insurance will not pay for apap

He means that RTs aren't allowed to show YOU how to access the CLINICAL menu without a doctor's order.

It's called a clinical menu, because it's intended for the clinician, NOT the patient.

That said, when a patient asks me, I always tell them that I'm not allowed to show them, I'm only allowed to set the ordered pressure.

The reason is, the same reason that ventilators and bipaps with rate are set so the controls can be locked. It's a liability issue. If someone hurts themselves, and I'M the one who showed them how to do it, when the lawyer comes calling for my cash settlement, it's ME who pays, no matter that the patient insisted on me doing what I did. It's called CYA, cover your ***.

Now, what you decided to do on your own, is your own business. Nobody can force you to take the whole pill, if you decide you only want to take half, or two, but you can't sue the doctor for not fixing you either, if you decide to do it differently than he ordered.

fidget wrote:He means that RTs aren't allowed to show YOU how to access the CLINICAL menu without a doctor's order.

Not true. He was responding to my post:

TGregg wrote:My DME rep didn't believe me when I told her that the ResMed S8 Elite had an Advanced/Detailed patient menu. . .

and he said:

Anonymous wrote:And sometimes BECAUSE these DME RTs are NOT ALLOWED to set access to the Advanced Patient Menu w/o a doctor's order they feel it is safest and/or easiest to just play "dumb" about them.

(emphasis mine)

There's no way to set access to a clinical menu. Either you tell the patient how to get to it, or you don't. But you do set access to the advanced menu (from the clinical menu).

So I'm guessing that as far as you know, RTs are allowed to set access to the advanced patient menu?

fidget wrote:He means that RTs aren't allowed to show YOU how to access the CLINICAL menu without a doctor's order.

It's called a clinical menu, because it's intended for the clinician, NOT the patient.

That said, when a patient asks me, I always tell them that I'm not allowed to show them, I'm only allowed to set the ordered pressure.

The reason is, the same reason that ventilators and bipaps with rate are set so the controls can be locked. It's a liability issue. If someone hurts themselves, and I'M the one who showed them how to do it, when the lawyer comes calling for my cash settlement, it's ME who pays, no matter that the patient insisted on me doing what I did. It's called CYA, cover your ***.

Now, what you decided to do on your own, is your own business. Nobody can force you to take the whole pill, if you decide you only want to take half, or two, but you can't sue the doctor for not fixing you either, if you decide to do it differently than he ordered.

You may be right on with your assumption that he may have meant the "clinician" menu instead of the patient menu. Nevertheless, it still suggests that the guest poster is more ignorant about xPAP equipement than many of the forum members he is attempting to educate.

I'm certain that there are well informed DME RTs/clincians out there with perfectly good intentions of helping OSA patients ... but the guest does appear to be a jerk ... an ignorant one at that.

fidget wrote: It's a liability issue. If someone hurts themselves, and I'M the one who showed them how to do it, when the lawyer comes calling for my cash settlement, it's ME who pays, no matter that the patient insisted on me doing what I did. It's called CYA, cover your ***.

Interesting that your company would tell you that, fidget. We know already though that information regarding clinical menus is not legally restricted in any fashion whatsoever. Liability would come into play if you, in the course of treating a patient, commit an act which harms the patient (such as setting the wrong pressure), or if you are negligent in performing your duties (such as not instructing the patient in how to properly use the CPAP).

Regards,
Bill

Any patient menu you should have full access to, IMHO.

I've actually had RTs tell me they refuse to show patients how to set the ramp pressure. That's just crazy stuff.

And I apologize, we don't use Resmed machines very often, (cost issues) so I have to have a manual in front of me as well.

Liability occurs if I do anything against policy and procedure, which is to not show patients how to access the clinician's menu.

And you're correct, the guest is the type of RT who gives the rest of us bad names, by assuming the patient is always to be kept in the dark. This stems from the type of medicine where us all powerful types tell patients, "do what I say, I'm the smart one". I have actually had a doctor tell me, as a patient, that if I wanted to question his orders, I should find a different doctor. I did.

fidget wrote: I have actually had a doctor tell me, as a patient, that if I wanted to question his orders, I should find a different doctor. I did.

Thank you for the honesty, fidget.

Regards,
Bill

fidget wrote:I've actually had RTs tell me they refuse to show patients how to set the ramp pressure. That's just crazy stuff. . . .

And you're correct, the guest is the type of RT who gives the rest of us bad names. . .

At least part of that is feedback from interactions with us, the patients. Many of us are not even slightly interested in our therapy (with an obvious exemption for readers of this forum). Just tell us what we need to do so we can get back to whatever we were doing.

I was the very first person my DME ever saw actually lie on the floor to see how my mask fit lying down.

