DME visit: My worst fear might soon be realized...(long)

[drummergirl410]

My RT returned this morning, as expected, to download the data from my machine. My two-week trial is officially over, but I'm not very happy.

The RT comes in to my house while talking on her cell phone. She continues to do this about three-fourths of the time she's here. In the midst of her conversations, she pulls out her laptop, downloads the data, and then swithes out the Resmed s8 Vantage I had for an s8 Compact!
I'm standing there thinking, "OK, you'd better get off that cell phone and answer me some questions!" She noticed me bending down to get a better look at the new machine and I'm sure she noticed the grave expression that crossed my face. She quickly ended the converstaion at that point.

She looked at the data and told me that I definitely got an A+. The machine took care of all my apneas and I had a almost a 0 leak rate. I had a few hypopneas, but the machine kicked in to take care of those. My pressure setting is a 7, which she said seemed to take care of everything. (I was up to 13 in the sleep lab during titration and they wanted to go it a bit higher, but time just didn't allow.) Maybe it's fine. I've been much more relaxed at home and I've gone into REM sleep every night, which didn't happen during my titration. Still somehow this just doesn't seem logical to me.

When I asked her about the change in machines, she said that usually someone doesn't need a machine that "hefty" at home. I know that the Compact is not full data, so then ai asked about having a machine that would be full data, so I could monitor my progress. This got no response. I then told her that I knew that this new machine wasn't auto titrating and asked her what would be done if for some reason I needed that capability later on. She simply said that they would bring the Vantage back and swap out again. I told her that I had found the Vantage to be very comfortable machine to breathe with. She then said that I shouldn't notice a big difference with this one. I find that hard to believe because you're basically going from a Cadillac to a Chevy! I told her that I would give it a try, but that I would expect a change if I found that this new one did not meet my expectations. She assured me that I should call back if there were any problems. She realizes now that I know a lot more than I'm "supposed" to. I can understand if it's an insurance issue. I will just ask the doc. for a scrip for an autopap and buy it outright when tax time rolls around again. But if they'd pay, I dont' see why I have to be stuck with a baseline bare bones machine! If nothing else, I'll check out the Elite or the Escape and ask them to at least consider one of those instead.

Up to this point I've been really pleased with my doctor and Resource Medical, the DME. But if I have to start argueing with them and making myself heard, then so be it. I'm planning to go in at my next sleep doc. appoitnment which is just a couple weeks away and ask for copies of EVERYTHING including the data that came off the machine this morning. I've had the blessing of having good doctors and I haven't had to make a practice of matching wits with them on stuff like this. I think my doc. is good and will listen to me. I'll readily admit that I don't intend to self perscribe at this point. That's not my reason for wanting a better machine. If he's not willing to accept my intelligence and self-advocasy, he's in for a battle! I'n not ashamed to admit that I'm as stubburn as they come! They won't be able to just tell me anything and get away with it. Persistence and knowledge are a one-two punch that's impossible to beat, even if it goes into the long run!

Wish me luck!

[Snoredog]

if you were smart you would have demanded they leave the machine you got an A+ on. Your insurance has already paid on that machine so WHY are you letting them take it?

In fact I would never ever let a RT or DME into my house period compliance or not. If they want compliance details they supply a machine that gives it.

This is the big "game" by Resmed dealers, they set you all up on a Vantage get you compliant then they pull the rug out from under you by swapping your machine out with a plain jane cheapest machine they can supply.

I call that tactic "bait-n-switch" and there are FTC laws against that practice, I see this as no different.

[drummergirl410]

Yea, I totally agree! My only fear was that the insurance wouldn't pay for the Vantage and right now I can't come up with that much cash. Tax season is a bit different.. I'd shell out my return for an APAP without a second thought! I'm going to give a call to my DME this afternoon and talk to someone who knows the paperwork and see exactly what's what. I'm going to then demand that they at least give me the s8 Elite, which does have software and EPR, if not the Vantage. If this doesn't work, I'll have it out with the sleep doc. and make him write a scrip for an autopap, if that's what it takes and either get it through the insurance or outright on my own terms.

I will definitely bring up the "bait n switch" part!

[RosemaryB]

This is the big "game" by Resmed dealers, they set you all up on a Vantage get you compliant then they pull the rug out from under you by swapping your machine out with a plain jane cheapest machine they can supply.

The other day I walked into a new DME in town. I asked if they dispensed autopaps for patients if they had a script for one. They said that they usually gave the patient the auto machine for a week to see how they are doing on it then, if it was ok, they switched to the cpap unless there was some reason to keep the auto, like wide variations in pressures. I was surprised. This must be widespread, then.

Why not just make all machines data capable and auto?

[NomoreCrashcart]

The primary interest for a patient centers on getting the best treatment.
The primary interest for the DME is making money; it's a business.

Divergent interests with respect to financials and best care should not be the pillars of any civilized health care system.

And yet... that's what happened.

