How badly did my DME lie to me?

6 mos is WAY too soon to be changing machines

Oops.... I guess my speed reading needs some improvement. For some reason, I though we were talking 6 years.

GoofyUT wrote: So here's the trick: When you go see your doc, tell him/her that yhou change positions frequently in your sleep (if you do), that you anticipate dramatic weight change in the near future (if you are), and that you occasionally drink alcoholic beverages in the evening (if you do) and that you want a machine that will adjust to those changes.

preemiern wrote:Another idea is to tell your primary doc that you are swallowing alot of air during the night, and that it is very painful, and that you have learned that auto titrating machines help eliminate the swallowing of air by giving you only the pressure you need based on sleep position, etc.

Surely y'all aren't advocating lying to your doctor in order to defraud the insurance company into paying for additional medical equipment!

1) your sleep studies show how much you move around while asleep.
2) no doctor is going to believe you are going to dramatically change weight until it happens. The don't prescribe based on a patient's psychic premonition.
3) your daily intake of alcohol is part of your medical history. How do you explain to your doctor that you went from not drinking or doing so socially to drinking often? Not to mention that this will affect ALL your current prescriptions.
4) you tell your doctor you're swallowing air at night all that might happen is a script for a full face mask.

WOW! I can't believe what I read! This is some really bad advice!

My two cents

Trish

Sleep studies show how much you move around on one given night with all kinds of wires attached to your head and body, a wire at your nose, in a strange place, not in your own bed, not with the person who normally sleeps next to you etc. Plainly stated it only shows a brief snapshot of oftentimes a bad night's sleep and was not representative of "normal" sleep for me.

How is an APAP "additional equipment" if it is designed as a straight CPAP as well as an APAP?

TM

Hey Lyza,

Tell your DME that you know of one Okie that lives out in the sticks that is enjoying his APAP machine just fine....and only $604 to boot.

JeffH

I just woke up and read this thread that I posted to last evening. As Borat would say: "WaWaWooie!!!!!"

Matt: I substantially agree with all you, and I agree with you that APAPs are NOT for everyone. I agree that, other than here, MOST FOLKS know nothing about data and could care less. I do believe that most DMEs make the sound business decision to dispense the cheapest but fully adequate equipment that they can in order to maximize profit margin. Only makes sense to me. Mine didn't BTW. I was given an expensive F&P HC608 to start, when I knew NOTHING about this xPAP stuff.

The reason I discussed APAPs is that I have become convinced after reading here that the price differential between a top data capable machine and its corresponding APAP,such as the ResMed S8 Elite and the S8 VAntage, or the Respironincs REMstar Pro2/M Pro and the REMstar Auto/M Auto is too small to NOT justify spending the additional bucks to gain the additional versatilities and capabilities of an auto-titrating machine which contains full data capabilities, can be used entirely as a CPAP, and may serve the purpose of performing effective re-titrations in the future, even if it is NOT used as an APAP initially. That is, of course, if contra-indications are first medically ruled-out. Simply a question of price/performance ratios.

Regarding candor and honesty, Matt has, in my opinion, always been entirely forthright in offering his opinions, for which I deeply value and appreciate bhis comments.

Trish, HOW DARE YOU ACCUSE ME OF SUGGESTING DECEPTION??? I made a point to express in my original note that the author of this thread discuss possible sleep position changes, weight changes and alcohol use IF SHE DOES experience them. And you have the nerve to say that I was suggesting that she deceive her doctor? SHAME ON YOU and don't EVER suggest that I propose dishonesty in any form if you have no evidence to confirm that.

Chuck

Hi Lyza,
All DMEs are not created equal.
Not all DMEs clerks will treat you with the same respect.
All Doctors are not equal.

I've had battle after battle with my DME over pricing, but that's just my DME. I've had battle after battle with my DMEs therapists about leak rates, but that's just my DME. IMHO however I think that generally DMEs (being profit motivated) take advantage of any opportunity to maximize their profits. That being said, DMEs are obligated to supply what is prescribed.

So, If you want a new or different machine you need to get a new prescription. (Some kind DMEs have been known to call a doctors office to get clarification or modifications to the original Rx - so this process looks to the patient as if they just had to ask the DME)

I'd strongly suggest that you align yourself with a sleep specialist. Relying on your primary care physician who acknowledges that he doesn't know about Xpap therapy is just another risk that you don't have to take. Of course you can get help here, but it's not the same as dealing with a doctor who has a ethical and legal responsibility to you.

BTW, in my neck of the woods, Northeast Ohio, the insurance code for CPAP and APAP with minute-by-minute data recording is the same: E0601 and the my BCBS insurance allowance is 70.00 per month. This year I stepped up to auto titrating BiPap with the same recording capabilities. That code and allowance is E0470 and 164.00 per month.

Glad to see you on the forum, keep asking questions (at the forum and of your doctor). Best wishes for New Year

Anonymous wrote: How is an APAP "additional equipment" if it is designed as a straight CPAP as well as an APAP?

