For new people, be aware of even your sleep center.

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Slinky
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Re: For new people, be aware of even your sleep center.

Post by Slinky » Tue Oct 14, 2008 2:16 pm

Did I mis-read or not understand what Michelle was saying??
MichelleFL wrote: ... I am paying for this machine myself ...
So WHY shouldn't Michelle get the auto CPAP she wants?? There is absolutely NO REASON to not give her a script for the CPAP she wants, she's not asking for a script for a bi-level or an SV, etc. She just wants a script for an auto type of CPAP.

Michelle, as far as the software and cable reader: 99 times out of 100 you will pay considerably MORE for them thru a local DME supplier IF they will even sell it to you WITH or w/o a script. You do NOT NEED a script to buy the software and cable reader via an online DME supplier and the prices will be cheaper.

Unless the local DME supplier is part of the sleep lab the sleep lab makes its money off the sleep evaluations, titrations and consults. They don't make a penny off of your equipment purchases. VERY FEW labs and DME suppliers are affiliated as it is very difficult to get licensing approval for such an arrangement.

Keep in mind thru all this you were discussing your equipment w/a staff person, NOT the sleep doctor. Patients who provide ANY input into the equipment they want are VERY FEW and FAR between! You COULD have been the FIRST person who asked for this staff person! She probably knows little to nothing about the various brands and models of xPAPs on the market. Heck, lots and lots of local DME suppliers don't know much about the xPAPs they provide their clients or are only familiar w/one brand. They tend to follow the Quick Set Up Guide and seldom actually look at or read the Clinicians' Manual. In all likelihood this office staff person has no RT or RPSGT training or experience and really didn't know how to handle the situation except as best she could shooting from the hip.

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Hawthorne
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Re: For new people, be aware of even your sleep center.

Post by Hawthorne » Tue Oct 14, 2008 2:34 pm

MIchelleFL- Are you going to be paying the WHOLE cost of the machine yourself??

If you are, take your prescription for a cpap and order online from cpap.com for example.
With a prescription for a cpap, you can buy an auto online. The prescription will (should) have a pressure stated on it.

If you buy an auto online, it will be sent to you set in cpap mode and set at your prescribed pressure. You will also get the clinician's quick set up guide which will tell you how to switich it to auto and adjust the pressure(s). If, by chance, you don't get the quick setup guide (which you won't get at all if you buy from a DME) just ask on the forum and someone will send it to you.

That's what I did and my prescription is over 6 years old.

The thing is to get the prescription yourself and not let them forward it to a DME.

As Slinky said, IF you could be the software and reader from a DME, it would cost a lot more than online. I 'm Canadian and know that a machine costs a lot less online than from a Canadian DME. I think that is also true for DME and online purchases in the US.

Someone will correct me if I am wrong.

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Snoredog
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Re: For new people, be aware of even your sleep center.

Post by Snoredog » Tue Oct 14, 2008 2:49 pm

if you went to a sleep doctor, the sleep doctor will write the script. While the sleep lab may have a specialist on site or consult with one that will be the recommendation for cpap.

Pretty stiff argument for an autopap when your pressure requirement is 5 or 4.9, 5.0 cm pressure is the Minimum most labs start you off with.

If you are thinking long term or later resale, the auto would be a better seller. But you need to look at what was found on your PSG first, what type of events were seen and the severity seen. If the severity is below what your insurance dictates, they may not even cover it.

It goes back to how well the doctor did in screening you for the PSG in looking at your symptoms. If the PSG indicates you have OSA it should be backed up with raw data to prove it. In which you should be able to go back to the referring doctor and get them to write the script for an autopap. Then just take that script and buy the auto yourself. You can buy the Sandman Auto directly from cpap.com for probably less than you can get a cheapo plain jane cpap machine. So why bother with the hassle of doing that, just buy it online and fax over or email a copy of your script. Machine will from set up from 4 to 20 and if you truly need 4.9 it will find it. You can also buy the software if you want that, but NO insurance will pay for that so I wouldn't bother arguing the point. If insurance pays for software they did it by mistake.

I suggest you look at the Sandman Auto:
https://www.cpap.com/productpage-bundle ... undle.html

At your pressure you would NOT benefit from Cflex or Aflex, in fact those features don't start working until you get over 6-6.5 cm pressure.
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Re: For new people, be aware of even your sleep center.

