Info he gave me:
The dr is guessing on my titration level because they didn't do a titration study when I had my sleep study. Also, the sleep study people in the report said I fell asleep at midnight. They told me I fell asleep at 3am and they got me up a little before 6am so I could meet my dh in the pkg lot. So the sleep study charged me about $3,000 to tell me not a whole lot and to necessitate me going to yet another professional who will have to decide for me what titration I should use.
He pretty much said cflex is a "gadget" that isn't noticably effective for most people.
He said that most people who have autopap, have their numbers pretty close (like 8 or 9 to 12) and that with numbers that close, they don't even notice the diff between the cpap and autopap.
He said the software only shows if you've used the cpap and for how many hrs. The only apap they use for this purpose is resmed w/heated humidifier.
He said they only use the autopap for 2 wks to see what titration I need and then switch to cpap. I asked what titration the dr said to set the auto at and he said (pardon me this is the apnea brain drain speaking as I was doodling and half listening and falling asleep on the phone) between either 6 or 9 and 18. So he said HE'D need to figure out what titration I needed (as in, I couldn't figure it out and set it myself)
He said the PB GK 420G and the Respironics Remstar are about $900 (both w/heated humidifier I'm thinking) but he can't quote for sure, check w/billing and ins.
He said he saw the AEIOAURA w/battery pack and heated humidifier last week and his opinion was that because the battery pack itself costs about $300 it was too exp to replace every 2 yrs or so.
He said you rent the machine and the ins co ends up buying it for you (of course there are out of pocket costs)
RE: Interfaces:
He doesn't like the NasalAireII (7 out of 9 of his seasoned cpapers couldn't use it) which I want to try and two friends have and love. He said it is louder than many others.
He doesn't have the Infinity in stock and didn't know how it compared w/Nasal AireII in customer satisfaction.
He suggested the Aura....(which from the pics looks too cumbersome to me but what do I know????)
He said when I decide what I want to do I should call him and come to their office and he'll let me try things out there.
I'm still processing all of what his take is on things....Terry
talked w/rt/dme
equipment
You are being handed the same line of "hooey" we all get. Get the Remstar Auto with CFLEX. If you do not like the auto mode, you can also use it on regular CPAP. The encore program tells you apneas, hypopneas, flow limitations etc. not just compliance, which is all they are interested in.
Most insurance will rent for a certain period and then purchase if you want. After 10 months on the same machine, my insurance calls and gives you the choice of purchase or continuuing to rent. If you opt for purchase, they will not pay for repairs. Heated Humidifier is a must. They do not like the auto because if you use it, you do not need them.
I have never ever heard of putting someone on a CPAP machine and guessing at the titration. That is utter ignorance. The auto will automatically titrate frpm 4 - 20. Most people cannot stand 4 because of feeling of suffocation. My auto is set from 5 - 12. I reset it to 6 - 13. So your doctor's "guess" of 6 - 18 pretty much covers the entire titrating level. Without a titration, they do not know if they will cause central apneas at higher levels. Personally, I think this is dangerous waters.
I personally could not use the Nasalaire - other people love it. There is a new Nasalaire II out that appears to be much smaller. Look at pictures on the internet and decide what you think will work best for you. What one person loves, you may end up hating. Your first mask is really a guessing game. Many people love the Activa - it gives a great seal but in all honesty, is much heavier on your face,
My most honest recommendation to you, without any access to your report, would be to get a copy of your report and find a NEW sleep center that WILL do a monitored titration on you. I would run, not walk, away from these people. Good Luck!
Most insurance will rent for a certain period and then purchase if you want. After 10 months on the same machine, my insurance calls and gives you the choice of purchase or continuuing to rent. If you opt for purchase, they will not pay for repairs. Heated Humidifier is a must. They do not like the auto because if you use it, you do not need them.
I have never ever heard of putting someone on a CPAP machine and guessing at the titration. That is utter ignorance. The auto will automatically titrate frpm 4 - 20. Most people cannot stand 4 because of feeling of suffocation. My auto is set from 5 - 12. I reset it to 6 - 13. So your doctor's "guess" of 6 - 18 pretty much covers the entire titrating level. Without a titration, they do not know if they will cause central apneas at higher levels. Personally, I think this is dangerous waters.
I personally could not use the Nasalaire - other people love it. There is a new Nasalaire II out that appears to be much smaller. Look at pictures on the internet and decide what you think will work best for you. What one person loves, you may end up hating. Your first mask is really a guessing game. Many people love the Activa - it gives a great seal but in all honesty, is much heavier on your face,
My most honest recommendation to you, without any access to your report, would be to get a copy of your report and find a NEW sleep center that WILL do a monitored titration on you. I would run, not walk, away from these people. Good Luck!
