2nd sleep study, masks, and sticker shock!

[Wrenna]

So I just finished my second titration determining sleep study. I didn't really sleep all that well during it due to several factors. The Resperonics Bipap Symphony(?) (run in cpap mode) was very noisy. I also had what the technician called REM-rebound, and I call the nastiest, most vivid, nightmare I've had in a long time. (involved mushroom clouds and major cities my family lives in, 'nuff said).

I started out with the OptiLife nasal pillow mask and I detested it. It pushed on my nose, the nasal insert things irritated my nostrils, and they collapsed so I felt like my nose was blocked and I couldn't breathe. I also seriously seriously hated the fact that the hose was fixed pointing downwards. I found that to be very awkward, hard to change position with, and I kept bumping it with my arm and pushing the mask farther into my nose. I just couldn't sleep with it on.
So I had him switch me to the comfortgel mask I used in my at-home trial, but in the petite rather than the small. The petite size was a huge improvement with no leaking, dry eyes, or that mangled upper lip feeling the small size gave me. However, possibly due to not having it perfectly adjusted or from moving around, I did still have a mark on one of my undereye areas which I'm not fond of.
He did offer to let me try the Swift II, but since I always sleep on both sides a Swift wouldn't work for me. I wanted to try the Comfortlite with the nasal cushions but they no longer had them available.

On the plus side, during my first month trial rental period I can (one time only) return the mask I'm using and try out a second one. The way this sleep center works is that I rent a machine for 1 - 3 months before buying. The technician told me I'd be given a straight cpap machine without exhalation relief as my pressure needs were low (around 8 ).

Now here comes the horrifying part: As I left this morning the technician handed me a piece of paper with the (possibly not current) charges for cpap equipment.
Rental of a CPAP machine: $185 a month.
Purchase of a CPAP machine: $1473
Mask: $111
Headgear: $60
Hose: $48
Heated Humidifier: $466.
So for the whole set up it's $2158, and if my insurance (poor thing) pays 80% then I'll pay $431.60. And that's if their prices haven't gone up.
ARE THEY FREAKING CRAZY?? For a non-auto non-EPR machine??
No way am I doing that. I'll do their one month trial, but at the end I'll insist that I get a written prescription. I'm normally a very nice person, but in this case I think I'll throw a fit if they don't let me buy my stuff online. Forget Insurance, it'd be cheaper to buy online and pay for it myself than to pay 20% of their prices!!

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap machine, bipap, humidifier, hose, nasal pillow, swift, Titration, CPAP, Prescription

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap machine, bipap, humidifier, hose, nasal pillow, swift, Titration, CPAP, Prescription

[Wulfman]

So I just finished my second titration determining sleep study. I didn't really sleep all that well during it due to several factors. The Resperonics Bipap Symphony(?) (run in cpap mode) was very noisy. I also had what the technician called REM-rebound, and I call the nastiest, most vivid, nightmare I've had in a long time. (involved mushroom clouds and major cities my family lives in, 'nuff said).

I started out with the OptiLife nasal pillow mask and I detested it. It pushed on my nose, the nasal insert things irritated my nostrils, and they collapsed so I felt like my nose was blocked and I couldn't breathe. I also seriously seriously hated the fact that the hose was fixed pointing downwards. I found that to be very awkward, hard to change position with, and I kept bumping it with my arm and pushing the mask farther into my nose. I just couldn't sleep with it on.
So I had him switch me to the comfortgel mask I used in my at-home trial, but in the petite rather than the small. The petite size was a huge improvement with no leaking, dry eyes, or that mangled upper lip feeling the small size gave me. However, possibly due to not having it perfectly adjusted or from moving around, I did still have a mark on one of my undereye areas which I'm not fond of.
He did offer to let me try the Swift II, but since I always sleep on both sides a Swift wouldn't work for me. I wanted to try the Comfortlite with the nasal cushions but they no longer had them available.

