My time (for xPAP) has come! (Slinky, Rested Gal? Help!)

[schleima]

Hello all-- I've been lurking here for several weeks now, while anxiously awaiting my CPAP titration results from my second sleep study.

First study - moderate apnea, 22 per hour

Second study (with titration) - less than 1 per hour! (90% sleep efficiency)

I can tell you that I woke up from that second sleep study feeling incredible, and in the 2 weeks since, it's been a nightmare living with the memory of that great night's sleep.

I just got off the phone with my doc (Dr. Yan-Go, who runs the sleep clinic at UCLA). She is knowledgable but rather short in manner, and gets annoyed easily. (She prefers the flow of info to go in one direction only). I had a list of questions to ask her based on my research on these forums, and I only got through about 1/10 of them before she nearly hung up on me (she kept trying to rush me off the phone)

In order to head off the DME problems of getting a cheapo machine (I've read all the horror stories...), I asked her to specify APAP, but she said it was fraudulent for her to prescribe a specific machine... she said she can only specify CPAP, ramp, titration pressure, etc. and the rest would have to be done through the DME rep, Brian at Aircare.

I did manage to get her to include heated humidifier on the Rx before she summarily shuffled me off the phone... and most importantly, I got her to fax me a copy of the prescription.

So all in all, I think I did relatively well, considering what I had to work with. However, I am still quite curious about your collective opinions regarding my xPAP choices, based on my criteria.

- I travel several times a year, so for ease of portability I was gearing towards the PB 420E, the H20 Humidifier. At 9cm H20, is this a good choice? Should lack of exhalation relief be an issue at this pressure?

- I sleep on my stomach with my head to one side, and tend to move around, so I feel that an over-the-head kit like the PB Breeze Sleepgear is the way to go (versus a machine where the tubing comes off the side of the face, and could crimp if I move in the wrong way)

- My insurance pays for a 15 month rental before purchasing. How should this impact the DME provider in terms of his profit margin, and gearing me away from a higher end, more versatile machine? (Don't worry, I will absolutely NOT allow them to strongarm me into non-data capable machine... it will be the Resmed S8 Vantage, Respironics M w A-Flex or PB 420E, no matter what)

Thanks for your input and opinions... would love to know what you think before Brian calls me.

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CPAPopedia Keywords Contained In This Post (Click For Definition): 420E, respironics, resmed, breeze, humidifier, tubing, Titration, CPAP, DME, Ramp, Prescription, APAP, Travel

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CPAPopedia Keywords Contained In This Post (Click For Definition): 420E, respironics, resmed, breeze, humidifier, tubing, Titration, CPAP, DME, Ramp, Prescription, APAP, Travel

[NightHawkeye]

... would love to know what you think before Brian calls me.

I think you've made a good start. You know what you want. Now, it's a matter of negotiating. I noticed you mentioned a specific DME, Aircare. Unless your insurance limits you to that specific DME, you have the option to go with a different DME, say one which you find easier to work with, or that offers the equipment at a much better price. Legally (since your doc likes legalities), you certainly have the right to go with any supplier you might choose. Check with your insurance though.

Illegal to prescribe APAP?

Your physician's LYING to you. .

Sorry to be blunt, but you're gonna have to deal with that fact one way or another.

Best of luck. Since you already know what you want, you should be successful. Just don't let them bully you like the doc did.

Regards,
Bill

[ozij]

The PB 420E and the Breeze sound fine based on what you told us. Get yourself the software too, while you're at it.

You can buy an automatic machine online without the script saying Auto. If "Brian" agrees to sell you an auto - fine. If he tries to sell you a bill of goods - you'll have learned something about your doctor's way of adding her personal financial considerations to how she treats you - and you can order your equipment elsewhere.

Good luck!
O.

[ww]

... would love to know what you think before Brian calls me.

I think you've made a good start. You know what you want. Now, it's a matter of negotiating. I noticed you mentioned a specific DME, Aircare. Unless your insurance limits you to that specific DME, you have the option to go with a different DME, say one which you find easier to work with, or that offers the equipment at a much better price. Legally (since your doc likes legalities), you certainly have the right to go with any supplier you might choose. Check with your insurance though.

