Has OSA become a cash cow.

[newhosehead]

Maybe on second thought I was a bit harsh; however if somehow we could get insurance companies to send their patients to accredited sleep labs to insure quality service and care and not send their patients to the used car sales sleep labs and dme as mentioned by someone who was obviously shafted by lack of education and service, we would not have such bad attitudes on both side of the discussion.

Being fairly new to this, I have not posted much but I feel a real need to respond to somotech's last posting. I have been having much the same thought about insurance coverage for non-accredited sleep labs. I had TWO studies done over the course of the last few years at a lab that I later found was not accredited. My last study, done in an accredited lab, finally resulted in my diagnosis. My experience at the first lab consisted of a tech walking in in the am, saying, "Wow, you sure do snore, but you're fine". My insurance company paid for the testing done in both labs. The same insurance company, I might add, that denied me coverage post-hysterectomy when standard post-surgical biopsies showed that I had cancer. Well, yes, that is another story and I don't need to bore anyone here with that one.
However, if insurance companies are going to have their finger in every decision about my medical care (and they DO) why do they pay for these crap labs?? And let me hasten to add that I was the one who finally got enough energy (from somewhere) to start researching and took charge of where my sleep studies were done myself. I know full well I should have done this research earlier, so I do not hesitate to bear my share of the blame. But in a world where my insurance company dictates what I can and cannot have done (because of cost) I want them to step up to the plate also. Rant over. I hope

[Wulfman]

Maybe on second thought I was a bit harsh; however if somehow we could get insurance companies to send their patients to accredited sleep labs to insure quality service and care and not send their patients to the used car sales sleep labs and dme as mentioned by someone who was obviously shafted by lack of education and service, we would not have such bad attitudes on both side of the discussion.

BINGO!!!

It's been my interpretation that those "professionals" who visit/frequent this forum are GOOD folks who do their jobs well and are credits to their professions.
But, you have to take into consideration that the reasons many folks find this forum (or the others) are because they were mistreated by those members of those professions who did NOT have their patients' best interests at heart. AND, once they find their way here and find out that their experiences were not as they should have been, they become seriously angry (if they weren't before) with everyone they've dealt with in this process.

Several problems exist......(from the patients' side of the equation)

The patients going into this are too sleep-deprived to know what questions to ask. PERIOD!

They also do not know what is the "norm" as to how the process transpires. (but, there are many differences in how those processes may transpire)

Many patients are not familiar with how the insurance process works with these situations......sleep studies, DME purchases, etc. (and those vary considerably according to the insurance provider's benefits packages)

Many patients are "pushed" to DMEs of the doctors' choosing, rather than being given their prescription and allowed to shop around. (some of those DMEs may not be considered "in-network" by their insurance provider, either)

Many (sleep) doctors don't go over the sleep studies with their patients, or don't give the patients copies of their sleep studies. Some patients never even get to meet with their sleep doctors.

Many (most?) DMEs hand out the equipment that will make the most profit for their business.

Manufacturers make too many flow generator models that are not (fully) data-capable.


The list of issues goes on and on, but there is enough blame to go around from all points of view. Unfortunately, the patients suffer the most from less-than-satisfactory treatment.......and therein lies the problems regarding the lack of compliance with this therapy.


Den

[rayt435]

When the insurance company calculates you lifetime total capped at say $100,000., do they count the amount billed or the amount they paid?

Good question, but I have no idea.

Lifetime maximum is only based on the benefit the insurance company pays. If a company bills the insurance company $5,000.00 but the insurance only pays $1,000.00, the $1,000.00 is all that is applied to the lifetime maximum.

[rested gal]

Thanks, Ray.

[Slinky]

I don't blame the sleep labs so much as I do the local DME providers. And I blame the sleep doctors most of all. I feel it is the sleep doctor's responsibility to see to it that they have an experienced staff member, RRT, RN, RPSGT, whatever, who is accessible to the patient and who provides the education, support and encouragement. I don't know of any other medical sub-specialty where the "specialist" can get by w/doing or contributing so little for their patients - and yet they charge on a par w/other sub-specialties.

[jnk]

The way I see it: Techs gather data. Docs diagnose. Therapists treat.

So, I would blame the tech if the data was bad. And I would blame the doc if my diagnosis was wrong. And since I didn't find a therapist who knew how to provide therapy, I have learned what I can here and have taken my therapy into my own hands.

Now if I have problems, I can only get mad at me.

[Slinky]

Yeah, but, jnk. You are smarter and faster to learn than I am. I agree w/you for those who can but there are those of us who need HELP grasping all that's entailed in our therapy and are slower at getting up to par and figuring things out. CPAP therapy I grasped fairly well, this bi-level bit my learning curve is building up much slower and I'm a bit intimidated but struggling to grasp and learn.

