Need Advice (conflict with DME & Dr.)

[vapat75]

My doctor, (cardio) said I needed the Resmed S8 Elite II, well I wanted the Resmed S8 Elite II auto set, and asked the lady at the doctors office to see if I could have that machine she said she would check with the doctor; well later that day the manager from the DME said she had ordered a Resmed S9 Auto set and set up a another appointment after the machine comes in. Well the techican at the DME called and said I could not get that machine because they have a standing order from my doctors office to use these machines and that I didn't need the auto set type, and that the doctor wanted me on the S8 and that I would have to talk with him to change it; well the one who ordered the study was the drs. np and the one who sent the order to change machines. Well apparently the tech called the doctor about the change in machines and said I would be getting the S8 Elite II unless the doctor said other wise. Well I am very upset with both parties, the dr. and the DME tech. I called the Drs. office today and asked that he call me, it was late (4:50PM). I am waiting to see if he will call me tomoroww. Also from what I gathered from the tech, the drs. fnp got a "talked too" about ordering a change in machines. I asked the tech why I could get the auto set machine, he said some people go in a change the setting, and the auto setting could put too much pressure. I have a lot of hypopneic events. I am at a loss at what to do next, just get the Resmed S8 Elite II or insist on the R9 Auto Set that they ordered? First of all I am going to talk to the Dr. and asked him if he even look at my study, and also when I went for my check up I didn't see him, only the "new" FNP. At least the doctor could have come and introduced the np to me. My appointment was with the doctor, not the np.

Also there was not prescription written, the sleep doctor listed in his interpretation CPAP therapy. The nurse pract. sent copy from the sleep lab DME certificate of medical necessity: Equipment orfered: Nasal CPAP with heated humidifier, setting at 8.0 cwp. Need Advise as which avenue to pursue.

[sleepmba]

I think you can trust the machine they want to give you. They probably found in your study that CPAP 8 worked well for you. So, that's why they are giving you a machine pre-set instead of an autoPAP. I recommend you give the machine a try for a few weeks or until your follow up appointment and then take it from there. Is there a particular reason you want the Auto machine? Good Luck!

[oscar98]

If I understand your post correctly you had you doctor convinced to right the script for an S9 at one point. You are entitled to a copy of your script. Why can't you just pick up a copy of the cpap script from you doctors office and then go to a different DME???

It is your treatment and you have to live with that machine for many years. The DME will be providing you will services for many years to come so you would think that at some point some of these DME's would realize they have competition and happy customers result in life long customers. I had DME issues and couldn't get what I needed. I got a copy of my script and found a new DME, problem solved. I got a shiny new S9 and the new DME got a happy loyal life long customer.

The S8 Elite II is not a bad machine by any means but if you want to download your data to your computer then you will need a resmed card reader because it uses a smart card. I wouldn't trade my S9 for the world and I love that it takes SD cards.

It's your treatment, fight for what you want. Do the leg work and find out what other DME's are in your area that take your insurance. Maybe even call ResMed and ask them who in your area stocks the S9. It's not up to your doctor where you buy your cpap equipment anymore then it is up to him where you buy your groceries. Take Charge.

[Sleepy Eagle]

Dear Vpat75,

What a struggle!!! I know I just went through exactly the same issuse the past 6 weeks. I was diagnosed in hospital by my sleep tech and neurologist. A script was written for a S9 Fixed CPAP machine. At that point I didn't even have my tir.. (pressures) measured. My healthcare didn't want to pay for a 2nd night. In the end I was loaned a S9 Auto set for a week to measure my pressures. I felt great from night 1 to 7. They got the data and my pressure range. After this the DME brought me a new S9 Fixed machine. I sleept on the machine for a week and I felt HORRIBLE! Half way into the night I took the mask off, I got up in the morning more tired and irritated than before. I just didn't understand this. I told the DME and she adjusted the pressure to a lower setting. My mask leaked and they just strapped it tighter to my face. I felt that I could'nt breath and they adjusted EPA. At this point I felt that I was being pressured into buying something I didn't even really understand why? I didn't feel well. Then I discovered this website and started reading up on all the machines, and what you really need for your individual treatment. I started asking the right questions of which most could not be answered. After a week on the Fixed S9 I took it back and told them I needed time to research some more. After another weeks research and reading on the forum I decided that the S9 Auto set was the machine for me. I contacted my lab tech and the neurologist. At first they fought me until I told her how I felt an absolute difference on the two machines. She was clever enough to get the data from both machines and compared the results. She got back to me and told me that I defnitely must buy the S9 Auto set and not the fixed CPAP machine. I got more apneas on the fixed, sleept less, my saturations levels where lower compared to the data on the Auto set. Armed with this info and the feeling in my gut all along I bought the S9 Auto set yesterday and slept with it last night for the first time again after 6 weeks of frustration, hardship, misunderstandings and exhaustion. I slept for a record total last night of 7.2 hours with an AHI of 0.2 where it used to range between 6-8 on the fixed machine. The lab tech was totally suprised by this outcome as was the DME that tried to sell me the machine. I changed to a new DME and worked with my lab tech and neurologist. If your have to try sleeping with both machines and have the data analysed, it has given me upeace of mind that I did get the right machine for me! Listen to what the dr has to say but he needs to listen to yo aswell. Keep me posted I'd like to know what happens and keep educating yourself. Its the best. Sleepy Eagle.

