After 7 years - a Newbie!

[jpatterson]

Greetings, all you wonderful people! I must first thank all of you who have (unknowingly) helped me over the past couple of days while I have been scouring this forum and related web pages, soaking up all the terrific information you have provided! I know hindsight is 20/20, but I really should have been looking into this years ago! I truly feel as though I have just now learned about OSA, and the new machines are outstanding!

I was diagnosed with severe obstructive sleep apnea syndrome (780.53) in August of 2006. At the time of my study, my AHI was 79, and my oxyhemoglobin desaturation nadir was 82%. I was prescribed a CPAP with 9cm H2O, and my TERRIBLE DME (in cahoots with the study center) delivered my Everest (no choices - who knew?) with an ill-fitting mask. I had to fight to get my nasal pillows, but once I got my Swift Mirage, I have had very few issues with therapy. I am currently still using the Everest (over 15,000 hours - and almost as many miles - on it) but am getting a new machine very soon.

Once I had the CPAP my sleep quality (and overall health) improved so dramatically that I never thought about trying to improve on my setup. Now that my humidifier has failed and the start/stop button has been acting up, I asked my new primary care doctor (I've moved several times over the years) about a replacement machine. Now the fun begins, making calls and jumping through hoops. It hasn't been too bad so far; my doctor had no problem writing a new prescription for a machine based on my previous study and a thorough exam/Q&A, and my insurance (Humana) plan covers cost up to $750 without authorization. Humana provided me with the number for Apria, and Apria wants the sleep study and prescription in writing. I will probably need a new sleep study, so my doctor provided me with the name of a sleep medicine specialist.

So after all that; I am wondering just how often forum members have their sleep studies done, if ever? Do the new adaptive machines reduce the need for periodic testing? Is there a rule of thumb for re-testing frequency?

Also; any feedback on Apria would be appreciated.

Thanks, again, for being here and providing a wealth of knowledge!

JP

[herefishy]

I can't imagine that it is kosher for a DME to require a sleep study - maybe consider another DME? I had a disagreement with my sleep doctor and would hate to have to go back and ask him for a copy of my sleep study.

[Pugsy]

Your new machine is going to cost more that $750. Check with your insurance company to see what they are going to require. Have they been your carrier all this time since initial diagnosis? If not, then they might require a new study...it all depends on what they require. The insurance is who determines the need for a new study...not Apria.

The new technology machines are great but there are still things that are looked for during a formal sleep study that the machines can't cover.
I haven't ever heard of any general rule of thumb for time limit for retesting. I am 4 years into this therapy and there hasn't been any need and I don't see the need unless I feel something is not working right.

[Nooblakahn]

Another note. Apria is not generaly well respected on this forum and doesn't always seem to have the patients best interests at heart. There are exceptions to this of course... as I've also heard peoples local apria doing.g fine by them. Id sure stay on alert when dealing with them though.

[squid13]

Check with your insurance and get a list of DME's that they deal with in you area. That way you can go shopping for the best DME.

[jpatterson]

Thanks, Pugsy -

The refreshingly nice Humana rep I spoke with stated $750 is the threshold for authorization, but they would pay more if the DME called for authorization. She also sounded surprised that my group policy was written with no copay or deductible for DME - she put me on hold while she went to double check. Humana has not been my carrier from day one, but the rep was satisfied that I had a prescription from my primary and gave me a reference number for the conversation.

I had sensed some tension about Apria on the forum and didn't know if I could specify which machine I wanted from them. My original DME (Remway in Miami) told me the Everest was the only choice - what the doctor prescribed - and I learned much later that there was anything else...

[Pugsy]

Is your Humana coverage an HMO type of coverage or PPO type of coverage?

If HMO they may be tied to Apria at the hip and you may not have any choice but use them.
And yes, unfortunately there is a reason why we use the term Crapria... A lot of it is going to depend on your local office though. There are some really good Apria local offices but unfortunately they are in the minority.

If your insurance doesn't require a new sleep study....there is no reason for Apria to require one.

[2 B Sleeping Soundly]

Hi JP, welcome to the forum!

I can share about my limited experience with Apria. For me Apria is only a supplier, not my DME. My DME would be Kaiser who is also my medical provider. I call the Kaiser DME, they send the information to Apria, and Apria sends the PAP supplies directly to my house. I never have had to deal directly with Apria and I have always received exactly what I asked for from the Kaiser DME. For me, no problems, but others here may have much different experiences dealing with Apria as their DME.

