my DME is harrassing me !

[Summer Rain]

I have not had an easy time adjusting to my Cpap.........my body is just sort of "freaking out" at all of the changes it entails and it has also been very hard for me on an emotional level, as well. I already had a" lot on my plate" and I guess I wasn't prepared for the transiton I would have to go through starting Cpap. Anyway...I just decided to take my time and keep reading and learning and sort of "growing" into becoming a Cpap user...one day at a time.............? I let myself get out from under the pressure of having to "get it right" immediately.....because that just wasn't gonna happen! So....I would just let myself sleep without my Cpap.....because I WAS SO VERY TIRED!!!!.....and Cpap gave me insomnia.......then, when I did use it, my throat would get so dry, I couldn't even swallow....so just the throat dryness would wake me up, after just an hour or two? Then, I started learning about mask liners and found them helpful....so that was a" perk"...I started making my own out of t-shirts...and they felt so much better!!!! So...slowly I have been "making friends" with my mask! I wore it for an hour and a half, again, last night! Then, TONIGHT, (SUNDAY, AROUND DINNER TIME) I get a call from the DME (which is a "vast organization", here.) And it was a teleprompter, not a person... And they said that if I hung up and didn't answer their questions, my insurance wouldn't pay for my Cpap? Then they asked me quetions about how often I was using my Cpap and for how many hours each time etc......I had to answer? Now, I am concerned that if I said the wrong thing they will report it and the insurance won't pay? I see my Doctor in a few days...which will be the first time I've talked to my doctor, since the sleep test. I didn't get to talk to a person on the phone, so I tried to call them back and got their answering service...who said that they were closed on SUN. ! So I said ,well, why are they "harrassing me" on Sunday, then? I hate their "impersonal service" and I am worried that my insurance won't pay because I told them the truth... i.e. I haven't been using my Cpap that much?

[bjcyorkiemom]

What insurance is involved ?

[Summer Rain]

Regence Blue Shield is my Provider

[kaiasgram]

Regence Blue Shield is my Provider

Summer, what is their criteria for coverage -- how many hours per night average for how many nights? Where are you in that time frame?

[fm1520]

In order for CPAP to work you have to use it, they are not going to cover you to have one and not use it. What you are experiencing is not that unusual, the insurance that is. You need to talk to your doctor asap and get the fact that you are having problems documented and of course treated. How long from when you got the machine till when they called? Additionally, your machine probably has a sim card with your data on it that they will read to verify. I was told they are looking for an average of 4 hours per night.

[Summer Rain]

4 hours per night just seems truly impossible! I was having " Plurisy like" symptoms from using my cpap (i.e.''chest pain")..... and pressure (leaning toward pain) in my inner ears and just inability to sleep...which was truly taking it's toll!! But just the dry throat, alone, is a severe enough symptom to keep me from being able to use it for very long? The pressure probably needs to be adjusted, because in order to avoid leaking,I have to have the mask on so tight that it leaves permanent creases in my face ,even with the liners?

[4betterO2]

Sorry you are experienciing such difficulty. You seem very courageous. It seems the pressure setting might be too high on your CPAP machine. Or, like many people, you cannot tolerate CPAP, as it is very difficult to exhale against incoming pressurized air!
Did you have a titration sleep study? Normally, if the patient complains about CPAP during that type of study, the RT tech will switch the machine to BiPAP, which is also covered by insurance. With BiPAP you get the same pressure you need for inhaling, but less pressure when you exhale. At this time, it seems only your doctor could solve your issues: either change the pressure setting, or, order a new titration study for a BiPAP machine. I believe most insurance companies will give you 90 days for compliance, but getting the right settings and the right fit is not really easy, it is team work between you, the doctor, and the RT, and it takes time, different things may get tried depending on the data your machine gives on your sleep statistics. I would go to see the doctor ASAP to work on your problem.

The rule for compliance is usually, at least 4 hours per night, and at least 21 nights in a 30-day period. You can get the coverage approved early if you get all those requirements done the first month but if not, you still have 2 more months to try.(Check it out with your DME though, don't take my word for it).

Going through your doctor might be the most successful way to deal with your insurance at this point as the doctor can explain to them that you are having problems and new settings may be necessary. The tech at the DME can change some settings, but those determined by the Rx, (pressure setting, I'm not sure what else for CPAP) can only be changed by the doctor, and believe me, it can be done, and may save the day.

It seems strange that they called you on the phone; does your machine have a wireless modem? a SD card?