So we (as inquiring patients) have to overcome a lot of interia generated by less interested patients. A big part of that will be industry professionals who expect to deal with patients that do not ask questions, don't know much, and aren't interested. Methods, processes and standard operating procedures are streamlined to control costs and maximize productivity. It's much faster for all the pros if they keep the patients in the dark and herd them through one gate after another. And since most of the patients don't mind. . .

I guess I should have expected it. And since there's no way the average patient is going to wake up and want to understand his treatment, this is going to be a normal situation that we'll have to deal with, just another part of our therapy.

TGregg wrote: And since there's no way the average patient is going to wake up and want to understand his treatment, this is going to be a normal situation that we'll have to deal with, just another part of our therapy.

I'm not so sure, TGregg. Sure seems to be a lot of interest here in understanding treatment. My own opinion runs more along the lines that it's nearly fruitless to question anyone other than physicians because the "stock" answer is, almost invariably, along the lines of "Oh, your doctor will discuss that with you."

It's very frustrating because the techs who know won't tell you (because they can't) and the docs won't tell you (because they don't know). What a wonderful Catch-22 that is.

Regards,
Bill

NightHawkeye wrote: I'm not so sure, TGregg. Sure seems to be a lot of interest here in understanding treatment. My own opinion runs more along the lines that it's nearly fruitless to question anyone other than physicians because the "stock" answer is, almost invariably, along the lines of "Oh, your doctor will discuss that with you."

It's very frustrating because the techs who know won't tell you (because they can't) and the docs won't tell you (because they don't know). What a wonderful Catch-22 that is.

Regards,
Bill

Yeah, we're pretty serious about it. But we are a self-selecting group. Everybody here already expresses interest by looking for this board. They express even more by registering so they can post. Most every time I interact with an industry pro, I get some surprise. Whether it's lying on the floor to check my mask, asking for a data collecting machine or having my data processed and sent to the doctor, a big part of my therapy is telling the pros what to do.

Now there might be other valid reasons for some things, like DMEs holding down costs by being reluctant to upgrade my CPAP machine. But my doctor's office being clueless about getting data from machines? My RT being astonished that I want to lie down to see if my mask leaks? There's no reason for subterfuge here, this is the honest reaction from pros that have not seen a single knowledgable patient. While my DME also deals with other equipment like oxygen tanks and such (and could make up most of their biz), my RT is a hosehead, and she's clueless. Surely my sleep doctor's nurse (who only deals with sleep problem patients) would be familiar with data-collection machines, but nope.

There is strong evidence that I am the first interested, internet user these pros have seen. Admittedly, many people are not yet connected. But even broadband is in what? Just shy of 70% of Americans, so surely almost all of us are OL, even if some of us just use the computers at the library or work or at a friend's house.

From my sample of just the OSAs who use my particular RT, and just the OSAs who use my particular sleep doctor the overwhelming majority (virtually everybody but me) are not interested in their therapy. It could be something about the culture here or who knows what, but I doubt it.

That's not to excuse some of the things that have been reported by others on this board. Even my DME either should have some intergrity or training to be able to either turn on my advanced patient menu or tell me she cannot unless the doctor says so. But it does explain a lot of what happens, and more importantly it tells us that we will continue to struggle with this for as long as we are treating. In my case, that means to take a deep (CPAP assisted) breath, and figure out how to handle these types of problems. I need to make sure my DME understands that I know the facts, and I'll switch DMEs if I need to. I'll escalate any issues I have with my nurse to the doctor. And if I get grief from my doctor, I'll switch doctors and let my referring doctor know how unhappy I was with his choice.

It's very fortunate that we have the net and resources like this board. And the ability to buy our own equipment. Armed with that, we can overcome all these other obstacles.

I know it boggles my mind that my son in law who has been on xPAP for several years knows diddley-squat about his pressure, etc. And he has no interest in knowing. Whatever doctor/DME says is what goes. He doesn't question. And he isn't doing all that well w/his xPAP therapy, better than he had been but ... no dramatic improvement in how he feels.

Say what??? Darned if I'm gonna go to the trouble of learning to live/sleep w/xPAP if I don't see some improvement! I had a hard time being patient as we've tweaked my settings, equipment, etc., especially those first 30 days, but from then on I got PUSHY. We improve things or else I start looking elsewhere for answers. And I did say "we", not doctor or DME or whoever, I mean "we". Don't try to shut me out of the information, reasons, reasoning, etc. or I'm gone!!!

Hey hick boy, how's it going in hickland?

Anonymous wrote:Hey hick boy, how's it going in hickland?

Which one you talkin' to???
(I have a feeling there are lots of small town/rural folks on the forum)

If you were talking to ME......

GREAT!!!