[geoDoug]

I realize I'm preaching to the choir, but I'm confused. Yes, I realize that the issue is the almighty dollar. However, from the perspective of caring for the patient and logically this makes zero sense. If you've got a machine that you're getting an A+ on, why fiddle with a good thing??? Seems to me that's the last thing you should do! If it ain't broke and all that.

Doug.

[drummergirl410]

I'm definitely in agreement with everyone! It would make things a whole lot simpler to only do auto machines with full data.

I called and talked to someone at my DME. I found out that my insurance will pay for any machine the doctor perscribes, with the excaption of a nominal $20 to $25 dollar charge. The machine will be a capped rental with a period of ten months, in which time it will be paid off and become my property, free and clear. I spoke about my concerns of a machine that isn't full data and doesn't have any kind of exhale relief. Apparently the person I talked to wasn't up on the different machines. I explained to her that there is a whole line of Resmed s8 machines and the one I got today was at the lowest end. She assured me that they would work with me and my doctor if for some reason a change was necessary. I did find out a few other details in regard to my insurance coverage that are helpful to know.

Looks like I'n stuck with this one until I go back to the sleep doc on the 24th. I'm going to go in there with the printouts of all the s8 machines and the capabilities of each. I'm going to mention that I am planninmg to loose weight, which will affect my pressure setting. It doesn't make sense to not have access to the data so that changes can be made more quickly and without subsequent expensive titration studies. At the end result I'm planning on accepting nothing less than the s8 Elite, which isn't auto but does have EPR and full data. Sadly, because the Vantage was only a trial machine the insurance hadn't started paying on it. When I talked to the lady at the DME she said that nothing had been proccessed yet.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, Titration, DME, auto

[Slinky]

AT THE VERY LEAST INSIST that you be given the Resmed S8 Elite!!!! Call your insurance company, ask them what local DME suppliers they are contracted with. Hopefully you have a choice of more than just this one. Then call your current DME supplier IMMEDIATELY and tell them you are returning this S8 Compact and either they replace it w/at the VERY LEAST the S8 Elite or you will be taking your business to another local DME supplier who WILL provide you w/AT LEAST the S8 Elite.

Just tell them up front you will NOT accept LESS than a FULLY DATA CAPABLE CPAP. And be sure to mention the RT spending all YOUR time on HER cell phone, etc. It will probably be worth your while to speak to the manager. Keep your cool. Be polite BUT FIRM.

[echo]

Wow... just wow. All I can say is GOOD LUCK!!!

[snoregirl]

I would tend to agree that to do something as fast as possible is best. Don't wait for the 24th if you can. Sometimes the threat to bring the machine back is enough to get them to give you what you want.

[drummergirl410]

I've agreed to give it one shot tonight. But if there is ANY change in the way I feel or ANY type of side effect (aerophalgia, etc.) My DME will get a very early wake-up call in the morning! If I don't notice any change, I'll call anyway and asked to be upgraded to the Elite at the very least and get back with the sleep doc in the meantime if need be. Thanks everyone for the advice and support!

[amandalee]

I agree that you should definitely call (or email) your insurance company and complain for a good long time about what happened with the DME today.
I find it totally unacceptable that they started you out on a good machine, that gave you "A+" results, then switched you to some crappy one. Mention the "bait & switch" thing. Tell them you don't think you'll be able to tolerate/be compliant with your therapy unless you have the original machine. Mention how well you were doing, and that you'd like to continue doing so well/being so compliant, but if you're no longer able to tolerate the PAP therapy it will put you at risk for other health problems that could end up costing them alot more money than the good machine.

That's essentially the message I sent to my insurance company today when I wrote them an email complaining that my stupid DME was dragging their feet on giving me an AutoPAP even though my doctor wants to switch me to one.
You DESERVE the better machine that gives you A+ results.

[drummergirl410]

I hope your DME will come around and give you the APAP soon! I hate to think that other people have been through what I've gone through today, but from what I've read, it's happened numerous times. What gets me is they have no way now to know whether I'n keeping the A+ or not. At this point I REFUSE to go through any more costly titration studies because they "wrote me off" at that pressure and now have no other way to check behind themselves. If I don't manage to get this rectified before the doc visit, he's going to get an EARFULL, mark my words!

[amandalee]

Yeah, DMEs jerking everyone around seems to be the norm, unfortunately...

Your whole experience with the DME rep talking on her cell phone the whole time, etc, sounds really "high quality." <sarcasm>
I'd mention that too when I called the insurance company. Not only is your DME not giving you the best care possible, their reps are rude too, and don't pay attention to the patients when they're on house calls. Tell them you found the whole thing totally unacceptable, and maybe ask why they would do business with a company that treats patients so badly.

Ugh, as if having OSA isn't bad enough...

[drummergirl410]

Ain't that the truth!

Yea, looking back on it the cell phone thing really irks me! If I were to teach my classes at school the way she conducted my visit, I would NEVER hear the end of it from my principal or the parents! I don't know what makes people think they can do their jobs any differently from the rest of us!