Hey NyNurse!!!!!

[preemiern]

Still anxiously waiting to hear how your f/u appt. went!! I sure hope you were able to get the machine you wanted!! Please let us know soon!! Cindy

[kavanaugh1950]

YEAH, WHERE ARE YOU? PAT

[NyNurse33]

Grrrrr....Not 100 % happy.

Started off with the fact that it is now 6:23 and I just got home. My appt was scheduled @ 3:45, but did not see her until a little after 5!! Can you believe that? This happened when I saw her last fall too.

So she asks" How is the therapy going for you?"
Me: Not too well, I'm experiencing aerophagia and pressure in my ears, and being a nurse I know this is a side effect of straight cpap
MD: Oh
Me: I think auto cpap would be a better choice, plus the fact that I will be losing weight and there is the possibility of weight flucuations
MD: Well, I can't give you an anwer about that right now, I'll have to check with Nancy-------, she is the one who deals with that and can check into it. Some people can't use it if they have central apnea
Me: I don't do I?
MD: No
(by the way Nancy is the manager of the sleep center, initials that follow her name are, RPsgT)
Me: I also think I would benefit with c-flex for expectory relief. I was titrated while sleeping on my back, which I don't do @ home.
MD: well maybe you'll get relief just from the c-flex and not auto. APAP is a more expensive machine, so maybe you'll be willing to pay the difference
MD: She can check with your insurance and all that.
Me: My insurance will cover it and its the same billing code as cpap
MD: I don't know anything about all of that stuff. Nancy will be back in the office on Tuesday and I will leave a note on the front of the chart and talk to her then. It sounds like you have the luxury of good insurance (I do, 80/20) and the complaints of aerophagia and eustacian pressure will probably be enough.
Me: My insurance says to just do a courtesy pre-authorization call to find out
MD: Why don't I see you in 2 months and we can discuss after we find out all the other info, what kind of machine you would like.
Me: I can't wait that long, I have only 1 more month on rental
MD: Well, we'll have Nancy look into it

So basically I will be on Nancy's behind next week. The MD didn't shoot it down, but I felt like she wasn't 100% for it either. I can't figure out why, she is not paying my insurance, if I don't have central apnea, then why the big fuss? No medical reason not to. All financial, I'm sure. I told her that I don't want to keep coming in for titrations with weight loss. I did get a copy of my sleep study and titration. If anyone can help me figure it out, please PM me. Don't worry, I'm not finished with my crusade yet. I guess she can't or won't make the decision on her own. Who is this Nancy? This is the MD for crying out loud, why couldn't she just write the script. Is it because she is just an ENT and Nancy has to intrepret for her?

[sleepinggoodfeelingood]

If you are willing to pay the difference, shouldnt if matter to the dr. what the insurance will or wont pay? Its coming out of your pocket, the difference right? Since she didnt shoot it down I would think it might work out of you, why would they care if the cost or the rest of the cost is coming out of your pocket? I dont get it?

[NyNurse33]

That's become my slogan since starting cpap " I don't get it" I agree, as long as there isn't any medical reason for me not to have apap with c flex, please just write me the script. That's why I think its all $$$$. They want me to keep coming in to get titrated. Believe me, since I now know that this Nancy chick has more power than the MD, I will continue with her next week. At least its not like my current machine isn't working @ all. I'm just a spoiled brat and I want what I want.

[NyNurse33]

By the way, do you think my primary MD would touch this? Think he might write a script. I see people are never even titrated, just given apap, so what's the difference?

