Slightly frustrating DME visit

[Country4ever]

I know some of you will tell me to just avoid them, but some of us can't, in terms of our insurance.
I asked my doc for a new machine, since this Resmed Autoset 8 is getting old. Originally, 7 years ago, he put me on APAP settings, but I discovered that straight CPAC worked much better for me.
I also went up on my pressure to 9cm from 8. The doc's staff was a little miffed at me for doing that, but my doc seemed okay with it.......but told me not to tell anyone that I make my own changes.
When he wrote the Rx for the new machine, he said he had to write a range, since it was for an APAP machine.
So when I went to pick up the machine today, she set APAP settings. I told her that he only wrote that because he thought he had to. Unfortunately, he didn't write my straight CPAP setting.
The DME lady called the doc's office and they said I'd have to call them and have the doc "officially" change the RX. Now I'll have to take the machine back to have the DME do, what it would take me approx. 10 seconds to do here at home.........and they'll probably charge me for it too.

Could my doc have ordered me an APAP machine, yet wrote the pressure for straight CPAP? When the DME called the doc's office, it sounded like the lady told her if I was on straight CPAP, I would have to order a straight CPAP machine. I think that's B.S. Have you ever heard that?

So........I will go through the "proper channels", but I won't like it. But.........if I can't get back to the DMEs soon, and I want to try my new machine..........could I just take out the data card and they'd never know? Or is the usage amount kept somewhere else in the machine??

Its so ridiculous. The order was for 8-12 cm pressure, and I want 9cm of straight cpap. What's the big deal if I change it??
I understand that life would get complicated if ignorant/sick people started messing with their own machines, but I'm fairly intelligent, and a pressure of 9 isn't going to kill me.
Anyhow........what do you think?
Thanks.

[Leadhead]

Its so ridiculous. The order was for 8-12 cm pressure, and I want 9cm of straight cpap. What's the big deal if I change it??

It is absolutely no big deal...change it..I change mine all the time. It's your health...take control of it and don't worry about pleasing the RT or anyone else.

[Wulfman...]

I know some of you will tell me to just avoid them, but some of us can't, in terms of our insurance.
I asked my doc for a new machine, since this Resmed Autoset 8 is getting old. Originally, 7 years ago, he put me on APAP settings, but I discovered that straight CPAC worked much better for me.
I also went up on my pressure to 9cm from 8. The doc's staff was a little miffed at me for doing that, but my doc seemed okay with it.......but told me not to tell anyone that I make my own changes.
When he wrote the Rx for the new machine, he said he had to write a range, since it was for an APAP machine.
So when I went to pick up the machine today, she set APAP settings. I told her that he only wrote that because he thought he had to. Unfortunately, he didn't write my straight CPAP setting.
The DME lady called the doc's office and they said I'd have to call them and have the doc "officially" change the RX. Now I'll have to take the machine back to have the DME do, what it would take me approx. 10 seconds to do here at home.........and they'll probably charge me for it too.

Could my doc have ordered me an APAP machine, yet wrote the pressure for straight CPAP? When the DME called the doc's office, it sounded like the lady told her if I was on straight CPAP, I would have to order a straight CPAP machine. I think that's B S. Have you ever heard that?

So........I will go through the "proper channels", but I won't like it. But.........if I can't get back to the DMEs soon, and I want to try my new machine..........could I just take out the data card and they'd never know? Or is the usage amount kept somewhere else in the machine??

Its so ridiculous. The order was for 8-12 cm pressure, and I want 9cm of straight cpap. What's the big deal if I change it??
I understand that life would get complicated if ignorant/sick people started messing with their own machines, but I'm fairly intelligent, and a pressure of 9 isn't going to kill me.
Anyhow........what do you think?
Thanks.

Listen to your doctor!
It's NO BIG DEAL! Just change your settings yourself. It's YOUR therapy, YOUR machine, and YOUR sleep.