On the plus side, during my first month trial rental period I can (one time only) return the mask I'm using and try out a second one. The way this sleep center works is that I rent a machine for 1 - 3 months before buying. The technician told me I'd be given a straight cpap machine without exhalation relief as my pressure needs were low (around 8 ).

Now here comes the horrifying part: As I left this morning the technician handed me a piece of paper with the (possibly not current) charges for cpap equipment.
Rental of a CPAP machine: $185 a month.
Purchase of a CPAP machine: $1473
Mask: $111
Headgear: $60
Hose: $48
Heated Humidifier: $466.
So for the whole set up it's $2158, and if my insurance (poor thing) pays 80% then I'll pay $431.60. And that's if their prices haven't gone up.
ARE THEY FREAKING CRAZY?? For a non-auto non-EPR machine??
No way am I doing that. I'll do their one month trial, but at the end I'll insist that I get a written prescription. I'm normally a very nice person, but in this case I think I'll throw a fit if they don't let me buy my stuff online. Forget Insurance, it'd be cheaper to buy online and pay for it myself than to pay 20% of their prices!!

Why wait? Get your prescription and get your stuff ordered. It'll arrive within a few days (overnight is a possibility, too) and you can get started and save a couple hundred bucks.


Den

[Wrenna]

*sigh* I wish. But the way this place works is that first I have to wait until the doctor 'reviews' and interprets my sleep study. He promised he'd look at it friday, so monday. Then I make an appointment. Then I get a rental machine. Then I come back in a week to talk to the DME lady about how I'm liking the machine and mask, and change the bits out I don't like. Then I come back in 3-4 weeks to see the doctor again for a follow-up. At that point I can ask for a prescription. *grumble* He won't do a long term thing until I've had a machine for at least a month.
I can live with that. Especially since I can try out two different sets of equipment. I can't live with their purchase price. No wonder health insurance is so high! I can't imagine what could possibly justify that kind of markup from the online prices!!

[DreamStalker]

What Den said.

I too started out with the strong desire to let my insurance pick up the 80% of the take-home equipment costs. After getting past the learning curve I realized that just paying out-of-pocket to get what you want is really not that much more expensive than using the insurance and dealing with a sleep center/DME ... and it's a whole lot less stressful.

True, the lab study and titration would not have been affordable for me without the insurance but I now also realize that with my plain vanilla OSA condition, I could have easily got to where I am now simply with the help of the fine forum members here and an APAP machine and software.

Best-o-luck!

[NightHawkeye]

*sigh* I wish. But the way this place works is that first I have to wait until the doctor 'reviews' and interprets my sleep study. He promised he'd look at it friday, so monday. Then I make an appointment. Then I get a rental machine. Then I come back in a week to talk to the DME lady about how I'm liking the machine and mask, and change the bits out I don't like. Then I come back in 3-4 weeks to see the doctor again for a follow-up. At that point I can ask for a prescription. *grumble* He won't do a long term thing until I've had a machine for at least a month.
I can live with that. Especially since I can try out two different sets of equipment. I can't live with their purchase price. No wonder health insurance is so high! I can't imagine what could possibly justify that kind of markup from the online prices!!

Answer: Nothing

[Wulfman]

*sigh* I wish. But the way this place works is that first I have to wait until the doctor 'reviews' and interprets my sleep study. He promised he'd look at it friday, so monday. Then I make an appointment. If you have an appointment with the doctor, THIS is where you should ask for your prescription. Then I get a rental machine. Then I come back in a week to talk to the DME lady about how I'm liking the machine and mask, and change the bits out I don't like. Then I come back in 3-4 weeks to see the doctor again for a follow-up. At that point I can ask for a prescription. *grumble* He won't do a long term thing until I've had a machine for at least a month.
I can live with that. Especially since I can try out two different sets of equipment. I can't live with their purchase price. No wonder health insurance is so high! I can't imagine what could possibly justify that kind of markup from the online prices!!

