Can Apria legally give me the book used by the clinic people

dllfo · Post by **dllfo** » Mon May 22, 2006 6:02 pm

I have the Respironics Auto Bipap machine. Got it from Apria. They have been
great so far.

If my health allows, we are leaving town for 6-8 weeks. I wanted the same manual the people in the clinic use to change the settings on my machine.

1. Does Respironics ship these "clinician's books" with each machine?

2. Can you and I, as customers and users, legally have the book with the
codes, etc. in it? Is there a law against us having it?? Apria called me
today, saying they have a prescripion in for my machine to be changed
and for me to have a manual. I told the nice lady I had already
changed mymachine and have they sent me my manual? She said yes,
we have sent you the manual. I asked her if it is the manual used by
their people for making changes in the machine or is it another "users
manual"? She said is is the users manual. I told her I already have
that one, the doctor said I could have the one with the description of
how to change the codes. I explained I would be out of town for weeks
and might need to make my own changes...WITH the doctor's
agreement. The nice lady said she was NOT authorized to give a
customer THAT book. I asked her who had the horsepower to make
that decision? She did not know. I called the head of Customer Service
who has been so helpful before. She has not called back yet.

What say YOU??? Is it "illegal" for me to have a copy of it??

Did this "clinician's" book come with my machine and they kept it out or is
this some special book Apria has to buy for themselves?

Goofproof · Post by **Goofproof** » Mon May 22, 2006 6:18 pm

The book is shipped with the machine as is the bag and hose, you pay for it all, you didn't let them take the hose, did you? They aren't thieving the book in your interest, they are taking it for two reasons, they want to sell it, or they want to keep you in the dark on how to set your machine, so they can charge you to do something you can do for yourself. Jim

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DME_Guy · Post by **DME_Guy** » Mon May 22, 2006 6:27 pm

CPAPs and BiPAPs both require an RX and also requre an RX to change the settings. Apria can't legally give the clinician manual away, only the users manual. Apria can't legally sell the manual either.

snoregirl · Post by **snoregirl** » Mon May 22, 2006 6:37 pm

Whether or not they can legally sell it is a question I don't know, but I do know that someone sells them on ebay.

When I bought a book (ebay) for my Remstar Auto, it was the actual book, not a photocopy. So these books are coming from somewhere (probably from our machines).

I picked up my auto today (bought the book a couple weeks ago knowing I would probably have trouble getting it from Apria) I forgot to even ask for it. I was more worried that I got all the other parts that should be coming to me and the billing was written as I had been told.

Oh well.

My advice is to go to ebay and buy your manual on there. Mine came very quickly from some woman in Canada. $6 is nothing compared to all the rest of the costs and also to have the peace of mind that you can do what you want with YOUR machine in the future. $6 to feel happy that you can thumb your nose at Apria and never visit them again.

Yes it is annoying that someone is taking your stuff, but at least there is a solution that ends up giving you what you really want with a very minor cost.

Wulfman · Post by **Wulfman** » Mon May 22, 2006 6:48 pm

If you buy your equipment from CPAP.COM, ALL of the manuals are included.

Den

dllfo · Post by **dllfo** » Mon May 22, 2006 7:35 pm

DME guy---IF the book was included in my original package and IF Apria removed it...they have a choice...send it to my doctor or I will call the state
of California to insure they don't sell it anywhere else.

AND my wife goes in for her Sleep Apnea test Wed pm. If she needs a machine I will certainly consider buying it online if I get EVERYTHING
included.

Apria might get to keep my book, but it will be an interesting battle to see how
in the heck they say my pulomologist can't have it.

It would be dumb of them to fight about it.

If it is a legal thing, they can send it to my doctor and I will buy on line. If Tricare paid for it, I should get it. Whether from Apria or my doctor.

DME_Guy · Post by **DME_Guy** » Mon May 22, 2006 7:55 pm

I just looked at my clincian manual for my Remstar Auto and it doesn't say anything about not giving it to the patient. I'll check with my rep to see what the actual law is. Maybe it isn't illegal. I know that's what I've been told but I can't find any proof of it.

RedThunder94 · Post by **RedThunder94** » Mon May 22, 2006 8:16 pm

mine is a downloaded version of the clinician manual, it does say in the book to not leave the setup manual with the patient to keep them from tampering with the therapy, i doubt it is a legal issue, it's prolly just a C.Y.A. type thing, who knows.

pratzert · Post by **pratzert** » Mon May 22, 2006 8:17 pm

How many of these set-up manuals does Apria, or any other DME, have to STEAL before they can learn how to set the same machine over and over again? If they are THAT DUMB that they have to read the same book every time to set the machine, I worry a great deal about their competence to touch the machine in the first place.

