Sleep lab results, says no auto machine

kcl wrote: It's so hard to get into or speak with a Dr. unless you have an appt. and this Dr. is booked for weeks and weeks. I do like the particular Dr. but we will see. I will communicate with him, just might have to be through the nurse.

Call the office and tell them you will be by to pick up a copy of the prescription. Once you have it in your hand call your insurance company to find out who is in network and call them up. If that is not possible then do some comparison shopping on line at secondwind and our host. Print out what you find and head back to the DME and tell then they can either sell you what you want or lose your business (even if you don't have the cash to do that they don't need to know it) Play hardball. It is a lot like buying a used car off a sleazy car lot. Just remember they are in business to SELL products and if the don't sell they don't get any profit.

Stormynights wrote:I have only seen a sleep doctor one time and I was so happy to get an appointment with her because she also uses a cpap machine. She told me that she uses a straight cpap and will never prescribe any other type of machine because this is all she needs so she thinks it is all anyone else will need. I went back to my primary care doctor and he wrote the prescription for an ASV machine because he thought this was what I needed. Get a copy of your sleep study so you can get a second opinion.

My Doc also uses a cpap. Would be curious as to what type.

My dentist uses an Airsense 10 CPAP.
All that school, and still no clue.
Every APAP made can be set and run in cpap mode.
DME's really hate it when you make them admit that in front of a room full of people.

I have had two DMEs and I don't think either of them gives a hoot whether I order from them or not. That is why I have had two. I just switched back to the first one because the second one wouldn't give me the mask I wanted without me driving 100 miles for a mask fit. They also wanted my Dr to change my prescription to a certain mask instead of mask of choice. Why would I want to do that?

kcl wrote:Yesterday I talked to the sleep tech (not sure of his actual title) about my sleep study 2 weeks ago. I've recently asked here for suggestions and info on machines, etc... since my last one was years ago. They will be raising my pressure from 9 to 11 as I was having events until that level. I asked about getting an auto machine which has been suggested here but no way he would do that, said I don't need it, it would be like starting over every night, blah, blah. He even said I didn't need it because I can just come and get a sleep study and know the pressure I need (which I'm thinking if it were that choice I'd take the machine over all their wires and sleeping in a strange bed with someone watching me and huge copay!) He also made a comment, sounds like someones been on the internet which I found condescending. Of course I educate myself! He said they prescribe a respironics machine but I haven't talked to the medical supply company to know what the scrip actually says and what machine they will be giving me. I'm calling them tomorrow. He said it will be one that monitors usage (which isn't a problem, can't sleep without one).

Tell the control freak that since you and your insurance are PAYING for the machine, you want an auto machine. You want current technology and not old crap. Auto machines have both a cpap and apap setting. You can set it for cpap, but it provides actual data and not just a summary for the night, which is TOTALLY USELESS!

Like the others have said, put your foot down, then the other.
Turn around and walk out the door.
Your doctor should not be able to fire you just because you want to go elsewhere for your equipment.
If he does, you will be better off with someone else.

Caution: RANT

I'm getting to the point where I think we should be able to get the machine we want BECAUSE WE WANT IT. As long as it delivers the prescribed treatment and insurance covers it, it's none of the doctor's business or the DME's why we want it, WE have to sleep with it for 5 years, not them. So give me what I want or get out of my face. (Literally).

Too bad if the DME can't make $30 or so more off me and too bad if profit margins are "so tight". Perhaps the insurance companies wouldn't feel compelled to do that if they weren't nickeled and dimed for each mask part separately. But that's the DMEs problem, not mine!

I'm in a choiceless situation because of Kaiser unless I pay completely out of pocket, but I think the rest of us should TELL the doctor what machine we want and fire any doctor or DME who doesn't give us what we want.

Jan, I like your thinking.
I fired three local DME's in under five years; and bought my first TWO APAPS from cpap.com.
If somebody is butt-hurt because they missed a sale (and my loyalty), out comes the tiny violin.

A DME is a customer service company, it just needs to be reminded.

Just compare a DME to a high end shoe store. The sales staff is all over you letting you try on shoes talking abut features and makes. If you are buying athletic shoes they make you run barefoot around the store before picking the style of shoe best for you but if you don't like them they will gladly let you try on what you want. My daughter has foot issues (Plantar Fascitises(?)) and the service you get when buying a $200 + pair of shoes is amazing.

Janknitz wrote:Caution: RANT

I'm getting to the point where I think we should be able to get the machine we want BECAUSE WE WANT IT. As long as it delivers the prescribed treatment and insurance covers it, it's none of the doctor's business or the DME's why we want it, WE have to sleep with it for 5 years, not them. So give me what I want or get out of my face. (Literally).

Too bad if the DME can't make $30 or so more off me and too bad if profit margins are "so tight". Perhaps the insurance companies wouldn't feel compelled to do that if they weren't nickeled and dimed for each mask part separately. But that's the DMEs problem, not mine!

I'm in a choiceless situation because of Kaiser unless I pay completely out of pocket, but I think the rest of us should TELL the doctor what machine we want and fire any doctor or DME who doesn't give us what we want.