Could use some moisture though.

Have a good one.

Den

After reading some of the horror stories about DME's; I guess I was lucky. My DME informed me of all my options then, with my approval worked the best scenario for ME. I have nothing but great things to say about my DME. They even gave me a loaner for a couple of days(No cost to me or my insurance co.) because there was a delay in insurance approval.

I generally don't respond to this kind of crap, but I have been reading some of the comments in this particular thread with great amusement. I also live in good ol' Wyoming, having had my fill of big citys. Damn right I'm from hickland and proud of it - Go Pokes - Oops we lost, plus now we need a new basketball coach.

I am new to this. I was diagnoised last month AHI= 59.5 RAI = 60.6
I thank you all for the information you provide here as it gave me the information i needed to request my doctor prescribe an APAP instead of a CPAP. The recommended DME SleepMed (who not so coincidentally is also the provider of the Sleep Study) had on the sleep study itself recomended a cheap machine and one of the cheapest masks on the market. My doctor knows so little about this stuff he didnt even know what an APAP was (thanks to all of you i was able to educate him about this) or i think that there were a variety of masks available. ANyhow originally he was just going to write the prescription for what the DME suggested until i told him what i had learned on here. However, Sleep Med is apparently not concerned with what is best or even good for the patient and i hope if you are reffered to them you find someone else to do business with because they refused to provide what the doctor prescribed under the rates covered by my insurance company. Anyhow - sincere thanks to all of you who post here as it is information i have been unable to find elsewhere - big virtual hugs to all of you for helping the rest of us.

My Story and a Couple Questions:
Using the information found on here, I received the APAP prescription and certiicate of medical necessity from my doctor and had it sent to bill my insurance.com with my sleep study. Bill my Insurance.com was by far the best deal with using my insurance (Blue Cross). However they said the sleep study was only a 110 mins and not the 120 mins required by the insurance company so they could not provide the machine. Blue Cross company sent a letter saying 110 mins. was ok with them, but ALL DME providers i could locate within 65 miles refused to provide the machine without the 120 min. study because they say when they submit to Blue Cross, despite the letter saying 110 was ok they simply would not pay and have a history of this. Bill my insurance.com said the process was such a hassle they wont even do business with me now because of the screw up. I have been delayed a month now due to SleepMeds screw up which was simply their technicians error in hooking me up 10 mins to early to the cpap machine during my split night sleep study.

Anyhow, after billmyinsurance.com says they dont want to mess with this situation I go back to SleepMed who did the test and was also the suggested DME. They FINALLY agree to redo the sleep study - it is scheduled for tomorrow night. But they insist because i talked my doctor into prescribing an APAP instead of a CPAP that i must pay the $150-$250 differance in the cost of the machine because it was patient choice. They also say my sleep study does not justify prescribing an APAP. (Does anyone know if there is such a justification and if so, what it is?) This despite the fact that the letter of medical neccisity says it is mandatory. They say the nurse told them i requested it so it is patient choice and dont care what the letter of medical neccesity says or what the doctor prescribed.

I called Blue Cross they say they will pay 80 percent of what ever is prescribed but SLEEP MED insists on charging me the differance between machine costs estimated to be $150-$250. Being disabled and on a fixed income i cannot afford this. I explained to Sleep Med that the doctors letter of medical necessity says it is mandatory. They refuse to comply unless i pay the differance in cost. I am TOTALLY friggin exhausted from fighting with these people over the last month - which i know many of you can relate to but i swear i dont know if ihave what it takes to keep fighting these fools. I have a chronic pain syndrome after 2 back surgeries which forced a medical retirement and I take heavy doses of pain meds and muscle relaxors just to be able to move around. This combined with the sleep apnea had me thinking i was crazy -i had become suicidal thinking i was just broken and not fixable untill i had the sleep study and found out what was going on and that there was hope for a better life. Now that i know what the problem is i cant get the companies to follow thru - it is so friggin frustrating.

I see many people on this forum have experienced similar problems. Is there anything we can do about this? Is there a lawyer among us ??- is this not a form of extorsion or fraud? Can we file a class action suit against the DMEs for what they are doing. If our Doctor prescribes it and the insurance company approves it and they are the insurance company's preffered providers we must use dont they have an obligation to furnish the patient what is prescribed? Dont the doctors requests or the studies that show higher compliance rates with APAP hold any weight? Can our legislators do anything about this? Does ANYONE have any ideas on how we can fight back as a group that is not having our medically necessary needs met?

Lastly - can any of you recommend a GOOD DME in Northern California? I live in a very rural area near Yosemite National Park, but could drive say 100 or so miles (Sacramento or the Bay Area) for a decent DME that will respect my best interests and doctors wishes. THANK YOU for being here!