Fighting for a better Machine

[Mike6977]

I think it is important for you to play 'dumb' about the software angle.... just insist on a fully data capable machine, and then we can help you access the data.

Sad but true.

It's best to have your Doctor (and that can be any willing MD) write a very specific script that specifies exactly the make and model of the machine, masks, etc., along with DAW (Dispense As Written).

While you may or may not have a choice about local DMEs for your machine (I don't know if it's mandatory that a tech set up the machine), you certainly have a choice when it comes to masks, etc.

The DME can UPS your mask, etc. to you, so any DME reachable by phone can fulfill you order as far as I know.

Once you do, you are locked into a 5 year replacement cycle unless you buy out of pocket.

Doesn't this depend on your diagnosis and insurance plan? I've had GHI tell me they will replace anything on an "as needed" basis, which I assume means a new script.

[EO_123]

I can't tell you how much I appreciate your help on this. It's really bad when your DME has you so mad you can't sleep!

Thanks for the link to the Rx form - can I have my doctor sign that and take it to another DME? Is it going to matter that it has another supplier's name all over it?

[Janknitz]

One warning: Do NOT return your current machine unless you are POSITIVE you have another machine lined up. A brick is better than no machine at all--don't cut off your nose to spite your face.

An RX is an RX and having one with CPAP. com written on it indicates your willingness to go elsewhere if the DME screws with you.

[EO_123]

Gracious I have had a morning.

I went to the doctor, got a new Rx written that says "auto" after telling him the story, he told insurance rep to set me up with a new DME. Insurance rep was great and contacted a DME, verified they had the machine - I drove over to DME's office to give them all the paperwork and the script ASAP, only to discover that that DME had moved to a city about an hour away - I don't feel comfortable working with someone so far out of my area - I live less than 2 miles from about 8 other companies, so I wanted to try and see if one of them would get me the machine I wanted. The more frustrated I got, the more I decided I 'needed' the S9 Autoset. I went to LinCare who initially was more than happy to take my business, until they saw my prescription and the machine I wanted. They told me they can only give that machine if the script lists it by name - however they had a room full of S8's, I told them they could keep their S8's. I visited another company that said they would have to make some phone calls, and proceeded to yet another DME who said they have 10 S9 Autoset's in stock, getting me one would not be a problem. I gave them a copy of everything and changed over the referral with my insurance company (this takes a few days to process) I have a referral with the respiratory therapist on September 9 to pick up the machine. (this was the soonest appointment with their respiratory therapist - but I think I'm okay with that)

THEN I called to break up with my current DME. They were of course shocked and heartbroken and asked for the opportunity to 'fix' the situation (what have they been doing for the last 3 weeks?) They told me it was fine that I bring the machine back next week (I'm not sure if I trust this though) I'm as confident as I know how to be that I'll be getting a machine from the new DME - I have an appointment set, the insurance put in the referral and they have my paperwork. I accepted the machine on July 29th so we are really close to that 30 day mark - the old DME didn't seem worried about when they got it back and said they would give me a ticket - of course I want to go the minimum number of days without a machine - but I might not be able to do anything about that. I have a feeling that it's a bad idea to keep the old machine more than 30 days, even though the DME said that was fine and I could return it whenever I was ready.

Any advice?

[archangle]

Be sure it's an S9 AutoSET, not an s9 Escape Auto.

Look a the pictures on cpap.com, figure out where it will say "AutoSet" next to the power button when you pick it up.

[Fitness Seeker]

EO, May i ask what your diagnosed AHI was ? I've been on my apap for 3 wks but not working well and trying to get a diff machine but the DME says that I have to talk to the MD. They wont' communicate w/ them. Boo. And when i contacted my sleep clinic they told me the other machines are for more 'severe apnea' sufferers...

[Fitness Seeker]

Is the policy "30 days" for masks and equipment?? Yikes, all along i thought it was "90 days"!!! Gosh, the sleep clinic told me to come back 4 wks after using the machine. Well I have the same issue w/ EO. My MD appt isn't for another few wks (and it takes along time to secure an appt). And what happens if the MD agrees to let us use a diff machine and after a trial we find that the 1st one works better?

[archangle]

Is the policy "30 days" for masks and equipment??

Most mask manufacturers offer 30 days free exchange on a new mask through local DMEs. It's not 100%.

Machine exchange policies are much less clear. Insurance often mandates machines be rented to start with, which gives you some flexibility.

[EO_123]

I'm not sure I know how to read my sleep study - but at one point it says Apneas+Hypopneas Count : 30 and Index : 6 (I'm not sure I'm reading numbers from the right place though - if someone would be willing to take a look and take a shot at interpreting, I'll scan and post)

My apnea was called 'mild' and I still haven't really had anyone "officially" explain the results of my study to me. From what I can tell hypopneas were the most common problem for me. One of the things that sticks in my mind the most is when the sleep tech told me at the titration study "you have mild apnea, but mild is treatable and so we are going to treat you"

I kind of used a loop hole to get my prescription updated - I never saw the sleep apnea doctor who did my report- my PCM Dr put in the referral - and by the time my study was completed, I was transferred to a different clinic and had a new PCM. I was contacted by the DME, I've had to figure this out myself, and with you guys So I saw a new Dr who had to take me at my word - I was very knowledgeable and convincing and knew more about CPAP, and Insurance and DME's than him. I explained that sometimes I felt great, other times I didn't- and that an auto machine would help him figure out why because he'd be able to see actual data and set a pressure range etc... I basically sold him on the concept, and it worked. I might not have been as lucky with a sleep Dr. We are in the Military medical system (Tricare) and the left hand seldom knows that there is even a right hand.