Life is not a dress rehearsal
Re: talked w/rt/dme
This would give me pause - sounds like he's a big insensitive guy who might not relate with much sensitivity to little sensitive women? The CFlex has been helpful to me, it helps me settle down, quiet down, after the agitation of getting the mask set. And if you're a little person, 8 to 12 would be like 16 to 24, wouldn't it?Terry Flower51 wrote:Info he gave me:
The dr ... pretty much said cflex is a "gadget" that isn't noticably effective for most people.
He said that most people who have autopap, have their numbers pretty close (like 8 or 9 to 12) and that with numbers that close, they don't even notice the diff between the cpap and autopap.
41yow, 118lb, severe OSA, lots of allergies, had surgery for deviated septum.
click to see my introductory post.
click to see my introductory post.
correction
Just found my scribbled note...he said to titrate between 8-16....Now I'll go back and read what you responded! T
ps
PS> The "he saids" in my post refer to the rt/dme, not the doctor except for the titration numbers...I asked the rt what titration the dr had written to set it at and he told me what the report said....the rt said it takes 3-4 hrst of sleep to get the results of a sleep study....MAYBE I got close to 3. T
difference of oppinion
You're going to get some difference of oppinions here with some of these subjects. The only insurance companies that rent cpap's for 10 months is medicare and medicaid. the other insurance companies rent them for 2-3 months until the doctor says that you are compliant and benefiting from the therapy, and then they purchase it. Usually people pay 10-20% of the total cost of the device if they have reasonable insurance. Sometimes you may have a seperate deductible. Please call your insurance and ask them what they cover.
Being on an auto because they couldn't determine your cpap pressure isn't totally uncommon, it happens in our sleep lab occasionally, maybe 1 in 50 patient's need to go on auto for 2-4 weeks. The problem with staying on an auto, is that insurance often won't pay for it past those 2 weeks, unless you've failed cpap first. Many people don't realize this, and it depends on your insurance companies requirements for an auto.
Cflex is not a gimick and it definetely has allowed many patients to adjust to CPAP that otherwise could not. Cflex has really improved cpap compliance with the general population, but of course it helps more with higher pressures (10 and above).
The new Remstar Pro2 and Remstar Auto has more data on the smart card than just complaince. Sounds like your doctor isn't up to date on his information, I would recommend going to the Respironics homepage and printing out the information on the Remstar Auto, Remstar Pro and Remstar Pro2, it tells the features on their web pages and I would take that to your doctor during your next visit and let him know that they have changed. If he doesn't work closely with a DME company or the manufacturing reps don't visit him often, then he won't have that information.
The nasal aire II is very noisy, some need to wear ear plugs if it's the only one that works for them. If you are considing a direct seal (nasal pillow) type system, the swift is good unless you like to sleep on both sides (left and right), the nasal snapp is a good mask and i like it more than the nasal aire, but the noise level is the same. the nasal pillows with conjo headgear is still a reasonable choice, but also loud. Any device that goes directly in the nose is going to be noisier, the swift is the quietest of the nasal pillow types.
Hope this helps,
Joyce
Being on an auto because they couldn't determine your cpap pressure isn't totally uncommon, it happens in our sleep lab occasionally, maybe 1 in 50 patient's need to go on auto for 2-4 weeks. The problem with staying on an auto, is that insurance often won't pay for it past those 2 weeks, unless you've failed cpap first. Many people don't realize this, and it depends on your insurance companies requirements for an auto.
Cflex is not a gimick and it definetely has allowed many patients to adjust to CPAP that otherwise could not. Cflex has really improved cpap compliance with the general population, but of course it helps more with higher pressures (10 and above).
The new Remstar Pro2 and Remstar Auto has more data on the smart card than just complaince. Sounds like your doctor isn't up to date on his information, I would recommend going to the Respironics homepage and printing out the information on the Remstar Auto, Remstar Pro and Remstar Pro2, it tells the features on their web pages and I would take that to your doctor during your next visit and let him know that they have changed. If he doesn't work closely with a DME company or the manufacturing reps don't visit him often, then he won't have that information.
The nasal aire II is very noisy, some need to wear ear plugs if it's the only one that works for them. If you are considing a direct seal (nasal pillow) type system, the swift is good unless you like to sleep on both sides (left and right), the nasal snapp is a good mask and i like it more than the nasal aire, but the noise level is the same. the nasal pillows with conjo headgear is still a reasonable choice, but also loud. Any device that goes directly in the nose is going to be noisier, the swift is the quietest of the nasal pillow types.
