How badly did my DME lie to me?

[Lyza]

Ok so I'm at work today and finally remember to stop by the DME and get some replacement air filters... I work at a hospital, my DME is only 2 floors up.. So I go up there ask for the filters, he checks my name to check the time frame of when I got my machine (its been 6 months) and he's like sure lemme get em. "You want a new mask too?" he asks? I'm like can I get a different style? different brand? He's like sure, set up an appt, so you can bring in your machine with your pressure already set and I'll give you a new hose, and testing new masks will be better that way. I'm like cool..

I already knew I could get a new mask every 6 mos... Now he's being so cool about everything, I decided to ask about upgrading my machine from the simple resmed S8 compact to something that has software/data recording. I want a machine that I can interpret data from so I can see whats going on while I sleep. I am single, so nobody is around to tell me if i'm snoring, not breathing, or my mask is leaking bigtime, etc.... I've been 100% compliant from day1 with 1587 hours logged so far. I'm not looking for top of the line machine, just the next step up that will tell me if i'm having any episodes and/or if perhaps my pressure needs adjusting.

Sidenote,...... I rarely post, but I'm here daily reading, and reading and reading posts, gathering info, making mental notes, etc...

So I ask him about upgrading my machine. He just laughs at me. He said that will never happen. I'm like why not? He goes.. nobody has those machines. I'm like bullcrap.. Tons of people have them. He said well people around here don't. They cost way way way too much money.

Now I *thought* I had read that there was only 1 billing code the DME uses for cpap machines regardless of high end or low end machine, ect... Did i get my info confused somewhere?

Anyways bottom line, we Argued quite awhile over it and he wasn't budging, saying that nobody has those machines, and only the dme's use the data, which again I told him was a load of bull. I explained why I wanted it, to see how MY own therapy was going, etc.. He was like are u snoring? I'm like dude If i knew that I wouldn't be asking for the machine now would I?... He said the only way he was giving me that type of cpap was if I could get my dr. to get a prescription for it and then laughed at it, saying no dr. would do such a thing cuz they are too expensive.

Now overall, My DME is super cool... I just think he's rather ignorant in this particular area or I've completely misunderstood things I've read here...

Sorry for the rant and/or confusion.. looking for information before my appt next week.

How did everyone else get machines that record data?

[GoofyUT]

Well, he didn't exactly lie to you. DMEs like to give the CHEAPEST and simplest CPAP because they get the SAME insurance payment regardless of whether they give the MOST expensive and sophisticated APAP or the most basic and inexpensive CPAP. So, logic dictates that they'll give the cheapest one that they can to maximize their profit margin. And, most patients know nothing about data and could care less. Its really only the well-informed folks here that care about having data capabilities. Even most docs don't care about efficacy data. Both docs and DMEs want only compliance data to satisfy insurance company requirements that you actually use the machine, given the fact that overall, compliance amongst CPAP patients is pretty low.

So here's the trick: When you go see your doc, tell him/her that yhou change positions frequently in your sleep (if you do), that you anticipate dramatic weight change in the near future (if you are), and that you occasionally drink alcoholic beverages in the evening (if you do) and that you want a machine that will adjust to those changes. An APAP is really the only answer to those conditions and all APAPs are both auto-titrating AND data capable. And, they can all be set in CPAP mode. Remember though, that APAPs are NOT for everyone, and certain medical conditions like congestive heart failure and Cheyne-Stokes respiration need to be ruled out before you should try an APAP.

If your doc agrees, make sure that he writes a prescription for "auto-titrating PAP" or APAP, and then your DME will have no choice but to furnish you with an APAP. I would urge you to attempt to try the different models of APAP for awhile, since the treatment algorithms vary dramatically from one brand to the other, and each individual will respond better to one or the other. APAPs are NOT created equal. One is NOT as good as the other, for any given individual.

Hope this helps!!!

Chuck

[Lyza]

Ahhh I see where you are going with that logic and what you are saying...

