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Can you call the pulmanologist's office and ask that very question?

No. They don't return calls, never faxed info to the DME (which is why I ended up getting all the info and faxing it myself) and wouldn't fork over a copy of my prescription until I called them three times.

Is there a different DME in-network with your insurance that you can use? It's not up to the DME to decide whether or not you need CPAP. Hmpf.

I live in the sticks. I only have three DMEs within 60 miles and two are the same company.

My advice is to get the copies of your sleep studies, get the doctor to write you a prescription and then bypass "the system" and purchase out-of-pocket. Odds are you'll be money ahead due to the deductibles, co-pays, etc. There are numerous places to get the equipment without going through the brick & mortar money-grubbing jerks.

I have no money and I'm too tired to sell my body for sex (that was a joke). But yeah at this point I at least have copies of everything.

My bigger gripe is if the CPAP is being denied based on the results of my first test and now I owe $1,300. I find it hard to believe my insurance company would have approved a titration study for equipment I wouldn't qualify for. I don't mind being in debt if I'm no longer a zombie. But zombie + a $1,300 bill and all the bills from last year + no resolution is just cruel and unusual punishment.

Dedicated Monetary Extractors

I see what you mean.

Thanks again all. I'm all cried out. Tomorrow is another day.

Two more small ideas:
Go to the pulmanologist's office in person and talk to them? Maybe make an appointment if you need to?

My insurance co. has told me in the past to let them know if I have trouble with a provider. Is that a possibility?

I hope you get a break tomorrow.

Contact your insurance company directly, ask if it is covered, if the claim is denied get it in writing, file an appeal. Your insurance company may have some sort of ombudsman to assist. Also consider contacting your state Commissioner of Insurance.

Long and short -

1) You have been DIAGNOSED with a sleep disorder, plus co-morbidity(ies), that would benefit from xPAP therapy. Some doctor (your pulmonologist), even if crappy to deal with, has said this. Your insurance hasn't denied anything yet, has it? They go by what your DOCTOR says, not the DME. So far, the DOCTOR hasn't denied xPAP. Only the DME has.

2) And so what if they do? Yes, the $1,300 would be rough, that's a lot of money, but the lab can't get blood from a stone. They are more likely to argue with the insurer before trying you anyway. As AMK pointed out, even insurers can be helpful sometimes. You might try talking to yours. Besides, you say the insurer approved the titration study - if they did that, I don't see how they could refuse to pay now. If they could refuse to pay when the test is negative, I personally would owe about a million bucks by now.

3)As to equipment, from what I've seen here, it's often possible to get equipment from Craigslist or people here for a few hundred bucks, that you would probably be paying as your share with the insurance anyway. And people here will look at your studies and your prescriptions and help you get the right thing. You don't even have to DEAL with the stupid nasty jerks in your corner of the world. Plus, there's CPAP.com, where things are much cheaper than at the DME also. Since you have your prescription, you can use them.

4) You're absolutely right - tomorrow IS another day. Maybe your first DME-free day !

I agree that you need a machine asap.

You need to get a used machine that will give you plenty of data.

You load the data onto your computer and read it using the free cpap software Sleepyhead. You
can post your data here and also at http://www.apneaboard.com/forums/Forum- ... oard-Forum
where the online communities can help you understand and improve your results.

You can get new masks online for $35-$80. I just bought 3 from https://www.cpap.com. A used machine can go for as little as $100-$200. The machines are mechanically all very similar. They pump air like a fish tank pump. Some are a little
smaller, some are quieter etc., but you don't need the latest unit to fix your apnea.

So I recommend you pursue 2 avenues. The first avenue is to get a used machine as described above. Don't tell your doc, dme or insurance about it. At the same time keep working the doc and insurance company to get what you are entitled to.

Immediately find a new dme. Even if they are not close, do it remotely. All you need is the machine paid for by insurance. Clearly your current dme is not on the same page.

I agree with Player as this is exactly what I did. The doctor wanted a sleep study since the last one was seven years ago so I went and had it. He wrote a prescription for the latest AirSense 10 Auto and sent it to the DME. When I heard nothing after a few weeksI called the doctor's office and asked. They said the prescription had been sent and that I had to wait until I heard from the DME and/or insurance - that they would work it out.

But even before the sleep study, I went to craigslist and got the machine in my signature for $100 and couldn't be happier with it. If I end up getting a better machine through insurance, that will be great and I'll have a backup. But, if not, at least I have something that works and I'm not suffering in the meantime.