How badly did my DME lie to me?

Regarding the CPAP vs APAP dilemma, here's a post by an RT on the same subject:

KansasRT wrote:I would agree with giving patients an apap to begin with, but not always having it be set as an apap. I am not convinced that everyone needs apap settings. But I do agree that having that technology available would be benefical. I do not agree with a DME company billing an insurance company for a cpap and providing an apap and making the patient pay the difference. The billing code is the same for both machines, but you still have to provide the insurance a description of the equipment. Not giving the appropriate description to an insurance company is not a practice I would feel comfortable doing. Also, if you are a contracting provider with an insurance company it is a touchy issue in billing a patient for something that technically should be covered by insurance. How I handle this situation is we would provide a patient with an apap and bill the insurance for an apap. Most generally they will not cover it, but will reimburse for a cpap. I would be responsible for writing off the difference, not billing the patient. Until I was on this site, I had never heard of billing a patient the extra for an apap. $200 seems like alot to me for the difference anyway. I guess I have different view of things.

From this thread:
viewtopic.php?p=135852#135852

What I wonder is if we'll eventually see the manufacturers phase out the dumber machines in favor of the smarter machines. If the ultimate goal is compliance, it seems to me providing an APAP with exhalation relief right off the bat makes a lot of sense. I think it is very unfortunate a patient has to battle for an APAP and is forced to suffer through proving intolerance to CPAP before he/she can get one. My guess is that's the point where we lose half the people prescribed this therapy.

neversleeps wrote:What I wonder is if we'll eventually see the manufacturers phase out the dumber machines in favor of the smarter machines. If the ultimate goal is compliance, it seems to me providing an APAP with exhalation relief right off the bat makes a lot of sense. I think it is very unfortunate a patient has to battle for an APAP and is forced to suffer through proving intolerance to CPAP before he/she can get one. My guess is that's the point where we lose half the people prescribed this therapy.

I stated similar suggestions and thoughts (starting with my second post in this thread) when I was led to believe that I was speaking with someone from one of the manufacturers.

viewtopic.php?t=12063

Den

Just a question....how do you know you aren't mouth breathing? I had been doing it for a long time and didn't know it until I read about it on this forum and tried taping my mouth. What a difference.

And BTW, I have someone to sleep with and they didn't know I was mouth breathing. They only complained about getting air blown on them during the night.

You might try taping for a couple of nights and see if that doesn't help you.

Den, The post you referred to was excellent and bears repeating:

Wulfman wrote:

Wulf, just what exactly would you like to tell Respironics? Thank you.

Thank you for asking.

Actually, I already told them one of the things over a year ago. Come out with an "Encore Pro Light" version of the software that the end-users can use (and understand) to monitor their own therapy with. Either include it and the reader with the machines or else make it available at a more attractive price (everywhere....not just CPAP.COM). After all, it is OUR therapy.

Don't make machines that don't record sleep statistics. That way, the user will get more value and will be able to monitor their own therapy. I would also think it would cut the manufacturing costs by not having so many versions in the same basic case design. This would also limit what the (evil) DMEs can pass off to the users at high prices.

Don't be so oblivious to the ultimate end users....US. I DO think Respironics (for one) may be better at this than at least one of the others I can think of (that also starts with "R"). Again, it is OUR therapy.....WE are the ones who ultimately buy the products......WE pay the insurance premiums, the deductibles and co-pays.

WillSucceed wrote:
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.

justtrish wrote:
I think part of the question here is not just whether she should get the machine, but whether the insurance company should pay for it after only 6 mos on her current machine based on the criteria she used which is:

My comment has nothing to do with who pays for what. I'm encouraging Lyza to get whatever machine gives her the best treatment. OSA is a curse no matter which way you slice it and if one machine will give better treatment over another, then do whatever you have to do to get the better machine. Further, Trish, I have heard way more personal accounts from people on this and other forums regarding the minimal information and options that they were given by their equipment suppliers RATHER than accounts of having been given lots of info and options.

