New not-a-user looking for some advice

I was diagnosed last month, and the doctor sent off some paperwork while I watched. He didn't give me any paperwork other than the results of my study, which are a little over my head and simply seem to indicate that I need a CPAP, like he said.

He told me the provider would contact me to get me a machine, and then he would want to see me in a while to evaluate the results. A week later I got the paper referral in the mail so I knew that the provider should also have received it. However I didn't get any phone calls from the provider, so I called them a couple of days later.

The phone service was lackluster at best - the operator simply told me my order was being processed and someone would call me within 2-3 days. 5 days later I called again, and was told "still processing - we'll call you" again.

So here I am, a week later, with no calls back. I take time away from work to call again, I'm told I need to be transferred to the "processing department" and then sit on hold for 15 minutes. I call back, am told I need to be transferred again, ask for a supervisor and try to escalate the call, and I'm put on hold for another 10 minutes. When I hang up in frustration the operator calls me back, tells me she will have a supervisor call me before the end of the day. I wonder if I should ask her "should I hold my breath?" but I'm not sure she'd get the apnea joke. Needless to say I didn't get a call tonight either.

So I do some research into the provider I was referred to, and discover they're the worst ones in my area, hands down, based on yelp and google reviews and have been rated an "F" from the BBB.

How much leverage do I have with my HMO to insist they refer me somewhere else? Am I being unreasonable to think that waiting over three weeks to get this machine is two weeks too long?

Last question (I promise!) what is the consensus about the best model . . . if I should break down and decide to buy my own stupid machine just to get started on therapy, what should I look for? I would rather have the insurance I pay for kick in to supply the machine, but not if it means waiting longer and paying more for it . . . .

Thanks for letting me rant. It's taken my husband three+ years to convince me to do something about my snoring. Now that I've become resigned to it, I don't want to wait any longer.

Geez, that must be darned frustrating!!

Next you'll develop bruxism (teeth grinding) and have to throw in a mouth guard!!

As for your HMO, if enough of you complain to them, they'll get the message and maybe dump the DME who can't be bothered with you. So, my counsel, even if you're the very first, would be to call and complain about the service. The worst they can do when you ask if you can switch providers is to laugh uproariously and have to call you back.

There seems to be a gap in the process here. Your doctor sent off the forms to the DME yet there is no mention of any contact with your medical insurance provider (HMO). From what I have read it was your doctor that decided on the DME and not the HMO. That is not his decision as the HMO are the guys you are paying your hard earned cash to so I would contact them directly to find out if you have a choice of DME and if not, why not! Forget your doctor for the moment, talk to your medical insurance guys and find out the full story.

You should have a copy of your Sleep Study AND the doctors prescription. Then you can go anywhere in your insurance network. If you buy on your own, you may or may not need a prescription. Whether you buy on your own or use the DME you want a Data Capable Machine......ResMed Airsense 10 Autoset or Respironics Dreamstation Auto. Don't accept any other.

HMOs are a whole different animal and they will most likely be looking to supply you with the cheapest cost savings (to them) machine out there. You can call them up and ask them but I am betting one cpap supplier only on the list.

How much is the hassle factor worth to you? Can you afford to just buy your own equipment and tell them where to go?

Holden4th wrote: From what I have read it was your doctor that decided on the DME and not the HMO. That is not his decision as the HMO

Actually here in the US and with HMOs...the doctor probably does know who the HMO wants to be supplying stuff because there is likely only one supplier the HMO works with and the patient has zero choice in the matter. It's part of the HMO...it's a cost savings plan (usually lower premiums) but in return the HMO dictates every level of care you are going to get and you know how they save money so they can charge lower premiums...yep...they cut corners whenever they can on every aspect of medical care.

Pugsy wrote:HMOs are a whole different animal and they will most likely be looking to supply you with the cheapest cost savings (to them) machine out there. You can call them up and ask them but I am betting one cpap supplier only on the list.

You have a different HMO than mine. In January, I had two problems with my DME. One of the problems was refusing to supply an item because they claimed it wasn't covered. I called my HMO, and the lady quickly informed me it was covered and asked me what was going on. I told her the DME claimed it was not covered. The HMO lady immediately offered to call the DME and set them straight. She also looked it up and told me there were two other DMEs in their network in my area. Good service from my HMO! (As usual.)

ChicagoGranny wrote:Good service from my HMO! (As usual.)

Yeah well...apparently not so good of service for the OP in this thread ...she still hasn't got anything from them. Not even a return phone call.
Doesn't point to a nice helpful DME.

A lot will depend on which HMO plan it is....and if it is under Medicare age insurance HMO coverage or Medicare HMO coverage.
I know of a woman whose Medicare HMO ONLY supplies the 3B brand machines...like the ResMart Luna...absolutely no choice in the matter.
Would you be happy with that? I wouldn't.

Let's see what fargosmom HMO will let her have before we go talking about how good it might be...assuming they ever get back to her.
Not even a phone call after a week despite repeated calls...doesn't bode well for how helpful they might be.

Find out exactly what your HMO will pay for.
If they will only allow you a "brick", you can go online for a full data machine.
(ex. cpap.com or secondwindcpap.com are excellent--and reasonably priced)
A no-data machine could be a usable travel or backup machine, if the price is very low, or free.
HMO's are to be used when possible, avoided if necessary, and never trusted.

fargosmom wrote:Last question (I promise!) what is the consensus about the best model . . . if I should break down and decide to buy my own stupid machine just to get started on therapy, what should I look for? I would rather have the insurance I pay for kick in to supply the machine, but not if it means waiting longer and paying more for it . . . .