[sleepmba]

Sleepy Eagle....very interesting. Thank you for sharing that.

[Kevin G.]

First you cannot get the machine that you want if the doctor is not comfortable with it. Suggest you consider seeing a sleep specialist as opposed to a cardiologist. My doctor, who is a sleep specialist, is pragmatic and has been willing to accomodate my preferences. I have an the ResMed S9 setup as an APAP. It could also be configured as a constant pressure CPAP.

Why not get the new S9 model instead of the S8?

I would suggest that the DME should have given you the machine specified in your prescription but now that the doctor has said no they have no option. My impression is that this never would have been an option if you had bought the machine over the internet. The internet supplier would have seen the prescription and provided you with the machine. The only problem is that most if not all internet suppliers are not signed up with the insurance companies so it may cost you a little more.

In my case it appears that the insurance company pays the same for the CPAP or the APAP version. The internet cost is slightly more than what the insurance company will pay.

I believe that you have a legal right to have a prescription so that you can have it filled at any appropriately licensed location. Your options may be limited if you want the insurance to pay the maximum. Sometimes they will pay less if you go out of network.

Regarding the concern about patients changing the settings, the reality is that you can easily find how to access the clinicians manual on the web. When I had a CPAP machine my physician wrote a prescription instructing the DME to show me how to change the pressures on the machine. My current prescription calls for me to have the software which would allow me to adjust all settings.

Regarding the statement that the APAP could supply too much pressure. This reflects ignorance or incompetence. The idea with the APAP is to supply the minimum pressure necessary so you will see lower pressures on the average with an APAP. You can set both a lower and upper pressure so if there was a concern about too high of pressure then you would set the upper limit to prevent the problem.

As I noted you can set the S9 APAP machine and would assume the S8 to act as a CPAP machine. Convince the Doctor to prescribe the autoset version so that an experiment can be performed with the machine in both modes. The doctor can then compare the data and see what works best for you.

My problem with DME's is that they seem to bumble and that they try to impose there version of reality and make it difficult to implement the plan agreed with my doctor.

The secret is to have a physician that will work with you. If you cannot reach agreement consider finding another doctor to treat your sleep apnea.

[jnk]

Vapat75,

What was your diagnosis? What health issues, specifically, is the doctor hoping to address with the machine? And what other health issues do you have?

For example, a heart patient dealing with centrals may be in a very different place from where those of us with a "simple" OSA diagnosis are. A "simple" OSA patient may have no trouble using an auto in auto mode, but someone with more complicated health issues may need to use a constant pressure.

Cardiologists are often a special breed of doc, from what I understand. It is just as irritating when they try to play g*d, but sometimes they have good reasons for doing so. Just sometimes.

j*ff

[DoriC]

Why do they make things so hard for patients! This machine will be yours for a long time and if there is any change in your weight, allergies or other health issues,etc, an auto would be so helpful in self-titrating if necessary. My husband is sensitive to pressure changes so we use our auto in cpap mode most of the time but occasionally I switch it to auto in a narrow range for awhile to make sure his pressure needs haven't changed. I'm thinking your Cardio may not even know all the new equipment available and was surprised that you even knew enough to ask for your preferred machine (many newbies don't), and maybe he just got his feathers ruffled and now he's being arbitrary! I'm sorry you have to experience this, but it's worth fighting for YOUR treatment.

[brazospearl]

While there are reasons a straight CPAP might be best, it appears that it's too early in your journey to know for sure what will work best for you. Get the data (from your reading on this website and anywhere else you can find it) that supports why having the S9 will help you get the best possible therapy. Take that info to your doctor and ask him to show you his data that a less-adaptable machine will provide you the options you MIGHT need as you progress in your therapy. Ask your doctor why he doesn't want you to have the most effective therapy. Get a copy of your prescription--it's your legal right to have this--and remember that if it specifies a particular machine you'll be tied to that one. A more general prescription can be filled with any machine, and the DME doesn't have the right to refuse to sell you the one you want. That doesn't mean they won't try to get you to settle for what works best for THEM, but your concern should be what works best for YOU. If I were purchasing a machine today, the minimum requirements would be: fully data-capable, auto- and straight cpap modes available, and returnable within 30 days. Good luck, and let us know what's happening!

