Frustrated in Oklahoma

[idahogal]

Bumping up so maybe some of our experienced people can help.

[NightHawkeye]

8. My concern is where do I go from here? Find another doc in Tulsa? Find another DME? Ask the doc for a written prescription and buy the machine I want from cpap.com? Be insistent with the doc and DMEon wanting a REMstar Auto C-Flex CPAP so that my pressures are correct in all sleep positions? If yes, be insistent to whom?

Hi jeepdoctor,

I'm sorry to hear of the trouble you had, especially after you apparently did your homework up-front, and then met with the ultimate resistance anyway rather than getting any sort of cooperation. Some DME's and doc's are that way.

FWIW, a lot of us have been through seemingly endless frustrations in the diagnosis and treatment of our sleep apnea. Unfortunately, there's an epidemic of don't-care-itis in the sleep care industry. Just don't give up. The struggle is worth it.

I can't offer any better advice for you than to request your prescription directly from the physician's office. It's my understanding that you are legally entitled to it. That way you are free to shop around. Depending on your insurance coverage and amount of free time you have, you might be able to do better out-of-pocket than online. Judging from what you say though, the exercise might be pointless as well as time-consuming. I can vouch for the fact that you can get your machine the next day through CPAP.com though.

It sounds like both your sleep doc and DME are worthless. Have your records sent to your local physician and then fire both the sleep doc and DME after you get your prescription. To get an APAP from CPAP.com, you only need a CPAP prescription. If your records are safe with a trusted personal physician, then that's all the sleep apnea diagnosis you should ever need. And, yes, your pressure needs can change based on body position and from night-to-night. Mine do.

Hope this helps.

Regards,
Bill

[Guest]

There's nothing wrong with the equipment the DME would get for you: the Remstar Pro 2 with C-Flex and a heated humidifier and a smart card. You could buy the card reader on your own so you could follow your nightly progress and learn from your data if you should adjust your set pressure. You definitely shouldn't be snoring on cpap therapy and even without the smart card data I would suggest you raise your pressure to eliminate the snoring. Lincare will never even know you're doing this because they don't bother to look at any of the smart card data (in fact, they probably don't know how) other than to see if you've been compliant.

Your situation is sadly quite common. The solution depends on how sick you are of dealing with the DME and if you can afford to buy everything out of pocket. Have you contacted cpap.com's insurance site (http://www.billmyinsurance.com) to see what their policy is with Tricare?

I think you are legally entitled to have your prescription and cpap.com can fill a prescription written for a cpap with an apap. The million dollar question is whether or not your insurance will cover it.

After my third questions, the doc said “If you have been reading on this to the point you can ask these kinds of questions, you have too much time on your hands,” and refused to answer my questions.

Once you've gotten the paper prescription from him, I wouldn't even consider going back to that doctor, other than to tell him what an a** he is.

[rested gal]

jeepdoctor, excellent post describing your experience so far and your thoughts.

Also excellent advice from NightHawkeye and the guest. Get a copy of your prescription. The word "cpap" on it will allow you to buy an autopap from cpap.com. You won't need a new prescription.

The machine will come with BOTH manuals...even the therapy setup manual that the DME employee you've been dealing with apparently didn't read and isn't interested in reading. You sound more than capable of taking up the reins of your own treatment yourself.

In the meantime, given what you said about this:

6. For the last two nights, my wife has mentioned that when I sleep on my back, I still snore. Her observation caused me to think back to the sleep study which indicated that although my overall AHI was 12, my supine AHI was 22.5. I sleep mostly on my side and am wondering if I have an insufficient pressure setting to deal with sleeping supine. Thoughts on this, anyone? I am also wondering what to do at this point. Do I call the doc, so that he can insult and demean me some more? If I do call him, how do I approach the subject and what do I say? I can’t help but thinking that if he had prescribed the machine I asked for, I wouldn’t be recounting this part of the story, since it would have auto-adjusted, and eliminated the snoring.

If it were me, I'd not bother to discuss anything more with that doctor. I'd simply raise the pressure on the machine myself.