Post by jules » Tue Oct 14, 2008 3:49 pm

For anyone's information - 4.9 was her RDI the night of the study - not the pressure



from viewtopic.php?p=298854#p298854
MichelleFL wrote: 1. Primarily REM dependent obstructive apnea of moderate severity which are associated with arousal (overall RDI 4.9 & REM RDI 15.0)

looking4zzzz
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Re: For new people, be aware of even your sleep center.

Post by looking4zzzz » Tue Oct 14, 2008 4:06 pm

I don't believe MichelleFL ever said she was going to ignore her doctor's feedback. Unless I read it wrong, she said she was going to work closely with her general practitioner. I thought she was disagreeing with a tech who has no way of knowing how the sleep doc would have reacted if MichelleFL had been able to ask him for the equipment she wanted and been able to explain her rationale for those requests. I say let's forget about slamming her grammar or her choice to gather information from many sources, including this forum, then make her own judgments , then work with her family doctor to improve her health. Anyone who wants to ignore forum members' shared experience is free to do that. MichelleFL is just as free to explore and utilize that experience. I'll apologize in advance for any grammatical errors I might have made.

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congahands
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Re: For new people, be aware of even your sleep center.

Post by congahands » Tue Oct 14, 2008 5:01 pm

Me thinks that guest (a.k.a. thedean) may have a dog in this fight.

When medical professionals have financial motivation to prescribe anything, the patient MUST beware. Is my doctor recommending a certain therapy because they honestly believe it is the best one, or because they have been marketed to heavily, or even worse because they are getting kick backs under the table.

I would love to believe that all sleep center folks are only interested in my best interests. I'd also love to believe that all physicians are concerned enough about my health to investigate whether my high blood pressure, slightly elevated cholesterol, and depression is caused by a sleep disorder instead of just prescribing medication.

No doctor EVER asked if I snored, or woke up covered in sweat every morning.

Why does my sleep center push Respironics? Is it because the machines perform best? I'd like to hope so, but it may be for the same reason that the basketball players for one university wears Reebok, and the other school wears Nike (large shoe contracts).

But never mind anything I say thedean. I'm just a niave newby.

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Slinky
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Re: For new people, be aware of even your sleep center.

Post by Slinky » Tue Oct 14, 2008 6:23 pm

Generally, if the sleep labs or docs have a preference of brand of CPAP it is because their experience has been mostly w/that brand. Resmed, Respironics, Puritan Bennett all produce sleep software for PSGs and titrations.

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Re: For new people, be aware of even your sleep center.

Post by Julie » Tue Oct 14, 2008 6:29 pm

To The Dean ("Guest") - I believe Michelle's 'poor grammar' is a result of her native language being French, and as such, I think her English is terrific and quite easy to understand. A little tolerance and imagination would help in your case I think.

I am One Tired Puppy

Re: For new people, be aware of even your sleep center.

Post by I am One Tired Puppy » Tue Oct 14, 2008 7:23 pm

Guest wrote:Den, with all due respect, please let us know what assessment you've made concerning MichelleFL's health. How much does she weigh? What's her lung capacity? Any admormal physical traits? What about whether central apneas or irregular breathing was presented in her past? Yes, I get it,,,it's HER healthcare. Why it is that she'd trust a forum full of strangers over her doctor is beyond me. She's obviously confused on many issues. Some doctors prefer to prescribe straight pressure just to see how it's tolerated (to confirm the PSG). But hey, according to you guys, it's just air. RestedGal--why don't you send her a provider's manual!
the dean (guest),

It is unfortunate that when diagosed with sleep apnea, even before you get your machine, you are not given enough vital information to know what to do and what not to do.

For example, If about 15% of people with sleep apnea are prone to develop central apneas from too high a pressure (which may not be that high for others), should they not be told about this possibility before they start therapy? Please don't answer with "No one should be adjusting their own pressure." Most people can do this safely without any problems but apparently that 15% cannot. The problem isn't with people taking charge of their therapy with autos and software. The problem is people aren't given this information before they start therapy.

The whole reason people even need to take charge of their therapy and, yes, adjust pressures until they are at the right pressure to eliminate obstructive apneas is because we don't get the followup we need and are not given vital information in the beginning.

I trust some of the people on this forum more than I trust the doctor who was not in the least concerned at seeing clinical results of apneas getting worse, not better, over the first month and thereafter. He was not interested in even seeing more recent results with a more updated clinical software (the new sandman) that reveals centrals (cardiac oscillation) plus many cnt hypopneas. The apneas are still up and down and the obs hypopneas are few. He calls the clinical software "garbage." Needless to say, I will never see him again. I am finished with him and his clinic. He does not care about my health! I don't even want to believe that most clinics and doctors are not caring, but this guy just convinced me, that he doesn't really care. I do believe there are some doctors and dme staff that truly care, or maybe I still just want to believe that.

