I am so mad

NyNurse33 · Post by **NyNurse33** » Tue Sep 05, 2006 7:52 am

Ok, I just called my DMEs to ask about getting a new mask and getting a better machine. For those of you who don't remember, I had done really well with the ultra mirage II for the first few weeks and then suddenly developed leaks. This mask was a freebie and the mask they gave me was the flex fit (petite) and it just simply does not fit. Not much luck with the swift either (another freebie). They told me to get a script from my MD for a mask refit. This is understandable, I can live with that. But when I questioned why I was given the escape, they looked and told me that's what my MD put on the script. And why do I want the elite or vantage. I talked about being able to read my readings every am on the LED and she told me that's for their use, not for mine. That's part of the "service menu". And then she said she doesn't know if my insurance will pay for another machine. I'm only renting it and just finishing up my first month! GRrrrrrrrr. Last night, I decided to fool around with my mirage and shut the ramping off and put it on full pressure...10 I think to get the mask to fill out and then adjust the straps, I heard about doing that on here. Well I noticed right away that my ears started popping, I developed a headache and it just seemed like too much pressure, how could I have that going like that all night. That's why I think an apap is better. I ended up putting the ramp back on, so I could fall asleep, but I think that's when I begin to arouse again is after 20 minutes and its up to full blast. The mask fit better last night, probably because I fitted it according to full pressure. Does it seem that I can't do anything with my machine until the MD writes specifically for another type? I can't change what the MD wrote. I'm not seeing her until 9/29 for my first appt since I've had the cpap titration sleep study. I did call the office and asked that they send a script to the DMEs for a refitting of my mask. But didn't want to leave a message about the machine, I figured I'll wait until the appt. Any thoughts?

GoofyUT · Post by **GoofyUT** » Tue Sep 05, 2006 8:02 am

Tell em to come get their Escape, and that you'll use another DME who is willing to work with you. They'll start becoming more friendly. They know that OSA is a life-long condition and they're looking forward to soaking you for new machines, masks, hoses, filters etc. FOR THE REST OF YOUR LIFE! If you threaten to walk, and burst that bubble for them, you may find that they suddenly remember what customer service means.

Good luck!

Chuck

tmaiberger · Post by **tmaiberger** » Tue Sep 05, 2006 8:22 am

I just went through a switch in machines during the rental phase. I was originally given a S8 escape by resmed (interestingly, the doctor's prescription for the intial machine specifically noted c-flex, which is only on respironics machines). I did not make a big deal about the lack of cflex or brand of machine at the time becaue I did not get a copy of the prescription until after I had already started with the machine.

When I had my follow up with my doctor I told him I wanted an auto machine and a respironics one with cflex. He did not have a problem with writing the prescription exactly how I asked him (respironics auto with c-flex and heated humidifier).

Once I got this I went to my DME and they said they would have to order it specially, which they did. It took a little time, and they did not really want to do it, but (as advised to do here) I told them I will be on this probably forever and am not afraid to use my insurance benefits for supplies (hoses, mask parts, filters etc.) and they would certainly make their money off of me and my insurance company. That line of reasoning (pointing out that they will make money off you) seemed to work for me. They did end up swapping the machines and I signed a piece of paper noting that I had returned one machine and recieved another (the one I wanted).

Also, if the DME says your insurance company would present problems, ask them who at your insurance told them that, because most insurance companies code an APAP the same as a CPAP, i.e. it makes no difference to them at all. I would check with your insurance company to see if they code it differently, and if they do not and your DME says they do, then you know they are blowing smoke.

Hope some of this helps.

jum001 · Post by **jum001** » Tue Sep 05, 2006 8:31 am

I think the entire medical profession resembles deer in the headlights. They see change coming and are helpless to do anything about it. While that engenders sympathy, it is also maddening to deal with. Last week I went to a new doctor about another problem and there was a plaque in the treatment room saying something about only one of us being the doctor. Obviously didn't want any patient input. I left.

kavanaugh1950 · Post by **kavanaugh1950** » Tue Sep 05, 2006 8:53 am

tell them to fax you a copy of your script so you can go elsewhere to get your machine. thats what i did. they faxed me the script and called me 1 hour later to tell me they had spoke with their boss and she agreed to change out the machine for me. they had a whole attitude change at that time. if you get the elite you won't need another script. you may for the apap. they get paid the same for all c-paps as they are coded the same, they try to give out the cheap ones so they make more money. pat

Guest · Post by **Guest** » Tue Sep 05, 2006 8:57 am

Do you have a copy of your perscription? Chances are it said cpap, along with the pressure. Despite what your DME says, it probably didn't specify the Escape model

greyhound · Post by **greyhound** » Tue Sep 05, 2006 8:58 am

That was me.

chdurie2 · Post by **chdurie2** » Tue Sep 05, 2006 9:04 am

My Nurse:

1)Suggestion: it's usually not a good idea to tell DME's that you want to look at/play with numbers. 2) In terms of ramp vs. no ramp, it makes no difference whether you get apap vs. cpap--they both have ramping features, but on apap, it's called settiling. only difference may be that on an apap, the full pressure will start at the lowest number. realistically, i don't know if that makes much of a difference, since it ought to be only 2cms from your desired pressure. someone else can help here better than me because i don't use ramp/settling. but maybe your mask fitting dilemma will be persuasive in getting you an apap.but whether it's apap or cpap, you may need to put the ramp feature on 5 minutes to do a mask fitting, given your ear problem. 3) i don't think in NY a prescription is required to get a mask. 4) my guess is that if you want an apap through a dme, you're going to have to get that cleared through your sleep doc yourself. a dme has no incentive to get you an apap rather than a cpap because they cost more and i don't think they can charge more.