Here's a study that demonstrated the answer is "yes" to this question:

http://ajrccm.atsjournals.org/cgi/reprint/167/5/716
Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?

Excerpt from the study:
In summary, this study demonstrates that self-titration of CPAP in patients with OSA is as efficacious as manual titration in a sleep laboratory, with similar subjective and objective outcomes.

The people in that study did not even have benefit of software. They were making their pressure adjustments based on how they felt and the observations of bed partner about things like presence or absence of snoring.

[Lyn]

It sounds like both your sleep doc and DME are worthless. Have your records sent to your local physician and then fire both the sleep doc and DME after you get your prescription. To get an APAP from CPAP.com, you only need a CPAP prescription. If your records are safe with a trusted personal physician, then that's all the sleep apnea diagnosis you should ever need.

Talk your regular physician about the problems you're having with the sleep dr & DME & ask him/her to write the prescription for the apap.

I might have missed it, but did you purchase your machine or are you renting it? If you're renting it, you might think about turning it back in & checking with billmyinsurance.com & if they can't help you just purchase outright from cpap.com.

Lyn

[rested gal]

jeepdoctor, here's a link you might be interested in.

viewtopic.php?t=10726

[jeepdoctor]

My CPAP machine is on a monthly rental.

[Guest]

you should go with the Remstar Pro2 and let insurance pay for it. You have to buy the software and reader on your own if you want that.

ASK how much this is all going to cost based upon your deductible, if it is too much buy the machine from cpap.com.

Get a copy of your sleep study and a copy of prescription, by law you have a right to any tests and instructions from the doctor.

Get a copy of that script, it never expires and you can buy any cpap you want with it.

[linda b]

Jeepdoctor,

I also have Lincare as my DME and would give them about a C+ so far. My doc ordered an APAP for me and Lincare gave me no flack over which machine or mask I wanted to order. (Of course there was no clinician's manual even though the box was sealed!) The main reason I give them a lower grade, however, is that I had to ask twice to get a copy of charts produced by the smart card and I went almost a month without a smart card after having mailed mine into to them to read. The RT was supposed to send it right back, but she didn't. (We were traveling on the date they wanted to pick it up, so I had to mail it.) I intend to get the software and reader for myself soon. My other complaint is receiving nasal pillows instead of simple cushions on an order I recently placed.

I also agree with you about the charges being so high for the machines. But my insurance is such that I will only be paying about $250 for it out of my pocket. I really couldn't believe what they charged for the humidifier! On the other hand, when I asked the RT to order some simple cushions for me after three days of torture trying to use the nasal pillows (CL2) she simple gave me three of them ($90 worth) at no charge. Then the little elbow broke and she gave me two of those ($12 worth). So it's hard to complain too much.

Have you considered asking for a different RT to work with, perhaps someone with more experience? There is no excuse for the person you have been dealing with not to understand what C-Flex is. That is not brand new technology!!

About your pressure setting and the fact that you are still snoring: That should show up on the smart card charts as evidence you can use with your doctor to justify an APAP because it will cover a wider pressure range. My other comment is that you must be mouth breathing if you are snoring. And if you are mouth breathing, you are not getting the full benefit of whatever pressure setting you are on. I use Poligrip Strips rather than tape or a chinstrap to keep from mouth breathing. I find this method very comfortable, easy to clean off, and, if necessary, I can pop open my mouth while they are still in place.

Good luck with your therapy and GET A NEW DOCTOR!!

[OwlCreekObserver]

7. Another issue that bothers me is the DME’s billing for the Remstar. This machine costs about $ 550 form cpap.com. Tricare’s agreed payment for any CPAP machine prescribed is $ 1,200. I can’t see any way that I will receive $ 550 of value-added from the local DME, especially since they don’t even know what C-Flex is and what settings are user-adjustable. I wish I knew how to ask for a Congressional investigation. This pricing agreement between Tricare and the DME looks like pure fraud/waste/abuse to me. No wonder the cost of medical care is bankrupting the country.