Illegal to prescribe APAP?

Your physician's LYING to you. .

Sorry to be blunt, but you're gonna have to deal with that fact one way or another.

Best of luck. Since you already know what you want, you should be successful. Just don't let them bully you like the doc did.

Regards,
Bill

[rested gal]

The "sleep doctor" is mistaken about it being fraudulent for her to prescribe APAP. She apparently just prefers to have people use a basic cpap unless the sleep study shows they need a different type of machine. What she is missing though (in her notion of "fraudulent") is that an autopap IS a cpap machine in the eyes of Medicare. Most insurance companies take their cue from Medicare and bill the same way Medicare does.

The billing code is the same whether it's a plain cpap, a cpap with C-flex, a cpap with EPR, or any autopap. An autopap is a cpap which can have auto-titration turned on...or not. If auto-titrating is not turned on in the setup menu, the autopap operates at one single pressure all night, just like any cpap machine.

My guess is that the doctor also prefers not to rock the boat with the DME. She likes leaving all the machine "stuff" up to the DME.

The DME, of course, prefers to see plain prescriptions for cpap or bilevel machines so they can choose which brand they give out.

ww is exactly right about this:

She WILL have to revise the Rx to say AutoPap or you will have to get the DME to agree to give you the AutoPap you want and set it up to CPAP, which he can do

And, ww is right about this, if the sleep doctor and/or the DME are stubborn about "no autopap for you!":

have your family doctor write the prescription for an autopap set to a CPAP pressure the same as your titration.

It doesn't matter one bit which doctor writes a prescription for "autopap." Any MD can write the Rx.

I agree with ozij that the 420E autopap and the Breeze nasal pillows mask are very good.

[Snoredog]

... would love to know what you think before Brian calls me.

I think you've made a good start. You know what you want. Now, it's a matter of negotiating. I noticed you mentioned a specific DME, Aircare. Unless your insurance limits you to that specific DME, you have the option to go with a different DME, say one which you find easier to work with, or that offers the equipment at a much better price. Legally (since your doc likes legalities), you certainly have the right to go with any supplier you might choose. Check with your insurance though.

Illegal to prescribe APAP?

Your physician's LYING to you. .

Sorry to be blunt, but you're gonna have to deal with that fact one way or another.

Best of luck. Since you already know what you want, you should be successful. Just don't let them bully you like the doc did.

Regards,
Bill

[schleima]

Patients ARE told of this on very first visit usually done by student doctors. They are always going to prescribe fixed pressure because all diagnosis rendered is reviewed by other doctors, professors and even program directors. A student doctor wouldn't be writing the script as they don't get that until they finish their 4th year and passed national boards.

Just to clarify, at no time during my sleep study and consultation at UCLA (http://www.neurology.ucla.edu/clinical.jsp?m=2&s=4_14) did I deal with any student doctors. I dealt directly with the medical director of the sleep clinic and polysomnologists that had worked for over a decade.

[schleima]

The PB 420E and the Breeze sound fine based on what you told us. Get yourself the software too, while you're at it.

Out of curiosity, has anyone been successful getting their insurance to pay for their software? My insurance is a very generous self-administered plan through Screen Actors Guild (Blue Cross) and according to the rep at the health plan, they will pay for it if the doctors deems it medically necessary.

[schleima]

If he gives you a hard time, have your family doctor write the prescription for an autopap set to a CPAP pressure the same as your titration.

That's a great suggestion... my endocrinologist is much more approachable and would likely be fine with writing me a prescription for whatever I want. Thanks for this.

[schleima]

The "sleep doctor" is mistaken about it being fraudulent for her to prescribe APAP. She apparently just prefers to have people use a basic cpap unless the sleep study shows they need a different type of machine.

I think she just is too short tempered and too busy to care. Even the receptionist warned me that the doctor won't talk about the merits of specific machines. In fact the doctor herself told me "I prescribe the titration, ramp, etc. and you pick whatever machine you want." The moment I started dictating how I wanted my prescription written, she started to get impatient.