when you're new to cpap (or even if you're not), it's a good idea to try stuff out for more than one night to get out the kinks. cpap is an adjustment, as you're finding out.

i would love to agree with chuck's reasoning on why they should treat you better, but i think dme's know that most cpap patients are one-shot deals because most give up on the therapy within a short time of trying it. they should look at you as a lifetime gold mine, but i'm guessing that most don't.

good luck.

caroline

Vader · Post by **Vader** » Tue Sep 05, 2006 9:17 am

I do agree that you have to be assertive with your DME. Tell them what you want. If they aren't willing to accomodate, call a different DME and ask them if they can give you what you want. If they can, they'll call your present DME and say they are transferring your prescription, just like a drugstore would do if you changed an Rx there.

You can get what YOU want. I know it worked for me.
Good luck.

snoregirl · Post by **snoregirl** » Tue Sep 05, 2006 9:19 am

You need to get your prescription directly from your Doctor's office. Keep the original and give others a copy it doesn't expire. No need to see the doc, just go get your prescription that is in your file from the office staff, that was faxed to the DME. Chances are it didn't specify a machine type like someone above said. Staff may want to check with Doc but you shouldn't need an appointment for that.

You should have this script as well as a copy of your sleep study in your posession so you can control your treatment.

You don't just let the doc fax your pill prescription to the drugstore of his choice do you?? Same here.

You need to call your insurance yourself. Don't rely on what a DME is telling you your insurance will cover. I agree with the comment above that there is only one billing code for CPAP/APAP (E0601) and the insurance company won't know the difference between being billed for straight CPAP, cheapo CPAP or APAP. Mine didn't and it just got paid after 3 months rental (APAP). Long story and you can search it on this site if you care. And that was after insurance said they wouldn't pay for an APAP (deluxe machine they called it). They did because the code is the code and they can't tell the difference.

Take that machine back to the DME and tell them that you are going elsewhere if they don't give you what you need. Be ready to walk. As long as you have your script (I don't rercall if CPAP.com needs the sleep study -- check the site) and you can afford to buy yourself you can have a replacement in a day or two from Cpap.com. Get names of other acceptable providers from your insurance company first. Chances are there are a couple more local DME providers that your insurance will work with. Contact them first before you drop the $$ to buy with no insurance.

Worst case you are out $649 for buying the bundle Elite from Cpap.com, but more likely you can get another DME who will help you or this one will come to their senses beore they lose a sale and a supplies customer.

You can buy any mask you like with no prescription (just have to pay yourself) from CPAP.com.

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NyNurse33 · Post by **NyNurse33** » Tue Sep 05, 2006 9:27 am

Ok I am so confused, I just spoke with this RT I know who works for another DMEs that I am not using. She says she isn't aware that the elite gives patients a read out on the LED, but I've read on here that it does. SHe thinks it is a download. Am I mistaken? I called the sleep lab where the RT there wrote the script for the escape machine, according to the Lab. I'm going to ask her to change it to a respiratory componet machine, which is what all of you and my RT friend says is better.

Vader · Post by **Vader** » Tue Sep 05, 2006 9:28 am

I just checked with my sleep center.
The CPAP Rx, is good for life. It can be transferred anywhere you want, even if you move to another state.
They further reiterated that if a DME doesn't give you what you want, you should definitely go somewhere else.

Again from my own experience, some DME's tend to lie about what the insurance company may or may not cover .

snoregirl · Post by **snoregirl** » Tue Sep 05, 2006 11:02 am

I am sorry that I can't help you with what you can read on the Resmed machines (since I have Remstar) without software. Maybe if I bump this up someone with the Elite can chime in and verify what info you can get.

I do remember reading posts from folks on Resmed machines that talked about the machine resetting data at noon. I wonder if that is why the RT you spoke with didn't know there was data? What are the chances of her actually seeing this data (before noon on the same day) unless she is a CPAP user. This wouldn't surprise me given the level of competance I have experienced with the RT's that I have dealt with.

I also do not know what a " respiratory componet machine" is that you mention you want to have your prescription rewritten for. Maybe someone else can explain this one since I am curious.

I assume you have now verified that the original script actually did say "escape"?

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Bob... · Post by **Bob...** » Tue Sep 05, 2006 11:04 am

NyNurse33 wrote:Ok I am so confused, I just spoke with this RT I know who works for another DMEs that I am not using. She says she isn't aware that the elite gives patients a read out on the LED, but I've read on here that it does. SHe thinks it is a download. Am I mistaken? I called the sleep lab where the RT there wrote the script for the escape machine, according to the Lab. I'm going to ask her to change it to a respiratory componet machine, which is what all of you and my RT friend says is better.

You can read this on the S8 Elite LCD:

Pressure
Leak
AHI
AI
HI

These are shown in:

Daily
Weekly Average
Monthly Average
6 Months Average
Year Average

I use an S8 Elite every night and I check these numbers every day.

Bob

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CPAPopedia Keywords Contained In This Post (Click For Definition): AHI

chdurie2 · Post by **chdurie2** » Tue Sep 05, 2006 11:15 am

yes, but to do that, don't you have to go into the clinical menu? on my vantage, you do. not a problem for most of us, but it's not in the patient menus either. that's why you're borrowing trouble to talk to a dme about looking at numbers, imo.

caroline

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