Oxygen added to CPAP

[6PtStar]

Trying to get some idea as to how many that got on CPAP also got Oxygen added to the air. My sleep study showed that my SAO2 ranged from 99% to 81% with 6.0% of the time spent below 90%. They wrote the script for 2 liters of oxygen added. I have talked to several people whose Oxygen level was worse than mine and the straight CPAP took care of the Oxygen level problem. My DME has my insurance and medicare so fouled up that I'm afraid they may pull my CPAP. I got a notice today that they paid for 2 months (Been on it for 7 months) and the best I can understand the bill they won't pay any more. They filled an appeal and it was denied.

Figured I could buy the CPAP from CPAP.com but what to do about the Oxygen Concentrator. I really feel that I don't really need the Oxygen. I have slep several nights when I forgot to turn it on and haven't noticed any difference in the way I feel. I don't have an oximeter to find out for sure. Anyone know if they rent them. My DME has everything so fouled up I don't think they will ever get it straightened up and I am not about to pay the remainder of the $1338 for my CPAP out of pocket.

[rested gal]

If I'm not mistaken, I think your doctor can order an overnight recording pulse oximeter test for you, and the DME will do that free. Free one time, anyway.

Margie (a lady in town that I help with her cpap stuff) had her oxygen level drop down to 46% during her sleep study. O2 was added right there during the study.

Her doctor prescribed 2 liters O2 for her to use at home attached to her cpap setup.

A few months into treatment, her balky doctor finally agreed to let the DME do an overnight pulse oximeter test (free) on Margie at home -- using her autopap and no supplemental O2. Her oxygen level stayed up beautifully in the mid-nineties all night. After the pulse oxi was returned to the DME, the O2 concentrator was not far behind.

For the past year Margie's been using just the autopap. No supplemental O2. Doing fine. She's gone on several excursions with her church group...something she'd stopped having the energy to do for quite a few years. She's enjoying life again.

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[Slinky]

6PtStar, I don't know or else don't remember if you have requested and gotten
1] a copy of your sleep evaluation data (including graphs, the report should be about 5-6 pages long)
2] as well as a copy of your sleep titration study (w/graphs and about 5-6 pages long)
3] and the evaluation and titration dictated results report
4] and a copy of the overnight oximetry report
5] and a copy of the order for the oxygen concentrator
6] and a copy of your CPAP equipment order

If you haven't, it sounds like it would be a darn good idea that you did so ASAP. It would only slow things down by one day to put your request IN WRITING and mailing it via Certified Mail, Return Receipt Requested. Just in case you need proof of 1] your request for that information and 2] it looks like you just might need the above information to validate your NEED for the CPAP and possibly even the 02 concentrator if it turns out you really do need that too.

I've read of an overnight oximetry being provided by a DME supplier from for free to as much as $35 to $65. They do have to be scripted by your doctor if a local DME supplier provides the overnight oximeter. My sleep lab doesn't charge to loan me their oximeter to run an overnight oximetry but I assume that that also depends on the sleep lab.

I have COPD as well as OSA and I have needed 02 supplementation w/my CPAP - but - I seem to be having some improvement w/the COPD and this last overnight oximetry I barely qualified for the 02 supplement w/CPAP which doesn't make much difference except in my electric bill if it were determined I didn't need it w/CPAP because I do need it thru out the day as well.

Also, if you DO need 02 supplementation, MANY electric power companies do have a special considerably lower rate for life sustaining equipment. One must contact the electric company to determine that and it does require a letter from your doctor supporting your need for that equipment. Since an 02 concentrator CAN add as much as $30 to $40 to your electric bill it is a wise idea to check into that. Altho President Johnson did see to it that Texas has its own power grid whilst he was in office so maybe you pay less for electricity than we do in the eastern midwest.

[BrianRT]

Be warned...........that is a common trick that DME's do (the unscrupolous ones anyway)

Usually, your SpO2 will be low during your first night study. They will use this info to get an order for O2. O2 is then setup by the DME, typically before you have a titration study.