[herefishy]

You also need to talk to your Insurance company - my cpap was on my face like an old friend from the time I got it, but there also was never any check of my compliance. Call your company and explain your situation and ask them if they do have any compliance rules, and if they say no, call your DME and tell them that.

[Mary Z]

I understand and am sympathetic to your problems. I was fortunate that my daytime sleepiness was so severe I couldn't drive or stay awake during the day- I HAD to use the machine. It wasn't easy, I struggled with mask fit and leaks. Your problem is one reason you need to keep in close touch with your doctor if you are having problems so your difficulty adjusting is documented for insurance. Doesn't seem like you were being harassed- if you had good answers to their questions it would not have mattered. Get in to see your doctor ASAP and solve your problems dealing with CPAP. I would hate to see you lose your machine, but they do take them back if they are just used as ornaments. I wish you the best of luck in sorting this out. You don't have to get it right all at once- you just need to try. For dry mouth get your humidity adjusted and start using the Biotene line of dental products for dry mouth. The quattro can be a difficult mask to deal with. I use the Mirage FFM and Macks silicone earplugs all the time for a more comfortable seal and less leaking. Your mask should not leave marks on your face that last more than a couple of minutes when taking it off. Tightening too much is counterproductive, but I've been there where the only solution for leaks was to tighten it down.PM me if you're interested in using the silicone earplugs to enhance fit of the mask. Take some tylenol or aleve or something long acting before bed to deal with the rib pain. I know that's a bummer and a deal breaker.
How long have you been on CPAP? Again, good luck.
Mary

[herefishy]

To fit your mask, lie on your back with the bottom straps loose and your machine running, the air should be coming out everywhere. Gradually tighten the straps in equal amounts on each side only till the air stops blasting.

[BlackSpinner]

4 hours per night just seems truly impossible! I was having " Plurisy like" symptoms from using my cpap (i.e.''chest pain")..... and pressure (leaning toward pain) in my inner ears and just inability to sleep...which was truly taking it's toll!! But just the dry throat, alone, is a severe enough symptom to keep me from being able to use it for very long? The pressure probably needs to be adjusted, because in order to avoid leaking,I have to have the mask on so tight that it leaves permanent creases in my face ,even with the liners?

1) chest pains (after checking them out) are normal due to the muscles having to work harder - just like leg muscles hurt after you start a jogging routine. It goes away with time and use.

2) inner ear problems can be due to humidity levels causing sinus congestion.

3) dry throat, use a chin strap to avoid mouth breathing and adjust your humidity.

4) leaks - if the mask has to be to tight to stop the leaks then the mask is wrong, not the pressure. You don't cut your toes off to make the shoe fit.

Take the list of problems and your emotional issues to your doctor to document the problems you are having and get him to write you an exemption for the insurance company. And CALL YOUR INSURANCE find out what is covered and what their compliance requirements are. Don't trust your DME to know it.

[Denial Dave]

no matter what your pressure is set at, you need to start having quality time with your mask and machine.... watch TV ( non violent shows).... get used to it being on your face!!

Those strap marks are not permanent, they go away... but they & probably your pain issues are caused by having your straps way too tight. I know it seems counter intuitive, but loose straps work better. Please go to this site and REALLY follow the guidelines given for using the Quattro mask.

http://maskarrayed.wordpress.com/taming ... e-quattro/

You need to start wearing the mask for at least 4 hours every night for your insurance company to pay for the machine and to get your DME from annoying you.

I spent my first 30 days of use sitting on the edge of the bed each night calming myself to try to get over my claustrophobia of wearing the mask.

It takes time to get accustomed to wearing the mask and to be able to not micro-manage every little leak or noise coming from of it.

your mask & machine are now your life partner....you might as well enjoy each others company.

[archangle]

By the way, it's not the DME at fault. Your insurance requires this checking or they won't pay for the CPAP.

In this case, the DME is trying to help you by collecting the data so they get paid and you get to keep the machine. I'm sure they'd rather not bother with gathering this information.

Now, maybe they should not be such dicks about it by having a robot call you and threaten you, but it is in your best interest.

[herefishy]

I have Blue Cross, and no one ever checked my compliance - that's why I'm wondering if it's an over-anxious DME.

[chunkyfrog]

Mine either; but the copay is outrageous; and it doubles for out of network..
BCBSNE, they still bite. Remember, Blue is not one company any more.
They pimp the name off to whatever sleazeball outfit writes the check.
Quality and uniformity is a thing of the past.