Really PO'd now!

Nenetx2004 · Post by **Nenetx2004** » Mon Feb 28, 2005 10:53 am

I just got off the phone with my ENT who prescribed straight CPAP. Not seeing a significant change in my fatigue level, I asked about an autopap which has been highly recommended by the incredibly well-read and up-to-date folks here on the forum. Rather than answer me, he sent me to have blood work done. Got that back and everything was normal. Called again this morning and I was told that the doc doesn't prescribe autopap.

Now he wants a follow-up visit in 3 weeks. My fear is that he's going to try and persuade me into having surgery (NOT!!!!). What could possible be his reason for not wanting to prescribe an autopap? And does anyone know of a doctor in the Austin, Texas area that would? At this point, I might as well go the "out of pocket" route rather than hassle with insurance docs, etc., etc.

Jeanne

LDuyer · Post by **LDuyer** » Mon Feb 28, 2005 11:06 am

Gosh, that is awful, what's happening to you.
Definitely find another doctor. Sorry, I'm not from your area, but maybe someone will respond. But is there a sleep study clinic somewhere? Maybe affiliated with a hospital like mine was? Calling them for a referral might be good. In your situation, and without a direct personal referral, ANY referral might be preferable to that person. Worth a try anyway.

Good luck, and let us know how it turns out. I know I'm curious!

Linda

meister · Post by **meister** » Mon Feb 28, 2005 11:08 am

Certainly you can request a "2nd opinion" and your insurance company
should cover it. It is customary and reasonable. Surgery should be your
very last resort. Don't go the surgery route until you have tried AutoPap,
BiPap, and Dental Device. Since it can take 2 or 4 months to see PAP
actually work, you should not move forward on surgery before June!

Guest · Post by **Guest** » Mon Feb 28, 2005 11:10 am

when you bill, there's one code for cpap. so the company gets paid the same amount for a basic cpap as for an autopap but it has to pay more to the manufacturer for the auto than for the basic. This makes companies want their customer sto have basic cpaps and not the autos.

LDuyer · Post by **LDuyer** » Mon Feb 28, 2005 11:16 am

meister wrote:Certainly you can request a "2nd opinion" and your insurance company
should cover it. It is customary and reasonable. Surgery should be your
very last resort. Don't go the surgery route until you have tried AutoPap,
BiPap, and Dental Device. Since it can take 2 or 4 months to see PAP
actually work, you should not move forward on surgery before June!

Jeanne, I agree with Meister. And I bet Guest is right. But my doctor prescribed a bipap and my insurance took it. I don't know, but he probably had a good argument for it for me (high pressure and hypo ventilation). Still, I'd say it's time to get real agressive. I would start getting on the phone and calling around, ask questions, find pulminary doctors, a clinic, or a local organization which might make a referral. Do you have to go through a doctor from an insurance list? Look for a specialist there and demand a doctor's referral. It's your right. Don't give up. Ask away. And if you are put off, just keep trying. It may be worth it.

Good luck.

Linda

Ionizer · Post by **Ionizer** » Mon Feb 28, 2005 12:21 pm

Gee guys,
Didn't this question get asked and answered a week or so ago. I believe the answer Waverly, chrisp and Wader and others gave was something like this.

"Just get any ol Rx for a cpap and go to cpap.com . You will have your new auto unit in a few days . Why go thru all the heartache dealing with your Doc. Just go around him. " Not exact quote but close enough.

Stop boo hooing . You were advised the best way to go about this.

Those that refuse the lessons of history are doomed to repeat it.

Sorry this is a bit harsh . Some just don't listen.

Ready, Aim, Radiate

Ionizer

Nenetx2004 · Post by **Nenetx2004** » Mon Feb 28, 2005 12:38 pm

Gosh, I'm so stupid. Thank you so much for pointing that out to me because I was way too dumb to read that topic.......NOT!!!!!!! I need to get the prescription, dipwad! The DME can't release the old prescription because I've changed insurance companies. My primary care physician hasn't returned my call.

It must be nice to feel so much more superior over the rest of us. Thank you so much for being so supportive, you twit!

Jeanne

Liam1965 · Post by **Liam1965** » Mon Feb 28, 2005 1:14 pm

Wow, that's a new one. I've had trouble getting a hold of my prescription, too, but not because anyone said I CAN'T have it, just that they're going to make me jump through hoops to get it. I'm pretty much figuring when I have my follow-up visit with the sleep doc, I'll tell him about the problems I'm having, and that I want my prescription.

Since the prescription was not written by the insurance company, it would seem to me that they're lying through their teeth to you.

Good luck!

Liam, superior to no one, except maybe the lake.

