My Doctor is the Problem, Not My DME re:Mask Return

[smurfyabs]

I posted previously about my mask hurting my teeth. I found that if I tilted the arm it'd putting the pressure on the bridge of my nose rather than my teeth. But of course that made me feel like the mask was cutting my nose and cheeks. Of course it didn't really, but my nose and cheeks are red and bruised. Regardless, this is not the mask for me.

So I called my local DME and they were more than happy to switch me out for a nasal pillow, but they only have Respironics products. That's fine I'd try it. They just needed me to call my insurance, Allmed, to send them the order. Turns out that my doctor wrote this mask on the prescription (same issue with my brick of a machine). So I call and leave a message at his office that I need an open prescription to allow me to try different masks and different mask types including the nasal pillow. They never returned the call but they did change the prescription.

My DME is on her way with a few nasal MASKS for me to try. ARGH! She said they wrote nasal MASK on the prescription this time. So yes, while I can get away from the torture device I have, I cannot get the nasal pillow. Heck, I can't even order it myself out of pocket because of the way it's written. I left another message for this woman to call me, but I doubt she will.

I do have a follow up on June 12th. Whether my new mask works for me or not, he's rewriting that script, so help me!!!

They're bringing this mask https://www.cpap.com/productpage/profil ... onics.html# among others. It does look better than what I currently have, but we'll see.

Pray for my sanity!

P.S I'm beginning to really love my cpap machine. I didn't know I had a problem (hypopnea) until I began treatment. I removed the offending mask at 1 am last night and slept like crap. I always thought I was a light sleeper, but now I realize that's not true, I just couldn't breathe adequately!!!

[the_nap_ster]

So yes, while I can get away from the torture device I have, I cannot get the nasal pillow. Heck, I can't even order it myself out of pocket because of the way it's written. I left another message for this woman to call me, but I doubt she will.

Hi there,

First of all, it is WONDERFUL that you're coming to love your machine. I think they're pretty lovable, myself.

But a brief note on Rx rules/laws: this may indeed be a problem with your DME AND your doctor. Legally speaking, a Rx for CPAP/mask is sufficient clearance for a DME to sell you ANY mask. This doesn't mean they will do it. Apria (my DME) likes to play a game where they will only submit for insurance coverage *exactly* what my doctor orders (so they don't have to pay a penny more for anything other than the cheapest options). But they are MORE than happy to sell me whatever my heart desires out-of-pocket.

I don't support doing business this way, so I uploaded my Rx to our hosts at cpap.com, and I pay for masks out of pocket through them. When I find the one(s) I will commit to, I'll have my doctor write the Rx for exactly that model and make Apria pay for renewals.

But in the meantime, you can indeed buy whatever you want out of pocket. Upload your Rx to cpap.com and have a field day. Don't settle for something that doesn't work for you!

[smurfyabs]

I assume though that I can't order a Swift FX if my doctor wrote ComfortGel Blue on my prescription though right??? Are you saying it doesn't matter what the prescription says?

If so, at least my local provider seems to be ok, it was AllMed (insurance) that gave me the problem and requested a more open prescription.

You know, going into this, I had no idea how complicated being a CPAP user could be!!

[Pugsy]

Idiots...what is so hard about writing "mask of patient's choice" on a RX pad"?

I have a used Swift FX nasal pillow for her mask that I would be happy to send to you. Nasal pillows will be new though. I only have XSmall and Small though.
Silicone part of the headgear and short hose assembly are used but the back strap is new. Silicone discolors just a bit over time but it doesn't hurt it. Easy to wash though and color change isn't huge.
Just private message me your mailing address.

If you like it and want to keep it..consider it a gift. If you don't like it and won't be needing it all I ask is that you either return it to me so I can then offer it to someone else in a pinch or you yourself offer it to someone else. I hate to see them go to waste.

Ebay is also a source. If used mask freaks you out you can find new parts on EBay and build your own mask.
I just saw a buy it now price for the headgear and short hose assembly for $62...nasal pillows easy to find new for about $15 and sometimes less.

PS.....I do have pets in my household but they so far have never used my equipment and I have kept the gear in its own special bag, if that is of concern.
I do clean everything thoroughly before I ever send it out to someone else.

[Janknitz]

You can ask any doctor to write a script for "mask of patient's choice" including your dentist.

[Slinky]

Well, as long a "we're" rattling the DME and sleep doctor's cage to get the equipment "we" want, as JanKnitz said, any doctor can write your script for you. If you have a good rapport w/your family or another doctor, and you've had that "brick" CPAP less that 30 days, ask him/her to re-write your script adding "CPAP w/access to Leak, AHI and AI" and "full face, nasal cushion, nasal pillows or oro-nasal mask of patient's choice". If you've had your "brick" more than 30 days .... just alter the mask description as it is too late to exchange your CPAP.

