Hopefully soon...

[Krelvin]

Last Wed, I had my sleep study. First 3 hours were typical sleep patterns for me, all over the bed and I even tried to sleep on my back with what I thought was no sleep at all. At 2am, the came in and said lets try the mask.

They fit me with two different full face masks as I definately breath through my mouth all the time. The first they said wasnt fittin right, the second I only used for about 20 minutes. They said the flow was too high... They then tried a third and I could tell that the pressure was a lot less and very easy to exhale...

The asked me to stay on my back if possible and left...

A couple minutes later, I was trying to figure out how to get the mask OFF... the tech came in and helped me get it off. I said, that I guess that didn't work well and he only said... "are you sure?"...

A glance at my watch showed that the few minutes was more like 3-1/2 hours of unmoving, undisturbed sleep. WOW!

I gotta get me one of these thing now.

The study place provided no real details about the study, "you have to see your doctor for that"... it was obvious to me though that using a mask was going to help be finally get some sleep.

When I got home, I realized I had no folloup appointment, I called the next day and got the next available slot a week later... That will be tomorrow.

I am not really sure what to expect... I'm sure I will get the results, and I assume that I will get a RX for one, but I don't know what is covered (Aetna HMO). I don't know if the study place will tell them what masks worked and which didn't and I'm not quite sure if I really know the difference between Cpap and Apap or I would need the latter.

I do know that a humidifier is necessary as it is very dry here and my mouth is always dry when I wake up.

I had kinda hoped, they would have called me and said see X Y and Z to get your equipment but so far, all I've got is the appointment tomorrow.

Nice forum...

[Moogy]

You might want to examine pictures of all the masks on cpap.com and try to find a picture of the one that worked, so you will know what kind it was. A good mask fit is essential for successful therapy, so lobby hard to get the one that worked for you.

I am sorry that I am not familiar with your insurance, so I can't warn you about any problems there. However, I can tell you that MANY of us choose to buy additional masks out of our own pockets in order to get what we need.

Good luck!

Moogy

[Krelvin]

To be honest, I don't know what it looked like. I didn't have my glasses on at the time and I was dead tired and a bit cranky.

I'm hoping that they might have it in the report from the study.

I have enough flexspending money available to cover even if they don't. I would have already just gone out a bought one if it weren't for the need of having an RX to get one.

I also like the idea of getting a second portable machine for travel as well.

The idea of being able to actually sleep at night is worth a lot to me. Its been years since I've been able to do that.

[birdshell]

I do not know about HMO's either, but would suggest that the Aetna HMO should have a number for you to call to check on your coverage.

I know what you are saying about the sleep lab folk. Years ago, I had a hurried late Friday afternoon ultrasound. I had a very worried 24 hours until my doctor called me on a Saturday afternoon to say I had nothing wrong. At least the sleep tech told me that I had apnea!

However, my sleep lab had me come back for another night of titration. They were very good to me, and I actually looked forward to going back. However, there was no mention of a doctor appointment or even an interpretation of my results. It was kind of odd, to me, because it was as if I already knew what to do or what would happen; almost as if I wasn't a really interesting or really seriously apnoeic patient.

I called my referring doctor, who is an allergy/immunology expert. His office told me I would have to call the sleep doctor. Gee, he wanted to see the CAT scans of my sinuses himself and interpret them for me--isn't my sleep study of equal importance?

I called to make an appointment with the sleep doctor. When I saw him, right away he asked me why I had made an appointment! I wasn't unhappy, it is just my body and I wanted to know the results. For another year, I have great insurance for which I am very, very grateful. Since it pays for 90% of office visits, I wanted to have my questions answered. We all deserve to see someone to interpret our results.

If not for the forum folk, I would have been much more unhappy. It was a real comfort to find out how others are handling some of the problems unique to CPAP. We need each other, don't we?

So, in summary, while my apnea is not horrible--I awoke only about 10 times a night--it is important to my well-being. I am just plain tired of being tired and of sleeping 12-14 hours a day.

Sleep labs and sleep docs are great people, but sometimes when one is used to the topic and the surroundings one does not realize what things are like for the newbie. This is important for us all to remember, as the newbies need our help and experience the most. We all have different experiences and knowledge to share. Keep the great postings and information coming, and please do not forget the point of view of others.