For most people, the PAP will take care of any desaturations since it is secondary to the sleep apnea. (most people now, if you have an underlying issue like COPD, then your need for extra O2 might be from that, as in Slinky's case)

So then the DME sets you up on XPAP, bleeding the O2 into the hose, and secretly hope you never find out that you don't need the supplemental O2 now that you have PAP. That way, they can charge for both items.

You want to know why most DME's have a bad rep? Because they do it to themselves with nonsense like that.

[AdmiralCougar]

Also, if you DO need 02 supplementation, MANY electric power companies do have a special considerably lower rate for life sustaining equipment. One must contact the electric company to determine that and it does require a letter from your doctor supporting your need for that equipment. Since an 02 concentrator CAN add as much as $30 to $40 to your electric bill it is a wise idea to check into that.

Wow I never thought about the equipment raising the electric bill like that... Both the tech at my sleep study and my Dr. has talked about the possibility of adding O2. I do believe my parents will have a heart attack if their bill goes up that much because of it.... So I'll have to remember this to see if our Power company does.

[Wulfman...]

Be warned...........that is a common trick that DME's do (the unscrupolous ones anyway)

Usually, your SpO2 will be low during your first night study. They will use this info to get an order for O2. O2 is then setup by the DME, typically before you have a titration study.

For most people, the PAP will take care of any desaturations since it is secondary to the sleep apnea. (most people now, if you have an underlying issue like COPD, then your need for extra O2 might be from that, as in Slinky's case)

So then the DME sets you up on XPAP, bleeding the O2 into the hose, and secretly hope you never find out that you don't need the supplemental O2 now that you have PAP. That way, they can charge for both items.

You want to know why most DME's have a bad rep? Because they do it to themselves with nonsense like that.

Yeah, Brian.....but the DOCTOR has to prescribe it, first.
My sleep doc wrote 2 L O2 on my prescription and I never used it. I started investigating the costs of the concentrators (rental/purchase) and then thought "If I'm breathing at night, my oxygen levels SHOULD come up." SO, I told my doctor I was not going on O2 initially. After about a month, he ordered an overnight pulse oximetry (actually I fanangled it into 2 nights over a weekend in case there was some discrepancy in the numbers). Did the overnight thing.....reports were sent into the doctor and I never heard another word about it from him.....(before I fired him).
I think it's one of those "Once we getcha....we gotcha". I think it's harder to get rid of it than to get it. And, the doctors are in cahoots with the DMEs.....feeding them business.

Granted......there ARE some people that genuinely NEED it. But, I think it's been overly prescribed in many cases.

Den

[BrianRT]

Den,
Yeah I know it's prescribed item, but often it's the DME's that will call to get the order from the doc, usually the patient's GP. And usually it's the doc's nurse you talk to. They will say "Mr. X's O2 sat got down to whatever % during his sleep study and we'd like to get an order to set him up on O2 to correct this". The nurse says OK. Often it's just your typical 2lpm (and why is THIS the standard? Is this ever followed up on to see if more would be needed???......Hardly!!!) The order is rubber-stamped by the doc (no really....it's funny to see those rubber stamped signatures mis-ligned with the order form) and the DME has won......the patient's pocketbook has lost.

[6PtStar]

Thanks for the information. Thanks RG for the information. I will check witn my Doc and see if I can get a free rental on the pulse oximeter. I was not looking forward to going back through another sleep study to find out.

Slinky, I do have the full report from the sleep lab although there are no graphs, only words and only 4 pages. The recomendation from the sleep doc (this is the hospital sleep lab, they don't do DME) was for straight CPAP set at 9cm/h2o w/2lpm O2 bled in, heated humidifier and C-flex or EPR set at 3. My Doc wrote the script just like the report said (no APAP) The Oxygen report stated that the "SAO2 ranged from 99% to 81% for the entire study with a 6.0% of TST spent below 90% and a mean saturation of 94%. There were 212 desaturation events total, with the longest being 5.3 minutes." That is the complete oximety report. It was a split night study. Did not say anything about COPD.

