To keep or ditch a sleep doc...

After finding that with my $1000 deductible and the 10-month rental-to-own deal required by my insurance company, I'd be paying more that way than buying my machine outright from cpap.com, I ditched the DME and bought my apap out of pocket. Too much DME hassle as well, with their lying and refusal to provide the basic manual for the apap, much less the software.

So I now have questions about the future, where my insurance is concerned. Is there any reason to keep going to a sleep doc, if I am managing my own therapy?

1) Will insurance company demand that a doc be sending compliance data next year or in years to follow, in order for insurance to agree to pay for the routine supplies that I will continue to need?

2) If I need or want another machine in a year or two or three, will insurance company OR cpap.com require a new Rx for that which is not dated 2008? Also--will insurance co. require that same ridiculous rent-to-own deal on a second machine?

3) Is there any reason I am overlooking, for keeping a sleep doc who provides no value to my education or therapy, and basically just reads my compliance data?

4) And off topic, I am puzzled that although my insurance required the 10 month rental deal with the DME, they actually did credit toward my out of network deductible the entire amount of the machine I bought out of pocket from cpap.com! I don't get it.

plr66 wrote:
1) Will insurance company demand that a doc be sending compliance data next year or in years to follow, in order for insurance to agree to pay for the routine supplies that I will continue to need?

2) If I need or want another machine in a year or two or three, will insurance company OR cpap.com require a new Rx for that which is not dated 2008? Also--will insurance co. require that same ridiculous rent-to-own deal on a second machine?

3) Is there any reason I am overlooking, for keeping a sleep doc who provides no value to my education or therapy, and basically just reads my compliance data?

1. You need to ask the insurance company what they want to process a claim; some require new "supplies" scripts for each claim.

2. cpap.com will accept the old script, however your insurance company has their own procedures on replacing machines, and again you need to ask what they expect. Some insurance requires a new sleep study. The general guideline is 5 years for the machine but again each insurance will be different.

3. What you need will vary based on what your other medical conditions are and what the specialty of the sleep doc is. A PCP might be what you need to satisfy the paperwork requirements. Again, you have to figure this out.

plr66 wrote:Is there any reason to keep going to a sleep doc, if I am managing my own therapy?

I am not a medical professional and this is only my opinion...

Not if you can achieve good therapy numbers with the help available from the great folks here, but...

You may have have other complicating health issues or perhaps a more difficult sleep situation that will need some professional medical assistance to get under control.

I will tell you that if I had access to a good sleep doctor that I could work with that I would very likely be consulting with that person and showing them my data for the last few weeks... just to have their opinion and guidance. Unfortunately the sleep doc that reviewed my sleep study refused to see me because I reside in Quebec and he works in Ontario... so I slip through the cracks due to purely administrative issues.

plr66

4) And off topic, I am puzzled that although my insurance required the 10 month rental deal with the DME, they actually did credit toward my out of network deductible the entire amount of the machine I bought out of pocket from cpap.com! I don't get it.

My DME told me my insurance company did the rental policy because there where those
who would not be compliant. The machine could be returned and both would not suffer such
a financial loss. Plus one would be able to trade from straight CPAP to another more
compatible machine more data capable.
I would think that because your insurance company paid for your machine
that they are going to continue picking up the bill for the routine supplies for your therapy.

As suggested in previous reply I certainly would check it out.
My insurance company replaces every 5 years.

Be happy and get healthy. Moombeam

plr66 wrote:After finding that with my $1000 deductible and the 10-month rental-to-own deal required by my insurance company, I'd be paying more that way than buying my machine outright from cpap.com, I ditched the DME and bought my apap out of pocket. Too much DME hassle as well, with their lying and refusal to provide the basic manual for the apap, much less the software.

So I now have questions about the future, where my insurance is concerned. Is there any reason to keep going to a sleep doc, if I am managing my own therapy?

1) Will insurance company demand that a doc be sending compliance data next year or in years to follow, in order for insurance to agree to pay for the routine supplies that I will continue to need?

2) If I need or want another machine in a year or two or three, will insurance company OR cpap.com require a new Rx for that which is not dated 2008? Also--will insurance co. require that same ridiculous rent-to-own deal on a second machine?

3) Is there any reason I am overlooking, for keeping a sleep doc who provides no value to my education or therapy, and basically just reads my compliance data?

