Uncomfortable experience with the DME at the sleep lab

[beyondtired]

Hello,
I recently had a second night sleep study with CPAP titration, after being diagnosed with mild sleep apnea during the first sleep test. The next morning, I got to meet with a sleep doctor right at the sleep lab, which is in a hospital. He went over the test a little with me concerning the pressure settings, and he said 8 cm was the best pressure for me.(He didn't have a copy of the second sleep test results yet to give me, cause he still had to do the diction for it. So I'll get a copy of that test soon). They used the ramp up feature for me during the overnight test, starting at a pressure of 4.

So anyway, after I met with the sleep doctor, he took me to another room, and I talked with the DME. They already had a CPAP machine sitting on the table for me to take home(I wasn't expecting this). The one that they had for me was called The System One CPAP Machine with C-Flex. It wasn't an auto CPAP, and I think it only shows compliance data? The DME told me that the System One CPAP Machine with C-Flex is the type of CPAP that they use for the sleep tests, at the sleep lab I went to. And that it's the one they have all the patients get for their prescription. I had been reading before what others have posted concerning things to ask the DME, and I have Medicare as my primary, by the way. So I asked them if I would be able to pick from some other machines, and they said that I could pick from other ones that they might have at their main office, and if I had any certain ones in mind.(They also told me that they come every morning to the sleep lab). They said they didn't have the IntelliPAP Auto Adjust CPAP. They had the S9 CPAP machine, but not the Auto version of it? And they didn't have the version of the System One REMstar Auto CPAP with A-Flex. So I told them if I could think about it, and then decide a little later.

Then my sleep doctor had to re-write the prescription, cause I was told that he had written it specifically for the System One CPAP Machine with C-Flex. The prescription now says CPAP @ 8 cm H20 with warm humidification and C-Flex. Since it says specifically for 8 cm, am I able to even get an Auto CPAP? So do you think I did the right thing by saying I'd like to look around? The sleep lab isn't in my area, and the DME is even a little further away than that. So I thought that I'd go to some of my local DME's first before deciding. Is it a common thing for a DME to kinda be affiliated with a sleep lab like that? I just didn't like how they already had the CPAP for me. They should really give the person the option upfront about having a choice of the other CPAP's they carry, and just to also maybe mention that the person can shop around.

[Pugsy]

The prescription now says CPAP @ 8 cm H20 with warm humidification and C-Flex. Since it says specifically for 8 cm, am I able to even get an Auto CPAP? So do you think I did the right thing by saying I'd like to look around?

DME's will probably try to sell a straight CPAP BUT they can also sell the APAP set in CPAP mode with the pressure set at 8 cm if they would just do it.. Since the script says C Flex, Respironics is the brand that has C Flex. A ResMed machine's exhale relief is called EPR so the C Flex part might limit you to Respironics PR machines. It could be changed with a phone call and fax if the doctor would do it.

You did the right thing saying you wanted to look around.

You are on Medicare and by law the doctor cannot/should not have you use a DME that he is affiliated with. It could be that DME just has made a deal with the sleep lab to come by and offer their services. It is also common for sleep labs to promote their own equipment supply.

So look around till you find exactly what you want. Don't settle for less.

[Janknitz]

Then my sleep doctor had to re-write the prescription, cause I was told that he had written it specifically for the System One CPAP Machine with C-Flex.

There are TWO System One CPAP machines. The System One Plus has NO data--don't let them stick you with that. The System One Pro with CPAP Plus has full data, but it's not auto-adjusting. If you don't mind straight CPAP, that's OK to get. But you need to avoid the "Plus" at all costs.

The prescription now says CPAP @ 8 cm H20 with warm humidification and C-Flex. Since it says specifically for 8 cm, am I able to even get an Auto CPAP?

Since APAP's can run in either CPAP or APAP mode, technically you don't need the prescription to say APAP. But it does help ensure that an APAP is what the DME must give you if your script calls for an APAP.

So do you think I did the right thing by saying I'd like to look around?

Absolutely Awesome--you did great as a careful consumer!!!!!!!!

Is it a common thing for a DME to kinda be affiliated with a sleep lab like that? I just didn't like how they already had the CPAP for me. They should really give the person the option upfront about having a choice of the other CPAP's they carry, and just to also maybe mention that the person can shop around.

You are right to be concerned about the conflict of interest and pushiness of this practice. So many people are clueless and just think that they have to go with a set up like that because it's there and the doctor must therefore endorse it. They are often taken advantage of.

It may be a perfectly great DME, but you are wise to shop around BEFORE committing. Good work!!!!!!!!

[beyondtired]

Thanks for the replies, I appreciate it. I'm thinking that it might have been the System One Plus that the DME was trying to give me, but I'm not totally sure. The System One Pro with CPAP Plus is labeled as having 'C Flex Plus' I read?

So like was stated, if I decide to get a CPAP other than the Respironics PR machines, I guess I'm going to have to get the sleep doctor to change the prescription, so that it doesn't say 'C Flex' on it? Since he already had to change the prescription once, I don't know why he included the C-Flex part on it the second time? The sleep doctor who wrote the prescription isn't actually the sleep doctor I saw prior going to the sleep lab. They are both part of a group practice of doctors. And I think they each take turns going to the sleep lab. So I guess I'd have to call the sleep lab, since they have my orignal prescription(I have a copy of it), and have them contact the group practice office to have him change the prescription, and then his office would fax it back to the sleep lab? Then I guess I'd go there in person if I wanted to get another copy of it?

[LinkC]

I would take the copy of the 'script to a couple of local DMEs and tell them which machine you want. Things are competitive enough now that they may well accept your request to get your business.