I've inserted my thought about this process. The DME would HAVE TO HAVE a prescription from the doctor in order to hand you a machine......rental or otherwise. I would "short-circuit" the process (and the drain on my checkbook) at this point......if it were me.


Den

[DreamStalker]

*sigh* I wish. But the way this place works is that first I have to wait until the doctor 'reviews' and interprets my sleep study. He promised he'd look at it friday, so monday. Then I make an appointment. Then I get a rental machine. Then I come back in a week to talk to the DME lady about how I'm liking the machine and mask, and change the bits out I don't like. Then I come back in 3-4 weeks to see the doctor again for a follow-up. At that point I can ask for a prescription. *grumble* He won't do a long term thing until I've had a machine for at least a month.
I can live with that. Especially since I can try out two different sets of equipment. I can't live with their purchase price. No wonder health insurance is so high! I can't imagine what could possibly justify that kind of markup from the online prices!!

Hmmmm .... that sounds like the same proceedure used to hose some of the folks that get churned through a cash cow sleep center system ... sounds very familiar.

[BarryKaraoke]

You could also do this: Once you get a copy of your sleep study, head down to your family doctor with study in hand. Explain what is happening and ask him if he will write you a simple CPAP prescription to help prevent your checkbook from being ransacked by this bizarre Catch-22.

He might even write it out for the specific machine you want if you do your homework and ask nicely. Mine did.

[Wulfman]

You could always take all your info thus far and head to your family doctor. Explain what is happening and ask him if he will write you a simple CPAP prescription to help prevent your checkbook from being ransacked by this bizarre Catch-22.

They might even write it out for the specific machine you want if you ask nicely. Mine did.

This wouldn't have worked in MY case. Both my (poor excuse for a) "Sleep Doctor" and my GP both work in and for the same local "clinic".


Den

[Needsdecaf]

What Den said.

I too started out with the strong desire to let my insurance pick up the 80% of the take-home equipment costs. After getting past the learning curve I realized that just paying out-of-pocket to get what you want is really not that much more expensive than using the insurance and dealing with a sleep center/DME ... and it's a whole lot less stressful.

I agree with you about being less stressful doing it yourself, but disagree with the not that much more expensive.

That satement is individual to your insurance situation.

For me, an in-network supplier is paid at 100%

An out-of-network supplier is 80% with a $300 deductable.

So difference to me would have been almost $500 vs. $0. Not insignificant, and, to me, worth a two week wait for the perscription to be written correctly, the DME to order the machine that I not THEY wanted, etc.

The trick is to know what your insurance will cover, and to decipher the crazy process that they put you through. The run around between the doc, sleep doc, and DME can get unbearable. Just insist on a copy of your report and push for the perscription and speak to your insurance company and get details on what's covered.

BTW, I had to speak to 3 different people at my insurance company before I could get a straight answer of what was covered and how.

Persevere!

[DreamStalker]

What Den said.

I too started out with the strong desire to let my insurance pick up the 80% of the take-home equipment costs. After getting past the learning curve I realized that just paying out-of-pocket to get what you want is really not that much more expensive than using the insurance and dealing with a sleep center/DME ... and it's a whole lot less stressful.

I agree with you about being less stressful doing it yourself, but disagree with the not that much more expensive.

That satement is individual to your insurance situation.

For me, an in-network supplier is paid at 100%

An out-of-network supplier is 80% with a $300 deductable.

So difference to me would have been almost $500 vs. $0. Not insignificant, and, to me, worth a two week wait for the perscription to be written correctly, the DME to order the machine that I not THEY wanted, etc.

The trick is to know what your insurance will cover, and to decipher the crazy process that they put you through. The run around between the doc, sleep doc, and DME can get unbearable. Just insist on a copy of your report and push for the perscription and speak to your insurance company and get details on what's covered.

BTW, I had to speak to 3 different people at my insurance company before I could get a straight answer of what was covered and how.