I believe the "gold standard" machine would be the ResMed's AirSense 10 AutoSet (actually, I'm going to the Doc today and I'll tell him that this was my choice - I don't believe he is going to disagree), but the Respironics Dreamstation is not that far from the AirSense. These two machines are known worldwide and provide detailed data. You would be getting an excellent treatment with any of them.

Thanks to all for the answers! I may have misrepresented a little. My doctor submitted to the HMO for a referral for me; the HMO sent me to this POS DME. I called the HMO admin this morning and spoke with someone, who put me on hold a couple of times while she sorted things out (actually calling the doctor's office while I was on the line). The doctor is resubmitting for a new referral and she told me it would be to a different supplier. So I guess I spun the roulette wheel again - we'll wait to see if it stops on red or black.

As for the model they'll provide, the doctor specifically mentioned seeing me again after I'd been using it awhile to check the information it collects, so I guess that means he wants me to have more than just a "brick"?

I'm not going to bad-mouth HMO's - they do what they are designed to do - manage costs. I have been smart/fortunate enough to pick a group with excellent customer care. In the years I have had to make extreme use of my coverage, they have always come through for me, either with a great first-time referral, or by paying attention when I have spoken up about deficiencies. I don't know if it is regional or something, since I know there are not-so-great groups here in the LA area, but I've been with my HMO for over 20 years and they have kept me alive at no small expense.

So at this point I'm starting the wait over again - should have a new referral by the end of the week and I'll see what happens then.

I did ask the HMO rep to PLEASE advise someone to never refer any patients to this place again - I certainly hope they listen to me.

Thanks again!! I'll update once I get some traction.

you need to discuss what the doc ordered. machines with all the data are a fairly new science. for years doctors have issued bricks, looked at the hours you used and the pressure you were at. then they ask you how you feel. if you feel better, keep going. if you don't feel better try harder. do not ass-u-me anything. find out what he is ordering, you're the customer here. once you're issued a brick it will be a long time before you'll get a nice one. don't waste time here, find out what's coming before its too late to change it. get the exact model name or number because alot of brick names sound like data machine names.

fargosmom wrote:Thanks to all for the answers! I may have misrepresented a little. My doctor submitted to the HMO for a referral for me; the HMO sent me to this POS DME. I called the HMO admin this morning and spoke with someone, who put me on hold a couple of times while she sorted things out (actually calling the doctor's office while I was on the line). The doctor is resubmitting for a new referral and she told me it would be to a different supplier. So I guess I spun the roulette wheel again - we'll wait to see if it stops on red or black.

As for the model they'll provide, the doctor specifically mentioned seeing me again after I'd been using it awhile to check the information it collects, so I guess that means he wants me to have more than just a "brick"?

I'm not going to bad-mouth HMO's - they do what they are designed to do - manage costs. I have been smart/fortunate enough to pick a group with excellent customer care. In the years I have had to make extreme use of my coverage, they have always come through for me, either with a great first-time referral, or by paying attention when I have spoken up about deficiencies. I don't know if it is regional or something, since I know there are not-so-great groups here in the LA area, but I've been with my HMO for over 20 years and they have kept me alive at no small expense.

So at this point I'm starting the wait over again - should have a new referral by the end of the week and I'll see what happens then.

I did ask the HMO rep to PLEASE advise someone to never refer any patients to this place again - I certainly hope they listen to me.

Thanks again!! I'll update once I get some traction.

So I guessed right in my earlier post in suspecting that the doctor took matters into his/her own hands. Glad to see that your HMO is supporting you. I'd also think about referring said doctor to whatever medical ethics authorities you have in your state.

fargosmom wrote:As for the model they'll provide, the doctor specifically mentioned seeing me again after I'd been using it awhile to check the information it collects, so I guess that means he wants me to have more than just a "brick"?

Not necessarily. Some doctors are only interested in compliance - hours used - you could still get a brick. Hopefully, your doctor wants to see efficacy data and prescribed the right machine. But in any case, you need to understand the exact machine model the supplier plans to provide before you take delivery. It's always a good idea to post the model name/number in this thread to get advice. Some of the manufacturers use model names for good machines and bricks that are very close. It can be confusing!

fargosmom wrote: I called the HMO admin

Good step!

fargosmom wrote:I did ask the HMO rep to PLEASE advise someone to never refer any patients to this place again - I certainly hope they listen to me.

Another good step! DMEs can be kicked out of the HMO based on patient complaints.

So this time I've been referred to a company that really does call back. I have an appointment with the therapist (?) this Friday. He's told me I will be getting an Airsense 10 CPAP . Is there more than one model of this? I looked at their site but I don't know enough about them to know what I'm looking at.

Apparently my insurance will pay 50%, and if I followed his explanation, my cost works out to be around $300, including approx. 3 months of whatever supplies I need. I realize I will know more once I see him on Friday, but does this sound right?

I have no idea what I should ask, or expect . . .

Yes - you want the Autoset, not just plain Cpap. Autos can 'do' cpap if at some time you chose it (doesn't happen often to say the least), but plain Cpap's can't do auto and you want that option.