Nenetx2004 · Post by **Nenetx2004** » Mon Feb 28, 2005 1:28 pm

According to TX law, once a prescription has been filled, it can't be released to be filled elsewhere. Now that doesn't apply to prescriptions that are for a years worth of medication. It's the "one shot" deals that it applies. So if my doctor wrote a prescription for 12 antibiotic pills, I couldn't have it filled and then have it filled again at another pharmact. I had asked if this applied to DME's and they confirmed it. The insurance company has been billed. Now if someone can quote me the TX statute that contradicts this, I'll demand my prescription.

Jeanne

chrisp · Post by **chrisp** » Mon Feb 28, 2005 1:32 pm

Just ask your Doc for the Rx so you can purchase a spare for travel, your lake house, the houseboat, your safe deposit box. Whatever. Just ask for it.
And fax it. Keep the original. Its yours. just like eyeglasses.

Cheers,

Chris

snoozin' · Post by **snoozin'** » Mon Feb 28, 2005 1:33 pm

Could you possibly get a COPY of the prescription - Say you need it for tax records or something?
If you order online, you fax it in anyway, so a copy should work.
Asking the DME or the doctor just for a COPY, not the original prescription, might be one way around the restrictions.
Debbie

gailzee · Post by **gailzee** » Mon Feb 28, 2005 1:39 pm

I don't live in tx. but NJ. So if a state has regulations that are contradictory it's here. Nonetheless, you can ask/receive a copy of the prescription. I ONLY rec'd a copy of the revised autopap scrip. Dr. office was ''reluctant" they all refer to HIPPA laws now, etc. So sign a release form (ask 'em they have 'em) or best yet, if the dr./DME isn't far, go there in person. The squeaky wheel always gets the grease.

Then fax or mail it to cpap.com. They can fill it from that. They are very good to deal with, stand behind you, ask/ans. questions.

Don't let anyone yell at you, we're all here to help and walk thru the cpap obstacles, we've all tripped on when a newbie, that's for sure!
PS--be careful of surgery, it's always last resort option.

Good Luck!

Nenetx2004 wrote:I just got off the phone with my ENT who prescribed straight CPAP. Not seeing a significant change in my fatigue level, I asked about an autopap which has been highly recommended by the incredibly well-read and up-to-date folks here on the forum. Rather than answer me, he sent me to have blood work done. Got that back and everything was normal. Called again this morning and I was told that the doc doesn't prescribe autopap.

Now he wants a follow-up visit in 3 weeks. My fear is that he's going to try and persuade me into having surgery (NOT!!!!). What could possible be his reason for not wanting to prescribe an autopap? And does anyone know of a doctor in the Austin, Texas area that would? At this point, I might as well go the "out of pocket" route rather than hassle with insurance docs, etc., etc.

Jeanne

wading thru the muck! · Post by **wading thru the muck!** » Mon Feb 28, 2005 1:50 pm

Nenetx2004,

Ionizer means well, he is just VERY direct with his comments. This type of prescription is different than one for meds. You don't need to get a new prescription for eyeglasses just to get a new pair. If so, the optical people would be rich. This is the same as that. You can't use two machines at once so there is no harm in having two. I got two machines with one prescription and I made the purchase in TX. Someone is feeding you a line of TX bull!

Nenetx2004 · Post by **Nenetx2004** » Mon Feb 28, 2005 2:09 pm

Thanks Wader. I'll try again but I've had two different sources tell me otherwise. I'll make another stab.

As far as Ionizer is concerned, I wish I had all the time in the world as he does to track everything that goes on in this forum. However, with a full time job plus a heavy teaching schedule at a karate school I don't have that luxury. I always think it's interesting that the people who are "direct" but "mean no harm" are the ones who are not registered members.

Gail, I'm familiar with all the HIPAA stuff. I'll keep trying until I get some answers.

Jeanne

FL andy · Post by **FL andy** » Mon Feb 28, 2005 2:46 pm

Nenetx2004,

Since you TEACH karate my post is going to be nice... very nice!

I agree with most of the group. In Floriida I just give the DME a copy of the Rx and keep the original. I have to believe you will quidkly find another doctor to give you another CPAP prescription. Then have it filled thru cpap.com because when you compare cost of rental for two years to buying your equipment, you not only get the exact machine and mask you truly want, you don't spend a lot of extra money. Maybe some extra, but not a lot.

As long as you will see a second doctor, why not be sure he or she is Board Certified in Sleep Disorders or at least is a pulmonary doctor. This way you have quicker access to a really good and knowledgeable doctor if you need one in the future.

Good luck and best wishes, Andy

Really PO'd now!

Really PO'd now!

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