I liken it to the Car dealer stealing your owners manual from your car when you buy it.

Then, they demand that YOU pay them to show you how to change the turn signal bulb.

YES.... either YOU or your INSURANCE company PAID for that Book.... they have absolutely NO business STEALING IT !!!!

If it were truly "illegal" to let the patient or the person who PAID FOR IT to have it, then I am positive cpap.com would also set the machine and remove the book, OR, ship the machine wihtout the book and tell you have have to have an "authorized person" set your machine. We all know that does not happen.

dllfo · Post by **dllfo** » Mon May 22, 2006 8:32 pm

Well, it will get interesting tomorrow. I will call Apria and ask them for the
manual. They can send it to my doctor if they want, but after that I intend
to call Tricare and ask their legal department if Apria should be allowed to
remove our smart cards and sell them again. My guess is, that is NOT in
the contract and Apria will be in violation of their contract with the US Govt.
Not a fun place to be. $$$$$$$$$$ in fines and probably the loss of the
contract.

I am not mad at anyone, just frustrated that they are playing a silly game.
If anyone thinks we are NOT competent, I certainly understand that. Without
the training, their people are like us. BUT they could EASILY ask the buyer
to sign a waiver or something. I don't mind that. I have already told them
I changed my auto bipap. The lady today was all smiles when she called, saying my dr. had faxed over a change to my settings. I told her I knew, I
had spoken to him last Friday and didn't want to wait all weekend on them,
so I learned how to change it myself. SILENCE on that end. She explained
to me I could injure myself and I told her I agreed, but this was so simple
my grand son could do it. She was nice, but I think she realized they had
lost some money. Not much, but probably $50-80 I bet.

I also would like to purchase my wife's unit...IF she needs one on the internet so I can save the govt money and get all the manuals. AND I will
tell Apria that.

All Apria should need is a statement from me that I am making my own
changes to the machine....and they have a verbal on that.

Odd game going on here. It makes me wonder if upper mgt knows what
is going on "down stairs."

Let me tell you...TriWest handles our medical right now. My wife went over
to Tricare/TriWest on April 1st. We called them, we told them and today,
they said she was NOT in their system as having Tricare as the primary
medical plan. I was told my wife has to call. I was told it takes 3-5 days
for the info to get into the system.

I told them it would happen today, let me speak to YOUR supervisor. The
supervisor said she could not do it. Let me speak to YOUR supervisor.
On the 4th supervisor the clouds parted and when I explained to her we
had waited 52 days for them to get off their rear ends, she agreed and it
happened. She also told me where to find the forms so I can handle this
for my wife (she hates this stuff). I faxed that in today also.

SOMEWHERE in Apria, there is a supervisor who can see the ramifications
of smart cards being taken out and sold, booklets being sold on the internet
and so on. It would be criminally stupid to go to "war" over a smart card and
some manuals. Talk about dumb!!!!!!!!!!!!!!!!!!!!

To their credit, when I called them on it, they sent me my smart card.

dllfo · Post by **dllfo** » Mon May 22, 2006 9:16 pm

I looked on Ebay for the Respironics Auto Bipap manuals...I did not see one.
Lots of other machines though. Maybe I didn't search right.

Has ANYONE reading this bought a Respironics Bipap machine on the internet?
I would be curious to see EXACTLY what IS in the box when Respironcics ships
it out.

As I said earlier, if my wife needs a machine, I was going to use Apria, but if
they are keeping items from us, I need to see what my options are. This is
a shame, I really appreciated the way Apria got my Auto Bipap over to me,
that was great. I even wrote them a letter of appreciation for such fast service.

rested gal · Post by **rested gal** » Tue May 23, 2006 12:09 am

dllfo, if you can get your doctor to order the DME to give you the "Homecare Provider Setup Instructions" for your machine, that is the "clinician manual".

They shouldn't hesitate to give it to you, or have any legal problem about giving it to you, if your doctor tells them to do so. He might have to write it out on an Rx pad and fax it to them, so that they know it came from him. Or perhaps they'll want to call him to confirm it if you bring it in yourself.

