New and my Sleep Dr (or his staff) is gonna hate me :)

[MauraAnderson]

I had a split night sleep study last Wednesday. After feeling like I never slept the first part of the night, I slept for hours after the tech put the mask on me. My follow-up appointment is next Monday, 9/14, and I bet I'll get the diagnosis of OSA and an Rx for cpap. Good thing I've fought down my prior claustrophobia as I need a full face mask since I'm a heavy mouth-breather.

Being the type-A person I am, I've been reading like mad and taking notes from all the experiences and advice people have shared as well as checking my insurance paperwork. I know which machine I want and I believe my insurance will pay 50% of durable medical equipment (the cpap and humidifier, I believe). I've priced the machine on multiple sites and it will cost me about $600 out of pocket. On Tuesday, after the US holiday, I'll call the insurance company and see if they will reimburse the 50% if I buy the cpap from cpap.com. If so, that takes my out of pocket cost way down. If so, it's probably the best deal. If not, I'll have to see what "my" half of the cpap would be if purchased from the Sleep Dr's office and see whether I should just pay outright.

I want to make sure I'm getting the best price I can out of pocket. Getting laid off in January has me still pinching pennies as much as I can.

One question is whether my sleep dr would have issues working with me if I do not get the cpap through them, but instead get the device another way.
The second question is whether it's possible to obtain the resmedics software anymore. I notice cpap.com does not offer it any longer.

Thank you all for the great information and advice I've already taken advantage of here.

- Maura

[6PtStar]

Welcome Maura! Good for you!! You are going in with the right attitude; that armed with the information from this board you can make an informed decision. Resmed did pull the software but it is available from a company in Australia. If that is what you end up with I am sur someone will jump in and give you the link to the purchase.

Jerry

[jules]

Don't be surprised if you find the local DME will charge a lot more than 1200 for a basic cpap and humidifier so asking your insurance if they will pay half at cpap.com sounds like a good plan.

Unless you know what mask, you might want to use the local DME / sleep doctor for that at least this first time.

The doc should be able to understand the financial situation but if s/he doesn't is s/he worth keeping?

Great last name - know it well.

[elg5cats]

Being the type-A person I am, I've been reading like mad and taking notes from all the experiences and advice people have shared as well as checking my insurance paperwork. I know which machine I want and I believe my insurance will pay 50% of durable medical equipment (the cpap and humidifier, I believe). I've priced the machine on multiple sites and it will cost me about $600 out of pocket. On Tuesday, after the US holiday, I'll call the insurance company and see if they will reimburse the 50% if I buy the cpap from cpap.com. If so, that takes my out of pocket cost way down. If so, it's probably the best deal. If not, I'll have to see what "my" half of the cpap would be if purchased from the Sleep Dr's office and see whether I should just pay outright. One question is whether my sleep dr would have issues working with me if I do not get the cpap through them, but instead get the device another way.
- Maura

It's normal for most people to feel anxious when being assertative with a health care provider. Like you, I also prepared for my appointment including a specific machine request. This was after a sleep tech told me a doctor would NEVER give me a prescription for the machine of my wishes. When you go to your appointment, dress equally professionally best as you can, make direct eye contact, participate in the verbal exchange early in the appointment. Establish equality. My sleep doc appeared to be caught a little by suprise specific machine wish (which is not the brand in his sleep clinic nor office. I let him know I planned to get the clinical software as well and possibly purchase off line. He wanted me to work with a respiratory therapist. He gave the a script and DME contact infor for my preferred brand of machine.
I've seen him every 3 months since my first appoinment. I take my laptop in, he reviews the data and lets me know if he would like for me to cahnge my pressure. At the last appointment I took in my pulse ox and a few reports. He was impressed and wanted to show it to a colleague. Now that last weeks's surgery seems to have played havoc on my OSA, I'm looking forward to my next appointment to review the surgical effects upon my OSA. Your involvement in your care is very valuable. Hopefully, your sleep doctor will see the positives of patient involvement.

elg5cats

[MauraAnderson]

Thanks for the replies

I'm pretty good at being forceful, actually. After 13 years as a woman in the software industry, I'm not easily browbeaten. I'm a very active participant in my own medical care and my primary care doctor is a good backup if the sleep dr decides to be uncooperative. We get along very well and he knows I'm both not prone to over-reaction and I'm quite good at knowing what I need and why.

I just wasn't sure what the protocol was if the sleep dr (it's actually a whole sleep clinic - $$) isn't who you go through for the equipment. I know they have respiratory therapists on staff so maybe I just work with them.