Hope this helps,
Joyce
Joyce
Thanks Joyce. Am I making much ado about nothing? Could they have gotten enough info from me in 2 1/2-3 hrs???? I don't want to have another doctor's visit and ask him if I need another study done if I don't. Who needs another $3,000 bill to the ins co (translates to $400plus to me).
Thanks, Terry ps. I understand from Anthem that unless an apap (ditto for "extras" like cflex) is deemed medically necessary by my doctor, I'll be geting a cpap because they won't cover ANYTHING not medically necessary, not even a little bit! We just aren't in the financial position of footing the entire bill for an autopap w/humidifier, etc.... The deal is, (and she said "don't quote me") unofficially my Anthem BC/BS coverage will pay for 90% and I pay 10% of in network, they will pay up to $1,000.
Out of network, they'll pay 70% and I pay 30%. Right now, that's a lot of money to us. What I'm wondering too is if that is just for the machine itself. Does that mean they also cover interfaces and masks separately or is it included too??? Whats the custom???? T
Thanks, Terry ps. I understand from Anthem that unless an apap (ditto for "extras" like cflex) is deemed medically necessary by my doctor, I'll be geting a cpap because they won't cover ANYTHING not medically necessary, not even a little bit! We just aren't in the financial position of footing the entire bill for an autopap w/humidifier, etc.... The deal is, (and she said "don't quote me") unofficially my Anthem BC/BS coverage will pay for 90% and I pay 10% of in network, they will pay up to $1,000.
Out of network, they'll pay 70% and I pay 30%. Right now, that's a lot of money to us. What I'm wondering too is if that is just for the machine itself. Does that mean they also cover interfaces and masks separately or is it included too??? Whats the custom???? T
Titration
However, she said "they did "NOT" do a titration - which is different from having been through a "poor" titration, knowing there were no centrals and then being titrated on an auto. I myself, after a really lousy lab titration, spent a month on an auto. The DME could not get a download, so my titration was set on a 4 day readout. The important issue here is "what exactly did the sleep study show." If there are no mitigating circumstances, then, heck yes, go for the auto. Having made this mistake myself, I think it is extremely important to get a copy of the sleep study. Take the time to study it and get all the answers you need. You really need to talk to the sleep lab doctor who read the study. You also need to know exactly what his orders were. No offense intended, but the doctor writes the orders. The RT and DME have to follow what he wrote - they may suggest but they cannot prescribe.
Also, I have BCBS Major Medical. They, in writing, informed me that they rent for 10 months. At the end of 10 months, by law, I have to be given the right to either continue having the machine rented or have an outright purchase. My machine has been changed, by the DME, on 5 occasions. I figure my 10 months will not be up until 2098. If the insurance wants to pay rent - go for it. I do NOT want an outright purchase until I am positive that I am truly on the correct machine. I have asthma and my pulmonologist and cardiologist have both contacted the sleep center because I am on an auto. I see a NEW sleep doctor tomorrow. Until I get the answers I deserve, I do not care what anyone says. For my health, I want the correct decision made. I hope Terry will expect nothing but the best for her health.
I do not have Anthem but BCBS bills the interface separately and the headgear separately. Each and every hose, filter, humidifier etc. is billed separately. I do not have any copay on durable medical equipment.
Honey, just take your time. Study all your options, talk to the people who need to answer your questions. Check around - people are always selling equipment that did not work out for them. Read this board, you will learn a lot!! Just remember, it is important that you do what is right for you, not what someone is telling you might be right for you. Good luck!
Also, I have BCBS Major Medical. They, in writing, informed me that they rent for 10 months. At the end of 10 months, by law, I have to be given the right to either continue having the machine rented or have an outright purchase. My machine has been changed, by the DME, on 5 occasions. I figure my 10 months will not be up until 2098. If the insurance wants to pay rent - go for it. I do NOT want an outright purchase until I am positive that I am truly on the correct machine. I have asthma and my pulmonologist and cardiologist have both contacted the sleep center because I am on an auto. I see a NEW sleep doctor tomorrow. Until I get the answers I deserve, I do not care what anyone says. For my health, I want the correct decision made. I hope Terry will expect nothing but the best for her health.
I do not have Anthem but BCBS bills the interface separately and the headgear separately. Each and every hose, filter, humidifier etc. is billed separately. I do not have any copay on durable medical equipment.
Honey, just take your time. Study all your options, talk to the people who need to answer your questions. Check around - people are always selling equipment that did not work out for them. Read this board, you will learn a lot!! Just remember, it is important that you do what is right for you, not what someone is telling you might be right for you. Good luck!