[kavanaugh1950]

YOU GO GIRL! I WOULD ASK OR RATHER TELL MY REGULAR MD TO WRITE A SCRIPT FOR ME. I NEVER HAD TO GO SEE A SLEEP DOCTOR, THE ONE AT THE SLEEP LAB WROTE THE PRESCRIPTION AFTER MY SPLIT SLEEP STUDY AND TOLD ME TO FOLLOW UP WITH MY REGULAR MD IN TWO WEEKS. PAT

[preemiern]

yes--Get on Nancy's behind-whoever she is-and be a "squeeky wheel"!! Don't give up until you get what you want!! You could ask your regular MD also...what sucks is that it is now Friday evening, and you can't do anything more until Monday.
do you have any drs. that you work with that you have a good rapport with who might be willing to write you a script? that is another option. I know when my kids were young, I could get my unit docs to look at them for ear infections, strep throat, etc, and get scripts for them without the hassle of waiting in urgent care and ER's as usually when they got sick it would be on a Friday evening after the regular dr. office was closed.
anyway--just thought that maybe that might be an option for you too--you should not have to wait another 2 months!!
Good Luck!!
Cindy

[snoregirl]

What a bad setup. A doc shouldn't defer to a RT. What if you had said you wanted the script for APAP and you would deal with the insurance yourself (or get the machine elsewhere)? Did you happen to try that one? Or did you want a shot at Nancy first?

Absolutely no business of the doc what your insurance pays for. Nice of some docs to consider it and mention to the patient what they "THINK" their insurance will cover in case the patient is concerned and hasn't thought about it yet, but ultimately it is none of their business UNLESS they have a vested interest in the DME!!!

YES I would go to your regular doc. I also never saw a sleep doc. Some faceless sleep doc looked at my numbers and wrote a meaningless generic report for which he charged $220 each time and my regular doc wrote the prescription.

I would get out of that sleep center monopoly now right after you get on Nancy's back. I wouldn't "come back in 2 months" You told her you were having issues and she wants you to come back in 2 months??? How much is she charging for each of these nice useless chats?

Go get Nancy then at the very least walk out with the prescription for CPAP so you can use it online if you ever want.

Then go to your regular doc. If he/she is with you get a script and see another DME (call your insurance to find out who) and see what you can do as soon as possible and give them their machine back at that first sleep lab.

[birdshell]

I absolutely know that my primary care physician/internist would write the scrip, given a copy of the PSG (which he already has). He is my rock (medically speaking).

When next I see him, I'm going to share some of the information from here. He treats many underprivileged folks, so he may be able to help them--if he doesn't already--by using APAP, etc.

RE: Nancy

Why is it that the doctor has not asked her a few of these questions? Truly inquiring minds (who are specialists in the field) should want to KNOW! My docs have known these things.

(And you may certainly tell her that I said so!)

[elliejose]

Melissa,

I have BCBS and mine is 80/20 also. I didn't pay any difference rental for APAP than for CPAP. The DME's just don't get reimbursed anymore for APAP than CPAP. I think that is why they put you off on it if they can.

I really had no trouble getting the apap. My md had put me on one for 2 weeks to check my pressures at home and when I told him I rested much better with it than straight cpap, he just prescribed it. My hubby also told me to tell him he requested it also, as he was able to sleep in the same bed with me on apap and not with cpap. Says I am too restless on cpap.

I am now trying to get the RPsgT at my clinic to let me have an auto Bipap. I asked for it when I went back in for titration (the am when I finished it) and he told me "No one NEEDS an auto." I told him I had had much better therapy with the auto than straight cpap. And he said "Well, you don't need it." I have a new MD (mine left the group) and I have asked him twice. I don't think he knows what I am talking about. He just ignores what I say about it. I called RPsgT again today, and he never returns my call. DME says he can't get him to return his either. Should I just ignore them when they send my bill, ya think??? DME seems willing, so far, just tells me he doesn't know anything about one. Never seen it. Says will ask his Respironics salesman about it. Surely the salesman will tell him yes, it is a good machine.

I am having so much trouble. I am about ready to give up. Early part of the night I cannot take the high pressure and aerophagia of the Bipap, so I use my Auto. When the pressure runs high on it in the early am and awakens me because I cannot exhale against the higher pressure, I switch to the Bipap. Not getting much sleep as it takes me awhile to get back to sleep when awakened. Some nights I may switch 3 times. What with all the switching around, hubby has moved back to other bedroom again. Good luck to you. My pressures vary a lot. Sometimes my 90% is 10 or 12 for a week, then it may be 18 - 20 for several weeks. Can't figure any reason for it. But, seems to me, this is reason enough to NEED auto. But who am I?
Just the lowly patient.