4) And off topic, I am puzzled that although my insurance required the 10 month rental deal with the DME, they actually did credit toward my out of network deductible the entire amount of the machine I bought out of pocket from cpap.com! I don't get it.

plr66,

Looks like you're well on your way to finding what works for you.
1. My insurance did not seem to require compliance data. They just wanted me to continue paying the rental. Your experience may be different, considering you're buying it outright and it goes toward your deductible.

2. Cpap.com will not require a new prescription, but if you need a new type of machine because you got retitrated and were prescribed a bipap or SV, they should pay for the new equipment. Some insurance companies will pay 100% of a second titration a year after your first titration. Mine did.

3. My sleep doc never even asked for compliance data, but I brought reports all the same prior to my second titration and MSLT.

4. My insurance pays nothing out of network. You're ahead of the game, from my perspective. Score!

My opinion:

See your Sleep doc about once a year like a physical. If you let them decide you will go back every 90 days for a worthless visit, in every 6 months for a PSG, they make money on every visit, they make money on every PSG you have and they charge insurance hundreds of dollars to interpret any results (last one I had it was $570 to tell me what it said).

OSA is a life-long disorder, there is no known cure, so until a cure comes along the diagnosis sticks, same for the treatment until they come out with something better.

Once you have the diagnosis and the treatment is known, your GP doctor should be able to handle your therapy write scripts for machines etc., mine does.

If you have a $1000 deductible, you might as well avoid the "under the thumb" hassle and buy your machine outright. For $1000 you can buy a new machine every year and still be ahead. A typical mask last me a year or more, I have never purchased a replacement hose in 8 years other than those that come with the machine or a heated hose.

Set up a medical savings account at work, then use that money to purchase masks, machines etc., then it is tax free. Buy from like CPAP.com and they have the medical bill codes right on the invoice.

Pay $1000 per year in deductibles using insurance where you are issued the cheapest crappiest equipment on the planet or spend less on buying what you want and getting top of the line, not too hard for me to figure out.

Can the Rental, buy a nice Autopap and software outright you will be money ahead and have better control over your therapy. That is all your doctor is going to do, get your AHI down close to 5 and then you are on your own anyway. Still tired? There is nothing they can do about that but send you through a bunch of tests, suggest narcolepsy and more tests and still leave you wondering.

Take SNOREDOG's advice, I agree 100%.

I've come to the conclusion that once you've had a good sleep evaluation to determine any and all sleep disorders one may have and when Dx'd w/OSA one has had the titration study and has their equipment order and full scored data summary reports from both studies MOST sleep doctors are nothing but a PITA. Save your money. If you have a good rapport w/your PCP a sleep doctor has NOTHING to offer the OSA patient. There ARE exceptions, we've occasionally read about someone having a good sleep doctor. But for the vast majority sleep doctors have NOTHING to offer the Dx'd apnea patient that their PCP can't provide.

"A" doctor is needed to write scripts on occasion. That doctor doesn't have to be a sleep specialist. The sleep doctors are ignorant of the various brand and models of xPAP "and" their capabilities other than to provide specific pressure that doctor orders.

It depends.......

I had a very adverse/hostile relationship with my sleep doctor, so this may affect my judgment, but I ditched mine after my second meeting after my sleep study.

I think it depends on the patient's relationship with the doctor (sleep and/or PCP).....if you have simple OSA or more complicated breathing issues (or other health issues if your sleep doctor is a pulmonologist)......if you have a data-capable machine and the software to interpret the data.....if you are getting good results with your therapy.....and whether you want to keep or sever the ties with the doctor.

I agree that far too many of the sleep doctors are clueless, money-grubbers. But, there are obviously some good ones out there who are progressive thinkers and are good resources. IF you can afford them and you think you may need them....then it's your call.

Den (taking the middle-of-the-road approach)

Thanks to every one of you who responded to my questions. Each of you brought something just a little different to the discussion, and I find it all very helpful and reassuring! I do not have any other complicating health issues. I am 100% compliant, and don't need to pay an MD to nod his head in approval of that. I had no idea that I might be able to ask my PCP for scripts, once diagnosed--and this is a huge relief to me, since I have a great working relationship with him. I've had my machine since the first of September, and have read this forum obsessively every day since the first of August. I am frustrated that my avg AHI remains in the 4-something range, with weekly spikes up to 6 or 7-something (and leaks are never above 32 max, which is great for my mask, I think). But I'm working at it patiently.

I will ditch the sleep doc. There are so many incredible folks on this forum to help, that it is just money down the tube, so to speak.
BTW--my out of network deductible is a whopping $2000, so it will likely never ever be met to benefit me in any given year. Still worth it to deal with the good people at cpap.com rather than a local DME.