I shouldsaythat one of the techs from the sleep clinic, did talk to me on the phone when I called him regarding getting my reports. When I told him I was titrating, he did ask me if I had software that would detect centrals. I didn't at the time but have since gotten the sandman therapy software. He told me that if I am going to continue self titrating to leave pressure in same setting for at least a month so that your body can adjust to it. He also told me to send him monthly reports on how it is going. Too bad his boss wasn't as caring. It's his doctor boss (one of them) that says the software is garbage.

I want to make it clear that I began titrating after 3 months on cpap and noticing my apneas were so up and down and were much higher than when first titrated at the lab.
The dme sent the doctor a copy of the first month and he should have realized something was wrong since according to sleep records my apneas totalled only 8. So what is the point of waiting for a so called sleep doctor (if he even knows much about apneas) to help you when they (not all) don't really care. When I first started titrating, on my own initiative, I didn't ask for help in how to do it. I just tried different pressures for a few days at a time. I screwed my self up worse. I should have asked for help from someone from the forum before I began titrating, but I didn't. I trust someone who has experience firsthand having mixed apnea then I would anyone. That's why I feel safer on this forum than I do in the so called sleep doctor's office.

I think the techs who do the initial titration know who is prone to pressure induced centrals and the doctor reading the reports also knows. It should to be immediately made known to the client...before they start therapy. Why isn't it? Is it because the right machine would cost so much more than a cheap cpap and the dme and doc who gets a cut wouldn't make a profit? Sad when profit matters more than a person's health and safety. Maybe they don't tell you that you are prone to pressure induced centrals because they want us to get worse and warn everyone to not use software and autos. They will never stop people from wanting to be involved in their own therapy and they shouldn't punish people by ignoring their evidence of worsening AHI upon using cpap therapy, even at prescribed pressure for over 3 months.

I am upset with the doctor and the clinic for not letting me know about pressure induced centrals and even more so, that they could care less. Right now, my CA's are increasing and I am seriously thinking about stopping therapy all together so they don't get more worse. I don't know what to do and the doctor doesn't even care to know.

I will get another sleep study done in four or five months at a different sleep lab that has a different doctor. At that time, I will have plenty of information and will know what to ask and what type of machine I will need. I just think it is not right that someone has to wait so many months to be on the right machine to handle centrals or mixed apnea.

If it were not for the good folks of this forum, I would have given up a whole lot sooner. They are, apparently, the only ones who do care and understand.

One Tired Puppy





I know my grammar isn't perfect but hopefully, it is understandable.

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Paul56
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Re: For new people, be aware of even your sleep center.

Post by Paul56 » Tue Oct 14, 2008 7:55 pm

I am One Tired Puppy wrote:we don't get the followup we need
<sigh> I am another statistical with respect to that.

My family doctor is pretty good. After about a year of treating my high blood pressure and gettng it under control I was reminded of some issues that happen with my sleep... snoring & stopping breathing for periods. I read up on sleep issues and discovered apnea and how among other issues it could result in high blood pressure.

I mentioned these sleep issues to my doctor who immediately schedule me for a sleep study. Spent three nights at the sleep clinic. After the final night the technician handed me a slip of paper that had my AHI and RDI scores along with the mask that was used and titrated pressure. The paper was signed the the clinic's sleep doctor and I was told this was a prescription that I could obtain a machine from a list of vendors (DME) that was also provided. Other patients were given a follow up appointment with the sleep doctor... yet I was not for the simple reason that I reside in the province of Quebec while the doctor has his practice in the province of Ontario and he does not deal with out of province patients. The reason for this is always that they don't want to deal with the paperwork and time it takes to get reimbursed from Quebec medical.

So with the above I've already fallen through the cracks twice. No followup with the sleep doctor who perhaps could have provided valuable guidance and being lead down the garden path when they suggested the paper was a prescription.

So I run off to the DME presenting my paperwork. I'm given a trial machine but told the paperwork provided is not a real prescription and that I will need to get my family doctor to write one. Okay, not a problem... that gets done.

The "respiratory therapist" at the DME is more of a sales agent than health professional... I have to pepper her with questions to get any information at all. Not only that but the pressure was set inaccurately on one of the machines I had.

I finally purchase my own machine. When I asked if she wanted to see me again... "no not necessary... perhaps in a month or two if you like". Again, a failure in followup... she is not keen on following up with me because having already sold a machine most of the profits have been made out of me... from this point forward I will be more of a drain on their profits.