Because if your sleep study shows that you obtained maximum improvement at one set pressure, then you clearly do not need an APAP machine. It's a huge waste of money to purchase an APAP and then run it as a CPAP.

Again, please note that as long as you have a valid script for a CPAP, any DME - brick & mortar or online - will gladly sell you their most expensive equipement with all the bells and whistles you can stand.... as long as you're willing to pay for it.

My two cents

Trish

So is going back for several sleep studies due to changes in conditions when an APAP could ADJUST to any changes (and costs a hell of a lot less than a sleep study)

TM

Because if your sleep study shows that you obtained maximum improvement at one set pressure, then you clearly do not need an APAP machine. It's a huge waste of money to purchase an APAP and then run it as a CPAP.

And, to add to the last post, If my Insurance company will not pay for a replacement for 5 years, then I want to get a machine that will give me the most options today.

The machine has too many hours to be swapping straight across with the DME. They already made a lot of profit from selling it the first time and don't want to lose the money. AND, it's too soon to get the insurance provider to pay for a different one.

The reason hardly anybody gets the higher-end models is because they usually don't know they exist at the point that the DME hands them the cheapest models......hence, the high rate of non-compliance. (The cheapest machines in both of the "R" lines don't even have exhale relief).

The time to do research in this therapy (specifically, machines, masks, etc.) is BEFORE you commit to (have your insurance) purchase them.

It doesn't hurt to have a backup machine, so take your prescription (if you don't physically have it.....get it!) and purchase a new machine from CPAP.COM.

And, don't lie to your doctor (or anybody else).

Best wishes,

Den

justtrish wrote:

Anonymous wrote: How is an APAP "additional equipment" if it is designed as a straight CPAP as well as an APAP?

Because if your sleep study shows that you obtained maximum improvement at one set pressure, then you clearly do not need an APAP machine. It's a huge waste of money to purchase an APAP and then run it as a CPAP.

Again, please note that as long as you have a valid script for a CPAP, any DME - brick & mortar or online - will gladly sell you their most expensive equipement with all the bells and whistles you can stand.... as long as you're willing to pay for it.

My two cents

Trish

First of all does your DME carry Respironics machines? Resmed is not making their software or card readers available to the public.

Lyza, you noted in your original post that you are aware of the wisdom of trialing several different APAP's to find the one that gives you best treatment. If possible, make an effort to trial a Puritan-Bennett 420E as well. Contrary to the belief of some, Respironics is NOT the only machine maker.

While I would not encourage misleading to your Dr., I would encourage you to advocate for youself as much as possible. Get the machine that gives you the best treatment with as many options as possible, including access to the data that is collected during the night and, the ability to run as an APAP collecting data AND/OR a CPAP collecting data.

GoofyUT wrote:Trish, HOW DARE YOU ACCUSE ME OF SUGGESTING DECEPTION??? SHAME ON YOU and don't EVER suggest that I propose dishonesty in any form if you have no evidence to confirm that.

Ok, so what did you mean by saying: "HERE IS THE TRICK"? Your words, not mine. It's clear that the way you were using it was to mean "a crafty or underhanded device, maneuver, stratagem, or the like, intended to deceive or cheat; artifice; ruse; wile."

Give me a break!

Trish

Lyza,

It sounds like you have a darn good DME and I hope your "discussion" regarding the actual machine hasn't damaged that relationship.

I'm sure you can now understand the reasoning for the DME's equipment they started you with. And also understand that w/the hours you've put on that machine its really not fair to expect them to just swap it for another new machine.

Its unfortunate that most of us are totally ignorant when we first start PAP therapy. I'm with you, as are most all of us here, in wanting to know and understand as much about our results w/PAP as possible.

Its also true MOST sleep labs, sleep doctors and DMEs are ONLY interested in compliance data for reimbursement purposes. I have never been able to completely trust ANY doctor or medical professional. Even my favorite doctor today is so overwhelmed with the patient load they must carry in order to meet expenses, pay off education loans and make a decent living in line w/the investment in education to practice medicine they really have a diffiult time staying "on top" of all our health information.

"I" want to know for myself. That way, if there is a result that needs to be questioned I can do so. I can point it out to my doctor(s) and ask about it. The good doctors will address the issue and reassure you that its either not important under your given circumstances or work w/you to correct the problem. It sounds like you have a good family doctor. Hopefully now you can upgrade your equipment and still maintain or re-establish a good relationship w/your DME.

GoofyUT wrote: Tell ya what: New Year's eve is upcoming. Go out and SPLURGE!! Go get PLOWED like many folks do on New Year's EVE, then go to sleep with your CPAP set at your 11 cm which was prescribed after a ONE NIGHT, stone-cold sober sleep study, and see what your AHI is on New Year's Day!

If you feel one shouldn't accept the results of a "stone cold sober night", then you can't also accept the results of a "totaly wasted drunk night" also.

Hopefully most people have more stone cold sober nights than they do drunken ones...

So you feel everyone should be handed an APAP because they have a constitutional right to getting drunk every once in a while... tell that to your health insurance company.. watch what your premiums go up to next time they renew your plan...

Did the party start early this year?

My two cents

Trish