Hi, all. A brief introduction.

[BleepingBeauty]

Whoa. I had time today to read about the BiPAP Auto SV machine that Bev linked to (https://www.cpap.com/cpap-machine/bipap ... -cpap.html). That's like a dream machine, for me. But I seriously doubt my DME is going to provide something as costly as that. (I know the insurance code is exactly the same, no matter what kind of machine it is. My DME's policy re: data-capable machines sucks.)

It's really frustrating, to say the least, to be caught between a rock and a hard place like this - especially when it comes to healthcare. The doc gave me the data-capable scrip last year, but the DME wouldn't fill it. I just want my condition to be treated properly. If I could afford to purchase my own machine, I'd do it in a heartbeat, but finances are really tight right now.

I should say that I'm grateful to have a machine at all, since it does allow me to sleep. But I'm definitely in the dark re: whether or not my SA issues are being taken care of with my current therapy. (Well, obviously, they're not, since I'm not sleeping enough and still have to nap.) When I get the results of my recent sleep study, I'm going to approach my sleep doc with a more demanding attitude. I need to be able to monitor and adjust my treatment myself. If he won't fight on my behalf to get me what I need, I'll be switching doctors.

My most recent sleep study was my fourth. FOURTH! I've been seeing this guy for 16 months now. He's fairly cavalier about my complaints, and I'm tired (pun intended) of being jerked around.

[jules]

the code is the same for a cpap as an apap but a specialized machine will be a different code - it is like a bipap is a different code than a cpap

if you have the diagnosis of complex sleep apnea with Cheyne-Stokes respiration, you need to find a new sleep doc if all they say is sleep at X cm of pressure

[Kiralynx]

Thanks for that info, Bev. I'll make note of it and question the doc when I see him for my study results.

Bleep,

I have complex apnea -- diagnosed with OSA, and when they went to titrate me, the ole brain said, "Shucks, don't need to tell her to breathe any more!" which must have been a shock to the techs doing the titration.

The RT at the DME (Apria) was very good -- although I'd been researching since the diagnosis, I did not yet know what all those centrals showing up during titration meant.

The RT's recommendation was for a Bipap Auto SV. My doctor wrote the script for it, and the DME filled it.

It IS a dream machine....

...and it costs less than two of those sleep studies!

But it's NOT impossible for insurance (or a DME) to provide such a beastie for you! Mine did!

[SharkBait]

Whoa. I had time today to read about the BiPAP Auto SV machine that Bev linked to (https://www.cpap.com/cpap-machine/bipap ... -cpap.html). That's like a dream machine, for me. But I seriously doubt my DME is going to provide something as costly as that. (I know the insurance code is exactly the same, no matter what kind of machine it is. My DME's policy re: data-capable machines sucks.)

I'm pretty sure that's a different insurance code. If your doctor gives you an rx for a $5500 bipap machine (cpap.com's very low price), no way a DME gets away with giving you a $400 blower...

You're talking apples and oranges when you are talking bipap vs cpap/apap...

[OceanGoingGal]

Hi Sleeping Beauty and welcome. Your sleep habits sound like mine. I too only sleep about 6 hours a night. I feel a lot better since starting the therapy. I know my sleep is much better and I feel good during the day. Like you I am up and around in the night. For myself I feel that it is just that I require less sleep than a lot of folks do. I got rid of my Dr awhile ago and have been happier since. She seemed uninterested in anything I had to ask about my sleep study. I got another Dr and I like her a lot better. She is right on top of everything and acts to correct anything for me.

Laura

[BleepingBeauty]

the code is the same for a cpap as an apap but a specialized machine will be a different code - it is like a bipap is a different code than a cpap

if you have the diagnosis of complex sleep apnea with Cheyne-Stokes respiration, you need to find a new sleep doc if all they say is sleep at X cm of pressure

Thanks for that info, jules. I didn't realize there was a distinction between bipap and cpap/apap when it comes to insurance coding. I wish I still had the scrip the doctor wrote for me last year, but I gave it to my DME without thinking I'd need a copy (or the original, for that matter). At the time, I had only asked for a data-capable machine; I wasn't aware that a BiPAP might really be what I need to correct all of my sleep issues.