The reason the setup instructions booklets are withheld is probably because of this note which appears in the clinician manual for my Respironics REMstar Auto with C-Flex:

"Important! Prescribed therapy settings can only be set using the Therapy Menu. To prevent patients from tampering with the settings, do not reveal the directions to Therapy Menu access to the patient."

Gotta love the word "tampering"... like talking about a small child pushing buttons on a VCR.

I don't doubt there are people who should not mess with a VCR, much less their CPAP machine settings. But if your doctor is willing to trust you with handling your own settings and will tell the DME to give you that booklet, they shouldn't balk.

Here's an interesting study, by the way:
Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure? Published: American Journal of Respiratory and Critical Care Medicine Vol 167. pp. 716-722, (2003)

The answer was, "Yes."

NightHawkeye · Post by **NightHawkeye** » Tue May 23, 2006 5:14 am

dllfo wrote:Has ANYONE reading this bought a Respironics Bipap machine on the internet? I would be curious to see EXACTLY what IS in the box when Respironcics ships it out.

I bought a BiPAP-auto from CPAP.com the end of last year, Dave. It included all manuals, hose, carrying bag, filters, humidifier, couplings, and probably some other stuff that I don't remember.

It was nice to get the provider's manual although you really doesn't need it if you've gotten the "secret" access instructions. The provider's manual doesn't really add very much. You'll still have lots of questions after you've read the entire manual.

Regards,
Bill

dllfo · Post by **dllfo** » Tue May 23, 2006 12:54 pm

The lady from Apria called. The reason they haven't given me the clinician's
manual is........mine is still considered a rental.

If I had bought it, she said I could have the manuals. And if they can, they
will send me one this week.

I told them that was great.

For all the manuals I have seen listed for sale, the clinician's manual for the
Respironics Auto Bipap was not among them...unless I missed it.

Bill, thanks for the info. I found a website that sells the Respironics Auto
Bipap for $999. That is a few hundred cheaper than most. And they said they
would include ALL manuals.

Miss Rested Gal...thanks again, I will read that later today. You are right
about "tampering". One person at Apria told me I needed to have some
experience with electronics. I told him I held the highest rating for a ham operator, Extra class, so that should tell him I have at least a basic understanding of electronics. Does that help? Silence on that end. I do
understand their concern for liability and have already offered to fax them
a release of liability. More silence. We will see....the guy said no one had
ever asked for the clinician's manual before.

They KNOW I have the codes to make changes. I told them I did. I told
them I changed my settings to what the doctor wanted. I told them I do
NOT hold them liable. The only valid reason I can see is that it is a rental
for two more months. It is NOT going back. This machine is wonderful.
As I said earlier, it is good enough to convince my wife to finish her sleep
apnea test. Her first test was at home, about 3 years ago. A mess. But
after seeing my improvement she takes her test tomorrow night.

I also think reading the comments on this forum helped convince her to go
for it. She is not into forums, but this one interests her. Thanks to the
great group we have.

snoregirl · Post by **snoregirl** » Tue May 23, 2006 1:14 pm

That is interesting about them telling you you can't have it because it is a rental. That gives me an idea. Thank you!!!

Since I procured the manual elsewhere and don't REALLY need it, but want it out of general principle, I think I will wait until my unit is "purchased -- should be 3 months). I want to be a little careful in ticking them off until I have passed the compliance. Just in case anything is questionable and they have any say in discussions with insurance co.

DME told me that the 4 hrs a day I need for compliance doesn't have to be continuous. I am skeptical. I got up to use the bathroom last night (first night) and shut the machine off so it didn't disturb my husband. Then back on again. I wonder if the 3.5 hrs and the 1.5 hours after that (have to get up early to get high schoolers out) is still compliance. I got a 2 hr nap also at 8am. If they didn't lie it is ok, but if I have to have 4 hrs straight?? They will have the data to see the ons and offs not just the led screen that say how many nights at 4+ hours. I don't know if all that goes to the Insurance co or not.... Hate to get them really mad if there is any explaining of data to be done to insurance....

Then, I will hit them up for the manual and hope that they haven't "lost" it. If they have I will insist that they go procure me another one.

That will be an interesting conversation.

Thanks for the idea. The lack of MY manual is bothering me even though I have one. I am a person who doesn't like to be taken advantage of.

As for the electronics experience comment, just let them try that one on me. I think many of us her on this forum have more technical experience than most DME personnel including RT's.

Machine