Checking in and a question or two ;)

Lachesis · Post by **Lachesis** » Fri Sep 29, 2006 2:57 pm

OK went to my husband's appt this week and the doctor showed me what gives him an indication a sleep study is needed using my husband as a guinea pig (really kinda cool to see).
He thinks my husband has severe to dangerous levels of sleep apnea which I knew just from sleeping in the same bed. My husband goes in tonight for his sleep study. He is also having his lungs and some other stuff checked (a breathing test? and one other test-- I forget what).

I did get the OK to order our equipment online. But I have to call the doctor (or the online place does) with the exact CPap machines we want need. He will not just write the prescription. I told him the $500x2 at once is a bit steep (for my cpap the local company wanted over $1600, $500 out of pocket. The same one online was under $600 if I remember right-- WHY such a huge markup??) all at once.

So how does one go about picking a machine? Should I go with the resmed one they originally picked out--they said my insurance company said I *had* to have that one. This was with both insurance plans we have separate (but we could not combine the plans).
I want good machine that will last a long time. I wanted an APAP machine but the doctor refuses to go that route even after I pointed out the benefits of using it as a CPAP unless needed. It was a no-go
Where is the website (I clicked a link above but it was for seniors, not just anyone). I remember reading I could give them my insurance information and they would assist me. How it is going to work with the doctor, I am not sure. He said he will call/fax the order in.

I want the best I can get (as would anyone) but do not want to go wandering blindly. I do not even know my test results. I asked for them and he couldn't /wouldn't give them to me. It was close to 20x a night I would severely stop breathing. No other #'s were given to me.

Thanks!

DreamStalker · Post by **DreamStalker** » Fri Sep 29, 2006 3:05 pm

Fire your doctor ... he should not refuse your request for the sleep study results.

Find a new doctor or go to your PCP and have him/her get the sleep study results from the doc you need to fire. Your PCP can write you your prescription or refer you to a different sleep doc.

- r

Lachesis · Post by **Lachesis** » Fri Sep 29, 2006 3:20 pm

My family doctor highly recommended this guy. He reads all the films (I am told) for the area I am in. Dr Gill if anyone knows of him.

In all honesty, I do not want to wait (partial fear I may loose my insurance and my husband was told his job is iffy-- it's a 'grapevine rumor' at the moment but I do not want to mess around.) and loose out totally. If he looses his job, there is no way we can afford one, muchless two machines.

I can make an appt with the family doctor and ask for a prescription but I am sure she will ask me why I do not get it from Dr Gill.

I just want this to go as smoothly as possible.

krousseau · Post by **krousseau** » Fri Sep 29, 2006 3:21 pm

Is your sleep doc your primary care physician? If the sleep doc is a consulting physician get your regular doc to ask for the report (should be 4-6 pages long) then get a copy of the report from your regular doc and see if you can find another sleep doc. If your regular doc and the doc ordering the equipment/restricting access to your records (illegal) are one and the same. Let him know that you have a legal right to have copies of the report and the prescription. Get the copies find a new primary MD and a new sleep doc.

oldgearhead · Post by **oldgearhead** » Fri Sep 29, 2006 3:25 pm

Wow! This thread should draw some comments!

My suggestion - If you are not provided with a copy of your sleep study. or the Rx, tell them you are going elsewhere. They would then be required to send copies to your new doctor.

xPAP machines have one Medicare code number and the heated humidifier
has one code number. Your doctor need only write " CPAP with heated humidifier, masks and asseories". That is all you need to buy on-line.
Make and model should be you choice. So why buy from a REsMed only
supplier?

What does your insurance company say?

I did get the OK to order our equipment online. But I have to call the doctor

Who gave you this OK? How much is your copay? Compare the copay with the DME to the copay of buying online.

Because I've been on the merry-go-round before, I took the PSG, bought a used machine at an auction, bought a couple of masks from cpap dot com, met with doc and got his input on titration, and skipped both the DME and insurance company.

I have a bad taste in my mouth for ResMed...

SelfSeeker · Post by **SelfSeeker** » Fri Sep 29, 2006 3:28 pm

Did you get a titration study done, or bring a xPAP machine home that collected data which was then sent to your Dr?

