UPDATE: My quest for MSeries APAP over

[TossinNTurnin]

Update:

(synopsis: I had been given an Mseries PLUS by my DME. When I went to my doctor about "upgrading" to the MSeries PRO, I found out the original prescription HAD specifically asked for the PRO and said "NO SUBSTITUTIONS". So the doctor's office called the DME to get it that rectified. And the DME had to special order the PRO machine. But, I wanted to upgrade to APAP anyway. The doctor was reluctant because I only needed straight CPAP/C-flex and not APAP/A-Flex.)

Today: I just talked with my sleep clinic's/Neurologist and I think I've FINALLY talked them into changing my cpap prescription to the MSeries AutoPap with Aflex from the MSeries Pro. (Although they sort of verbally chastised me for "changing the machine again".)

I had gone to the doctor on this past Friday (1/18)... and the doctor DID convince me that straight CPAP and Cflex is the best therapy for me. So I was going to accept the PRO.

However, after asking for a copy for the original prescription, I did find out that doctor HAD specifically prescribed the MSeries PRO over the PLUS (No substitutions), yet the DME downgraded me to the the MSeries PLUS. Even when I asked the DME (not knowing at the time what the doctor had prescribed) who is responsible for choosing the MSeries Plus over the MSeries Pro for me -- the DME said the doctor did. So they definitely mislead me.

Anyway, presuming that the doctor's office has called the DME to change the script from MSeries Pro to MSeries APAP/AFlex... I'm expecting a call from the DME soon.

I'm wondering if they're going to try and give me a hard time.

But, at this point -- screw them. They mislead me. Whether they were too stupid to know the differences between the PLUS/PRO, or if they intentionally lied -- that's their issue/responsibility.

Today, I told the doctor that I wasn't asking to change my therapy (CPAP/CFlex -- APAP/AFlex), but since my insurance won't pay for a new machine for 3 years and we can't know what the future holds, ... and since it won't cost ME any more, I simply want the machine with the most options. I've shelled out close to $500 in deductibles, I want the most options for my money.

So the doctor agreed. Until I actually get the APAP machine in my home... I won't say this is a "done deal", but it's looking good.

Once again, I want to thank all of you for helping me out.

[Slinky]

Congratulations, TNT, for making it this far. Will be keeping my fingers crossed that things go thru as planned and the auto w/A-Flex ends up in your posession!!!

We can give the best advice in the world, but it is up to you, the patient, to be ablel to follow thru and make it work. YOU DID A GREAT JOB!

[Wulfman]

Sounds good so far......hang in there!

Den

[TossinNTurnin]

Congratulations, TNT, for making it this far. Will be keeping my fingers crossed that things go thru as planned and the auto w/A-Flex ends up in your posession!!!

We can give the best advice in the world, but it is up to you, the patient, to be ablel to follow thru and make it work. YOU DID A GREAT JOB!

_________________

Thanks Slinky. You've been particularly helpful not only on this board but through PMs. You've spent a lot of time with me, and I want you to know that I'm truly grateful.

If for some reason, I'm "stuck" with the Pro... I STILL wouldn't have even gotten that if it wasn't for the advice to make sure I end up with a machine that provides the AHI, snore and leak info. I never would've known to push for my Sleep Study records... which allowed me to see that the DME gave me a different machine from the one that was specifically prescribed.

Thanks

[engrdad]

Congrats on the fight. It really is a fight for most of us, isn't it. Standing up for yourself and the best equipment to improve your health is a goal worth fighting for. Best of luck.

[stevoreno]

[quote="TossinNTurnin"]Update:

(synopsis: I had been given an Mseries PLUS by my DME. When I went to my doctor about "upgrading" to the MSeries PRO, I found out the original prescription HAD specifically asked for the PRO and said "NO SUBSTITUTIONS". So the doctor's office called the DME to get it that rectified. And the DME had to special order the PRO machine. But, I wanted to upgrade to APAP anyway. The doctor was reluctant because I only needed straight CPAP/C-flex and not APAP/A-Flex.)

Today: I just talked with my sleep clinic's/Neurologist and I think I've FINALLY talked them into changing my cpap prescription to the MSeries AutoPap with Aflex from the MSeries Pro. (Although they sort of verbally chastised me for "changing the machine again".)

I had gone to the doctor on this past Friday (1/18)... and the doctor DID convince me that straight CPAP and Cflex is the best therapy for me. So I was going to accept the PRO.

However, after asking for a copy for the original prescription, I did find out that doctor HAD specifically prescribed the MSeries PRO over the PLUS (No substitutions), yet the DME downgraded me to the the MSeries PLUS. Even when I asked the DME (not knowing at the time what the doctor had prescribed) who is responsible for choosing the MSeries Plus over the MSeries Pro for me -- the DME said the doctor did. So they definitely mislead me.

Anyway, presuming that the doctor's office has called the DME to change the script from MSeries Pro to MSeries APAP/AFlex... I'm expecting a call from the DME soon.

I'm wondering if they're going to try and give me a hard time.

But, at this point -- screw them. They mislead me. Whether they were too stupid to know the differences between the PLUS/PRO, or if they intentionally lied -- that's their issue/responsibility.

Today, I told the doctor that I wasn't asking to change my therapy (CPAP/CFlex -- APAP/AFlex), but since my insurance won't pay for a new machine for 3 years and we can't know what the future holds, ... and since it won't cost ME any more, I simply want the machine with the most options. I've shelled out close to $500 in deductibles, I want the most options for my money.

