Do I really need...?

jennie_len · Post by **jennie_len** » Sat Apr 07, 2007 2:03 pm

I have the normal remstar m series machine that does not tell you any data. I know that there are more expensive machines out there that report leakage and all of that other lovely stuff. But insurance won't cover them at all and I am wondering how useful they are in the first place.

My Doc says they do not produce trustworthy results anyway since your oxygen levels and other bodily happenings are not recorded. Is this true? Should I just base my therapy on how I am feeling or should I save and save until I can get a data reporting one?

I am feeling better already with what I am doing, so I am wondering if this will all just become an unhealthy obsession if I devote too much more into it....does that make any sense?

As always, any comments are appreciated!

NightHawkeye · Post by **NightHawkeye** » Sat Apr 07, 2007 2:33 pm

jennie_len wrote:I have the normal remstar m series machine that does not tell you any data. I know that there are more expensive machines out there that report leakage and all of that other lovely stuff. But insurance won't cover them at all and I am wondering how useful they are in the first place.

Have you checked with insurance? Usually, insurance doesn't care what specific machine you get. Insurance only provides a single benefit amount though, so your DME has an incentive to provide you the cheapest machine possible. Competition being what it is, however, many folks have found other DME's quite willing to provide them a better machine while accepting insurance benefits.

jennie_len wrote:My Doc says they do not produce trustworthy results anyway since your oxygen levels and other bodily happenings are not recorded.

I suppose your doc thinks that no information is better than having specific detailed information about how many apnea events you experience nightly. I, personally, happen to have an oximeter as well, but my primary source of info on apnea events is my APAP machine. I think what your doc is really saying to you is that this stuff is far too complex for your simple mind. (I've fired docs before for less than that.)

jennie_len wrote:Is this true?

To be blunt, NO!

jennie_len wrote:Should I just base my therapy on how I am feeling or should I save and save until I can get a data reporting one?

Depends on whether you want to take an active role in managing your therapy. It takes some effort, and you have to learn a few things to do it well, but it's darned well worth it, IMHO.

jennie_len wrote:I am feeling better already with what I am doing, so I am wondering if this will all just become an unhealthy obsession if I devote too much more into it....does that make any sense?

Apnea's a lifelong proposition. Managing it wisely is in your best interests.

Just my $0.02.

Regards,
Bill

DreamStalker · Post by **DreamStalker** » Sat Apr 07, 2007 2:41 pm

Bill is correct. Apnea is like having diabetes ... the patient must be involoved in monitoring and treatment.

I think your doc may be affiliated witht he DME who provided you your machine and it is in their/his best interest (as opposed to yours) to keep you dumb so that they can make the most profit from your insurnace coverage.

I suggest you get a copy of both your sleep lab study and your prescription ... then find a doc that does have you health as the primary interest.

Give hell may they give you any flap over your request(s)!

Slinky · Post by **Slinky** » Sat Apr 07, 2007 2:52 pm

I have the normal remstar m series machine that does not tell you any data. I know that there are more expensive machines out there that report leakage and all of that other lovely stuff. But insurance won't cover them at all and I am wondering how useful they are in the first place.

My Doc says they do not produce trustworthy results anyway since your oxygen levels and other bodily happenings are not recorded. Is this true? Should I just base my therapy on how I am feeling or should I save and save until I can get a data reporting one?

I am feeling better already with what I am doing, so I am wondering if this will all just become an unhealthy obsession if I devote too much more into it....does that make any sense?

Yes, it makes sense. And you might or you might not obsess over the stats. Who knows? No one is going to make you access that data. But it is imperative for any sleep doctor worth his salt to have access to that data - which he doesn't w/the machine you have.

However, your doctor is NOT being truthful w/you when he tells you "insurance won't cover them at all". Nor is he being completely truthful when he tells you "they do not produce trustworthy results anyway since your oxygen levels and other bodily happenings are not recorded".

Your insurance pays for any CPAP machine with an HCPCS code. And ANY straight CPAP "or" AutoPAP machine has only one HCPCS code whether compliance data only OR fully data capable. The only other HCPCS code for xPAP machines is one for the bi-level xPAPs.

It sounds very much like your doctor has a vested interest in the greatest profit margin from your insurance company to the DME supplier. Is this a "one stop shop" sleep lab/sleep doctor/DME supplier all in one?