Brian, I did think of that but since it came from the hospital sleep clinic that has no ties to a DME I was inclined to beleave it although I felt they were overreacting because I came directly from a 4 day stay in the hospital for what they thought was heart failure (retaining fluid) but normal heart enzimes. Did not have me on O2 just heart monitor and last night in hospital heart stopped, skipped a beat and restarted 6 times ( I forget what they called that)

I have a copy of the the script for the CPAP and the oxygen concentrator and so does the DME. The problem is that they apparently dont know what they are doing and now have medicare and BC/BS filings so fouled up I don't think they will ever get it straight. They filled 2 months as a medicare provider and 2 monts as a medicare contractor. When they foul it up rather than take what they get they keep refiling it. They have filed one month 4 times and it is still denied. I have had it long enough that no one else will take me (I've checked).

Yea, the concentrator pulls about 350 watts over a 8 hours it does run the bill up.

[Wulfman...]

Den,
Yeah I know it's prescribed item, but often it's the DME's that will call to get the order from the doc, usually the patient's GP. And usually it's the doc's nurse you talk to. They will say "Mr. X's O2 sat got down to whatever % during his sleep study and we'd like to get an order to set him up on O2 to correct this". The nurse says OK. Often it's just your typical 2lpm (and why is THIS the standard? Is this ever followed up on to see if more would be needed???......Hardly!!!) The order is rubber-stamped by the doc (no really....it's funny to see those rubber stamped signatures mis-ligned with the order form) and the DME has won......the patient's pocketbook has lost.

Hi Brian.

Interesting...... Really improves my faith in this field of medicine.....NOT!

I guess, to my sleep doc's credit (and I hate to give him ANY), he DID write out the prescription in my presence and gave it to ME (I quickly took it from his hand)......and didn't do the "we'll fax it to a DME of OUR choice" thing.....although he did tell me which DME to go to. I did go there, but only to do some "window shopping" and get some pricing. That was the DME that I (with permission) went to their computer and brought up CPAP.COM's website and showed them the equipment and their online prices. I was told that CPAP.COM's prices were lower than that DME could buy them for.

After finding out how MUCH the O2 concentrator was going to cost to rent (even though my insurance would have paid 80%), that's when I decided to wait awhile and see how things were going to go with just straight CPAP first.
I also know of others (that I know personally) who are on supplemental oxygen......and I wonder for how long.....

I realize those concentrators are expensive to purchase, but at the rental price (I believe I was quoted $460+ per month), it shouldn't take too long to get them paid for and turn a profit.

Den

[BrianRT]

Sounds good 6pt. Do let me clear something up. What I am referring to is the DME leaving the O2 after the PAP is delievered and never picking it up though it isn't needed anymore.

Being on O2 until you get your XPAP isn't a bad idea, especially in the severe cases. Knowing how long it can take from titration to delivery of PAP in some areas it can be a good while. We've done that before, and we always picked it up when the XPAP was proven to fix the hypoxemia.

[BrianRT]

Oh believe me Den, the O2 concentrator market is a bigger rip-off than XPAP for DME's

True, the $400+ is the charged amount and then there's the allowed amount of which you would pay %20 of. BUT, until you rent that puppy out for the whole 36 month term (I'm using Medicare guidelines which a lot of private ins mimic.) it's not yours. VERY much like the Rent to Own shops to get a TV or washer and dryer. If for whatever reason you don't need it the whole term (DC'd by doc, turn it in yourself, you die, etc) then it goes back to the DME and cleaned up and set up again on a new patient to start making $$$ for them, ad nauseum.

Very much like Rent to Own's indeed.

But that's the way it is.

Faith in the field of medicine??......Oh hell no. Not me. I know too much. I've seen too much. Too much coverups and lies to patient's families. It's a personal story too for me, regarding family. But that's another time.