Den

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[BlackSpinner]

Change it yourself. Ask the doc if he requires diabetics to come in and get their insulin re set. It is just air. You don't need a control freak in charge of your AIR!

[Country4ever]

Thanks everyone. I guess I'm just insecure enough to worry about them getting upset with me. AND......more importantly..........the insurance company denying something because I'm not playing by the rules.

I just called the doctor's nurse and asked her to have the doc send the Rx change to Lincare. She said that I HAD to use the apap, since it was an apap machine. "Why would you want an apap machine if you you're on straight cpap?" she asked. Maybe I'm ignorant, but I wanted the choice in the future. She didn't seem to understand that an apap machine can do straight cpap too. I believe she was the nurse at my last visit who was miffed because I had gone up from 8 to 9 on my pressure, without a doctor's order! I just need to get through this getting-a-new-machine phase, and hopefully I'll be done with them for awhile. But like I said........Insurance requires we play by the rules.........

[JDS74]

Its unfortunate that you are going through this spell.

When your dioctor said he was fine with your change to 9 cmH2o and not to tell anyone you could change your settings and he had to prescribe a range so you could get an APAP machine, that should have been enough clues so you didn't discuss it with your DME or anyone else for that matter.

That said, your DME has no way of knowing whether or not your doctor has made changes to your pressure settings. PA's in the doctor's office certainly could.
They are primarily interested in compliance not pressures. They want to know that you are using the machine the average number of hours and the total number of days your insurance company requires for them to be paid.

You may find that because of your comment to the DME, they have locked the prescription values on the SD card.
If that is the case, then you may have to format the card before you can make a change that will stick.

After this, follow your doctor's advice and, to quote a famous expression, "Don't Ask and certainly Don't Tell."

[Wulfman...]

Thanks everyone. I guess I'm just insecure enough to worry about them getting upset with me. AND......more importantly..........the insurance company denying something because I'm not playing by the rules.

I just called the doctor's nurse and asked her to have the doc send the Rx change to Lincare. She said that I HAD to use the apap, since it was an apap machine. "Why would you want an apap machine if you you're on straight cpap?" she asked. Maybe I'm ignorant, but I wanted the choice in the future. She didn't seem to understand that an apap machine can do straight cpap too. I believe she was the nurse at my last visit who was miffed because I had gone up from 8 to 9 on my pressure, without a doctor's order! I just need to get through this getting-a-new-machine phase, and hopefully I'll be done with them for awhile. But like I said........Insurance requires we play by the rules.........

You're dealing with idiots at the doctor's office.
Your insurance and DME ONLY care that you're using the machine.......not that it's set to the doctor's Rx.

You can still set the machine in APAP mode with the minimum and maximum pressure set to the same pressure. It's essentially CPAP, but reports a few extra events on the reports.

Bottom line......keep your mouth shut and just use the machine. THEY DON'T CARE!


Den

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[HerbM]

Who getting upset worries you?

If it is the DME then don't give THAT another thought. They are just the "car dealership" and you don't owe them anything, not even an explanation.

BUT the DME is bound by the doctor's prescription -- if they set something different they could possibly be sued. THEY must do what they are TOLD. You aren't under that restriction, and beside you and your doc already discussed it.

If you mean the Doc, well he already got "miffed" then told you NOT TO TELL ANYBODY (like maybe the DME) and wrote an APAP prescription so you would get the GOOD MACHINE with FULL DATA.

He had to write a "range" perhaps to justify the APAP (at least in his own mind).

Change it back to what you and the doc discovered works and there is NO ISSUE -- no one to even get "miffed".

(That only leaves the insurance company and they do NOT CARE as long as you are getting the therapy they pay for.)

Some of us change EVERYTHING on our own. I changed mine BEFORE I used it for the very first time (it wasn't blowing enough to make breathing through the mask comfortable.)

My doc, looked at the results of my settings which were entirely incompatible with the ones he ordered. He either DIDN'T NOTICE or DIDN'T CARE since he never mentioned it. Maybe he thinks those settings which get near perfect results were chosen by him but then that would mean he doesn't really understand what or why he set something else to start.