[jkeene]

For Aetna, the policies on what is covered are described online. Go to their website, hit the search link and put in apnea. You'll want to read over the Clinical Policy Bulletins numbered 4 and 452. They're a bit like reading tax forms, somewhat hard when you're sleep deprived. The main one for OSA is 4, only need to get into 452 if you're dealing with bi-level machines or more complex conditions.

Specific machine coverage is going to be very dependent on the DME clause in your policy, I've not found things like that online.

[Krelvin]

I had looked on the Aetna website, but counld figure out the coverages. Since I don't know what the study actually said, there was nothing to really compare.

I have never seen a Sleep Doc, I was referred to the Sleep Study by my regular physician (a new one at that) so I have no idea what to expect.

I have been doing a lot of reading though.

I was told at study time I was have 90+ issues a night but they didn't clarify exactly what that was. So I don't know if it was waking up that many times or a combination of other things. When I pressed for more info, the clammed up and said there were not allowed to discuss results...

Thanks for the info.

[Krelvin]

Saw the Doctor today to go over the Sleep Study....

He didn't have it ...

I contacted the Study Place which said they had faxed the info to the office the day after the study...

Dr. said that when he sees it, he will order a machine via the Insurance. Said based on what I said about the study, I most likely need one. Would take a about a week to get a machine.

When I contacted the Dr. office to let them know they should already have the study, they said they would check. The study place is faxing a second copy over and I should be able to get the results from the Dr via their results system.

[kurtchan]

Krelvin,

This all sounds alarmingly familiar. In fact, I had an appointment with my GP (or PCP as the HMOs call them) today and he was really angry when I told him that: 1) the doctor from the sleep clinic had prescribed the machine and mask without consulting him and 2) the clinician from the Durable Medical Goods supply had done such a poor job with me -- only bringing one mask for me to try, not helping me to set up the equipment and forgetting to bring both the electrical cord and the manual for the CPAP.

I've learned from others at this forum that you need to arm yourself with as much information as you can so you can be your own best advocate with the doctors, insurance and medical supply. I've discovered that it's ridiculous to assume that the doctor from the sleep clinic will communicate with the referring physician unless you insist.

It's a terrible position in which to find yourself, especially with all of the new and somewhat scary info you're trying to process about your medical condition and what amounts to a life-long committment to treatment. I finally said to my doctor today "Get the doctor from the sleep clinic on the phone while I'm here in your office and let's have a conference call so we're all on the same page. I'm not a medical professional and I'm tired of trying to translate information or act as the go-between." I think I bruised his ego, but we finally accomplished something.

Long story short: pose a question at this forum if you want expert opinions -- and I mean the opinions of people that have personally dealt with sleep apnea and the equipment. You'll probably get more than one answer to your question, but it will help you (and your doctor) to be more informed when you make your final decisions. I received wonderful advice from forum members on how to tell my doctor what equipment I wanted/needed before he even wrote the prescription. As my mother always said, "Do your homework."

Good luck and keep us posted!

Kurtchan

[Linda3032]

Krelvin,

If at all possible, get a copy of your sleep study - either from the doctor or the clinic.

Contact billmyinsurance.com to see if they will handle your insurance claims for you -- instead of getting your equipment through a doctors office or their DME. Then, you could buy your equipment through cpap.com and let billmyinsurance.com do just that. That way, you could get the equipment you want, rather than take what the DME wants to clear out of their inventory.

But, if you feel that you need guideance from a DME - for help in fitting masks, etc., then go through the DME.

Be forewarned, there are many horror stories in this forum about "evil" DMEs. But, there are some "happy ever after" stories when someone is lucky enough to find one that cares about the patient/customer.

Many of us bypass the DME, purchase our own equipment, and file with our insurance companies - and have success stories. So, do what you feel is comfortable for you.

This forum is here to help, so don't hesitate to ask any questions.

PS: Yes, and Auto machine is very nice and many have tried to switch from what their DME pawned off on them to a more versatile machine.

[snoregirl]

Try to look at the masks on this web site and/or call the sleep center and talk to the tech that worked with you. Yes, your mask may be listed on the report, but mine was too and it was listed wrongly. So the more you can remember or find out before you get to the ordering the mask stage the more luck you might have in finding that mask that you liked so much.