As far as sleep studies, I did not go overnight to any laboratory, diagnostic center or clinic to have my OSA and its severity diagnosed. Kaiser sent me home with this machine for a overnight diagnostic sleep study http://www.healthcare.philips.com/us_en ... efault.wpd. Though sleep study purests will certainly cry heresy over a non laboratory or clinic sleep study, it does work for most of their patients and saves Kaiser a lot of money... which for a HMO is often the bottom line

John

[jpatterson]

Yep, Humana HMO, but the rep said she would email a list of DMEs for me to choose from (I did not get the list yet) so I don't think they're linked, Apria was just the closest to me.

The concept of shopping DMEs is new to me - but I'm a fast learner!

[Tino2You]

Hi JP,

Welcome to the forum. I use Apria. My initial experience with them was horrible. I had (very fortunately I might add) found this forum after my sleep study but before I was given a prescription. From the discussions here, I knew that I wanted an automatic pressure machine that recorded therapeutic data. When I showed up at Apria, I was told I could have my choice of bricks (non auto, records hours of use only). I went outside and called my doctor who FAXed a new script to Apria specifying an S9 AutoSet with a 5 to 15 range for pressure, "fill as prescribed". When I went back inside, I told the very nice (but not helpful) rep that there was a new script on her FAX and please use that one for my machine. Long story short, I was given the machine I want and the rest as they say is history. One thing you may want that was not offered (did I mention she was not helpful) was a heated hose which I later bought out of pocket (thank CPAP.COM) and have since added to my re-supply items with Apria.

Apria is very good about calling you every three months with offers to restock your supply. They send the supplies (based on your insurance company, but usually filters and pillows and a hose) quickly and there is little fuss. I am told there are good offices and bad offices, but the underlying theme with all of them is to push the bricks and load up their bottom line which sounds a lot like a corporate policy.

This is my experience, yours may be quite different.
-tino

[StuUnderPressure]

Apria wants the sleep study and prescription in writing.
JP

They may merely mean that they want a physical copy of your initial Sleep Study and your current prescription.

I will probably need a new sleep study, so my doctor provided me with the name of a sleep medicine specialist.

I do not think you will be required to have another Sleep Study - unless either your insurance or your Sleep Doctor require it.

If it is only your Sleep Doctor requiring another Sleep Study, you can avoid that by finding another Doctor.

My 1 and only Sleep Study was done over 15 years ago.

I am now on my 3rd machine.
Another Sleep Study was NEVER required - not even for the current machine I got in December 2011.

My latest machine was paid for by Medicare & even they do NOT require another Sleep Study (as long as your initial Sleep Study meets the CURRENT Medicare requirements).

I may actually have some good things to say about Apria (not for me, but for someone else) - but am awaiting the filing & acceptance of the actual claim before I say anything.

[TangledHose]

Hey JP !!! My name is John Patterson - - you must be my long-lost brother!!!

I was diagnosed with OSA during a sleep study in 2005 after complaining to my Primary Care Dr of fatigue. I didn't know much, and I was sent to Apria to get set-up with machine and mask. In hindsight Apria was the worst thing that ever happened to me!!! They set me up with a crappy machine, a mask that was totally inappropriate, and the charges they sent to my insurance company were ten times the real cost of the equipment, fortunately the insurance companies are wise to that game, but I still don't get why the DME always tries to charge over $900 for a mask - - it seems borderline criminal to me. Anyway, despite Apria I was persistent in edjucating myself about machines and masks and over the years have gotten set-up with the proper equipment that works for me - - some of it was purchased with out of pocket money because I felt my health was more important than getting shoe-horned by my DME into equipment that wasn't right. I feel that my success in treatment was inspite of Apria rather than due to anything they did.

I have regular old OSA and I found over the years that I get better AHI numbers with Auto-PAP as opposed to CPAP, so if I were you I would hold out for one of the better APAP units, keep in mind that APAP can also be run in straight CPAP mode so it's like getting two machines in one. My CPAP average AHI was 2.8 which was good, but my average with same manufacturer's APAP (F&P Icon) is 1.6 - - not a substantial difference, but I think the APAP is much easier to fall asleep with and after a wake up for bathroom break or any other reason it's much easier to get back to sleep.......I love the new APAP machines and I like the fact that my numbers are better!

Good luck with everything and glad you found this Forum - - tons of good help and information here from all the nice, and very knowledgable members!

[chunkyfrog]

I like Tino's procedure--we pay a lot to have the convenience of a cell phone--we should use it accordingly.
Good luck with getting the right machine and mask--for YOU!
And welcome back to the land of hoses.

[jpatterson]

Hey JP !!! My name is John Patterson - - you must be my long-lost brother!!!

I'm John Patterson, too! (or is that 2 )

I do have something that works for now, so do not feel the need to rush into anything. I will be sure to ask lots of questions and get as much machine as possible...

Regards,

JP