Somehow I don't think she's ever dealt personally with DME providers the way all of you have, or she wouldn't have been so dismissive about the whole thing.

By the way, let's hope that this isn't the same Brian that I'll be dealing with:

http://www.ripoffreport.com/reports/0/3 ... 304533.htm

!!

[NightHawkeye]

Report: AirCare Home Medical ...
Are you also a victim of the same company or person? Want Justice? File a Ripoff Report and don´t let them get away with it!
...
AirCare Home Medical
Phone: 800-981-7100
Fax: 800-478-6551

13311 Garden Grove Blvd #D
Garden Grove, California, 92843
U.S.A.
Submitted: 1/30/2008 7:28:13 AM
Modified: 1/30/2008 7:28:00 AM
...
At that time a very friendly Brian (...). He told me all about the CPAP, and said, all I had to do was give him a check for $117.00 and I could take the CPAP home. I paid the money, sign some papers to show I received the instructions on how to use it, and that I was given a complete unit.

During the whole time I spoke to Brian (...), never did he use the words rent, rental, or even lease. Suddenly, I began to receive invoices for $65.00. The invoices have specific dates, as if they were for an office visit. However, I did not have an office visit on the dates shown in the invoices. I call the number listed. The receptionist named Stephanie first said that it was a co-pay. When I mentioned that I did not have an office visit on that day, she said that it was a rental fee for the CPAP.

I told her I was never told that this CPAP was a rental. She laughed and said, Well, Sir, you sign the paper. Again, I mention that I was never told that the CPAP was a rental. She said that's your fault. I asked to speak to billing. Twice I was redirected a fax machine phone.

I called back, said I want to return the CPAP. If I knew it was a rental, I would have returned it several weeks before since the CPAP does not work for me, and I am not using it. I asked to speak with Brian (...) so I can return the unit, and that's where the run around begin. Suddenly, they cannot find Brian (...).

Each time I call I am told that Brian (...) is not in, or that he just stepped out for the day. When I ask for his phone number or voice mail, I am told that his phone is out of order. The receptionist said that she would give him my number for Brian (...) to call me. So far no, calls from Brian (...).

I want to return this CPAP to AirCare Home Medical, Inc.

I want the monthly billings to stop.

The CPAP is useless, and with it I wake up more fatigue then without it. It keeps me awake at night, mostly since it splashes water on my face.

Lucky you, schleima.

Did you know that the compliance rate for CPAP use in this country is less than 50%? Less than half the people prescribed CPAP use their machines. Brian and your physician are the reason why, along with the others out there like them. Some places on this globe have compliance rates greater than 90%. We don't. Draw your own conclusions.

Best of luck.

Regards,
Bill

[Slinky]

Sorry to be so late in responding. After months of a dry spell ran across a GOB of genealogy info and just could NOT leave it alone! (Also didn't sleep for beans last night and am TIRED this morning. 5 1/2 hours just doesn't "cut the mustard" any more. *sigh*

Anyway, the advice above was good. Call your insurance and ask what local DME CPAP providers they are contracted with.

Go to, call or write the UCLA sleep center and request a copy of the doctor's dictated results (1-2 pages) and the full scored data summary report w/condensed graphs (5+ pages) for both your sleep study and your titration study. You have a LEGAL RIGHT to these copies under HIPAA. (Just in case you have to remind them of that legal right and HIPAA)

Good for you for getting a copy of the script!!! Now you have the amunition you need to get your equipment.

Hopefully, you have the option of more than one local DME CPAP supplier in network w/your insurance. You can now "shop" and "negotiate" w/them to get the equipment you want. At 9 cms of pressure most likey you won't really need EPR, C-Flex or A-Flex and everyone who has that Puritan Bennet GoodKnight 420E loves them and speaks highly of them. I've never read of one complaint against them.

If none of the local DME suppliers want to cooperate then ask your Endo to write your script specifically for the 420E. Then they have no choice but to provide that specific machine.

Or just skip to asking your Endo for the new script for what you want and just shop your various local DME options for the one you are most comfortable with who has the most lenient mask exchange policy.