My education continues. Thanks.

[jules]

look at the bottom of this list - perhaps there are more codes than listed there

https://www.cpap.com/cpap-faq/Insurance.html#198

[Fredman]

Your DME doesn't get to tell you anything. They are a supplier looking to make the most possible money. Your DOCTOR decides your machine. If he writes a script for a data capable machine, that's what you will get. If you tell him that you are waking up frequently, having issues with night sweat or feeling like you are suffocating and want to be able to capture this and he says NO... find another doctor or take the perscription and buy M series Pro at cpap.com

I totally agree and I suggest you look at this post from "our Wisdom" that's the Yellow Light Bulb in the top banner. It is like a Sticky:

Suggested Specific CPAP Equipment Scripts (Slinky) (Diagnosis and Prescription)
our-collective-cpap-wisdom/CPAP-machine ... ption.html

[BleepingBeauty]

Thanks for that info, Bev. I'll make note of it and question the doc when I see him for my study results.

Bleep,

I have complex apnea -- diagnosed with OSA, and when they went to titrate me, the ole brain said, "Shucks, don't need to tell her to breathe any more!" which must have been a shock to the techs doing the titration.

The RT at the DME (Apria) was very good -- although I'd been researching since the diagnosis, I did not yet know what all those centrals showing up during titration meant.

The RT's recommendation was for a Bipap Auto SV. My doctor wrote the script for it, and the DME filled it.

It IS a dream machine....

...and it costs less than two of those sleep studies!

But it's NOT impossible for insurance (or a DME) to provide such a beastie for you! Mine did!

Hi, Kira.

Sounds like you had an excellent RT - and at Apria, no less (which I mostly hear terrible things about, but I guess every office and every RT is different). Lucky you.

I don't know if I can get past my DME's policy of only providing data-capable machines on loan for a week or two at a time, and I don't have a choice of DME with my insurance. I'm certainly willing to find another sleep doctor; the question is whether anything will really change, since I'll still have the same DME.

I'll keep the group apprised as things go along. Thanks for your input.

[BleepingBeauty]

Your DME doesn't get to tell you anything. They are a supplier looking to make the most possible money. Your DOCTOR decides your machine. If he writes a script for a data capable machine, that's what you will get. If you tell him that you are waking up frequently, having issues with night sweat or feeling like you are suffocating and want to be able to capture this and he says NO... find another doctor or take the perscription and buy M series Pro at cpap.com

I totally agree and I suggest you look at this post from "our Wisdom" that's the Yellow Light Bulb in the top banner. It is like a Sticky:

Suggested Specific CPAP Equipment Scripts (Slinky) (Diagnosis and Prescription)
our-collective-cpap-wisdom/CPAP-machine ... ption.html

I agree, too. But what am I to do if the DME refuses to provide what the doctor prescribes? I know the DME is only interested in their profit margin, and it behooves them to give me the cheapest piece of equipment they can (which is what they did). How do I fight that when the doc writes a scrip for something more sophisticated?

It's not as simple a process as elader makes it seem - not in my case, anyway. I can't change DMEs because my insurance only contracts with that one. I can't afford to purchase a machine on my own - especially one that costs thousands of dollars. Yes, I can change doctors (and I will do that if I'm not satisfied when I meet with my current one about my sleep study results) but, AFAIK, my DME will remain the same. Is it possible that a new doctor could actually provide the equipment, rather than the DME?

Thanks for the link to the Our Wisdom post. I've made note of exactly what I should be asking the doctor for and, if he's cooperative, I'll be sure the scrip covers everything. Still not sure I'll get anywhere with the DME, but I'll do my best.

[Fredman]

Good luck Beeping Beauty!

[Hose_Head]

If my current sleep doc won't take further action to get me a data-capable machine, I'll definitely switch docs. We'll see what my latest sleep study reveals.

Whoa! It sounds to me as though you problem is not your doctor. The problem is the DME. Dump them! They aren't doing you any favours and they ARE interfering with your treatment!