Just how does your sleep doctor intend to monitor your progress or lack of it, your response to CPAP therapy if your machine is NOT fully data capable and can only confirm your compliance or not of use? He certainly isn't any too concerned about your welfare or response to therapy when he tells you the data from these CPAPs are not reliable.

How do you think they determine your CPAP pressure needs during a titration study? They use a CPAP machine that the tech can manipulate the pressure up or down on from the office. The wires and finger clip are to record your heart rate, oxgen saturation, etc. but its a CPAP machine they use to adjust the pressures up and down.

No, the CPAPS don't record your oxygen saturation or desaturation levels - BUT - they DO record apneas AND hypopneas and by definition an apnea or hypopnea IS A DROP in oxygen saturation. So while they can't tell anyone how low your sats dropped they DO record the desaturations. And by definition an apnea does have a corresponding rise in heart rate. So while they don't tell anyone what your heart rate was it does confirm there was a rise in your sleeping pulse rate. Those reported apneas, hypopneas, leak rates and average pressure are IMPORTANT data for any doctor is interested in your receiving adequate therapy for sleep apnea.

If it were me:

I would ask for and insist upon receiving a copy, not just of the dictated final report of my sleep evaluation and titration studies, but also the full data from them, graphs, sleep positions, etc. They run about 5-6 pages, possibly more. They are a part of your medical records and in the US you have a LEGAL RIGHT to copies of your medical records. For him to refuse to give them to you is illegal.

I would also insist on THE script for your CPAP equipment, and it should either be for the EXACT machine you determine you want OR NOT mention ANY brand or type of machine at all, just CPAP, pressure(s) AND HEATED humidifer and nasal interface, including your pressure requirements as he determined them to be. Not a copy, an original. Again, it is part of your medical record and you have a legal right to it. He sounds just petty enough he'll try to write the script for a specific bare-bone, compliance data only, CPAP. Don't let him get away with it if you can avoid it. If he insists on writing it for a specific bare-bones machine. So what? Your family doctor should be willing to write a new script for the machine you want w/the pressures, etc. the sheister sleep doc included, changing only the machine designation.

If this sleep doc refuses, as I suspect from what you've told us about him, then put your request in writing (keep a copy for yourself) and send it to him via CERTIFIED MAIL, RETURN RECEIPT REQUESTED. Be sure to staple your receipt and the green return receipt card when you receive back in the mail to your copy of your written request and keep them safely filed. If he does not respond or refuses then you contact your state licensing board and provide them w/copies of your written request and proof of his receipt of that request and let them handle it from there.

You should also contact your insurance company and find out just exactly what your DME benefits are: copays, deductable, what DME suppliers they are contracted with.

Then I would shop your local DME options to see which machine they will provide you with, insist on one that is fully data capable. It is the same insurance reimbursement, the only difference is the DME's profit margin. They make more on a bare bones machine such as yours than they do on a fully data capable machine. But since YOU and your insurance company are the ones paying you have a RIGHT to a machine of your choice that falls w/in the HCPCS code. Ask each DME supplier what their mask exchange policy is and the time period. Fisher & Paykel, Resmed and Respironics will all replace any of their masks w/in 30 days free to the DME simply by the DME filling out the necessary request form. So you should be able to trial several masks during your first 30 days.

Of course, the ultimate proof of the pudding is in how well you are doing w/your CPAP and how rested you feel. But how can anyone feel comfortable w/a doctor who lies to them and who has no interest in monitoring their patient's CPAP response???

Good luck and God bless!

Wulfman · Post by **Wulfman** » Sat Apr 07, 2007 2:54 pm

jennie_len wrote:I have the normal remstar m series machine that does not tell you any data. I know that there are more expensive machines out there that report leakage and all of that other lovely stuff. But insurance won't cover them at all and I am wondering how useful they are in the first place.

My Doc says they do not produce trustworthy results anyway since your oxygen levels and other bodily happenings are not recorded. Is this true? Should I just base my therapy on how I am feeling or should I save and save until I can get a data reporting one?

I am feeling better already with what I am doing, so I am wondering if this will all just become an unhealthy obsession if I devote too much more into it....does that make any sense?

As always, any comments are appreciated!

Hi Jennie,

I'm glad to hear you're feeling better from your therapy.
These are tough questions to answer because there's different ways to look at them.