You did GREAT, especially considering the RIGID doctor you were stuck working with. Not being one to take that type of behavior from medical professionals I would be inclined to write a letter of complaint to the director of the UCLA sleep clinic setting them straight on a few items: such as an autoPAP being an HCPCS code E0601 CPAP; no difference in cost to your insurance; the IGNORANCE of the doctor regarding CPAP devices of your scripting doctor; pointing out the dismal rate of complaince of newly Dx'd patients and why, etc. etc.

Good luck!!

[xyz]

> I had a list of questions to ask her based on my research on these forums, and I only got through about 1/10 of them before she nearly hung up on me (she kept trying to rush me off the phone)

There are probably two things going on. First, she's just one of those doctors who are really bad with patients. Those type of people should never have become doctors in the first place. They are incredibly smart, can ace any test (which is how they got accepted into med school), but are really crappy with people. They never figured out that the difference between a doctor and a chemist/physicist/etc is that the former works with people and the latter just work in a lab. Avoid these types of doctors.

The second thing involves how they get paid. When you call a doctor on the phone (in most cases) 1) they don't get your co-pay and 2) they don't get paid by your insurance company either. 0 for 2 on the pay issue. Never try to do anything important with a doctor over the phone.

If you have a doctor who is dismissive or unhelpful, bring a relative or friend with you to the appointment. Doctors are smart enough (usually) to not be grossly unhelpful in front of a "witness". Say to the doctor, in front of your relative/friend, "I want a copy of where it is _written_ that it is fradulent to prescribe an auto machine." She will begin to weasel and try to bluster out of giving you anything in writing. So then say, "OK, then I just want you to put _in writing_ to me that it is fradulent." Don't let up, insist on it. This won't work unless you have a friend with you.

These days doctors who do not prescribe auto machines, which can adjust to your specific situation, are practically committing malpractice.

[schleima]

You did GREAT, especially considering the RIGID doctor you were stuck working with. Not being one to take that type of behavior from medical professionals I would be inclined to write a letter of complaint to the director of the UCLA sleep clinic setting them straight on a few items: such as an autoPAP being an HCPCS code E0601 CPAP; no difference in cost to your insurance; the IGNORANCE of the doctor regarding CPAP devices of your scripting doctor; pointing out the dismal rate of complaince of newly Dx'd patients and why, etc. etc.

I would love to send a letter to my doctor (the director) as well as the co-director of the sleep clinic. However, as I'm still pretty new to this, I am not very familiar many of the details you are referring to. If you could help define some of the specific details you're referring to, that would help a lot...

Specifically:

- What specifically is "the dismal rate of compliance of newly diagnosed patients and why"?

- What does "the IGNORANCE of the doctor regarding CPAP devices of your scripting doctor" mean?

- Other details regarding my doctor's claiming the fraudulent nature of providing a specific APAP prescription (do you have anything to back this up?)

- Anything else I should specifically include in the letter?

I certainly can summarize myself the DME horror stories I've read about on cpaptalk.com, so no need to elaborate there.

Thanks for your help, guys!

[schleima]

First, she's just one of those doctors who are really bad with patients. Those type of people should never have become doctors in the first place. They are incredibly smart, can ace any test (which is how they got accepted into med school), but are really crappy with people. They never figured out that the difference between a doctor and a chemist/physicist/etc is that the former works with people and the latter just work in a lab. Avoid these types of doctors.

I think it's relevant to note that my doctor is Chinese. I am married to a Taiwanese woman, so I am familiar with Chinese doctor/patient culture-- which is strictly a one-way affair... it is similar to the student/teacher relationship in Asia which also is an "information flows only one way" affair. Interaction with doctors/teachers is definitely a western concept... in Asia, students sit silently and write down what the teacher says. Similarly, in Taiwan, patients simply do not question what the doctor says... they just do it.

My original consultation with the doctor was truly a student-teacher thing. She even came out and said directly to me "I am here to educate you about sleep." My questions were cut off, but that was fine at the time because I really didn't know anything. After reading up on machines and procedures here on cpaptalk.com I came back to her fully armed with a salvo of questions and I don't think she was going to play that game.