[Kiralynx]

Sounds like you had an excellent RT - and at Apria, no less (which I mostly hear terrible things about, but I guess every office and every RT is different). Lucky you.

Can't say I haven't had my issues with Apria. They're gonna have a canary, with me coming up on my next mask when i ask them for something completely different from what I've had before.

I don't know if I can get past my DME's ... same DME.

Your DME does not call the shots. They'll try to tell you they do, but THEY do not prescribe your therapy.

If your doctor specifies a particular unit (see Slinky's list of What To Have The Doc Put On Your Prescription), then the DME is obligated to fill that prescription.

They won't want to because if they can fob you off with a cheaper machine, they make more money. A prescription for a Bipap Auto SV may be a horse of a different color. They may try everything under the sun, though, telling you that you have to fail at this, that, or the other thing before your insurance wull cover it. Or they may tell you that you have to pay an extra fee to "upgrade."

Check with your insurance first -- just ask them if the doctor prescribes a specific machine for my sleep apnea, does the DME have to give me that machine? Get it in writing if you can.

I'll keep the group apprised as things ... our input.

Absolutely! But get that prescription for a Bipap Auto SV (if you can persuade your doc) and then get it on file here and at CPAP.COM. If all else fails, you can keep an eye out for one on CPAP Auction, which is where I found my emergency machine.

[BleepingBeauty]

Whoa! It sounds to me as though you problem is not your doctor. The problem is the DME. Dump them! They aren't doing you any favours and they ARE interfering with your treatment!

Well, I have issues with both my doctor and my DME. Agreed, the DME is making me miserable. I posted earlier that the RT there is completely clueless. When I was due for a new mask a few months back, I called the RT and said I wanted to try the Swift LT. I was also interested in the Breeze but didn't know if it would be comfortable for me. She said, "Once you try on a mask, you own it." (I know most manufacturers offer a 30-day trial period, so she either didn't know what she was talking about or was testing me. Either way, she made a very bad impression on me.) I had to call her Area Manager to get any cooperation, and even HE gave me a hard time, saying that once you find a mask that works for you, you should stick with it. (Even if the manufacturer improves on the initial design? I'd been using the Swift II and wanted to try the LT - which I'm much happier with, btw.) It seems as if my DME's mission is to make things as difficult as possible for the patient, and they're succeeding.

I want my doctor to get tough with them and/or my insurance provider and get me the equipment I need. I have no choice in the matter as to who provides my equipment, since my DME is the only one contracted with my insurance provider.

The only other potential avenue I have is to buy the correct machine myself and then get reimbursed by the insurance co. for it. I don't even know if that's possible, but I'll be making a phone call soon to find out. I can't afford it if I have to pay for it out-of-pocket. *sigh*

[BleepingBeauty]

Your DME does not call the shots. They'll try to tell you they do, but THEY do not prescribe your therapy.

If your doctor specifies a particular unit (see Slinky's list of What To Have The Doc Put On Your Prescription), then the DME is obligated to fill that prescription.

They won't want to because if they can fob you off with a cheaper machine, they make more money. A prescription for a Bipap Auto SV may be a horse of a different color. They may try everything under the sun, though, telling you that you have to fail at this, that, or the other thing before your insurance wull cover it. Or they may tell you that you have to pay an extra fee to "upgrade."

Check with your insurance first -- just ask them if the doctor prescribes a specific machine for my sleep apnea, does the DME have to give me that machine? Get it in writing if you can.

Thanks, Kira. I'll call my insurance asap and find out what's what.

But get that prescription for a Bipap Auto SV (if you can persuade your doc) and then get it on file here and at CPAP.COM. If all else fails, you can keep an eye out for one on CPAP Auction, which is where I found my emergency machine.

I've shopped at cpap.com, but I've never checked out CPAP Auction. That might be a great avenue for me, although online auctions give me the jitters (Did I bid enough? Will someone else sneak in at the last minute and outbid me?), especially when it's something I really want. But it's a good option to have. I'll check it out. So thanks again.