Success! And Need Next Steps

[Zeds]

I'm the person who had the sleep test from hell. I scored an AHI 18 (moderate OSA), but a CMS AHI of 4.7 rounded up to 5. Only the CMS AHI of greater or equal to 5 counts for Medicare. This means the sleep doc wouldn't refer me for treatment.

Sooooo.....Natch, I looked up the Medicare guidelines. It looked like I qualified, because Medicare is now using round numbers, per the specs I saw. So, I sent the guidelines to the doc. She agrees!

Moral: it pays to research specs and regulations.

CPAP is evidently coming my way.

What are my next steps?

A titration study, presumably....

Do they send me home with a machine? With a mask?

When do I get to choose which machine I want?

What ducks do I have to get in a row before I take another step?

Thanks.

[Pugsy]

Read these 2 blogs
http://adventures-in-hosehead-land.blog ... -with.html

and

https://maskarrayed.wordpress.com/what- ... me-part-i/

Interview the DMEs in your area that are participating providers for Medicare and ask them what machine they routinely dispense.
Make sure you know the various models that are full efficacy data machines.

You may or may not have a titration study. Depends on the doctor. If you do have a titration sleep study they usually will send you home with the mask that you end up using but the machine comes from the DME.
Personally I would try to just get an apap capable machine and do the titration part at home but it depends on the doctor.

You actually don't get to choose your machine unless you can get the doctor to specify a certain brand and model ....this would be what I would try first. You don't have to accept a machine that you don't want though. If the DME won't supply the machine you want then you can go to another DME and see if they will. That's where it comes in handy if you have already interviewed the DMEs in your area that work with Medicare. Some DMEs dispense full data apaps right from the start but some will want to give you the cheapest machine they can get away with because Medicare pays them the same no matter if it is a fixed cpap brick or a full data apap.

I fired my first DME because they wouldn't dispense the machine that I wanted. Stand your ground. They work for you.
Make sure you know exactly which model does what and don't ever, ever accept what a DME might tell you without verifying it first.
They will lie when the truth would fit better.
When you interview your choices be sure to ask what their specific mask swapping policy is. Most will limit you to 30 days and they may tell you that your insurance allows only one swap and that's a lie. Your insurance will only pay for 1 mask within the replacement allowance period but the mask manufacturers will reimburse a DME for any mask swapping or returns so that they don't "lose" money giving you multiple masks to try out. They could all do it if they just would...all they would need to do is a little paper work but some DMEs won't do that little bit of work.

Hopefully you live in an area where you have multiple choices available and not in a competitive bidding area.