I'm assuming all of this would be done with my primary care physician, the one who originally sent me for the sleep study? Cuz the sleep doc, haven't a clue who he is, do any of us really? lol

My primary care doc has been good about this as well, after the study and my first followup with her, she flat out said she knew nothing about sleep apnea or cpap and the struggles of therapy. While I was explaining to her the headgear, taping my mouth shut to teach my self to keep my mouth shut, don't dare sneeze with the damn thing on or cough hard cuz you just about blow your ear drums out, etc, etc... SO I most very likely can persuade her to write the script to suite my needs. I have no other health issues besides the sleep apnea, clinical depression, overweight.

hmm.. all apaps not equal you say... I've been sorta disregarding all the posts concerning those as they didn't apply for these past months, guess i better start paying attention..

More researching to do! and looking forward to other ideas/opinions!!

[preemiern]

Another idea is to tell your primary doc that you are swallowing alot of air during the night, and that it is very painful, and that you have learned that auto titrating machines help eliminate the swallowing of air by giving you only the pressure you need based on sleep position, etc. Tell him/her that you have been doing alot of reading/research on your own, and that this is what you have learned...as you have been reading and researching.
Provided, as GoofyUT stated, you have NO underlying heart condition...
On your script, your doc will also have to prescribe a pressure range. It usually is 2 -3 cm below your titrated pressure, to 2 -3 cm above your titrated pressure. So with a pressure of 13, you would want a pressure range of 10 or 11 to 15 or 16. I would say maybe 10 to 15 would be a good range to start with based on your titrated pressure of 13.
As far as machines go--one thing to keep in mind--
The Resmed autopap has EPR which is pressure relief on exhalation--however-this feature DOES NOT work in autopap mode on the Resmed machine--it only works in straight CPAP mode. The respironics autopap with C Flex(respironics form of pressure relief) does work in autopap mode.
If you go with a respironics machine-you will also need your doctor to add C-Flex on your script.
As GoofyUT mentioned--if you are able to try different machines before making a final decision--that would be best so you can determine which feels more comfortable to you. If you aren't able to try different machines, and can only make 1 choice--then keep the expiratory pressure relief piece of the puzzle in mind, and that Resmed's APAP does not allow the function in APAP mode.
Good luck in your quest and on your journey to better sleep...let us know what happens!!
Cindy

[Catnapper]

If you want to keep track of the data, you may want to add information on how to access it to the selection of your machine. One machine may be easier than another.

I found that getting the software and card reader was pretty easy for my Respironics M series auto. If I had not been able to see the results, I might have had a difficult time persuading myself that I am making progress. Seeing the low AHI numbers convinces me that something is working even when I have those bad tired days. The Resmed Vantage I borrowed showed basic numbers on the screen, but I didn't have the software for it. I do like to look at the graphs for each night to see what happened and when. The visuals provided by the software appeal to me, but you may not want or need that. I also keep a diary to add to the info from the machine. I list things like the mask I used, and go on to add things like whether I felt rested in the morning, had trouble breathing because of congestion, and so on. This diary is separate, but I can look things up by date to compare.

Maybe someday I will feel so rested I won't need to rely on the data from the machine to tell me thiings are working. Until then, I want to know what is going on so I can try something different if that something is indicated by the data from the software.

I hope you find the perfect machine for you. Not to mention the perfect mask, etc.

[mattman]

No your DME did not lie to you.

It sounds like you have a very helpful provider. Please don't let some misinformation suddenly make you feel like you are getting ripped off or lied to. There is NO reason to suspect your provider of anything other than being a good company.

Also, some of the later responses regarding what may or may not be a motive behind your provider are wild speculation at best, and downright wrong at worst.

DME companies are not greedy pigs driven soley by profit margins without regard to patient care. Please don't let some misinformation make you think otherwise.

FIrst off - what it really sounds like you are looking for is a CPAP with data recording capabilities such as the unit I use - A RemStar Pro2. Remember - there is middle ground between a basic CPAP and an APAP. Many CPAPs record everything you talked about. Snores, Leaks, Apneas, you name it!

Your DME company is exactly right. Very few patients use APAP machines. Also, in 15 years of doing this I can think of exactly 1 patient who was interested in monitoring thier own progress. I am willing to wager a months paycheck (which granted aint much but it is to me! ) that I could put a display up right in front of our facility with FREE software for this equipment and I would maybe have 1 patient take it. Seriously.
You HAVE to realize that the types of people posting here are a VAST minority of the CPAP/APAP patients. The couple hundred users here are easily less than .001% of the users out there.

