get a CPAP with a smart card. You can occasionally either take the card to your DME or have them mail you a replacement and mail yours back to them. They can check everything and adjust treatment if it's needed. This would be something they do for free. It's what I do. So far in 7 months my AHI has been less than 2 and I haven't needed to change a thing from the pressure set during my titration.
This could also help avoid the cost of purchasing the card reader and software. Again, these are very nice convenience items that for MOST people aren't needed. Just as before too, there are some people who certainly can use them. There are just way too many variables to even make an educated guess if you would NEED them. Personally and in my opinion, I don't too much care if my AHI goes up now and again. I'm more interested in week or even month long trends which I get just fine by dropping my card off every couple months and having it read. So what if my AHI shoots up one night? I'm not going to freak out over it. If the other 29 nights it's less than 2, I don't care. If something ever shows up wierd I'll talk to my doctor about it and fix it.
If you are concerned about mouth leaks, take them on the offer to try one mask and switch out during the week long trail period. That sounds like a very generous offer and something that would be extremly useful.
mattman
don't forget to tell him you work for a DME and are biased towards suggestions that make YOU more money.mattman wrote:I'll post one other opinion as well.
Do you NEED an auto-pap? This is impossible for anyone to answer just yet. Most people do not NEED one. Obviously they are a very nice convenience. Some people absolutely do NEED them.
The Swift is a great mask that a very large number of people like. As has been said though, there simply will never be one mask that works for everyone. I happen to love my comfort classic. Lots of people hate them. It's a very personal choice. However, for a mask to start with - you can do a lot worse than the Swift.
If you are concerned about changes - one thing to think about would be to simply get a CPAP with a smart card. You can occasionally either take the card to your DME or have them mail you a replacement and mail yours back to them. They can check everything and adjust treatment if it's needed. This would be something they do for free. It's what I do. So far in 7 months my AHI has been less than 2 and I haven't needed to change a thing from the pressure set during my titration.
This could also help avoid the cost of purchasing the card reader and software. Again, these are very nice convenience items that for MOST people aren't needed. Just as before too, there are some people who certainly can use them. There are just way too many variables to even make an educated guess if you would NEED them. Personally and in my opinion, I don't too much care if my AHI goes up now and again. I'm more interested in week or even month long trends which I get just fine by dropping my card off every couple months and having it read. So what if my AHI shoots up one night? I'm not going to freak out over it. If the other 29 nights it's less than 2, I don't care. If something ever shows up wierd I'll talk to my doctor about it and fix it.
If you are concerned about mouth leaks, take them on the offer to try one mask and switch out during the week long trail period. That sounds like a very generous offer and something that would be extremly useful.
mattman
Total hogwash. The cheapo basic machines you DME's recommend don't record sleep details to the SmartCard only basic compliance, so suggesting that is totally misleading.If you are concerned about changes - one thing to think about would be to simply get a CPAP with a smart card. You can occasionally either take the card to your DME or have them mail you a replacement and mail yours back to them. They can check everything and adjust treatment if it's needed. This would be something they do for free. It's what I do. So far in 7 months my AHI has been less than 2 and I haven't needed to change a thing from the pressure set during my titration.
Fact: if they got the autopap as suggested they get AHI information right off the LCD display, then they don't need to see you as much and don't really need the software and reader but it is a good idea to get it if you want the details about your sleep.
My advice: Never trust a DME I have yet to met one that wasn't a crook.
Hi folks,
Thanks for all the info here - its all certainly helpful and I'll definitely use it to help guide my procurement of the gear I'll need to become a full fledged hosehead.
One other thing, the first person I spoke with at Alpha (maybe just the receptionist) sounded like she had never even heard of APAP but said that if there are problems with CPAP they proceed to BiPAP.
Is this a step up to an equipment class for which they get a much higher payment (thus bypassing APAP, which *may* be the correct solution for me but which doesn't net them any more $$)?
Thanks again and keep that advice coming!
--Andy
PS -
I've always been a bit wary of operations that design the test, do the testing and also sell the remedy - that was my first red flag with Alpha.
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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, CPAP, APAP
Thanks for all the info here - its all certainly helpful and I'll definitely use it to help guide my procurement of the gear I'll need to become a full fledged hosehead.