Agree with this to a certain point, however, insurance isn't going to cover bilevel because you want it. It has to be medically necessary. I do agree everyone needing CPAP should be issued a data capable auto-CPAP. On the other hand, you can have any machine you want if you don't rely on insurance to pay for it. Many on the forum have taken that option, and no longer use DMEs or insurance for their CPAP needs. This is especially true for high deductible and copay policies, which means it is becoming much more common.

UPDATE: I talked to the Medical Supply Comany and she said that they would likely be supplying me with a DreamStation APAP. She said they are still working with insurance so I don't have a final on that but I'm feeling better about it all. I did go by and get my report and prescription. Sad that I have to wait till next week (its been 3 weeks and I can't wait to feel better!)

Just want to thank everyone who commented with such helpful advice

Listen. Quite frankly, thats NOT GOOD ENOUGH. I am telling you this as a sleep doc. The only thing that would maek me comfortable is the following:

Ask for the following:

AutoPAP - ONLY AutoPAP. Even if your doctor writes prescription for regualr CPAP and they tell you they have you give you regular CPAP, nothing is forcing you to fill the prescription. SIMPLY DO NOT DO IT unless you get an AutoPAP.

2. Dreamstation APAP or Resmed Airsense 10 Autoset

3. Make sure they will supply you with a heated hose instead of just slim line hose.

4. Make sure that your dreamstation APAP will come with a cellular or a wifi modem. (i suppose with a dreamstation this is not a big deal as this can be added later vs Resmed I don't believe it can be activated later, don't quote me on this though).

I wish you luck. I just saw a patient today who got a machine few years back, ended up only getting a fixed CPAP. his biggest complaint for his inability to use his machine - "I can't exhale against the pressure". The problem? His machine has no comfort options and has no flex/epr setting. Dont set yourself up for failure. Give yourself every option you can get. And remember, it shouldn't really cost you any extra to get the best machine on the market, so if they try to upcharge you, just go to another DME/doctor.

Hope that helps!

OKCSleepDoc wrote:Listen. Quite frankly, thats NOT GOOD ENOUGH. I am telling you this as a sleep doc. The only thing that would maek me comfortable is the following:

Ask for the following:

AutoPAP - ONLY AutoPAP. Even if your doctor writes prescription for regualr CPAP and they tell you they have you give you regular CPAP, nothing is forcing you to fill the prescription. SIMPLY DO NOT DO IT unless you get an AutoPAP.

2. Dreamstation APAP or Resmed Airsense 10 Autoset

3. Make sure they will supply you with a heated hose instead of just slim line hose.

4. Make sure that your dreamstation APAP will come with a cellular or a wifi modem. (i suppose with a dreamstation this is not a big deal as this can be added later vs Resmed I don't believe it can be activated later, don't quote me on this though).

I wish you luck. I just saw a patient today who got a machine few years back, ended up only getting a fixed CPAP. his biggest complaint for his inability to use his machine - "I can't exhale against the pressure". The problem? His machine has no comfort options and has no flex/epr setting. Dont set yourself up for failure. Give yourself every option you can get. And remember, it shouldn't really cost you any extra to get the best machine on the market, so if they try to upcharge you, just go to another DME/doctor.

Hope that helps!

I can't tell if you are replying to my original post or my update. It sounds like the DME will be getting me a DreamStation Auto Cpap. They are not associated with the Dr. and I think my Dr. is good, its the sleep lab that I'm ticked at for how he was talking stupid to me. But it all may be just fine, will know more next week but I'll be insistent to get the apap. The prescription does say cflex 2. I will be sure to insist on the heated hose, I have cover on mine now and that works but makes cleaning big pain. I will also get a heated humidifier (have to in the winter).

I am curious about the pricing, CPAP.com has it for $639.00 as list price, is that about what they will bill the insurance company? I always feel like they jack up the price but then I have to pay my 20% co pay on their jacked up price.

kcl wrote:

LSAT wrote:
And how many thousands does a sleep study cost. Be aware that they may try to give you a low end model that does not record data. They make more money that way. Does your doctor have some relationship with the sleep lab or DME?

I know! Yes, the doctor does have a relationship with this lab. It's in their office. But I LOVE the Dr. Seriously, he saved my life when I had severe shortness of breath and primary was telling me to relax like it was anxiety (her nurse was anyway). This Dr. who is a pulmonologist got me in and discovered I had bilateral blood clots! I will call the Dr. over this first, anyway, and see what happens, at least if I can't get the auto machine.

I haven't read to the end yet, hopefully everything is turning out OK. DO NOT ACCEPT THIS DEVICE, you too can play hard ball, the insurance may be paying for it but you pay for your insurance. If all else fails, get a copy of your prescription (sometimes called "orders") and go to a different DME within your insurance plan - DO NOT ACCEPT THIS DEVICE!!!

kcl wrote:UPDATE: I talked to the Medical Supply Comany and she said that they would likely be supplying me with a DreamStation APAP. She said they are still working with insurance so I don't have a final on that but I'm feeling better about it all. I did go by and get my report and prescription. Sad that I have to wait till next week (its been 3 weeks and I can't wait to feel better!)

Just want to thank everyone who commented with such helpful advice

I have heard from others here that it is the same charge code for APAP or CPAP; don't let anyone tell you your insurance said Cpap only