[jnk]

I was agreeing with you that the therapy is what is lacking, since the RTs at the the DMEs need to provide treatment as therapists but so often don't.

I also agree 100% that there should be an RT on staff working with the sleep doc who should be available to represent the doc's office and an RT on staff at a sleep center if the RTs at the DME aren't going to provide any therapy.

I have no one to turn to for treatment advice other than the forums. And I DO get mad at myself. All I know is that if the theory is that the DME RTs are the ones who are supposed to make sure therapy is working for every patient, they ain't doin' their job in a lot of cases with a lot of patients. Maybe if there were more RTs at the labs and at the doc offices, there would be some checks and balances. Right now there are no checks but the ones transferring funds and no balances beyond the bottom line. Somebody out there needs to start making sure somebody is doing something--that's for sure.

And you deserve better than you've gotten, Slinky. It would sure be nice if the right doc/RT team was there for you.

jeff

[Slinky]

Thanks, jnk. Hope springs eternal! There's always tomorrow. And God bless the RPSGTs and RRTs I've encountered online who have offered me the best suggestions and assistance from the sleep profession. And God bless forum members such as you and so many others I dare not mention for fear of leaving someone out!!! I've certainly gotten much more help and had more success w/the suggestions from the forum than from the locals!!! (Like that comes as any surprise, right?)

[DarrenA7]

To go forward is to move toward perfection. March on, and fear not the thorns, or the sharp stones on life's path.

[geoDoug]

What we're talking about is the bloat problem inherent in our fee-for-service system. As long as fee-for-service exists in the US, doctors will have every incentive to run expensive tests that aren't needed. That's why health care reform can only be called "reform" if it scraps fee-for-service altogether.

[montana user]

I haven't looked on this thread for a while and quickly scanned last several posts. So I would like to add a couple things. Sometimes these subjects put me in the middle. A CPAP user on one, and the sleep tech on the other. I admit when I read a post about a "stupid" tech I get angry. On the other hand, I understand not every tech is trained the same and have the same love of this job. I work very hard to give my patients the best education I can on sleep apnea, how it occurs, the risks of not treating the apnea. I am always researching, studying, going to conferences, etc. Some times I feel that I go above and beyond what my actual job is ( as one person stated we just collect data) but I know that this may be the last time they get any education type information.

It only takes one bad tech to make all of us look bad. It is very true with say a police department. you get an officer with an attitude and treats you like scum, then that whole department is scum. So I guess what I'm trying to say here is, if you have a bad experience with a sleep tech, please don't put all of us together. There are several posts from people who defended us and I thank you! I wish out of the Sleep doctors, sleep techs, and DME, that the sleep techs would be the ones to rise. But sadly, we are not.

If anyone has a question on what happens in the lab, or what our job really entails, I would be happy to help! I wish there was a sleep doctor that would also offer his time to help out and clear any misunderstandings. I am true believer that education is key to apnea success. And I'm talking education to all the players from doctors, labs, to the user themselves. God knows I have learned a few things lately just on this forum. I started a post called " sleep study questions" you may find some info on there helpful. This was my way of reaching out to everyone and say, Hey..ask me! I'll explain it and maybe it helps, and maybe you will still be pissed. Thats ok. I don't always like or agree with answer's that I get either.

This forum is a great tool for people. Well I hope this doesn't come out negative, because I really do enjoy everyone's posts and am glad to see so many people on here helping a fellow CPAPer.

[Slinky]

Thank you, Montana.

[jnk]

. . . ( as one person stated we just collect data) . . . .

I am one who makes that point a lot. I hope you don't find it offensive, montana user, because as far as I am concerned, it has been the collection of data at the sleep studies that has been the most important part in the process for me.

My sleep doc earned his pay when he shot down my primary care physician's suggestion for me to have UPPP, explained to me my need to be on PAP therapy, and arranged for me to get a sleep study in his lab.

I never met my DME RT face to face. That is good for her and good for me. Made it easier to fire her and let my doc and insurance people know to avoid that DME.

BUT, I still have my sleep studies and those have become some of the most valuable pieces of paper I have for their lasting impact in my life. It was that collection of data, even if it was not done perfectly and had some flaws, that affects my decisions now more than any doc or RT. And that is why to many of us self-titrators, the sleep techs are the unsung heroes of the industry in many instances.

So I when I say that techs "just" collect data, it is my way of making the point that it is not the tech who is to blame if the doc doesn't act properly on the data or the RT doesn't properly provide therapy or the DME forces the wrong machine on someone. If the tech did his or her job correctly and professionally, I can't see blaming the techs and labs for other problems with the system. And if a tech is willing to take a chance in passing on useful information about docs, insurance, and DMEs, as a sort of off-the-record disinterested third party, to help guide patients through the process, bless that tech!

jeff

[Slinky]

I hear ya, jnk!!! RIGHT ON!!