What do I tell my doctor?

[fortomorrow]

A couple weeks ago I wrote my neurologist a note requesting an AutoPAP and a prescription for a new mask (the whole sordid story is here: viewtopic.php?f=1&t=34683). Instead of writing me a new Rx, he insisted on seeing me in clinic instead.

My appointment is tomorrow and I'm not exactly sure what to tell him when he asks why I want an Auto other than:

1. I'm having WLS in 2 months and I don't want to go in for another titration study when I lose weight. And then lose more weight.

2. I'm a very active sleeper and my pressure needs most likely change throughout the night. I'm currently on 12cm and have trouble keeping the mask on for more than 2-4 hours - but I'm only 2 weeks in.

3. At the very least I want a data enabled machine so I can monitor my own therapy.

I know that I *should* just be able to tell the doctor that I want one and he should write me the damn Rx for it, but things aren't always that easy. He wrote a very specific Rx before, and my medical group is insisting that I go to Apria for my supplies.

So what should I say? Are my reasons enough?

[givemesleep]

Hi, I asked my doctor to write me a new scrip just based on the fact that I was going to lose weight and I could not afford to undergo another sleep study/titration. He had no problem changing it for me. I have lost 45 pounds so far and my pressure generally ranges in the 7-8 range and my original titrated pressure was 9, so I think weight loss is a very valid reason to have an auto. Or you could always tell him that you are a huge lush and you know that the effects of drinking leads to a higher pressure and you need an auto to keep up with you

[Wulfman]

I didn't re-read all of that previous thread, but a person who really NEEDS to make the case for a data capable machine could always use the argument that it's an absolute necessity for people with diabetes to frequently monitor their condition......and this therapy should be no different. Doctors seem to try to make the argument that these machines aren't very accurate.....but, by the same token, glucose meters and testing strips aren't either......they can have a 20% variation (plus or minus) and still be considered "close enough". These machines use air flow and sensors for reading a person's breathing, but when done over a period of time, they DO give "relative" results. And, they ARE patented and have FDA approval. Some doctors actually DO like them for patient monitoring.

Den

[marshaeb]

Hi, fortomorrow.

Check your PMs.

Marsha

[fortomorrow]

I went to my appointment this morning primed for a battle (my blood pressure was up 10 points on both sides) and didn't get one. My doctor gave me everything I asked for without much justification on my part and generally thought my reasoning was sound. I take back all the petty things I said about him before!

He wrote a prescription for an M Series Auto with A-Flex and a Hybrid mask. I'm looking forward to taking all my stuff back to the DME - they told me I'd never get what I wanted.

Once again, thank you everyone for your assistance. I probably would have given up weeks ago without this place. And extra thank you to marshaeb, your information was great, even if I didn't need to use it after all.

[rested gal]

That's great news, fortomorrow!!

Glad to hear the doctor was willing to write the Rx for you after all.

Hope the DME is as cooperative, now. Maybe they will be.

[sepool]

I used Apria in North Texas to get my M-series Auto with A-flex. My prescription just said "Auto" and it took some talking to get the A-flex. Apria, at least here, deals mainly with Respironics, so the M-series Auto was no problem.

The humidifier and tank they gave me was the old-style AC leaky O-ring. They told me they didn't "all" leak. 3 weeks later, it did leak, and they exchanged it under warranty for a recertified new style DC compatible one (the only one that is current) shipped from Respironics, with the new J-tube tank. You might check for that.

Good luck!

[Babette]

Relax. He just wants to be able to bill your insurance for the labor of reading your note and writing the new scrip. I'll bet you anything it's not going to be as big a trauma as you anticipate.

I wrote my doc (also a neurologist) a 20 page portfolio on why I wanted an Auto, too. I waited to submit it in person. Never did hand it to her. She was very reasonable with my stated reasons and gladly wrote the scrip. Even offered to go head to head with my insurance company and DME on any problems. Love that woman!!!

Kimberly Mebust, MD - Puyallup & Tacoma, WA

Cheers,
Barbara

[marshaeb]

This is great news, fortomorrow!! (You’re welcome. The important thing is that you have the right Rx. )

Next step: What rested gal and sepool said are VERY important. Many DMEs, but certainly NOT all of them, are more interested in their bank accounts than in dealing with integrity. The “bad” ones intentionally don’t pay attention to the details. For instance, the name I gave to the first DME I contacted is “Bait ‘n’ Switch ‘r’ Us.” They told me one set of answers on the phone, and when I got there, tried to pass off completely different (and not surprisingly, cheaper) equipment. I refused to deal with them and was fortunate to find an excellent DME. It’s up to you to look at the equipment, read EVERY WORD on it and insist on your Rx being filled correctly. This might help:

Respironics auto APAP

Go to and print both pictures:
http://shop.talkaboutsleep.com/?action= ... 0&page=223
http://shop.talkaboutsleep.com/?action= ... 0&page=225

These are excellent pictures of the machine your doc prescribed. The first is the auto APAP alone, and the second shows it with the integrated heated humidifier. What you take home should look like the second picture. It needs to say ALL of the words you see on the picture.... REMstar Auto M Series A-Flex. (Note that it has “FLEX” on the right-hand button, NOT C-Flex.)

Respironics R3 heated humidifier

Two versions of the heated humidifier will fit your machine. You DO NOT WANT the older version (R2). It's well-known for serious water leakage problems. You want the model identified as R3. Again, pay attention to detail.

Go here: https://www.cpap.com/productpage/Respir ... amber.html and open, then print, both “How To Identify The Correct Chamber,” and “How To Tell If I Need An R3 Chamber.” In the first picture, the R3 iwater chamber is the one on the right... black latch, black middle seal and staggered round openings. The second picture is to remind you that there should be a line under the “5" on the dial on the outside of the humidifier. IF THERE'S NO LINE UNDER THE "5," it's an R2, and YOU DON'T WANT IT.

Take all four pictures along to your DME and match ‘em up. Settle for nothing less. Hopefully, they'll give you exactly the right equipment. If not, though, I'm going to quote Gasp, who posted this perfect response in another thread earlier this month:

Very nicely I would say "I can't accept a substitute machine. My doctor and I had an understanding on what he was prescribing and this is not it." If that fails, then adding "I will have to contact my doctor and let him know that you want to substitute another machine than what he wanted and have him get back to you. I'm certain he'll want to speak to the manager. Whom should I say he should call?"

We're looking forward to hearing about your happy ending.

Marsha

[fortomorrow]

I've already got the R3 humidifier at home. I don't even think I'm going to bother taking that back to the DME, I'll just bring in the machine and the horrid awful mask.

My doctor was VERY specific on his Rx (which is why I had problems the last time) and I've already gotten very friendly with the manager at my local Apria, so if they try and screw me I'll be on the phone with Bob before they can even try to give me the wrong machine. I'll definitely take pictures and verify that I'm getting the appropriate machine though.

Thanks!!

[Babette]

Clearly I didn't read the whole thread before I jumped in. Sorry for that!

Hope it helps someone else reading this thread!
B.