Is this the link you were looking for:

http://www.billmyinsurance.com/

Wulfman · Post by **Wulfman** » Fri Sep 29, 2006 3:33 pm

Have you read this, yet?

http://smart-sleep-apnea.blogspot.com/

It's a very well-done site. Full of good information.

Make sure that your husband gets possession of his prescription.
Don't let THEM make the decisions of what equipment to get (since your insurance provider has apparently given you the OK to purchase online). This is going to be your husband's therapy.....not theirs.

Do lots or price and feature comparisons on the following website.
If your insurance provider will reimburse you for out-of-pocket purchases, I would recommend purchasing from this site (the parent site of this forum).

https://www.cpap.com/

You may also be able to acquire his equipment through:

http://www.billmyinsurance.com/

(another site affiliated with this forum)

Best wishes,

Den

Lachesis · Post by **Lachesis** » Fri Sep 29, 2006 3:34 pm

Well I have a family doctor who, gives me a list of doctors to choose from (for whatever ailment) but will recommend one or two doctors (in this case she only had good things to say about one doctor, the rest (a list of 10 with in 30 miles or so of us that my insurance covers) Lets just say there was only one sleep study doctor she recommended.)

It is a whole new ballgame down here. And it isn't just my family doctor. My son is bi-polar, Heaven forbid his doctor (well doctors, we've gone through 2 and are onto a third doctor) recommend a good therapist, no you have to do all of the research and setting up yourself. Same for my husband and his issues. And hope for the best.
It really sucks. I realize they are busy but to not even help set up speciality appts is sooo... foreign to me. Having to do it all myself, is overwhelming. And you have to be referred. It's weird to put down your doctors name... I was worried I'd be rejected because she forgot she referred me or something. Thankfully it's never happened.

Would I call the family doctor and ask that she requests this information or make an appointment? I am sorry to sound so clueless... This is all really new to me, doing all of the legwork myself. I do not want to mess up.

[quote="krousseau"]Is your sleep doc your primary care physician? If the sleep doc is a consulting physician get your regular doc to ask for the report (should be 4-6 pages long) then get a copy of the report from your regular doc and see if you can find another sleep doc. If your regular doc and the doc ordering the equipment/restricting access to your records (illegal) are one and the same. Let him know that you have a legal right to have copies of the report and the prescription. Get the copies find a new primary MD and a new sleep doc.

Lachesis · Post by **Lachesis** » Fri Sep 29, 2006 3:42 pm

I asked my doctor when I took my husband to his appointment, I told him I found the same machine online for $1000 less +/- then a local company and asked for a prescription. He said have them contact him (or myself with the company's name and the model I want) and he will OK it.

As for who said I could only choose Resmed? Both my doctor (his exact words were "we start you out on one type of machine {which happens to be the Resmed S-8 Elite} and see if/how it works") the local company who deals with the machines called both insurance companies... blue cross/blue shield ($200 out of pocket, but they would pay I think 60%) and Guardian ($500 out of pocket, but would pay $90%) which said I had to choose this Resmed machine. I would also have to rent the machines for 12-15 months. I still am not 100% sure about that.

Again I am worried if I loose my insurance(s), we'll be FUBAR'd

I did fill out online the billmyinsurance.com and left comments... same as here. I know both insurances will pay for it and at different levels.

oldgearhead wrote:Wow! This thread should draw some comments!

My suggestion - If you are not provided with a copy of your sleep study. or the Rx, tell them you are going elsewhere. They would then be required to send copies to your new doctor.

xPAP machines have one Medicare code number and the heated humidifier
has one code number. Your doctor need only write " CPAP with heated humidifier, masks and asseories". That is all you need to buy on-line.
Make and model should be you choice. So why buy from a REsMed only
supplier?

What does your insurance company say?

I did get the OK to order our equipment online. But I have to call the doctor
Who gave you this OK? How much is your copay? Compare the copay with the DME to the copay of buying online.

Because I've been on the merry-go-round before, I took the PSG, bought a used machine at an auction, bought a couple of masks from cpap dot com, met with doc and got his input on titration, and skipped both the DME and insurance company.

