First visit to the Sleep Doctor

lola · Post by **lola** » Mon Aug 22, 2005 4:49 am

Today I finally got to see The Sleep Doctor. It was ok. He wasn't bad but he wasn't excellent either. So, ok. Heh. Asked me all the usual questions about medical history and such, went over my study results, etc. He did admit he usually deals with much older patients and I was fairly unique in being a young active person who's been doing research on the subject at hand. And he seemed a bit flustered when he suggested I look into lap-band weight loss surgery and I told him I'd already researched that and didn't think it was a suitable option for someone like me, but hey. And he didn't seem entirely positive about CPAP compliance and stuff like that. Overall, I guess I can live with him as The Sleep Doctor. (Although I kind of have to. He's the only Sleep Doctor for this entire region of the state!)

Still waiting for my CPAP machine to be "allocated". Apparently the machines are a couple of years old and don't have integrated humidification, but they work. I'm going to have to try saving up for one of my own, I think!

ozij · Post by **ozij** » Mon Aug 22, 2005 5:20 am

Lola,
Humidification doesn't have to be integrated, and for some people it's very important. So you might want to buy a separate humidifier first after you've saved the money you need.

O.

lola · Post by **lola** » Mon Aug 22, 2005 6:56 am

Oh I will be getting a separate humidifier unit with the CPAP machine, sorry didn't make that clear. Ack, this means I'm going to have to find some extra table space next to my bed. And I should probably sew my curtains too finally. (I hear direct sunlight's not so good for the masks and hose.)

I am so envious of all the lucky people who have tiny AutoPAPs with built in everything and tracking software! I love tracking information. *sulk* Now what can I sell on eBay...

SnoreNoMore2005 · Post by **SnoreNoMore2005** » Mon Aug 22, 2005 5:44 pm

I have had dealings with two sleep docs who are both certified in sleep medicine and members of the doctor sleep medicine societies, etc. Also with four respiratory therapists who work for DME's that provide CPAP's and help with CPAP.

I would have to say that none of those "professionals" I have dealt with could even hold a candle to how knowledgeable the people on this board like Dream Gal, Will, and others are when it comes to giving advice on adapting to and using a CPAP or APAP.

We're all very fortunate to have people like that and others to help us learn how to use CPAPs.

SnoreNoMore2005

Sleepless on LI · Post by **Sleepless on LI** » Mon Aug 22, 2005 9:02 pm

http://search.auctions.yahoo.com/search ... esults0=15

Lola,
I am not in the habit of recommending people go off-site to buy their cpap supplies and such, but you are in an unusual situation with not a lot to spend, looking to sell things on eBay to pay for what you really need.

So above is a link to Yahoo Auctions' cpap pages. There are heated humidifiers and machines and masks...hey, you never know what you'll find. As long as you check the seller's feedback and make sure it's positive before you bid/buy, you should be okay. It's a thought, an alternative, to not having what you really want. eBay is another site to look at.

Good luck.

lola · Post by **lola** » Tue Aug 23, 2005 10:05 am

Thanks for the link, Sleepless on LI. I'm keeping an eye on it and eBay and will see what machines tend to go for on the auction sites. A good deal at just the right time would be great.

And I definitely agree there, Snore No More...I've learned a lot more just from reading this forum than I have from the sleep doctor and the technicians, in fact the doctor yesterday told me he "didn't really think the internet was much use". I think next time I see him I'll show him a list of links useful for patients, maybe he'll look at them, maybe he might even tell other patients about it (not counting on it though, might give it away that he doesn't know everything! ). So thanks to all who post here, you're a wonderful resource and source of support!

BP · Post by BP » Tue Aug 23, 2005 1:20 pm

Hi lola, I had a similar problem when attempting to get a prescription from my sleep doc for and apap with software etc. he said there was no need for any of those fancy options, and he didn't trust the reporting software anyway. Since he owns the sleep clinic as well, accurate software would potentially cut into his bottom-line, so it's no wonder he's going to say that it's not accurate. Everyone has their biases.

I ended up getting a prescription from him, unfortunately my DME will not fill the prescription. They insist on giving me a basic machine, straight CPAP, first. In fact it's due to be delivered this week. I sure hope I don't have any issues getting used to the 10 cm of pressure, without c-flex or apap.