And while it's true that there is only 1 code for CPAP/APAP therapy it is a very regular misnomer on this board that they are interchageable under that code. Rather than saying 'An APAP is billing using the CPAP code E0601' it is much more correct to say 'There are times when you CAN possibly bill an APAP using the code for a CPAP'. They are NOT interchangeable at will. In fact there are some VERY specific cases where you absolutely cannot do so. at all.

This is not to say you might not want, benefit or even flat out NEED an APAP. I just hate seeing people get some inaccurate or sometimes downright wrong information and suddenly decide a perfectly qualified and decent company is crap.

If you are having aerophagia issues then by all means look into getting an APAP. If you are having issues with continual Apnea episodes - look into an APAP.

FYI - potential weight loss is NOT a qualifier for an APAP. Lose the weight - then they will talk to you. I've been saying I'm going to lose weight for close to 10 years now.

mattman

[cflame1]

Lyza... please note that mattman works for a DME. (correct me if I'm wrong mattman)

[Guest]

mattman did give accurate info.

I would not agree with everything he said. But I do agree with the fact that there is a middle ground such as the machine Matt mentioned and the newer Respironics M Pro, which will record leaks, apneas and hypoapneas and a chart of the time they happen.

First of all does your DME carry Respironics machines? Resmed is not making their software or card readers available to the public.

I got my Auto on line at CPAP.com with my Rx for a CPAP.

I do agree with Matt some people do not want to bother with the added info that I want. Someone told me that they would never want to deal with the data I deal with. They just want to put on their mask, turn on the machine and go to sleep. To each his own.

Can you switch to a Respironics Remstar pro 2 (not the pro) or an Remstar M Pro.

No your DME did not lie to you.

It sounds like you have a very helpful provider. Please don't let some misinformation suddenly make you feel like you are getting ripped off or lied to. There is NO reason to suspect your provider of anything other than being a good company.

Also, some of the later responses regarding what may or may not be a motive behind your provider are wild speculation at best, and downright wrong at worst.

DME companies are not greedy pigs driven soley by profit margins without regard to patient care. Please don't let some misinformation make you think otherwise.

FIrst off - what it really sounds like you are looking for is a CPAP with data recording capabilities such as the unit I use - A RemStar Pro2. Remember - there is middle ground between a basic CPAP and an APAP. Many CPAPs record everything you talked about. Snores, Leaks, Apneas, you name it!

Your DME company is exactly right. Very few patients use APAP machines. Also, in 15 years of doing this I can think of exactly 1 patient who was interested in monitoring thier own progress. I am willing to wager a months paycheck (which granted aint much but it is to me! ) that I could put a display up right in front of our facility with FREE software for this equipment and I would maybe have 1 patient take it. Seriously.
You HAVE to realize that the types of people posting here are a VAST minority of the CPAP/APAP patients. The couple hundred users here are easily less than .001% of the users out there.

And while it's true that there is only 1 code for CPAP/APAP therapy it is a very regular misnomer on this board that they are interchageable under that code. Rather than saying 'An APAP is billing using the CPAP code E0601' it is much more correct to say 'There are times when you CAN possibly bill an APAP using the code for a CPAP'. They are NOT interchangeable at will. In fact there are some VERY specific cases where you absolutely cannot do so.

This is not to say you might not want, benefit or even flat out NEED an APAP. I just hate seeing people get some inaccurate or sometimes downright wrong information and suddenly decide a perfectly qualified and decent company is crap.

If you are having aerophagia issues then by all means look into getting an APAP. If you are having issues with continual Apnea episodes - look into an APAP.

FYI - potential weight loss is NOT a qualifier for an APAP. Lose the weight - then they will talk to you. I've been saying I'm going to lose weight for close to 10 years now.

mattman

[SelfSeeker]

That was me who thought auto log in was working.