So the doctor agreed. Until I actually get the APAP machine in my home... I won't say this is a "done deal", but it's looking good.

Once again, I want to thank all of you for helping me out.

[TossinNTurnin]

Is there a good chance if a patient asks his or her doctor to write a script for a new CPAP or BIPAP machine and asks the doctor to write the script as specific as possible to indicate a specific brand, model number, etc. and for the doctor to sign the prescription to dispense as written, not to substitute; are you saying there is a chance; be it a small one that the patient will be able to get the correct machine as written by the doctor's order when the patient has to do battle with the DME?

Yes, it should be noted though that I've had the CPAP they tried to stick me with for less than 30 days. It's possible that AFTER that time, the DME would have no obligation to work with me on this.

I suppose the ability to return a machine varies from state to state and depends on any paper you may have signed. I'm not clear what your situation is. Is this your first machine... or is it time to replace your old machine??

But basically, if the doctor doesn't prescribe a specific machine, the DME has no obligation to provide you with a "better" machine. They will in all likelihood provide you with the one that's most cost effective for them.

The mask on mine was specified... however it did allow for me to make another choice... because what masks work for each person is such an individual preference.

So the DME first gave me what the doctor scripted, but it didn't work for me, so after that I went by the DME advice.

As far as which machine is better (RemStar vs. Resmed) I'm not knowledgeable about the different machines as of yet.

[stevoreno]

Is there a good chance if a patient asks his or her doctor to write a script for a new CPAP or BIPAP machine and asks the doctor to write the script as specific as possible to indicate a specific brand, model number, etc. and for the doctor to sign the prescription to dispense as written, not to substitute; are you saying there is a chance; be it a small one that the patient will be able to get the correct machine as written by the doctor's order when the patient has to do battle with the DME?

Yes, it should be noted though that I've had the CPAP they tried to stick me with for less than 30 days. It's possible that AFTER that time, the DME would have no obligation to work with me on this.

I suppose the ability to return a machine varies from state to state and depends on any paper you may have signed. I'm not clear what your situation is. Is this your first machine... or is it time to replace your old machine??

But basically, if the doctor doesn't prescribe a specific machine, the DME has no obligation to provide you with a "better" machine. They will in all likelihood provide you with the one that's most cost effective for them.

The mask on mine was specified... however it did allow for me to make another choice... because what masks work for each person is such an individual preference.

So the DME first gave me what the doctor scripted, but it didn't work for me, so after that I went by the DME advice.

As far as which machine is better (RemStar vs. Resmed) I'm not knowledgeable about the different machines as of yet.

[jsmythe]

After reading these posts, it really makes me realize how lucky I got with Apria when I received my machine!! As you can see, I have the Remstar M Series DS400 w/humidifier and C-flex. All my prescription says is

CPAP-17cm , Dx #####

.
I took it back to him and had him add "warm air humidifier" to it in case I get "lucky" and come up with the money for a HC150 humidifier someday. But the girl did not know how to set up all the features on it. And Thank you to all on this forum I may add, I finished the set up on it at home so I would know data.

[TossinNTurnin]

This will be my second CPAP machine. At present I'm still using my 8 year old Sullivan CPAP which had the setting changed by my DME recently from 14cm to my new pressure of 18cm. My old pressure was 16cm but I had the lab where I was tested last year check it out while there for my 2 night study; their machine said my machine was set on 14cm; not 16cm.

I saw my ENT on January 2nd to discuss the sleep study but my having a serious case of the "krudd", wheezing in my chest as well as coughing took priority on that day's visit so sleep study wasn't even discussed except I did get an order to have my old machine's pressure changed to 18cm.

The doc also wrote me an order for CPAP at 18cm with HH, nasal mask and supplies which I still have because my DME told me the only machine I would get from them with that script was a Respironics DS100; nothing else. I told them to hold that thought because I would get back with them on that soon. I see my doc tomorrow to talk about what wasn't talked about on January 2nd when I saw him for the "krudd".




Stevoreno
Biloxi, Mississippi
01/22/08

Well, it appears to me that if your doctor writes a specific script, the DME will have to fill it. Your DME pretty much told you as such. That he's not gonna give you any more than he has to unless the doctor specifically requests it.

I don't know how your insurance works... but my durable equipment deductible is $500. The humidifier, mask tubing etc... came to over $400. I will have to pay the "capped rental" on my machine until I reach my $500. After that I pay 20% and the insurance pays 80% until the machine is "paid off".

The insurance company is going to pay your DME the same contracted amount no matter which machine you get. That's the deal they make with the DME. So, the cheaper the machine, the more money your DME makes. So his/her motivation is to give you the least expensive machine. I suppose there are some more conscientious DME's out there, who care about good customer service... but, forgive the pun ... don't hold your breath.

Your doctor needs to be specific in order to get you a higher end machine. It really shouldn't make a damn bit of difference to the doctor what machine you get as long as it will provide the therapy he/she prescribes. So, since you're HIS/HER patient, he should be advocating for YOU not the DME.

I just went through a lot of this myself, so if you search for the threads I started, you might get a lot of your questions answered.

But I am a newbie to this... so, there may be more experienced posters who can add onto what I've said, or if there are any inaccuracies, correct them.