IF (and that's a BIG "if") your doctor got your pressure correct and you don't have any changes that would require a different pressure AND if your not curious about how your therapy is doing.....then your existing machine should work.

There's only about $115.00 difference in the price of the Plus and the Pro machines. (the Pro records all the details). I'm quite certain that your insurance would have approved the Pro model. They would have gotten billed the same amount no matter which model you were given.

What your doctor said is partially true......but the details that are recorded by the machine at least give us a "yardstick" to go by. The doctor can order an overnight pulse-oximetry study any time he wants......it's free and only requires a prescription from your doctor. With that, the DME gives you a recording pulse-oximeter to attach to your finger over night.....then you take it back to the DME, they download the info and print out a copy to send to your doctor. If you had a recording CPAP, the reports from the two machines could then be somewhat compared to see if the events during your sleep were causing desaturations in your blood.

From the way your worded your post, I have the feeling that you'll want more data at some point. If you absolutely CAN'T get the DME (and insurance) to switch machines to a Pro model, then I would suggest saving for another machine for the future. Make sure that you have a physical copy (preferrably original) of your prescription. It's good for life and would allow you to purchase from an online supplier.

This is YOUR therapy.....not the doctor's or the DME's or the insurance provider's.
It'll be whatever you make of it. That can be "BAD" to "SO SO" to "OK" to "GREAT".

Good luck with yours.

Den

jennie_len · Post by **jennie_len** » Sat Apr 07, 2007 4:57 pm

I suppose that, in a way, I already knew all of this. I guess I felt comfortable by my ignorance....it is easy to take the non-active approach and to believe the Doc. But, this is a one-stop shop, and he would have many reasons to look out for the DME and/or the insurance company.

I asked him to get a copy of the full report, and he chuckled and said "that was the full report". But then once I asked him to go over it in detail, I saw pages that were new to me. I told him I did not have the graphs and he said for me to ask the desk. Well, by the time I was out of his office I totally forgot. So...eh. But, I go back again shortly, therefore I will attack that one at that point.

I do get the feeling that the Doc isn't really too concerned with how my progress is going. I did point blank ask him how he planned on knowing my progress, and if he was just going to base everything on my stated "feelings". This is when he went on a slight rant about the Pro machines and how he did not feel comfortable with the data and did not feel that he could base anything legit on them. And that they were expensive, that insurance generally did not cover them, and that I usually could not even pay out of pocket to my DME. I mentioned getting one straight from another vendor, and he said that would be my choice, but he def. let me know that he did not find it needed.

Ugh, I sooo don't want to search for a new Doc. But maybe I should. You all are right...this is something I should not be so willing to be ignorant about.

Anyone on here happen to be in the Cincinnati area? I just moved here from Houston and I have no idea of any other sleep clinics that would be any better. (I know, long shot, but I thought I would try).

Thank you everyone, great info and wonderful support.

Wulfman · Post by **Wulfman** » Sat Apr 07, 2007 5:20 pm

Jennie,

Look at it this way......
If you have a machine with which you can monitor your own progress, you won't have to look for another sleep doctor.....or even use this guy again. The machine and software will essentially pay for themselves by the money you'll save on doctor visits.

Den

WifeIsHappyNow · Post by **WifeIsHappyNow** » Sat Apr 07, 2007 6:05 pm

Slinky wrote:
Your insurance pays for any CPAP machine with an HCPCS code. And ANY straight CPAP "or" AutoPAP machine has only one HCPCS code whether compliance data only OR fully data capable. The only other HCPCS code for xPAP machines is one for the bi-level xPAPs.

In my experience, it is not always that straight forward. My insurance pays the DME based on what machine I actually have. I've seen how much the DME charges and how much my insurance actually pays, and there is a big difference. Surprisingly, what they pay is very close to what I could by this machine for at CPAP.com.

When I asked about getting a machine that records more useful data, they said that the machine I had was providing the medical neccessities of what was prescibed, and therefore, they would not pay for a better machine.

Having said that, they did say that if I can get my Dr. to write a prescription for a different machine or different capabilities, they would cover it.