I'm nice -- to start -- and always polite, but I won't settle when it comes to my medical care.

Of course, the years as a software engineer also mean I'm a data junkie I ask a lot of questions and want to know how things work and why. This gets on the nerves of doctors who want me to just accept what they say and get out of the way. I've not met this dr yet - I met a substitute because he was sick the day of my appt.

Guess we'll see Now I just want to see my results, hear what the diagnosis is and get this show on the road.

[jules]

make sure you get a script in hand before you leave

some docs will have their own in house DME - most won't - did he run / own the sleep lab too?

[MauraAnderson]

Yes - he runs and owns the clinic.

I'll definitely have Rx in hand I'm glad to know what to look for and what's available. It's much much better than guessing with no data.

- Maura

[jdm2857]

You should be able to purchase the ResScan 3.7 software package from http://www.cpapaustralia.com. It may be cheaper to purchase the card reader separately from an online vendor in the U.S. Note that cpap.com (this forum's sponsor) will price match any reliable online vendor.

[MauraAnderson]

Thank you, jdm2857!

Bookmarked it!

- Maura

[Slinky]

cpap.com WILL price match any ADVERTISED price. The problem w/these darn MAP (minimum adveritsed pricing) policies Resmed and Respironics have instituted against the online DME suppliers is that not all make that "unadvertised sale price" available online via a "coupon" or "code word" as cpap.com does but instead require calling their toll-free number - which negates the opportunity to price match w/cpap.com

[clanrat]

make sure you get a script in hand before you leave

some docs will have their own in house DME - most won't - did he run / own the sleep lab too?

This is the part of this whole game I hate the most: The way some of the sleep docs and DMEs work the insurance system like the pros they are. Without devolving into pure rant, I feel that this is a clear sign of how broken western health care has become - the fact that it's about profit and not keeping people well. The DMEs I've encountered have zero interest in how I'm doing, all they wanted was my insurance paperwork. CPAP.com is invaluable in that it lets you see what a reasonable cost for these machines actually is. If your co-pay is 50%, I bet it will be a wash in most cases if you just skip the local DME altogether and buy directly from CPAP.com. Hopefully your insurer will accept CPAP.com as an acceptable DME. Mine wouldn't, so I got stuck with the local scam artists.

I also had to more or less threaten to report my sleep doc to the oversight board before his office would cough up my records and prescription.

Best of luck with your therapy! I know I'd be (back to) a total mess without my machine.

[plr66]

Maura, I strongly agree with Jules' suggestion above. In addition to asserting with your MD your need for the best data-capable machine with the most options that you can afford, it actually makes sense to spend nearly the first month with a local DME. This allows you to do trials of a number of masks before settling on one. Huge savings for me when I did this. Yes I paid my copay for one month's "rental" of the machine as required by my insurance. But this was about a fifth of what I'd have paid in masks before getting the right one. It also gave me time to work on the sleep doc to convince him to write a Rx for a better machine that I knew I wanted.

Do the math on the insurance rip-off. Generally speaking, they require something like 10 months rental before paying their portion...and you still have to deal with deductible. In my case, with $2000 deductible and no other medical issues to pay that down other than the sleep study, I was WAY ahead to just pay out of pocket for a machine from cpap.com. Insurance actually finally agreed to pay out of network for my purchase of a back-up machine.

I haven't been back to the sleep doc since that first month. No need, with this forum! I truly believe I knew more about what was going on than he did after I spent 2 months of study here!

[plr66]

Whoops--Maura, I meant to also mention that when you're doing the math, be sure to determine what's involved if your health insurance ends when you are laid off, or if you go to Cobra in the middle of this process. Could get a little tricky, what with deductible usually re-setting in January. Be careful!

[GumbyCT]

Almost everyone has a problem finding a mask to fit their face. There is no doubt using a sleep lab and/or DME for mask fittings is helpful esp. when allowed to lay down and use your full pressure. Ask the DME/lab if they have a 30 day mask exchange if the mask you try does not work.

Also compare your cost if you buy from cpap.com and pay 100% to what your cost will be for the 50% co-pays, etc. Write these numbers down so you have them when you see the doc owned DME.

If your sleep doc gives you the least bit of problem, you may want to have your primary write the script for you.

Good Luck

[6PtStar]

If your sleep doc gives you the least bit of problem, you may want to have your primary write the script for you.
Good Luck

I do agree with Gumby. My primary care wrote my perscription and has been a LOT easier to work with. I really never saw my sleep doc after the sleep study.

Jerry