Yes, cflame, Matt does work for a DME. He has never hidden that fact. Which in my opinion gives him a different side to it. As a CPAP user now, he can get an other understanding 'of us users".

Like in all fields and as some RTs have said on chat. They are not all the same. And not all do the same work.

Lyza... please note that mattman works for a DME. (correct me if I'm wrong mattman)

[sleepyWI]

He was not very honest with you about the price, or at least ignorant. The Resmed compact is among the more expensive straight cpap machines. You can find an apap that costs the same or even less. On this site one of the Remstar autos is only $35 different from your S8 compact machine fully loaded, humidifier, software, the works. ($835 vs $800)

[mattman]

Lyza... please note that mattman works for a DME. (correct me if I'm wrong mattman)

Yah, hence that whole paragraph in the middle where I made a point of mentioning it and the thing about putting the software in our place.

m

[snorestats]

Even though I'm a newbie, only just finishing my 3rd night of CPAP, I can assure you that this issue is fairly simple to resolve. Of course, this is going to make me sound like a total A$$:

If you want a new machine and your insurance company is going to pay for a new one, then there is no reason not to get what you want.

Simply do some DME shopping. Get a list of those that your Insurance covers. Tell the DME that you have a working machine but your insurance company will now pay for a new one. Tell them that if they're willing to send you the machine you want then you'll do business with them. It's a win-win! Be stern and tell them what YOU want. If you want the humidifier, ask for that up front also (although that might require dr to add to prescription).

DME will get paid the same amount of $$$ regardless of what machine they send you.

If that does not work (and I'm certain it will), simply demand your doctor to write a script for EXACTLY what you want. If he says no, ask him if the machine that you want will work for your prescription, if he says yes (and it's a 99.999% chance he will), then kindly ask him to prescribe it for you. If he still says no, then tell him you'll find a doctor that will.

Regardless of what step you are at, keep pushing. Be an ass if you have to. Keep badgering. Be determined. This is your problem! This is your show and you are the star of it! This is your insurance company.

Trust me, most people who deal with doctors or DME's simply take what is given to them. They are not used to dealing with demanding folks and will fold like a house of cards!

That said, get the "REMstar Auto C-Flex" or the "M Series Auto C-Flex".

By the way, I got what I wanted simply because I was firm with my DME. My original prescription did not call for a Humidifyer, but my doctor was kind enough to add it (no problems at all). My prescription did not call for an APAP.

[whatrdreamsmadeof]

great info your getting here IMHO go with Goofyut (chuck)'s advice......I took it went through my fab primary care dr. fought with dme...paid out of pocket for my remstar auto w'cflex, software and reader and it is great,,,,,,,,,,not worth the fight with dme.in the long run the out of pocket pays for the piece of mind......and you are in control....I bring my reports to my primary care doc, and let go of the so called specialist that was charging me a bundle,, but couldn't see me for 6 months or more, and couldn't even give me advice based on the reports..take control and enjoy your treatment.......Ellen ..also the folks here will help you with everything you need.. bravo to all those who contribute here.......

[stoverquill]

DME=stigma

Not all DME are bad...why suspect them unless you have reason.

[justtrish]

Ok so I'm at work today and finally remember to stop by the DME and get some replacement air filters... So I go up there ask for the filters, he checks my name to check the time frame of when I got my machine (its been 6 months)

I decided to ask about upgrading my machine from the simple resmed S8 compact to something that has software/data recording. I want a machine that I can interpret data from so I can see whats going on while I sleep. I am single, so nobody is around to tell me if i'm snoring, not breathing, or my mask is leaking bigtime, etc....

He wasn't lying per se. 6 mos is WAY too soon to be changing machines, simply because you are curious as to how your treatment is going. I don't know which insurance company you have, but they usually want to wait longer before purchasing another machine for you.

If you've noticed improvement since going on the machine, then everything is going along as it should.

Insurance isn't a blank check for people to fulfill their whims. If you wanted all that, you should have discussed it with your doctor before you got the first machine.

Nothing is stopping you from getting whatever it is you want - as long as you're willing to pay for it, but I'm willing to guess that if it's coming out of your pocket, all of the sudden you might decide you can do without it.

My two cents

Trish

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, DME