Can a doctor force me to use a specific machine?

[Guest]

Hello, everyone! I'm completely new to all of this. I tried searching, but couldn't find relevant information, so forgive me (or redirect me!) if this is a question you get a lot!

I recently went through the testing for sleep apnea, and just found out late this afternoon that my prescription had been finalized. I found a machine I like (Resmed S9 w/humidity), and a supplier who could get it for me for free since I've met my deductible for the year. My doctor's office wouldn't answer my questions about my prescription, and insisted that I must direct my questions to their cpap supplier (who they insist is not affiliated with them). When I called the cpap supplier, they told me that my doctor had written the prescription for a specific machine only (Respironics REMstar Pro with C-Flex), and that I don't get a choice at all. This doesn't seem fair to me since I'm the one who is paying (or my insurance is) for the machine, and I'm the one who's going to be strapping it to my face for 1/3 of my life! Why wouldn't I get a choice if the features are similar?! It seems very shady to me.

So my question is, can they force me to buy only one specific machine? I left a message asking them to change my prescription, but I'm obviously running low on time with the new year around the corner. I have a high deductible, so the difference in cost would be enormous. I hate feeling bullied, but do I have any options?

Thank you for any help or advice!

[Wulfman...]

As long as it's a CPAP-class machine, I would say "NO". If you were wanting a CPAP machine and the prescription was for a Bi-Level machine with specific EPAP and IPAP settings, then I would say that ain't gonna happen.

The insurance providers pay by insurance codes and ALL CPAP machines have the same one - E0601.
The APAP/Auto you mentioned can be set for single pressure, so that shouldn't be a problem as it appears your doctor wishes you to be on a single-pressure machine.

In any case, be sure to get a copy/original of your prescription. You're entitled to have that.


Den

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[Wulfman...]

Maybe I misread your initial post.
What specific model of S9 were you looking at getting? The ResMed Elite model is single pressure machine and the ResMed Autoset is an APAP (will accommodate pressure ranges or single pressure).


Den

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[kaiasgram]

I would not assume that your doc really specified a make and model on the Rx. Suppliers (aka DMEs) have been known to lie to unsuspecting newbies in order to keep their profit margin high. This is why, as Den says, you need a copy of your Rx.

Call your insurance and find out which DMEs they accept. You should be able to use any of those.

Get a copy of your Rx from the doc's office and take it to the DME you want to work with.

The S9 series includes several machines. Which one were you hoping to get?

* You aren't with Kaiser, are you? If you are then it's a whole different ball game. Let us know.

[Guest]

ResMed S9 AutoSet™ w/H5i™ Humidifier and ClimateLine is the one a friend of mine uses and loves. It also seems, from what I've read, that the ResMed I listed above is much quieter and less bulky than the REMstar. Mainly, I just feel like I should have a choice. As long as it's set up as a CPAP, and the pressure is set according to my doctor's specifications, I don't see why they can force me to use only one specific model. I can get that ResMed with no out-of-pocket cost from another company I found, but the cpap supplier my doctor wants me to use won't give me a specific number--just that my cost is 20%. I had to call my insurance company to get the amount I'll owe, and even that wasn't set in stone. The whole thing just feels like a scam to me.

[Guest]

I have Blue Cross Blue Shield.

[Wulfman...]

ResMed S9 AutoSet™ w/H5i™ Humidifier and ClimateLine is the one a friend of mine uses and loves. It also seems, from what I've read, that the ResMed I listed above is much quieter and less bulky than the REMstar. Mainly, I just feel like I should have a choice. As long as it's set up as a CPAP, and the pressure is set according to my doctor's specifications, I don't see why they can force me to use only one specific model. I can get that ResMed with no out-of-pocket cost from another company I found, but the cpap supplier my doctor wants me to use won't give me a specific number--just that my cost is 20%. I had to call my insurance company to get the amount I'll owe, and even that wasn't set in stone. The whole thing just feels like a scam to me.

They really can't force you to use a specific brand of machine or force you to use a specific vendor/supplier. As long as it's in the right category of machine and is set for the prescribed pressure, that's all that should matter.
Something sounds a little shady in this relationship of entities you're dealing with.


Den

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[kaiasgram]

I have Blue Cross Blue Shield.

OK. Then what Den said...

Also: If your sleep doctor keeps stalling and putting you off and time is of the essence, bear in mind that if you have a copy of your sleep study you may be able to get a new Rx from another of your healthcare providers -- your primary care doctor or nurse practitioner, even a dentist can write a CPAP prescription.

[Guest]

Thank you for your replies. This entire process has been really unpleasant. I've only seen the doctor once, and didn't feel like he was really listening, and some of the technicians and front office employees have been really rude to me. Not explaining things, and acting irritated when I asked questions. I want to switch to a new office as soon as possible.

To be going through any of this is confusing enough since I don't understand why I have OSA other than having too much soft palate tissue. I already feel weird enough about the whole thing without the doctor's office being rude to me. To have someone answer kindly really helps, so thank you!


Oh, okay!! I'll call my primary doctor! Thank you!!

[Wulfman...]