I'm sure the folks here have heard all this before and worse reports than mine. The lack of followup is pathetic... so I am pretty much forced to take charge of this myself. It is our health... at the end of the day no one cares more about it than ourselves. So it is our responsibility to take at least some interest and play an active role.

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Re: For new people, be aware of even your sleep center.

Post by MichelleFL » Tue Oct 14, 2008 9:00 pm

Thank you very much everyone for sticking up for me on this.. Sorry thedean I was at work all day making a living and not bashing someone on the computer.. What's your excuse?? Anyhow I was making a point to be aware of what you do and how possibly these centers can rip you off. I am not paying for this machine in it's entirety but I do have a co-pay of 25% and my insurance pays 75%... My sleep center doctor who does not even know about me at all and who I never have even met is the one recommending a straight cpap. I would rather get an auto even if my pressure is not high so that the machine will adjust itself and I do not have to worry further down the road about it.. After all, I can change it to straight cpap if need be. But, if my insurance will pay for it, and I have yet to find this out, why not go for the Cadillac or Lincoln?

As far as educating one self, I have learned over the years not to trust what my doctor says! I have been to so many, have had so many tests done, been through this contraption or another, that I am pro-active about my healthcare. And what I have learned about my own healthcare is that sometimes you have to do your homework and help yourself understand the test results you were given.. Since when does a doctor take out the time to tell you all about your test results? I don't know about you but usually all I get is, they were fine... Fine? So why do I still feel like crap..

Why you even bother thedean to first off hide behind being a guest and then to criticize one who is trying to help others with her experience as they have helped me... Maybe your the one who needs help.. So stop hiding behind your computer and log in so we can see who you really are..

Oh and forgive me if my grammar is not perfect. Noone is perfect and your not either.. Why bother to read it?
Newbie to sleep apnea. Anxiety and panic attacks. If I can do it, you can too! It's not as bad as you think.. :)

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MurphysLaw
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Re: For new people, be aware of even your sleep center.

Post by MurphysLaw » Wed Oct 15, 2008 4:57 am

Hello Michelle,

I give you great credit for having the courage to get the proper machine from the start. I wish I had. Now that I have the APAP, I realize how much better my sleep has become. I use the same mask as you and am sleeping straight through the night more often than not. Don't back down for what you want. You'll be just fine.

Lynne

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Re: For new people, be aware of even your sleep center.

Post by Wedge » Wed Oct 15, 2008 6:42 am

MurphysLaw wrote:Hello Michelle,

I give you great credit for having the courage to get the proper machine from the start. I wish I had. Now that I have the APAP, I realize how much better my sleep has become. I use the same mask as you and am sleeping straight through the night more often than not. Don't back down for what you want. You'll be just fine.

Lynne
Seconded, only I haven't been able to get a new, better machine yet. I wish I had have come here, and other such resources, first, and done the research and taken much more of an active role. But I didn't know, so I let the people who are "supposed to know" handle it. Now, I was told by my DME that the only way for me to get a new machine with my insurance (the only way it's gonna happen on my budget) is for my current one to be completely non functional. I find that hard to believe, but haven't gotten around to calling the insurance company to see if they'd accept a new script from my doctor.

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Slinky
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Re: For new people, be aware of even your sleep center.

Post by Slinky » Wed Oct 15, 2008 6:56 am

Michelle, I was under the impression that you were paying for your CPAP and equipment yourself due to no insurance. Let me explain how "the system" usually works. Since your insurance pays 75% with you having a 25% copay I am going to use Medicare's 80% w/20% copay to save having to do the math.

Medicare REQUIRES a 13 month "capped rental" (i.e. rent to own). Most insurances have some type of rental requirement first, anywhere from 1 month to 10 months to even 13 months as Medicare does. This "rental" of at least one month is to ensure that the patient is really using the xPAP and NOT giving up on it so that insurance is paying for an xPAP sitting in the insured's closet gathering dust. Understand that in the US the xPAP compliance rate has been running around only 60%. So rental is paid for X months at which time the xPAP becomes the property of the insured.

Further understand that a bare bone, compliance data only CPAP costs the DME supplier less than a fully data capable CPAP which costs less than a fully data capable auto PAP. Auto PAPs are considered CPAPs for insurance purposes. Insurances reimburse by HCPCS code and NOT by brand and/or model. All CPAPs are HCPCS code e0601. Bi-levels, SVs, etc are entirely different HCPCS code than CPAPs and reimbursed at a higher rate due to their higher cost.