[jnk]

Although I personally have never owned either machine, I would prefer an S8 Elite II over an S9 Auto, myself. To my way of thinking, an S8 Elite II would give me more data (because of the way it counts events) and would therefore be easier to titrate to the most effective pressure. But hey, that's just my warped, nonstandard way of looking at things.

That being said, I agree that OSA patients should be able to get an auto when they want one, if the OP is an OSA patient.

[fisamo]

It sounds like the question is whether or not your doctor wants you to have any ownership of your therapy. IMO, you--the patient--should be able to direct your therapy, within reason, and with your doctor's advice. Given that the only real difference between an APAP machine and a CPAP machine is the ability to allow the machine to change your pressure within a preset range, there's no reason (that I, a layperson, not a medical professional, can think of) to require CPAP therapy over APAP therapy. It's very much within reason to ask your doctor just why it is "best therapy" for you to be using that particular S8 machine to the exclusion of all other models, especially since ResMed offers an S9 CPAP machine (not auto-set, the S9 Elite) with additional comfort features (e.g. Climate Control) and possibly a better user experience than the S8 machines. Consider how the doctor responds to your questions, because his attitude will very likely tell you much more than his words.

Keep in mind that regardless of whether you get the APAP vs CPAP, the end goal here is for you to use your machine every night, and if the machine is not picked to fit your needs and, to some extent, preferences, you're less likely to use it. I'm not advising you to pitch a tantrum if you don't get the S9 Autoset, but to read about the options here and put together a case for why the Autoset is the best machine for your treatment, and see how receptive your doctor is.

All that said, the doctor still has much control over what machine you will get--he could write the prescription for a specific model (and apparently has done so). But, just because he's written a prescription does not mean you have to get it filled. I don't make a recommendation to change doctors flippantly, but if your doctor isn't willing to listen to your concerns, it would be a big red flag to me.

[WilsonVilleUSA]

Not to be a downer, but the reason may be as simple as the Dr. or DME make more money by giving you the machine they are pushing.

As far as insurance goes, a CPAP, is a CPAP, is a APAP. They are all covered under the same billing code (E0601).

When it goes to insurance, it says "CPAP device E0601 - $950" Make/model doesn't matter, all that matters is the billing code. If your DME is a "Network" provider, your insurance company may have a standing agreement on what machine to give and an agreed cost. This goes for masks as well and they severly limit your choices. When talking to my network DME's I had my choice of two basic cheapo machines, and I was going to be paying 20% of full boat allowable price of $950, meaning my cost was going to be $190. The same machines could be had on cpap.com for less than $500. I instead bought an APAP (my sleep doc was very accommodating and changed the script from CPAP to APAP) and bought a high end RemStar Auto (Tank) with full data capability. At the time it was running about $700 with the humidifier, and even though I had to pay a higher percentage for going out of network, had to front the money and deal with reimbursement, I saved in the long run. I spent less money out of pocket, got better gear, and had many more options.

I am far more comfortable sleeping with an APAP than a set CPAP, the Data capability has been fantastic for dialing in my settings (either personally or by your Doc, the info helps sort it out). You buy a CPAP now and 6-9 mo down the road you decide a APAP works better, guess what- you get to buy a new machine. Why not spend a little more now and have one that you can grow with.

Remember, you are the CUSTOMER. Find a doc and a DME that listen and work with you, they are out there. Find out what your insurance coverage is and use it to your advantage. There is more leg work involved, but in the long run it may very well be worth it.

[carbonman]

Need Advise as which avenue to pursue.

vapat75/newbies, having been down this same road when I began my therapy,
and now, for almost 2yrs, listened to the same story over and over.....

I have come to the conclusion that it is a critical rite of passage to cpap.

In the depth of our pain, fatigue, disorientation and misery,
it is a necessary part of the total cpap experience.
It is the fire that tempers the steel of our cpap perseverance.
It is a trial that tests our resolve to endure.
It is a baptism of sorts.

It is an awakening to our untapped abilities.
It is the message that this is our journey, alone.
It is the harbinger of the personal growth to come,
not just w/cpap, but in every facet of our lives.

For those that have mustered the strength to
turn into this wind and stand strong,
the rewards are incredible.