In my case, when I asked about APAP to help deal with the problems I was having at a pressure of 15, I was told by the equipment supplier that the only place APAP was used was in places where there were no sleep labs to do sleep studies. I had to petition very heavily for myself with the insurance company to get them to pay for an APAP after they had already paid for a vanilla CPAP. Had I been educated better in the first place, I would have pushed harder for the APAP in the beginning and the insurance company would have NOT paid for two machines, but for one that was only a bit more expensive than the vanilla CPAP.

Further, if the supplier and insurance company really cared, they would both insure that patient is fully informed and getting the best equipment for their needs rather than (seemingly) always defaulting to the lowest price piece of equipment that is available.

I realize that the suppliers and insurance companies are in business to make money, but not at the cost of people's health.

So, I don't promote deception, but I also don't promote that ANY patient settle for less than the best just because the insurance company wants to save a few bucks.

JeffH wrote:Just a question....how do you know you aren't mouth breathing? I had been doing it for a long time and didn't know it until I read about it on this forum and tried taping my mouth. What a difference.

And BTW, I have someone to sleep with and they didn't know I was mouth breathing. They only complained about getting air blown on them during the night.

You might try taping for a couple of nights and see if that doesn't help you.

I think i've trained myself in the 6 months.. that piece of crap chinstrap was worthless, so I started taping after the second night.. after about 3 weeks i stopped taping. I'm guessing I would know if i was still mouth breathing because previously before all this started and the night with chin strap or inproper tapings, im a heavy heavy drooler lol... so my thinking is no drool, no mouth breathing..hehe... And I only sleep on my side, Never on my back, so the drool would show up

UPDATE--- for anyone interested...

Had the followup appt today with the DME to get new mask and hose. Got that taken care of, so I asked him if he carried the S8 Elite that has the Efficacy Data (DME seems to only push the ResMed S8 compacts).. he just laughs and said I told you before I don't have those machines. So I ask you don't have a single machine in this office that measures anything at all? He said nope. I said and if I came in here with a script for such a machine? He said first of all, no dr will write such a script because its too expensive and secondly if you did convince some dr. to do so you'd have to wait several weeks until the machine came in because I'd have to order you one. I'm like what kind of hokey place is this? You have nothing in here that monitors anything? He goes nope you have to go upstairs to the sleep lab for that. I ask if they loan out machines up there, he said nope but they'll do a study on ya... friggin smart ass lol..

oh .. one more thing i wanted to add... I believe my therapy is working because i'm dreaming more and more, so I must be getting into deeper sleep than before cpap therapy... However, I'm not feeling 'better' or more energized then before hence my dr. has put me on provigil for that. I know it takes time, and I don't expect miracles overnight or even in 6 months.

The fact is I work in a laboratory, where everyday i see the simplest of machines go haywire and here I've got this machine that basically keeps me breathing and alive everynight yet I can't QC it , I can't calibrate it, etc.. although I made the DME calibrate it today and it was right on point.... So its a bit unnerving to me that I can't 'see' a result or data of whats going on... the anal labrat scientific nerd in me that wants a printout report to analyze instead of just putting the mask on and pushing start.

Thats where all of this is coming from... I feel no different than before this diagnosis, when I didn't even know I had this problem... only difference is I'm dreaming.. LOL

I don't know how long you have had this machine, but it seems 6 months looking at your date of joing this board and you saying you got a new mask etc. I also don't know how long your rental period is if any. If you really want a machine with data I see two choices. Get script for one and make them give it to you, or buy cash online. Depending on what you are paying this DME cash may not be all that bad. Maybe what the RT told you is standard for their office (about not giving a machine that collects data) but it is a very sad excuse. Too bad you didn't demand that up front when you started or shopped DMEs for one who would give you the machine you want.

Good luck.