[chunkyfrog]

Since it's bothering your teeth, it centainly is within your dentist's purvey to write a prescription for 'mask of patient's choice'.
You shouldn't even need to have an office visit. Just ask!
Edit: If you got your brick on or about May 1st, (as indicated on prior posts)
it's not too late to take back the brick and get a smart machine.
See if your dentist will write an RX for CPAP (or APAP) machine =WITH LEAK AND AHI DATA!
Then you should be rolling! (God willing)

[the_nap_ster]

I assume though that I can't order a Swift FX if my doctor wrote ComfortGel Blue on my prescription though right??? Are you saying it doesn't matter what the prescription says?

With a few asterisks, yes, this is exactly what I'm saying.

One of my colleagues is an attorney who works for my university's hospital, and we recently had a talk about the legalities/logistics of XPAP therapy. Here's the basic deal:

If your doctor wrote the Rx for a very particular model/mask and wrote "dispense as written, do not substitute," you may (just may) be out of luck. According to my attorney friend, even that is probably enough for a DME to permissibly sell you any mask.

If your doctor writes something very specific and does NOT write "dispense as written" it is certainly the case that a DME may sell you whatever you want.

If your doctor writes "mask." a DME may sell you any mask-device, including nasal pillows, FF masks, anything.

If your doctor writes "mask of patient's choice" or "nasal pillows, full face mask, or nasal mask of patient's choice", this legally means the same thing as "mask." It's just a way to try to placate insurance companies and work with mentally incompetent DMEs. It's a GREAT thing to have your doc write, but it legally means the exact same thing as "mask."

If your doctor writes a Rx just for a machine, a DME may STILL sell you a mask. How about them apples? The machine is legally considered the medication, the mask the delivery system (like an asthma inhaler and a spacing chamber). The Rx for the machine is the relevant part.

The information above deals only with the legalities of the Rx, not insurance coverage/payment. That is a very different ballgame, and insurance companies often demand very particular things on the Rx (in the hopes that we won't jump through the required hoops and they won't have to pay).

Now, here's where it gets sticky. You'll notice that I've used the word "may" above. That is to say, it is permissible that a DME sell to you. "Permissible" does not mean "required." They can refuse to sell you whatever they want, for whatever reason.

This is one of the reasons I buy through cpap.com. I have three different XPAP Rxs from three different doctors (mainly because I had an idiot doctor at my sleep lab write me a Rx for a brick without even talking to me, then a separate idiot specialist who also wrote a crappy Rx, and finally, my MD colleague who wrote a good one for exactly what I wanted). Cpap.com has one of my crappy 'scripts, because that's what I had uploaded at the time. And yet, they sell me whatever I want. Which is the legally permissible and appropriate thing for them to do.

[smurfyabs]

Idiots...what is so hard about writing "mask of patient's choice on a RX pad"?

I have a used Swift FX nasal pillow for her mask that I would be happy to send to you. Nasal pillows will be new though. I only have XSmall and Small though.
Silicone part of the headgear and short hose assembly are used but the back strap is new. Silicone discolors just a bit over time but it doesn't hurt it. Easy to wash though and color change isn't huge.
Just private message me your mailing address.

If you like it and want to keep it..consider it a gift. If you don't like it and won't be needing it all I ask is that you either return it to me so I can then offer it to someone else in a pinch or you yourself offer it to someone else. I hate to see them go to waste.

Ebay is also a source. If used mask freaks you out you can find new parts on EBay and build your own mask.
I just saw a buy it now price for the headgear and short hose assembly for $62...nasal pillows easy to find new for about $15 and sometimes less.

PS.....I do have pets in my household but they so far have never used my equipment and I have kept the gear in its own special bag. If that is of concern. I would of course clean everything thoroughly.

That is very generous of you! I will message you.

I ended up with the Profile Lite Gel Nasal Mask. We'll see how that goes tonight. It looks and feels much better than the first mask I had.

Thank you for all the feed back, this helps!

[zoocrewphoto]

You can ask any doctor to write a script for "mask of patient's choice" including your dentist.

This is a good point. My mom asked about getting a new mask, but her old prescription was expired, and she told the DME that she doesn't want to go back to the sleep doctor she had. They told her that any doctor could write the prescription. So, she was able to ask her regular doctor, and get the mask a couple days later.

[smurfyabs]

The respiratory therapist from my doctor's office called today. She apologized for not returning my call last week. I told her about my mask issues and that the machine I was given is a brick. She was completely appalled. She's going to make the doctor rewrite the script and submit a new order to my insurance for a mask fitting to allow me the mask of my choice and a good machine. Hopefully this will be a turning point for me.

My "new" mask has also been a nightmare. The bridge of my nose is very narrow and I cannot get a good seal. I did the boil to fit last night and I still get leaks through out the night. I don't think they're enough to matter, but it blows in my eyes and causes irritation. Sometimes it comes dislodged and I end up breathing through my mouth to escape the mask...which of course leads to me swallowing air. It's really not any better than the first mask.

Hopefully they'll get me straightened out. Because the doctor isn't in right now and the local provider only comes to my town once a week, it'll probably be next Thursday, but something has got to give. I have been unable to make it through the night lately...my best nights I make it until 5 am but some nights only until 2 am. I'm not happy with that and want it to be better.

Fingers crossed!!!

[chunkyfrog]

If my mask just insists on blowing in my eyes, I put on my swim goggles.
--way looser than in the pool, but it's enough.