One other thing, the first person I spoke with at Alpha (maybe just the receptionist) sounded like she had never even heard of APAP but said that if there are problems with CPAP they proceed to BiPAP.
Is this a step up to an equipment class for which they get a much higher payment (thus bypassing APAP, which *may* be the correct solution for me but which doesn't net them any more $$)?
Thanks again and keep that advice coming!
--Andy
PS -
I've always been a bit wary of operations that design the test, do the testing and also sell the remedy - that was my first red flag with Alpha.
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, CPAP, APAP
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arthuranxious
- Posts: 120
- Joined: Sun Aug 20, 2006 3:19 pm
I use a Swift because I have facial hair, and that sometimes erduces the seal of a mask. I also leak the idea of not having part of my face covered... but that is a personal matter.
I begged and pleaded for an autoPAP, and eventually got one (long story) although my doctor thinks it is not necessary. My reasons were, working hard to lose weight and anticiapting weight variations, need to see if I was having leaks, and if I was having apneas with the machine on (my titration study reported inadequate treatment, continued apneas). I also felt my night for titration had been a fiasco and I hadn't attaioned normal sleep. When I read the results I saw that I had almost no REM despite having good REM stage untreated. I therefore felt APAP was needed.
In fact, my pressure has varied widely. Some nights 6.4 was all that was needed some noghts it has needed 11 cm and occasionally more, but I was titrated at 7 cm. in the sleep lab.
I achieve very low AHI by the APA's measurements, monthly average AI is 0 and HI (also AHI) of 2.5.
So, if you need to know your stats, ask for an APAP. Or if you expect variations of needed pressure. The cost difference isn't great, so the DME will often cave in if you make enough of an argument.
I begged and pleaded for an autoPAP, and eventually got one (long story) although my doctor thinks it is not necessary. My reasons were, working hard to lose weight and anticiapting weight variations, need to see if I was having leaks, and if I was having apneas with the machine on (my titration study reported inadequate treatment, continued apneas). I also felt my night for titration had been a fiasco and I hadn't attaioned normal sleep. When I read the results I saw that I had almost no REM despite having good REM stage untreated. I therefore felt APAP was needed.
In fact, my pressure has varied widely. Some nights 6.4 was all that was needed some noghts it has needed 11 cm and occasionally more, but I was titrated at 7 cm. in the sleep lab.
I achieve very low AHI by the APA's measurements, monthly average AI is 0 and HI (also AHI) of 2.5.
So, if you need to know your stats, ask for an APAP. Or if you expect variations of needed pressure. The cost difference isn't great, so the DME will often cave in if you make enough of an argument.
arthuranxious wrote:
So please correct me if I'm wrong and please add to this list - it sounds like there are some good reasons for APAP:
1) no extra cost to insurer
2) anticipated weight loss (Dr. wants me to drop 25 lbs)
3) reduced or no returns for later titration studies (you'd think this alone would seal the deal)
4) potential for flawed titration study in strange environment
5) varying pressure needs due to occasional stuffiness, having a cocktail before bed, stress, etc., anomalous sleeping conditions due to camping or travel
More questions:
How common is exhale relief?
Can the Dr. prescribe a smart card and software?
The notion that the DME's try to get into the driver's seat on some of this stuff really brings home the phrase "tail wagging the dog!"
Thanks again for all the help!
--Andy
I guess the good thing is that the insurance company is paying the same regardless of whether I get APAP or CPAP. And fortunately I've got a doctor who is generally reasonable with this sort of thing. So from what I understand I just need to convince my doctor to wriite the prescription for APAP?The cost difference isn't great, so the DME will often cave in if you make enough of an argument
So please correct me if I'm wrong and please add to this list - it sounds like there are some good reasons for APAP:
1) no extra cost to insurer
2) anticipated weight loss (Dr. wants me to drop 25 lbs)
3) reduced or no returns for later titration studies (you'd think this alone would seal the deal)
4) potential for flawed titration study in strange environment
5) varying pressure needs due to occasional stuffiness, having a cocktail before bed, stress, etc., anomalous sleeping conditions due to camping or travel
More questions:
How common is exhale relief?
