New to this. Trying to figure it out.

[yaconsult]

Might as well get the "For Her" version of the autosense 10 as it contains an additional mode and the price is exactly the same. It will give you one more options in your treatment. And also have the doctor specify the optional heated hose as it gives you a much better range of humidity settings.

You can read all about it on our sponsor's site here: https://www.cpap.com/productpage/resmed ... idair.html

[manwe]

Welcome! I love your brevity.

Next step. Call insurance company. What do they pay and how do they do it? Rental? Pay outright? In network, what are your options for DME? Can you buy online and get out-of-network reimbursement?

Look up and write down the names and model numbers of the 5 or 6 machines that provide actual data.

Go to Sleep Center and get a copy of your sleep study, not just the summary.

Thought I replied to this earlier, but I guess not. Thank you for the warm welcome. I had one question. How can I tell the difference between the "sleep study" and the "summary". The print out I received from the PCP was several pages long so I guess I assumed it was the whole thing and not just a summary. Maybe that was incorrect.

[Julie]

No, you're correct - the one pg summary doesn't go into details necessary for us to help much.

[manwe]

5) Call your insurance company and see which DME's in your area are in network for them. At this point, an out-of-network DME will be a real hassle. While on the phone, ask about whether and how they reimburse for purchase rather than rent-to-own. Some insurance companies will do rental for the first 30 days until you prove compliance and then authorize direct purchase so the DME billing hassles are over in two months. Others, just go for 13 months rental and then you own the equipment.

So I talked to a representative at my insurance company. She said I was covered 100% in network since I already maxed my out of pocket for the year (wheeeee). She suggested three in network DMEs in my area:

APRIA Healthcare

American Home Patient

Lincare

I asked about out of network and online, but she kind of danced around the questions with a "sure you can use them but your coverage might be different". I should have probably pressed the issue, but since they are paying 100% in network I figured I can probably stick with that.

I asked if there were any restrictions on which machine I was covered for and she confirmed that there was none. I asked about whether they require a rental period and she said that depended on the specific DME but that all rental fees would be covered as long as they did not exceed the purchase cost and warned me to make sure that they didn't exceed that.

So, it sounds like I'm pretty good as far as the insurance goes as soon as I get my prescription sorted out. Any opinions on those three DMEs ? Especially from anyone in the Tampa, FL area that might have dealt with these branches specifically. I think I've heard Lincare mentioned in some other posts so I assume people have some opinions about them at least.

[LSAT]

There are people on this board that have had problems with all 3 of the choices...especially Apria. Since you are covered 100% there is NO REASON to give any of these DMEs your credit card number. They will try to get it and if they do, you may start getting strange charges. Be specific on what machine you want. You don't have to take the mask your doctor prescribed. You can try on as many masks as you like and take the one that is the most comfortable. Normally the DME will allow you to make an exchange within 30 days of receipt of the mask.

[manwe]

So now I'm a little concerned. Here's the response I got from my PCP when I asked for the prescription to be written for the specific machine.

"Thanks for your input , I have ordered the CPAP machine that the Sleep Center has reccomended and I just go by what they advise as I am not the Sleep Apnea Specialist and do not know much about the various machines that are out there , You can contact the XXXXXXX where you had your sleep Studies done as they are processing the order for the CPAP machine and discuss with them and see what they have to say about its suitability or not the alternative approach is to see the Sleep Specialist Dr XXXXX who has read your sleep study and see what he has to say about it , Thanks"

I've never met with or spoken to Dr. XXXXXX (names removed by me) so I don't feel great about the likelihood of that going well. Not sure what to do now.

[LSAT]

Your insurance pays the same amount to the DME regardless of the machine they give you. Naturally some DME's will try to give you the machine that costs them the least. Talk to the sleep specialist.

[manwe]

I called the sleep center this morning and they said they had "already ordered" the only machine I was prescribed which was a CPAP. I said I wanted an APAP and only certain models and they explained that an APAP was different than a CPAP (I knew that). They told me I would have to talk to my PCP if I wanted anything different, which as you can see from my previous interaction with my PCP, would be useless. So I tracked down the Sleep Doctor and called his office. They had no record of me, but were willing to schedule an appt for me to come in and talk to him. I have to take the printout of the sleep lab results since they don't have it. I have that appt scheduled for tomorrow so we'll see how it goes. I still haven't been able to get a copy of the prescription for myself yet. I'm hoping the Sleep doctor will write me a new one. Hopefully he doesn't send me back to my PCP again.

The journey continues...

[manwe]

Ok. I uploaded the report details to photobucket. Hopefully these show up ok. I tried to get them in order for the most part. I have an appointment with the Dr. to review them and try ton convince him to write a prescription for a specific machine tomorrow evening. Any ammo you can give me to convince him would be appreciated.

[manwe]

Sorry for bumping my own thread, but I'm hoping someone might have some advice before I meet with the sleep doctor later this afternoon. Any suggestions on how to approach my Dr. about getting a more specific prescription written?

[palerider]

well, the 'recommendations' are pretty stupid "use caution when driving if sleepy" dur..

10 left you >< that close to 'untreated' in medical perlance, and with a crap ahi. (4.9) it's clear that the titration is was taken to the 'well, it's just (barely) good enough, NEXT!' level, and to get rest, you're going to need more adjustment.

[HoseCrusher]

If I were meeting with the doctor this afternoon...

I would write out the way I want the prescription written.

I would then, on a separate page, write down a justification for each key point of the prescription.

After handing these to the doctor I would then ask, "Is there any medical reason not to do it this way?"




Remember, you hired the doctor to provide expertise in an area that you don't know much about. When you hired your doctor, you reviewed his/her qualifications and felt he/she would be a good addition to your medical advice team. Since you haven't been to medical school you hire an expert to help you make decisions about your health.

It is all a matter of perspective...

[manwe]

I think I'm good now. Things went really well with the Sleep Doctor. He was easy to deal with and wrote the prescription specifically for the "ResMed AirSense 10 AutoSet with heated humidity and heated hose with advanced data capabilities". The only hangup was that I didn't have a copy of my original sleep study (take home machine) which they said they needed so they are getting that from my PCP. I'm supposed to be contacted by a DME by the end of next week. They said they did not recommend I go with any of the ones BCBS recommended though because "we've had a lot of problems with them". They claim that the one they will send me too is in network for BCBS and it's a lot easier to deal with. We'll see how that goes.

Anyway, one step at a time. Seems like I'm on the right track now at least.

Thanks again for the advice.

Rob

[palerider]

I'm supposed to be contacted by a DME by the end of next week. They said they did not recommend I go with any of the ones BCBS recommended though because "we've had a lot of problems with them". They claim that the one they will send me too is in network for BCBS and it's a lot easier to deal with. We'll see how that goes.

I'd say that's a red flag to check with your insurance company to verify coverage with that DME.

[manwe]

I'm supposed to be contacted by a DME by the end of next week. They said they did not recommend I go with any of the ones BCBS recommended though because "we've had a lot of problems with them". They claim that the one they will send me too is in network for BCBS and it's a lot easier to deal with. We'll see how that goes.

I'd say that's a red flag to check with your insurance company to verify coverage with that DME.

Yeah, I will definitely do that as soon as I have the name of the DME.