I just got off the phone with the "big boss DME" who is very sad I'm breaking up with his company. He said his office would have been glad to contact my doctor for an updated Rx, that they do this for patients all the time. I was told yesterday I couldn't get an auto set because "the boss says they are too expensive and the Rx doesn't say auto" I was furious with the notion that a stranger would put his bottom line before my health. Yesterday I couldn't talk to him, but they would email him a message - today he begged to help me and give me anything I wanted. Maybe my mistake was dealing with the respiratory therapist and not the office people up front - I felt like she was willing to even bend rules to help me, that she wanted me to have the best. I told her up front that if I couldn't get the machine I wanted/needed, I would go elsewhere, I told her that every time we talked. I guess she knows now that I wasn't bluffing. I wish it had gone differently, maybe I was emotional and hasty, or maybe they only care after I walk away.

VERY good point about checking on the S9 Autoset and not S9 Escape Auto.... I will confirm tomorrow. I did get the appt moved up to next Wed, so I should have my new machine from the new DME by then.

I don't know for sure about the 30/90 days. I just know that I'm really uncomfortable keeping this machine past 30 days. As it stands, I should only have 2 nights without CPAP.

*My mask is great (unless it leaks, and I don't know that yet....) and I intend to keep it. There is not clear language about the machine - but it is a rental. I just want a clean break, so I'm keeping it under 30 days, this is my paranoia. The old DME told me that my doctor could update the script and they would change out the machine at any point - but this was in his 'don't leave me' speech. However, I would like to think that a good DME probably would do that.

[archangle]

I'll suggest you be very sweet with the old DME, but take the line that "I tried, but I couldn't get you to help me before, why do I want to stay with you now that I've found someone who I didn't have this trouble with? They went to the effort to work with me, so I'd feel bad denying them my business."

Sometimes it's more fun to put them in a diabetic coma than to yell at them.

[newname]

I just read this entire post and I have a question. I'm due for a new machine soon and want to get the best. I want access to all my data, I want an autopap so I can see if my pressure changes. I don't want to spend alot of money on equipment or software to read my nightly numbers.
My latest sleep study showed severe apnea.
The prescription they sent me says: cpap at 14(E0601) I want apap. Can I get this?
it also says heated humidificsation (E0562)
Nasal mask (A7034)
Tubing (A7037)
Headgear (A7035)
H20 chamber (A7046)
Non Disposable(A7039)

Provide Clinical Sleep Apnea Management-Yes
Diagnosis code 327 23 Obstructive sleep apnea
Length of need Lifetime/99 years

What do all those codes next to the equipment mean?
What is clinical sleep apnea management?

My apneas are 60/hour

[Pugsy]

What do all those codes next to the equipment mean?

Those are just standard billing codes for insurance.

The prescription they sent me says: cpap at 14(E0601) I want apap. Can I get this?

From our host cpap.com or the cpapauction.. yes this is sufficient for APAP.
From a new DME or existing DME it could be if they would just do it. All they have to do is set it up in cpap mode before they give it to you BUT often they squawk really loud and refuse to do it.
BTW the APAP is still considered a cpap and the E0601 code is used for it also. Insurance pays by these codes.

What is clinical sleep apnea management?

Beats me unless it is fancy wording for doing what is necessary to insure therapy.

[archangle]

I just read this entire post and I have a question. I'm due for a new machine soon and want to get the best. I want access to all my data, I want an autopap so I can see if my pressure changes. I don't want to spend alot of money on equipment or software to read my nightly numbers.
My latest sleep study showed severe apnea.
The prescription they sent me says: cpap at 14(E0601) I want apap. Can I get this?
it also says heated humidificsation (E0562)
Nasal mask (A7034)
Tubing (A7037)
Headgear (A7035)
H20 chamber (A7046)
Non Disposable(A7039)

Provide Clinical Sleep Apnea Management-Yes
Diagnosis code 327 23 Obstructive sleep apnea
Length of need Lifetime/99 years

What do all those codes next to the equipment mean?
What is clinical sleep apnea management?

My apneas are 60/hour

See if your doctor will write a pressure range instead of "14" on the prescription. For instance, "12-16 autopressure" or even 13-15. That would help cut down on any arguments from the DME.

The numbers are "diagnostic codes." They have to do with getting paid for insurance. Usually the insurance will pay a fixed amount for a particular code, no matter what machine it is. Auto CPAPs get the same code as manual CPAPs. DMEs want to give you the cheapest CPAP they can because they make more money that way. They could give you an autopap machine, but will often tell you they can't or simply refuse to do so without doctor's instructions.

[newname]

Thanks for the replies to my questions.

[LinkC]

They do get it right sometimes. They also don't get it right sometimes.

AND sometimes it changes after the titration study. Sleeping conditions, position, weight loss or gain, congestion, etc. There are myriad reasons your optimal pressure will change over time. (Notice I said "will", not "can"...)

If you're gonna take charge of your therapy, the Auto is the way to go.