Can the Dr. prescribe a smart card and software?
The notion that the DME's try to get into the driver's seat on some of this stuff really brings home the phrase "tail wagging the dog!"
Thanks again for all the help!
--Andy
ColoZZZ wrote:
How important is exhale relief? Very important, especially if you have a GERD and a compromised or defective LES. The exhale relief makes it much more comfortable to exhale against. The machines with the best exhale relief for pressures under 15cm is Respironics CFlex. Resmed has EPR but it doesn't work in the Autopap mode.
lab puts you on Bipap if you have complications? Sounds about right, they will try and avoid the autopap like the plaque as it takes business from them (fewer PSG's are needed), but a Bipap doesn't it is a dumb machine just like the cpap machine but has 2 pressures (one for inhale, one for exhale), but if you still have pressure change needs (loss of weight, positional changes etc.) you still have to go back to the lab for another titration. Insurance usually pays for 2 of those studies per year, they want you to have a machine so they can take advantage of that. With an autopap you don't need to go back for a pressure change and they know it.
All excellent reasons to get the Autopap.So please correct me if I'm wrong and please add to this list - it sounds like there are some good reasons for APAP:
1) no extra cost to insurer
2) anticipated weight loss (Dr. wants me to drop 25 lbs)
3) reduced or no returns for later titration studies (you'd think this alone would seal the deal)
4) potential for flawed titration study in strange environment
5) varying pressure needs due to occasional stuffiness, having a cocktail before bed, stress, etc., anomalous sleeping conditions due to camping or travel
More questions:
How common is exhale relief?
Can the Dr. prescribe a smart card and software?
The notion that the DME's try to get into the driver's seat on some of this stuff really brings home the phrase "tail wagging the dog!" Rolling Eyes
How important is exhale relief? Very important, especially if you have a GERD and a compromised or defective LES. The exhale relief makes it much more comfortable to exhale against. The machines with the best exhale relief for pressures under 15cm is Respironics CFlex. Resmed has EPR but it doesn't work in the Autopap mode.
lab puts you on Bipap if you have complications? Sounds about right, they will try and avoid the autopap like the plaque as it takes business from them (fewer PSG's are needed), but a Bipap doesn't it is a dumb machine just like the cpap machine but has 2 pressures (one for inhale, one for exhale), but if you still have pressure change needs (loss of weight, positional changes etc.) you still have to go back to the lab for another titration. Insurance usually pays for 2 of those studies per year, they want you to have a machine so they can take advantage of that. With an autopap you don't need to go back for a pressure change and they know it.
Thanks Snoredog for the info. I feel like I'm getting fantastic advice here and will be ready well armed with good information when I sit down with my Dr for the prescription-writing session.
A few more questions:
1) What do the acronymns GERD, LES and PSG stand for?
2) Do Dr's ever prescribe the Smart Card and Software?
3a) Are masks sold the same way machines are (DME gets flat rate)?
3b) If so, would the Swift be a high-profit item (the DME was REALLY pushing it this morning)?
Thanks again for all y'all's help.
I'm off to the sleep lab for my titration study. Hopefully it'll be a good night's sleep too!
Looking forward to getting the treatment going,
-Andy
A few more questions:
1) What do the acronymns GERD, LES and PSG stand for?
2) Do Dr's ever prescribe the Smart Card and Software?
3a) Are masks sold the same way machines are (DME gets flat rate)?
3b) If so, would the Swift be a high-profit item (the DME was REALLY pushing it this morning)?
Thanks again for all y'all's help.
I'm off to the sleep lab for my titration study. Hopefully it'll be a good night's sleep too!
Looking forward to getting the treatment going,
-Andy
-
Guest
No, it's not really a high profit item. It's the same reimbursement as other nasal masks and it costs a fair bit more than many.ColoZZZ wrote:3b) If so, would the Swift be a high-profit item (the DME was REALLY pushing it this morning)?
-Andy
I know at this point most everyone is convinced otherwise, but you might consider the remote possibility that the DME folks really were trying to help you out and get you comfortable with your treatment.
Honest to God most of us don't go around eating babies and kicking puppies as we are made out to.
Aside from that, I'll stay out it since I don't want to sidetrack this into another bashing thread.
mattman