Good luck to you in getting what you need. But don't you hate the waiting, especially since your rental period is about up. Keep us posted.

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, bipap, Titration, CPAP, DME, auto, APAP

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, bipap, Titration, CPAP, DME, auto, APAP

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, bipap, Titration, CPAP, DME, auto, APAP, aerophagia

[GoofyUT]

Having been in practice myself, and one of the very FIRST psychologists on what were then new managed care panels in my state, I know that many docs are timid about ordering expensive meds, tests and durable devices that they aren't sure about since they're afraid that if they do that too many times, they'll be dropped by the insurance company from the managed care panels and lose access to all those patients that have that kind of managed care plan.

That probably is NOT a consideration when it comes to APAP -v- CPAP since they both share the same HCPCS (Medicare) code and so the insurance doesn't pay a penny more for an APAP. But, the DME certainly DOES care since it has to eat the difference between the cost of the cheapest CPAP and the most costly APAP. (Bi-levels have a different HCPCS code). That makes me wonder what financial arrangements exist bewteen your sleep doc and the DME. Or, it could be as simple as the prejudice that MANY docs feel about APAP since it IS contra-indicated with heart failure, CSR and mixed/central apnea, and many just feel that it is a new, untested whiz-bang that they just don't trust.

I remember back in the late 80s-early 90s when New York passed a law that prohibited docs from ordering lab-work from a lab that they had any financial interest in. Turned medicine pretty much on its ear, and I think that has since become federalized. The very same thing should happen with docs of ANY specialty and DMEs.

Good luck Melissa! (I do think that your PCP would be good to turn to.)

Cheers!

Chuck

[Gerald]

Melissa....From what I can see of the medical business, the doctors work hard at keeping their "pecking order" intact......They want to keep nurses afraid of them.......they want to dominate the nurses and their patients (customers) when they can get away with it. You see every day that much of the time the nurses know far, far more than the doctors want to admit they know. Keep up the gentle pressure......the "tree" will bend soon enough.

A few years ago, I was researching my great-great grandfather who commanded a group of mounted riflemen just at the time Texas was gaining its independence. One of the books I read was talking about the Rangers during that era......and the author related a quote about the lawmen and their attitude. He said, "It's almost impossible to stop a man who knows he's right...and who keeps on a'comin".

You know you're right....just keep on a'comin!

[quilterB]

I went to my regular MD and asked for another machine. I had all of the info about the RemStar. I explained that I wasn't feeling any different (after 3 months) and I wanted to be in control of my therapy. We talked about the fact that so many of his patients were not compliant and just quit the therapy. He seemed to think it was a good idea for me to have a working knowledge of how things were going. Wrote out the script without any more questions.

Good luck,
Linda

[wabmorgan]

That is about the same as my Auto-Cpap dr conversation went.

The only differance in mine was that I explained to my dr that with what the DME was charging for CPAP that after I paid the co-pays I could but the CPAP myself off an internet site. He asked what we the differance at the internet price and I said the differance wasn't much. He said he didn't think it would help much but he wrote me a Rx for an Auto-CPAP anyway.

Btw, it did help with the aerophagia. I rarely ever have that problem now.

Btw, I think I remember reading that if you order from CPAP.com that you can buy an AutoCPAP with a CPAP Rx!!!!!!!! So, if you don't mind paying for the AutoCPAP yourself that may be another way to get what you want.

Also, you might check what your insurance is really paying after all is said and done. In my case the dme was charging $1400 for the same unit that is sold here on CPAP.com for $375!!!!!!!!! So, after you figure your co-pay on $1400*20%=$280!!!! And that did not include a mask, hose, HH, ect. After all was said and done in my case it was about the same after I paid for the CPAP out of pocket!!!!!!