I have a bad taste in my mouth for ResMed...

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, humidifier, medicare, Titration, CPAP, DME, Prescription

Wulfman · Post by **Wulfman** » Fri Sep 29, 2006 4:10 pm

Lachesis wrote:....and asked for a prescription. He said have them contact him (or myself with the company's name and the model I want) and he will OK it.

Not good enough! He HAS to give (your husband) his prescription! It's good FOREVER, even if you move away from this doctor or change doctors.

Den

Lachesis · Post by **Lachesis** » Fri Sep 29, 2006 4:31 pm

I just called and they said I can get a copy of the sleep test (woo hooo). Which is more then I was told earlier! And believe me, I asked. I wanted to run the numbers you guys keep talking about by the group.

My husband goes for his sleep test tonight. Geez I am not even sure when his next appt is now that I think about it. I really want to get this all taken care of but at the same time I want quality equipment!

Wulfman wrote: Not good enough! He HAS to give (your husband) his prescription! It's good FOREVER, even if you move away from this doctor or change doctors.

Den

_________________

birdshell · Post by **birdshell** » Fri Sep 29, 2006 4:57 pm

Sometimes one has to work with what one has available, in doctors as well as other fields. If your list has board-certified docs, then they all had to pass a test...Just because she does not personally know of ALL of them, does not mean that another sleep specialist would be a BAD or WORSE doc for you.

However, it may be worth moving to a place where one can see "with-it" docs. I know, you just moved down there to enjoy your later years, perhaps?

Could your primary care physician not write your scrip? She would have the PSG results upon which the scrip is based. (If, in fact, you had a sleep lab PSG done.)

Best wishes, and listen to the folks here. They can ease your way.
_________________________________

RE: Renting the machines for that long....

Is that normal? My machine was purchased outright, as far as I know.

snoregirl · Post by **snoregirl** » Fri Sep 29, 2006 5:34 pm

I still can't figure out from all your posts if YOU called the insurance or the doctor is telling you Resmed machine is the only one you can have.

I seriously doubt that your insurance will only pay for Resmed.

Second. I see a lot of numbers on what it will cost you and am having trouble following. The first one I see is $500 out of your pocket. If that is what it will cost for an Elite, your insurance is worthless. You can get the Elite online for about that cash.

If you are going to have to pay $500 copay for a machine, you might as well get an APAP from CPAP.com ($700 ish)and reduce your future visits to any doctor for retitration etc. Other than mask fitting, there is not much else the DME or Doc can do for you now that you can't get from the people here. You will be the one to figure out how to sleep with the machine, which mask is best, how to reduce leaks, etc. You can get better suggestions free here than from DME or Doc.

If indeed you can't get this doc to give you a prescription, go to your regular doc or another doc and request your records be transferred to them. Once you have the records and the new doc writes you a prescription call the state board of health and find out how to report this doctor. While I am not a lawyer, I believe that you have a right to your prescription.

Another option is with the sleep study in hand find another doc (your regular one or another) to review the study and write you a prescription.

You really only need a CPAP prescription to buy APAP at CPAP.com if you are paying cash (I don't know about Bill-my-insurance). But if your copay is $500 for the elite, you might as well pay cash and add $200 for the APAP.

WARNING. If you take something from the doc/dme you may not be able to deal with another DME for insurance purposes. Calculate the costs out of your pocket for renting 12 -14 months. If you lose your insurance like you are worried about, you will be holding the bag for the rental. WAY more $$ than you would pay buying outright online now. If you realize that and return the machine after say 6 months then have to buy without insurance your are paying the cash price and the rental. Too much.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, cpap.com, CPAP, Prescription, APAP

Lachesis · Post by **Lachesis** » Fri Sep 29, 2006 5:58 pm

Sorry, I have 2 insurances... Blue Cross/Blue Shield. They will pay 40% on all future supplies, and I believe the machine it's self. But the co-pay for the machine is $200 I would pay 60% out of pocket.
My husband has a second insurance... forgot the name but they will pay 90%, the machine (the Elite was indeed quoted to me by some local guy, the doctor called-- just under $1600) but the co-pay on this machine is $500. I have to rent the machine via this company for 12-14 months. According to this local guy, I can not combine my insurances to cover the full cost.
I am working with Billmyinsurance as of today to see what they can find out on these 2 different insurance companies. My doctor said once the company (cpap.com) contacts him, he will give them the prescription. Now I faxed over a release form today and asked again for the sleep study results plus a prescription in writing for a CPAP machine. We'll see if I get it.