Thank you for your replies. This entire process has been really unpleasant. I've only seen the doctor once, and didn't feel like he was really listening, and some of the technicians and front office employees have been really rude to me. Not explaining things, and acting irritated when I asked questions. I want to switch to a new office as soon as possible.

To be going through any of this is confusing enough since I don't understand why I have OSA other than having too much soft palate tissue. I already feel weird enough about the whole thing without the doctor's office being rude to me. To have someone answer kindly really helps, so thank you!


Oh, okay!! I'll call my primary doctor! Thank you!!

Welcome to the world many of us have walked through. It was all I could do to be in the same room as my "sleep doctor" for a brief amount of time. For a pulmonologist, he was one nasty, obnoxious jerk. I was prepared for it because someone I worked with at the time had had a sleep study and had the same doctor.......and warned me ahead of time.

In my own case, I think that I should have been referred to an ENT to check for enlarged turbinates and deviated septum. The problems aren't always in the throat. But, this therapy is working for me and I didn't have to have any surgery.


Den

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[kaiasgram]

Thank you for your replies. This entire process has been really unpleasant. I've only seen the doctor once, and didn't feel like he was really listening, and some of the technicians and front office employees have been really rude to me. Not explaining things, and acting irritated when I asked questions. I want to switch to a new office as soon as possible.

To be going through any of this is confusing enough since I don't understand why I have OSA other than having too much soft palate tissue. I already feel weird enough about the whole thing without the doctor's office being rude to me. To have someone answer kindly really helps, so thank you!


Oh, okay!! I'll call my primary doctor! Thank you!!

You're welcome. As overwhelming and unpleasant as it has been, your experience is utterly par for the course. It's the most common story we hear on this forum. You're actually a little ahead of the game because many don't find this forum until after they've been sold a machine they don't want or can't monitor their treatment with. Let us know what happens, and good luck -- I hope you're able to get the machine you want before the New Year's Ball drops next week.

[Janknitz]

Nobody can force any machine on you, BUT. . .
If your insurance is an HMO you may not have a choice in provider or model. For example, Kaiser uses only one supplier and dictates the make and model they will pay for and if you don't like that you can certainly buy your own machine with your own money.

I don't think you are in that situation, but the only way to find out is to call your insurer about the specific pan you are on. Please see "What you need to know BEFORE you meet your DME " belw in my signature for more info.

[hyperlexis]

Yes.

It's their prescription pad, their medical judgment and their medical license. You pay them for their expertise and their medical opinion, and, if in their medical opinion they believe brand X machine is better than brand Y, etc., then that's their right to decide as a physician.

Now if you believe you know more than someone who spent years in medical practice, because a brochure or a photo may have made brand Y machine seem better than brand X, then that's your perogative. But your doctor doesn't have to believe you or accept your opinion on that basis.

I don't think that most doctors would care. They would give you a machine, taking your preference into account, when writing the prescription. -- But some may not.

So you either have to accept and trust your doctor's opinion and use Brand X machine, which is probably as good if not better than brand Y or Z, or just go find another doctor. But can you force a doctor to accept your demand? No.

[Guest]

Thank you, everyone!

Hyperlexis--I understand what you're saying, but I never claimed to have medical expertise. I just know I read more favorable reviews online (and the opinion of my friend who owns one), and I know someone who owns the one I've been prescribed (seen it in person), and I don't want that thing sitting on my nightstand. I feel like my opinion should be taken into account.

It's like if a doctor told me I HAD to repaint my den for my health. He could say I need to use an eggshell finish, interior paint, with low VOCs, and that would be understandable. But if he tells me I HAVE to paint the walls hot pink when green fits better with everything else in my life, that seems like an unnecessary detail for him to control. It's not as if I'm wanting to go with some off-brand piece of trash just because it has some gimmicky features. It's from a well-respected brand, and has similar features in a "package" that I prefer. I guess it comes down to the fact that I don't trust my doctor's motivations, and I hate that I'm "under the gun" with the insurance deductible.

[49er]

Thank you, everyone!

Hyperlexis--I understand what you're saying, but I never claimed to have medical expertise. I just know I read more favorable reviews online (and the opinion of my friend who owns one), and I know someone who owns the one I've been prescribed (seen it in person), and I don't want that thing sitting on my nightstand. I feel like my opinion should be taken into account.

It's like if a doctor told me I HAD to repaint my den for my health. He could say I need to use an eggshell finish, interior paint, with low VOCs, and that would be understandable. But if he tells me I HAVE to paint the walls hot pink when green fits better with everything else in my life, that seems like an unnecessary detail for him to control. It's not as if I'm wanting to go with some off-brand piece of trash just because it has some gimmicky features. It's from a well-respected brand, and has similar features in a "package" that I prefer. I guess it comes down to the fact that I don't trust my doctor's motivations, and I hate that I'm "under the gun" with the insurance deductible.

Guest,

Even if you wanted to go with some off-brand piece of trash because it has gimmicky features, as long as it performed the necessary medical tasks for your situation and was safe to use, that is all that should matter do your doctor.

If you don't trust his motivations, you need to find another physician. Otherwise, things will only get worse in my opinion.

49er