I don't know how long you have had this machine, but it seems 6 months looking at your date of joing this board and you saying you got a new mask etc. I also don't know how long your rental period is if any. If you really want a machine with data I see two choices. Get script for one and make them give it to you, or buy cash online. Depending on what you are paying this DME cash may not be all that bad. Maybe what the RT told you is standard for their office (about not giving a machine that collects data) but it is a very sad excuse. Too bad you didn't demand that up front when you started or shopped DMEs for one who would give you the machine you want.

Good luck.

Initially I knew nothing about any of this or I would have gotten the script for a machine that gave data but I didn't find this forum until after the fact...

And insurance is a funny thing... I don't know that much about insurance, I know mine is a crappy HMO insurance.. I got a bill for the origina dme visitr like 120$ which I paid, then I got a second bill for like 20$ (machine is a rental which i pay for so many months then insurance pays the rest, I forget how many months it is).. well I misplaced the second bill, so I'm like ahh I'll just wait for the 3rd bill to show up and pay that one with the over due payment from the 2nd bill... I've yet to see anymore bills arrive since the initial bill. Never saw a bill for the sleep study either..

Anyways, My new mask I got today was the Swift, cuz i wanted to try a nasal pillow mask and that was the only one they carry and after searching and reading about re-routing the hose properly over my head, I just had a test run... DANG that sucker shoots some air out that exhaust!!! My cat thought it was bed time, curled up next time.. felt that air hit her, looked at me like WTF?? what is this crap hitting me in the face? where's this air coming from?? That exhaust is more powerful than a fan man! So much air shooting around, hard to tell if its leaking or just the exhaust ! hehe...

Hi Lyza,

Very interesting post, I was in the same boat as you a couple months ago. I am tech oriented and once I found I could monitor my own sleep with the proper equipment and improve my sleep I decided I had to get the Auto to satisfy this need. Like you I went in to my first appt with the DME not knowing a thing about OSA treatment. I accepted what was presented. No information or education was given to me about the choices available. I showed up for my appt and the DME said here is your machine. I had more control over buying a set of tires than I did over choosing the equipment that will make me breathe at night. Thanks goodness I found this forum and was able to educate myself. I had a struggle getting the machine I wanted and chronicled my experience here:

viewtopic.php?t=15015&highlight=

To update: I have been on the APAP now for 300 hours. Have set my own range for treatment per the data readouts and sleep very soundly for 6+ hours every night with no mask problems. I tried the APAP in CPAP mode and found I did have some nights that produced mask leak problems that caused me to wake up and make adjustments. I went back to the APAP mode and seem to be doing just fine. I had an appt with my primary care doctor a couple weeks ago and gave him a printout of my usage and told him of the struggle to get the APAP, he said he was contacted by the DME but did not tell me of the content of the contact. He did say he was very happy that I was taking ownership of my treatment and he supports me in doing so.

So Lyza go for the machine you want, it is your life, your treatment.

DB

PS Your DME stating that it would take weeks to get an APAP is a bunch of bull**** . If they do any volume at all they should be able to place an order with thier supplier and have it within a week. These machines are massed produced and the supplier will have them available for immediate delivery. That (IMHO) was a lie.

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, DME, auto, APAP

Lyza,

You say you are waiting for the 3rd bill? Then if you want data, get that script and tell them to get it. That is not all that long into the rental period. But if it is rent to own, that period could be as early as 3 months and you will own what you have. Move quickly if you want different stuff.

It shouldn't take more that a few days for a DME company to get any equipment. If your insurance is like many HMO's you are probably renting for 10 months and at the end of 10 months the machine is yours. It should be easily interchangable up until the purchase. The DME telling you it will take weeks is their way of saying-- look at the hassle, it is not worth it.-- Most people would give up and go away. Stick to it and they should come around. I wish I could work with people out of state, I would gladly get you what you wanted and reasonably priced.

Also, what would be the problem for him to order your new machine and let you use the current one in the meantime?