These are 2006 amounts, Medicare reduced them in 2007, again in 2008 and is expected to reduce them again in 2009.
e0601 - positive airway pressure device - DME Billed: $135.00 - Medicare Allowed: $99.95 - Medicare Paid: $79.96 - Patient's CoPay: $19.99
The above is JUST for the CPAP and it is for 13 months.
The accessories are purchased outright at time patient receives their xPAP.
DME Billed: $548.00 - Medicare Allowed: $499.63 - Medicare Paid: $399.70 - Patient's CoPay: $99.93
They are broken down as follows:
a7037 - tubing used with positive airway pressure device - DME Billed: $48.00 - Medicare Allowed: $32.82
a7034 - nasal interface (mask or cannula type) used with positive airway pressure device - DME Billed: $130.00 - Medicare Allowed: $94.11
a7035 - headgear used with positive airway pressure device - DME Billed: $45.00 - Medicare Allowed: $31.80
e0562 - humidifier, heated, used with positive airway pressure device - DME Billed: $325.00 - Medicare Allowed: $240.97

That takes us to the local DME suppliers:
Most local DME suppliers buy the majority of the xPAPs they sell from one manufacturer and thus get a bulk discounted price for the devices they buy. If they have to order a device from another manufacturer they do NOT get the bulk price discount so they are paying HIGHER for an equivalent device than if they supply their usual brand. Their greatest profit margin is if they provide a compliance data only CPAP and their smallest profit margin is if they provide a fully data capable autoPAP because they are only going to get reimbursed the contracted amount for an e0601 positive airway pressure device.

As an aside: Resmed, Respironics and Fisher & Paykel will replace FREE to the local DME suppliers most of their mask models that patients have tried and been unsuccessful with IF the DME supplier will fill out a form and return them W/IN 30 DAYS.

Which takes us to the sleep labs:
The majority of sleep labs are totally independent of the local DME suppliers. They usually have someone on staff who does their insurance billing for the in-lab studies and sleep doctor consults and thus that person is able to determine what local DME suppliers your insurance is contracted with. Most patients have NOT asked their insurance company what local DME suppliers they are contracted with and rely on the sleep lab to suggest a local DME supplier or to tell them which local DME suppliers their insurance is contracted with and ask if the patient has a preference. If the patient doesn't indicate a preference the sleep lab will usually send the equipment order to alternating DME suppliers OR to the local DME supplier that they have reason to believe is more convenient to the patient's home location or to their knowledge provides the best support for the patient or to the local DME supplier who handles mainly the xPAP brand the sleep lab uses for their titrations.

So an informed first time patient first calls their insurance company and asks what local DME CPAP suppliers they are contracted with. The majority are contracted w/more than one local DME CPAP supplier which gives the patient some bargaining/negotiating room to get the type of CPAP they want. But it is up to the PATIENT to convince the local DME supplier to provide an autoPAP if that is what they want rather than the sleep lab/sleep doctor who has determined that the patient needs a CPAP. Unless the sleep lab/doctor has determined a special need for an autoPAP there is no justification for their scripting the more expensive CPAP brand or model just because that is the brand or model the patient wants. To protect their profit margin the local DME suppliers may contact the sleep lab/doctor that prescribes an autoPAP or a specific brand and model CPAP and ask for justification for that specific order. Strained relations between sleep lab/doctor and local DME suppliers can easily result in ALL patients from that particular sleep lab/doctor getting less support, etc. than others.

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Re: For new people, be aware of even your sleep center.

Post by DreamStalker » Wed Oct 15, 2008 7:17 am

Guest wrote:Michelle: Your doctor knows what's best for you...NOT a forum full of well-meaning strangers who have NO IDEA at all about each personal situation. An Auto is not the answer for everyone. Also, the sleep lab in your situation could care less from a financial standpoint which machine you'd get unless they were atatched to the DME.

If you lost weight, chances are your pressure would drop from 6 to 5 on an Auto? You wouldn't even notice a difference. In your situation and low pressure, you don't need an Auto.

Also, I don't think Resmed's software is for patient use. It certainly shouldn't be put on a script! Software isn't a medical device!

I encourage you to listen to your doctor and not some people who have bad, one-sided DME stories.
The only bad one-sided DME stories posted here are the ones posted by this Guest. "thedean" frequents this forum for one thing and one thing only, to provide misinformation and discredit the forum members here.

For the forum newbies, I encourage you NOT to listen to anything this Guest "thedean" posts on this forum.
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