My basic advice to you is since you haven't taken a machine from a DME, read read read, and decide what is important to you (size, cflex or not, humidity, data collection or not, auto titration or not...) and which machine you would perfer to have. Many with added features can function with less features, but the reverse is not true. Then, when you find out what the doctor ordered, or even before that, find out what he is PLANNING to order, you can either say, that is good, or I would really rather have this one, can you write the prescription specifically for my choice? Much easier than getting to a DME, if you are required to use one, and then trying to get the prescription changed when you find out you don't like what they are planning to give you.

If you are allowed to use another source (rather than the traditional DME), you can find this out NOW by calling your insurance. Consider that route if you don't need or want their help. Other than fitting on masks, CPAP usage is not rocket science. Takes some time for everyone whether they do it themself or DME assisted.

Most of all get a hardcopy of your prescription and hold it. You mention wanting a travel machine. Your insurance most likely won't cover a second machine, and if you want to buy one, you will not want to pay the price that the traditional DME's want. You will want to order the machine of your choice from a reputable online source. You can use that same prescription. Read the prescription requirements on CPAP.com to see what the prescription has to say. Don't give your copy to anyone (DME, Cpap.com etc). Not necessary. Can be faxed.

Good luck

[Krelvin]

At this point, I am trying to get a copy of the report.

Since the Dr didn't have access to the report, I currently have nothing. No report, no RX etc...

If I had an RX, I would have just gone out and bought one and have one tomorrow (I'd pay next day air). Heck, I'd buy the machine outright and deal with the insurance later.

The Dr's office should have received it by now and I have already called several times to get a copy of it.

As for a machine... based on what I have read, If I had a choice, I most likley would get a Remstar Plus M Series CPap with Cflex and the Heated Humidifier Option.

The mask would have to be full face and preferably the one that got used in the study as it worked very well the first time.

If what type of mask was used in the study is not in the report, I will contact the sleep study lab then.

BTW... the billmyinsurance.com says that I have to use Aetna's supplier.

[Guest]

I am an RT that works for a DME and I am well aware of how you all feel about DME companies. I just have to let you know that I only use downloadable machines with the CFlex or EPR option. I don't bother with any other machines because as far as I am concerned they are worthless. As far as the Apap/Cpap choice, as a DME your hands are tied as to what the Dr orders. That said, as a DME provider I can call the DR on behalf of the Patient and request an APAP machine and get a script from the DR for an APAP machine. Some times an RT calling can encourage the Dr to go ahead and order an APAp. The reason that Most DME's won't do that is because insurance will not pay anymore money for an APAP. The DME is out the extra money for the APAP. As far as masks go, I let my patients try as many masks as they want to for the first 30 days. They can take them home and try them. I am not in the business of giving people crappy equipment and crappy masks that they will not use. I just want you to know that there are decent DME companies that will help the patients as much as they can. I am sorry that so many of you have had to fend for yourself to get that treatment everyone should get from the begining.

[Guest]

Sorry- I had one more thing to add to the last post. I give every patient that I set up a copy of their script and a copy of there sleep study. I have never understood why those things are sacred. I make sure that the patients know what they are treated for and what there Dr ordered.

[ozij]

I don't bother with any other machines because as far as I am concerned they are worthless

I am a patient. I use a downloadable machine with neither ERP nor c-flex. It's obviously made by a third company. It's excellent.

There are other members of this forum who use this machine, and they too are extremely satisfied.

O.

[RedThunder94]

[quote="Anonymous"]I am an RT that works for a DME and I am well aware of how you all feel about DME companies. I just have to let you know that I only use downloadable machines with the CFlex or EPR option. I don't bother with any other machines because as far as I am concerned they are worthless. As far as the Apap/Cpap choice, as a DME your hands are tied as to what the Dr orders. That said, as a DME provider I can call the DR on behalf of the Patient and request an APAP machine and get a script from the DR for an APAP machine. Some times an RT calling can encourage the Dr to go ahead and order an APAp. The reason that Most DME's won't do that is because insurance will not pay anymore money for an APAP. The DME is out the extra money for the APAP. As far as masks go, I let my patients try as many masks as they want to for the first 30 days. They can take them home and try them. I am not in the business of giving people crappy equipment and crappy masks that they will not use. I just want you to know that there are decent DME companies that will help the patients as much as they can. I am sorry that so many of you have had to fend for yourself to get that treatment everyone should get from the begining.