My current DME waives my co-pay and is satisfied with that the Ins pays for supplies. You may be surprised just how willing they are to "work with you" these days.

[bap40]

It certainly sounds as if this practice is joined at the hip and expect patients to agree with everything because we are ignorant right? I started out in the exact situation except that the actual sleep doc was in another state. Everything was done by fax. I could not get them to change my prescription period. When I said I was going to have my own doctor write me a script for what I wanted the DME had the nerve to call my regular doctor telling him why they wanted me to have this particular machine. Granted it was a good machine but I wanted an auto and one where I could get all the data not just compliance. Unfortunately for me I had already accepted their machine…. not for long. I found out that ANY DOCTOR can write a prescription for a machine. I simply went to my regular doc and told him what machine I wanted and he was very happy to write me a prescription for WHAT I WANTED, not what they wanted. I returned the machine I didn't want, collected all my paperwork from them and went to another place with my new script and came away a happy camper. No way was I happy with what the first place tried to do. My doctor was appalled that the DME had actually called him to basically tell him not to write me a script. I simply explained why I wanted the machine I wanted and he was more than happy to let me have what I wanted.

You saved yourself several steps by not taking their machine right off the bat. Now you just have to get a doctor to rewrite the prescription for you. Good luck!
One more thing the insurance codes for these machines are exactly the same code whether it is a CPAP or an AUTO. This means they make more money when the sell you a cpap as opposed to an auto which is more expensive. So it is a money game also.

[Slinky]

1] You should call your insurance and ask them what local DME providers they are contracted with. That can save you some "shopping" time and perhaps a serious mistake in choice of local provider.

2] Your doctor can write you a script for Cardizem and unless he includes DAW (dispense as written) your pharmacist can provide you w/the equivalent dosage of Diltiazem instead. I am pretty sure that the "C-Flex" will not interfere w/your being provided w/a Resmed w/EPR or any other brand of PAP that has a form of exhalation pressure relief.

[jake2011]

You're correct, you do have a choice of DME comanies.
What I don't understand is why an auto cpap set in a CPAP mode. Doesn't the reimbursement to the DME remain the same buty the DME must pay more for the auto? Not sure a DME must suppy an Auto if, in fact, is not medically neccesary. Looking forward to the answer, I have my sleep stuidy scheduled in May.

[DoriC]

Good job! I once heard Fran Drescher (The Nanny) say that we have to start thinking of ourselves as "medical consumers" and not merely as patients.

[beyondtired]

Quick update. I talked to a different DME today, and I mentioned to them that my prescription was for a CPAP @ 8 cm. They told me that my Medicare insurance wouldn't cover an Auto CPAP, since my prescription didn't specifically say Auto on it. Is that actually true? I felt like calling Medicare up and asking them that? Also, even if it is true, like was stated earlier in this thread, why can't the DME just set an Auto CPAP in CPAP mode for me?

[DoriC]

Quick update. I talked to a different DME today, and I mentioned to them that my prescription was for a CPAP @ 8 cm. They told me that my Medicare insurance wouldn't cover an Auto CPAP, since my prescription didn't specifically say Auto on it. Is that actually true? I felt like calling Medicare up and asking them that? Also, even if it is true, like was stated earlier in this thread, why can't the DME just set an Auto CPAP in CPAP mode for me?

Medicare pays the DME the same $$ for cpap or auto(it has the same code) but of course the profit margin for the DME is less if he gives you an auto. With a little "prodding" our DME was willing to exchange the basic Plus for an auto but my Dr had to rewrite the RX with a range of pressures although he didn't have to change the wording from Cpap to Auto. It all seems to be nitpicking to cause tired patients more aggravation.

[Nealbopper]

When I last say my sleep doctor, I told him what I wanted and made him write it down on the script because I already knew what I was looking for and it was time for a new machine.
My old one has worked great for 12 years. Respronics, c-flex. When I called the Medical supply store, I asked them if they had the S9 Autoset and they said no. I asked them to order it
and it was there 2 days earlier. So, with a little persistance, you can get what you know is best for you. Most MS stores can order anything you want, you just have to have a script and ask.

[Janknitz]

Quick update. I talked to a different DME today, and I mentioned to them that my prescription was for a CPAP @ 8 cm. They told me that my Medicare insurance wouldn't cover an Auto CPAP, since my prescription didn't specifically say Auto on it. Is that actually true? I felt like calling Medicare up and asking them that? Also, even if it is true, like was stated earlier in this thread, why can't the DME just set an Auto CPAP in CPAP mode for me?

It's pure baloney. According ot Medicare, an E0601 machine is an E0601 machine. APAP, CPAP doesn't matter. The DME's want you to accept a CPAP because their profit margin is higher on the cheaper machine. End of story.

It helps to have your script state APAP, if only to head off this bullsh*t. They can't play this game if the script calls for an APAP. But they will still try.

Keep shopping around, this DME is not any good either.

[Tip10]

Keep in mind though if your script DOESN'T say APAP there is no requirement for your DME to provide you with an APAP machine just because you want one. They are filling the script as it is written and that is their only legal requirement.
The fact that Insurance doesn't make the distinction between machines is irrelevant. The fact that a machine can operate in multiple modes is not really relevant either.

Do it the smart way -- get your doc to write you an APAP script from the beginning and there's no issue at all.

I agree, there are a number of DME's out there who are more than WILLING to work with you on this but they are under no OBLIGATION to provide an APAP machine if your script calls for a CPAP. They ARE obligated to fill your script.

Again -- Do it the smart way -- get your doc to write you an APAP script from the beginning and there's no issue at all.

[XSnorer]

I was about to respond when I got to the Tip10 response. I second his response. It count not be put any better than that.