Lyza · Post by **Lyza** » Sat Apr 07, 2007 9:58 pm

Just a reminder, it all depends on what type of aholes your insurance is too. I got my Dr to write a script for the exact specific machine I wanted and the insurance denied it, saying I didn't medically qualify for it. The lesser machine I had originally been given with no bells and whistles was standard in treatment and was doing me just fine, they told me.

Yes i'm on HMO insurance therefore I don't have a sleep dr. Just my primary care physician and she admittingly knows nothing about sleep apnea. Therefore, to monitor my own therapy, I ended up purchasing what i wanted out of pocket. Peace of mind has been worth the $$$ so far.

kteague · Post by **kteague** » Sun Apr 08, 2007 12:07 am

Hi. I read your story and thought to myself, "That is verbatim what my friend's doc said to her - must be his clone." Then I looked at your location and had to laugh. Although this is not an uncommon stance of sleep doctors, if yours is young, good looking, and personable, and one of his offices is in the Colerain area, he's probably not just a clone. If that's the case, don't expect a change.
Kathy

P.S. The doctor I had wasn't much different, just said it in different ways. May be best to go thru your GP if you can. PM me if you want to discuss it further.

Slinky · Post by **Slinky** » Sun Apr 08, 2007 9:43 am

Lyza wrote:Just a reminder, it all depends on what type of aholes your insurance is too. I got my Dr to write a script for the exact specific machine I wanted and the insurance denied it, saying I didn't medically qualify for it. The lesser machine I had originally been given with no bells and whistles was standard in treatment and was doing me just fine, they told me.

Yes i'm on HMO insurance therefore I don't have a sleep dr. Just my primary care physician and she admittingly knows nothing about sleep apnea. Therefore, to monitor my own therapy, I ended up purchasing what i wanted out of pocket. Peace of mind has been worth the $$$ so far.

Lyza, what kind of machine were you asking for? There's only two HCPCS billing codes for xPAP machines: straight CPAP and AutoPAP for one code and bi-level PAP for the other code. The insurance only know the coded billing, not the actual machine capabilities.

UNLESS this HMO also sells and supplies the CPAP machines I can't imagine your "insurance" denying a fully data capable CPAP. Maybe they would deny an AutoPAP "if" your DME contacted them, crying bloody murder, wanting a higher allowed amount and swearing up and down your titration study didn't warrant an Auto.

I would have appealed both to the HMO "and" the state licensing bureau for a fully data capable CPAP stating the obvious: w/o full data capability the scripting doctor nor any doctor can monitor your response to CPAP therapy. W/o a fully data capable CPAP if your response is less than satisfactory the additional expense of another titration study or a loaner AutoPAP would be necessary. WITH a full data capable machine the data it provides on a nightly basis can easily guide your doctor to any pressure changes that might be needed to optimize your response. My appeal letter would be OBVIOUSLY cc'd to both the HMO "and" the state licensing board.

Lyza · Post by **Lyza** » Sun Apr 08, 2007 11:07 am

Slinky: My HMO does own my DME, My JOB, and the Sleep Center and My DR. So much for Hospitals taking care of their own employees eh?

Guest · Post by **Guest** » Sun Apr 08, 2007 5:37 pm

Sheesh! You've got that right! I sure as the devil hope they provide better care to their patients!!! Just in case, I'll remember NOT to get sick in OK!

oceanpearl · Post by **oceanpearl** » Mon Apr 09, 2007 2:11 pm

After having lost my BIPAP, I purchased a used BIPAP Pro with Biflex and card reader.. I would like to be able to monitor my stats on a daily basis.
The machine has a serial interface. What do I need to buy??

Wulfman · Post by **Wulfman** » Mon Apr 09, 2007 2:23 pm

oceanpearl wrote:After having lost my BIPAP, I purchased a used BIPAP Pro with Biflex and card reader.. I would like to be able to monitor my stats on a daily basis.
The machine has a serial interface. What do I need to buy??

Which machine do you actually have?

Your profile points to the "BiPAP Plus" model.....which wouldn't give any nightly stats.
The model listed below.....the "BiPAP Pro 2" would.
Look on othe top of your machine (if necessary).

https://www.cpap.com/productpage-bundle ... undle.html

You might want to call CPAP.COM and ask them if that model records nightly details. It would depend on how old it is. Some of the earlier "Pro" models of both the CPAP and BiPAP line didn't record detailed statistics (like maybe pre-2005 models).

Den

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