My understanding is that Tricare won't buy your RemStar, but will only lease it. I was told that's because of maintenance issues. Apparently they'd prefer to pay a monthly fee so that you can have the unit fixed or replaced if or when it breaks. Your inquiry almost sounds like they're buying your machine instead of leasing it, which isn't what I was told. In any case, what Linncare (or any DME) bills isn't necessarily what they'll actually get from the insurer. What your share of the difference is depends on what flavor of Tricare you have and whether they're on Tricare's list of authorized providers.

I'm in almost the same situation, by the way, but with a different DME provider. Because I haven't been billed yet for my CPAP rental, I don't know how much my Tricare Prime co-pay will be. Once I find out, I'll make the decision on whether to continue or to ask my doc for another prescription so I can buy my own machine.

It doesn't sound to me like anybody's actually out to get you. Apparently your DME rep isn't the sharpest knife in the drawer, which just means that you have to get as educated as possible on this stuff so you can try to keep everything straight using the hand you were dealt. I consider the time I've taken to learn about this whole apnea thing to be time well spent. The folks on this forum have been a real blessing.

[Guest]

I would do a couple of things.

First I would get a hardcopy of my prescription. Doesn't matter if it is for CPAP or APAP. It doesn't expire and you might want to buy something later from CPAP.com

Second, after I got the prescription, I would run FAST from that sleep doc who said you have too much time on your hands. Who is he to judge how you spend YOUR time.

Third. Since I know nothing about your insurance (only that I read in one of the posts that they may rent and not buy) I can't be conclusive BUT...
I would calculate how much copay you are going to put out with this rental thing and consider buying one (auto if you want it) from CPAP.com. Warrenty is 2 years, so you have to decide if the chance that it needs service after that is worth the risk based on what you will copay on rental.

Yes a good number of us agree that the prices from brick and mortar DME's are bordering on criminal, and the services that they provide are not worth what the difference is. I too had a DME who couldn't set up a machine properly. But at this point that is how it is. Many of us are stuck with insurance co's who won't pay for online purchases even though it would save us all money (insur and customer). In my case my machine cost under $300 vs $709 online with no insurance so I suffered the stupid DME who couldn't set up the machine properly, then went home and fixed it.

Now that you are done with the sleep study, see if your regular doc will just take over. I don't have a sleep doc, just one that had to be paid $220 to read my sleep studies. No appt was ever offered or suggested. Kind of like the guy who reads your xrays. Never see him and in some cases that is best

Good luck. Keep "wasting that too much time on your hands that you have" learning how to improve your own health

[jeepdoctor]

I talked to Tricare and it looks like I need two things. First, a written prescription for cpap.com or whoever I decide to buy from. Second, the doc must call Tricare and tell them that it is in everyone's best interest for me to own a CPAP machine. With the doc's ownership recommendation, Tricare pays 75% of the purchase price and I pay 25%. Without the doc's recommendation, Tricare rejects the application for reimbursement and I pay the entire cost.

I think I will rent for a couple of months while I sort out the issues.

Thanks to everyone for the good advice.

[jeepdoctor]

I was wrong about the Tricare cost reimbursement to Lincare for my Remstar Pro 2 with heated humidifier. It's $ 1,403 for a machine I can get for $ 545 for cpap.com. Anyone who thinks I am going to get $ 858 worth of service and value added from Lincare probably also thinks that pigs fly.

Once things settle down and I get Tricare's EOB, I will probably write the Tricare Management Activity asking for a fraud/waste/abuse investigation with copies of my request letter going to my congressmen.

[OSAGuy]

I know it's kind of off the subject but I have had the misfortune of dealing with LIncare in Wyoming. The local provider in SW Wyoming is great, but then I had the miosfortune of having to deal with their billing office - What a scewed up mess they have - Bills never correct, billing the insurance company for one amount and me a higher amount, etc. This on top of the fact that they are incredibly expensive. After about 2 1/2 years of dealing with Lincare I gave up and started looking around for other suppliers. I found a very good local supplier that is also in network with Bluecross, and various internet sites.