I don't care -- see him again in a year for a new Rx and he is a nice guy.

[StuUnderPressure]

You may find that because of your comment to the DME, they have locked the prescription values on the SD card.
If that is the case, then you may have to format the card before you can make a change that will stick.

Someone was asking me this just a week or so ago.

I thought that was the case, but could not put my fingers on any documentation in a hurry.

I never let my DME touch my SD card, so I do NOT have that problem.

But, if a DME puts the pressure settings on the SD card, is formatting the SD card the only way to remove that setting to allow you to put your own different setting by way of the machine?

In other words, if I make a change to the pressure setting on my machine, will it just revert to the setting that the DME put on the card every time I reinsert the card into the machine?

Or, does my pressure setting change on the machine override anything the DME put on the card?

[Pugsy]

But, if a DME puts the pressure settings on the SD card, is formatting the SD card the only way to remove that setting to allow you to put your own different setting by way of the machine?

In other words, if I make a change to the pressure setting on my machine, will it just revert to the setting that the DME put on the card every time I reinsert the card into the machine?

Or, does my pressure setting change on the machine override anything the DME put on the card?

Settings put on the SD card via software at the DME office will override anything we do manually.
So if we change something and something else is written into the SD card then when the SD card is inserted into the machine the settings will revert to whatever is on the SD card.
Not all DMEs will use the SD card to send changes though. Some do and some don't.
If they are indeed written into the SD card the only way to make them go away so that the changes we make will hold is to erase/format the SD card.

[chunkyfrog]

I have found that some people are stubborn and hate to lose control.
Just nod your head and agree; then change the settings when you get home.
Duplicity is a survival skill. Use it.

[JDS74]

Since your previous machine was a ResMed, I'm presuming that your current one is also.
In that case, formatting / erasing is the only way to remove the prescription information from the card.
When / if you do that, the machine will re-write all of the summary information that is stored internally in the machine, in particular the compliance information which is all the DME and insurance companies care about.
If there is additional information that will be written to the card, someone with more knowledge of how ResMed machines work than I will have to chime in.

For Respironics machines, the prescription information is contained in a separate file on the card.
Respironics are not nearly so picky as ResMed so deleting just that file (whose name I can't remember just now) will fix a Respironics machine nicely. Doing that with a ResMed card will cause the machine to reject the card and ask if you want to format it - same as if you formatted it yourself.

[Janknitz]

Could the OP just purchase a new card and use that one instead?

A new card will still capture the compliance data in case the insurer cares, and it will still capture the efficacy data in case the doctor's office cares. Yes, it will show the fixed pressure setting that the OP chooses over the pressure set by the DME, but it will override any settings on the original card. And WHO CARES one flying F if the DME is upset because OP changed his pressure settings???? There are NO CPAP police. Once the DME has evidence of compliance for purposes of insurance reimbursement, you don't have to show them the card ever again, if you don't want to.

Seriously, it's YOUR machine, YOUR body, YOUR health. Ultimately, the DME does not matter.

[zoocrewphoto]

Most DMEs will not provide an apap without an auto range listed in the prescription. It cuts into their bottom line. So, you need the auto range in the prescription even if you don't plan to use it. At least your doctor was willing to help you get the apap when you intend to use it mostly as a cpap.

I would just keep quiet about the setting changes and do it on my own.

[Country4ever]

Thanks everyone.

My concern is that when they download the data in the near future (required by insurance), the doc's office and the DME will have seizures because its not the "prescribed" setting. I don't want to risk the insurance company refusing to "pay". By that I mean I pay, is that I pay monthly for 9 months, but it goes towards deductible.
After this initial checking by the insurance co., I will only have to deal with the doc's office in a year....which might be uncomfortable, but not impossible.

Something else irritating..........the manual for the machine doesn't tell you how to access your AHI. But a You Tube video showed me.