Good luck,
BP

Sleepless on LI · Post by **Sleepless on LI** » Tue Aug 23, 2005 2:11 pm

BP,

Are you saying your DME was able to veto your doctor's prescription and give what he thought you should have? I cannot believe such an incredible thing. I know whenever my DME wanted to give me something, he had to have me get a prescription from my doctor before he could dispense it, like a pharmacist can't dispense without the doctor's prescription and can only give out what the doctor wrote the script for. I don't understand, if I'm understanding your post correctly, how a DME can override what a doctor orders. Does this make sense to you?

BP · Post by BP » Tue Aug 23, 2005 5:34 pm

Lori,

You can read all the gory details here:Please Help, Newly Diagnosed

Hope I did that link right.

But the bottom line is, that my doctor submits a prescription to CIGNA, CIGNA merely passes it on to Gentiva, who does all the approvals for xpaps, then passes it on to the DME who is Rotech. For a new patient, if the doctor prescribes anything but straight CPAP, Gentiva or CIGNA just rejects it. Period. There is no discussion about this. Believe me, I discussed it with everyone I could find. They told me I could submit a prescription for any machine I wanted, but after they rejected it, my only solution is to then appeal which takes 45 days. I really don't want to wait 45 days to begin therapy.

I know it sounds very bizarre, but that's the way they work it. It does appear as if I will have no out-of-pocket cost for this at all. For in network, with this particular plan, there is no deductible. It looks like I will be getting the machine tomorrow or the next day. So worse case scenario, I'll use it for a couple of months, until I can get a new insurance company, which I can change each year with the company I work for. Then use this one for vacations or backup, when I really won't have the time to check the software results anyway.

The only thing I'm really concerned about, is whether I will be able to tolerate 10 cm pressure right off the bat, without the advantage of cflex or auto.

-BP

chrisp · Post by **chrisp** » Tue Aug 23, 2005 5:46 pm

Sleepless on LI · Post by **Sleepless on LI** » Tue Aug 23, 2005 5:57 pm

The only thing I'm really concerned about, is whether I will be able to tolerate 10 cm pressure right off the bat, without the advantage of cflex or auto.

I was able to. It was no big thing for me. If you don't have any accompanying respiratory problems, I can't envision your having a problem at 10 cms. I didn't even attempt to use CFlex, or feel I wanted to, until in the very beginning with a nasal pillow interface. It felt stronger than it did with a nasal mask. However, after seeing my results on my software and them always being so much better without CFlex on, I turned it off and never looked back. I don't even know if there is any correlation between CFlex and AHI's, but in my case, there seemed to be. Also, I'm sure this machine will have a ramp button so you can start out on a lower pressure and then it will creep up to 10 a little at a time, hopefully by the time you're already asleep. I don't know if you're familiar with what a ramp button does, so I won't go into it on the chance that you do. But I don't feel 10 is that high a number that you should really have a problem. I know it wasn't for me.

Now, as far as your story, sounds like your insurance company is doing what mine does when it comes to medication prescriptions. My doctor prescribes a particular drug. I take it to the pharmacy to be filled. When I go to pick it up, they say, "Your insurance company denied it. There are other formularies that do the same thing..." and they tell me to call my doctor with the list of what they will accept. They just don't want to pay more money for certain drugs, even though sometimes it's essential I have the one prescribed. So I do what they told you to do, file an appeal due to medical necessity. Mine, however, only takes about 24 hours till they give you an answer, and so far it's always been an approval.

What I would do if I were you? I'd take whatever machine they give you now just to get started and then appeal it. Can you do that while you have the straight CPAP machine? I would think so. They're renting it for you, no? If so, then immediately put in an appeal with your doctor behind you. At least you'll be on therapy while you wait.

What kind of world we live in now when the doctors don't do the prescribing, but the insurance companies who aren't trained to dispense medication, or CPAP machines, have the final say. And for what we pay for our insurance policies, it's a crime.

Good luck. I'm sure you'll do fine on 10 cms. without CFlex. Keep us posted.