Persevere!

From what I read, she doesn't have the 100% insurance that you have ... but I could be wrong I suppose -- not the first or last time

But if I had it to do all over again, I would ditch the 20% copay and bull crap sleep center/DME and pay out-of-pocket ... less hassel, much quicker relief, and snatched out from the mortician's hand in the nick of time as I was more than half dead at the time. To each their own.

[Snoredog]

IF the Sleep Lab that performed your study dictates the equipment that is a direct "confiict of interest" and you should report it to your insurance carrier. Same goes if the doctor renders the diagnosis and prescribes therapy then also supplies the equipment that is also is a conflict of interest.

You should be able to:

1. Obtain the test with NO obligation to obtain equipment from the tester.
2. Obtain a diagnosis from the test performed by the independent testing facility.
3. Obtain therapy "options" which is YOUR choice from any supplier in your insurance coverage network.

the only place I know that this regularly happens is with the HMO Kaiser, with them you are lucky to get the test at all.

But even with Kaiser you have the legal right to obtain a 2nd opinion.

What if you decide you don't want the CPAP therapy and want to try surgery from an ENT?

Or a dental device?

With them dictating every aspect of your therapy that choice has been removed.

You seen what they charge for every item. Did you know the hose comes with the machine? The cushion with the mask? the headgear with the mask?

Your insurance demands the 1-3 month trial rental. The reason is nearly 50% of patients give up on therapy during that time. If you happen to be one of those, they are only out the test and 3 month rental. If you keep it then they will turn that 3 month trial into a 10 month rent-to-own where you own it after that period.
Insurance will then NOT buy you another machine for 5 years. 5 years, that is a long time to go with the cheapest machine on the planet that doesn't provide you with any data during that time to gauge how you are doing.

Of course they will perform 2 PSG's per year. your doctor gets paid for those visits they also get paid for interpreting the report (close to $600).

Yes your doctor wants you to have that cheap machine also, it means you have to go back and see them for every aspect of your therapy.

What happens say 5 months from now should you lose your job or insurance coverage? It can happen, did you know you are obligated to pay that remaining 5 month rental? You most likely signed a contract. They have your SS#.

In this state of the economy, coverage going down, premiums going up, have to keep it 5 years, I'd demand a autopap that has detailed data capability, at least if you lose medical coverage you will have a machine that will lessen the need to be retested or frequent doctor visits.

Sleep Medicine is a racket and a rip off, your doctor, DME and sleep lab are all poised to squeeze every last dollar they can out of you and your insurance.

Get the prescription and copy of the PSG test results. Those are yours, you should be able to even take those to your GP and have them write a script for Aflex then you get a better machine.

WHERE in your insurance policy does it state due to your pressure of 8 cm you don't get exhale relief? Fact is it probably doesn't have that clause at all and the sleep lab is trying to increase its profit by outright lying to you. I'd report their ass to your state medical licensing board for fraud. It would also be the last time I used them for a PSG.

Wouldn't surprise me to find out your sleep doc has a financial interest in the sleep lab used if they were the ones that set up the appointment.

[Pineapple]

Wrenna,

Nearly $2000 for a CPAP and humidifier is definately inflated. Did you call your insurance company and ask if there were other providers you could use? (DME or on-line) My need move would be calling the insurance company.

[NightHawkeye]

Wrenna, approach this thing with the right frame of mind and you can really have lots of fun watching your physician, sleep lab folks and DME staff squirm as they wriggle and writhe to avoid providing accurate and forthcoming answers to your questions. You'll likely get some of the most convoluted reasoning ever conceived by humankind.

Just keep asking questions. Keep your wits about you and enjoy ...

Regards,
Bill

P.S. Don't forget the easy way out when you tire of all the fun.

[Wulfman]

And, ALWAYS remember.......they're getting your money, so they're working for YOU!

(and, don't let THEM forget it, too.)

Den