The doctor said they start with one machine and work from there. The elite is the one they start with. IF it doesn't work, then we'd look into a different machine.
Will insurance companies let you switch machines? I suppose this is a stupid question.
This yahoo who called me last week said my insurance will ONLY cover the elite.

I got an email from billmyinsurance and they are contacting my doctor, so maybe we'll get somewhere going that route. I told my doctor there was a $1000 difference for the local person vs online. He said go with the online company.

I did not call the insurance company yet the guy my doctor contacted called the insurance company. Stupid on my part.

snoregirl wrote:I still can't figure out from all your posts if YOU called the insurance or the doctor is telling you Resmed machine is the only one you can have.

I seriously doubt that your insurance will only pay for Resmed.

Second. I see a lot of numbers on what it will cost you and am having trouble following. The first one I see is $500 out of your pocket. If that is what it will cost for an Elite, your insurance is worthless. You can get the Elite online for about that cash.

If you are going to have to pay $500 copay for a machine, you might as well get an APAP from CPAP.com ($700 ish)and reduce your future visits to any doctor for retitration etc. Other than mask fitting, there is not much else the DME or Doc can do for you now that you can't get from the people here. You will be the one to figure out how to sleep with the machine, which mask is best, how to reduce leaks, etc. You can get better suggestions free here than from DME or Doc.

If indeed you can't get this doc to give you a prescription, go to your regular doc or another doc and request your records be transferred to them. Once you have the records and the new doc writes you a prescription call the state board of health and find out how to report this doctor. While I am not a lawyer, I believe that you have a right to your prescription.

Another option is with the sleep study in hand find another doc (your regular one or another) to review the study and write you a prescription.

You really only need a CPAP prescription to buy APAP at CPAP.com if you are paying cash (I don't know about Bill-my-insurance). But if your copay is $500 for the elite, you might as well pay cash and add $200 for the APAP.

WARNING. If you take something from the doc/dme you may not be able to deal with another DME for insurance purposes. Calculate the costs out of your pocket for renting 12 -14 months. If you lose your insurance like you are worried about, you will be holding the bag for the rental. WAY more $$ than you would pay buying outright online now. If you realize that and return the machine after say 6 months then have to buy without insurance your are paying the cash price and the rental. Too much.

_________________

snoregirl · Post by **snoregirl** » Fri Sep 29, 2006 6:35 pm

Most likely Bill-my-insurance will not be the price of cash at cpap.com. Their prices are similar to brick and morter DME's.

The only way to get the low low price is cash online. Some people have been successful in getting insurance to pay for online cash purchases but most have not.

I tried that one with my insurance and their reasoning was it must be a rent to buy to make sure I comply with my treatment before they spend the money. So no go. Silly since they could have 2 out of 3 people not comply and still be money ahead by purchasing outright online.

I am sorry but I am still having trouble with your insurance numbers.

I am guessing what you are saying is the 60% you have to pay on a machine comes out to $200? Or is it $200 plus the 60% that the insurance doesn't pay? Seems unlikely that $200 total is correct if your insurance covers 40%. Most DME's charge $1500 or more for a machine and 60% of that is $900 minimum.

On your husbands 10% of $1600 is $160 so I am still really confused on the $500 copay. Not that I really need to understand since it is your insurance. AS LONG AS YOU DO.

My point is make sure the total of what you pay out of your own pocket is less than what you would pay cash for from CPAP.com or you are wasting money.

I would also be wary of only a 40% copay on future purchases. For example a typical DME charges maybe $30 for a hose. CPAP.com $10. 60% of $30 is $18 more than forgetting your insurance and ordering online. Same type of thing goes for mask and filters. Each has to be checked and calculated seperately to make sure which is the better deal for you.

Good luck

Checking in and a question or two ;)

Checking in and a question or two ;)

Docs