A Conflict of Interest???

WillSucceed wrote:Slinky:
Slinky, for what it is worth, I spend my day working in the critical care unit of Canada's largest children's hospital, helping parents advocate for themselves when they are dealing with the daunting task of learning all that they can about their child's illness. These parents almost always feel overwhelmed by knowing essentially nothing about a complex health-care facility and really need to learn skills that help them cope and get all of their needs met.

Dude, you've got my respect!

Another option if the sleep doc won't prescribe what you want is to have your records forwarded to your regular doc and have him/her write what you want.

Gotchya, Rabid. By the way, what kind of dog is that in your picture??

And SnoreGirl is right, you can always resort to asking your family doctor write the xPAP script for what you want.

Rabid1 wrote:

A Conflict of Interest???

Can be, my insurance at the time (AETNA) didn't hesitate to tell me that very thing when my Sleep doc, lab and DME were all owned by my sleep doc and his corporation.

At $3200 a pop for a typical PSG, a sleep doctor can make a killing on PSG's, all they need is an old Apartment building or warehouse, put up some dividing walls for bedrooms, decorate it in early poverty, install some cameras and monitors, hire some students from local college to hook you up with wires and they are good to go. Then they deal directly with cpap mfg's, might as well peddle cpap equipment while you are at it.

I remember when I went back for one of my PSG follow-ups and told my sleep doc I had purchased a cflex machine on my own, all he was interested in was how much I paid for the machine, when I told him he said that is way cheaper than what he could buy it for, then I told him maybe he should buy it from cpap.com like I did.

What I realized later was that so called split-night sleep study I had will nearly always fail and a second follow-up titration study will be required. Your report may include patient didn't tolerate cpap well. When I had my first split-night study, no one really told me what to expect, they wouldn't let me sleep on my side, in fact they woke me up to tell me to roll over on my back. Then several hours later they woke be up to put on this mask. Then all I had to do was mention the mask was uncomfortable as hell and I couldn't sleep with it and the test was all but over. No one told me beforehand that if I didn't fall asleep with the mask on that I'd have to come back for another test. So I can see where Insurance was coming from, had I known that at the time I would have tried a bit harder to fall asleep with that mask.

There were many things my Sleep lab could have done to prevent the 2nd half of the study from failing (like tell me what to expect), they didn't lift a finger to prevent that, and the reason they didn't was obvious when I looked up who owned the Sleep lab (my sleep doc). He did however give me copies of my PSG's and the original prescription, his office gal was reluctant to give me the information and I told her I wasn't leaving without it, he then walked out of his office and told her to give him what he wants.

If there is NOT a conflict of interest in your situation, your sleep doc should have no problem providing you with a complete copy of your PSG report along with a written prescription for cpap therapy and allow you to go obtain the therapy of your choice.

However, I can understand him not wanting to write the script without having a titration study. I think everyone should have one of those. If the diagnostic report looks comprehensive I would continue on with the titration study if insurance is paying for it. It is important to know how you respond under cpap therapy pressure, without the titration you are in the blind (don't really care what Kaiser does, wouldn't have that insurance carrier anyway, they have more malpractice claims against them than anyone).

Getting the therapy for OSA is the same as if they diagnosed you with asthma and gave you a prescription for medication, you should be able to take that script to any pharmacy of your choice to have it filled.

And if you can obtain that therapy cheaper on your own, then Insurance should be backing the patient with easy reimbursement methods instead of forcing us to use these ripoff DME's with the negotiated contract where the price is more than double.

However, if he is reluctant or doesn't provide the PSG report or the script after the titration, then I would file a complaint with your state license board, that would get his attention.

Rabid, I didn't suggest you go to a different clinic. I suggested getting titrated, getting your results, get your prescription, and then:

1. Check with billmyinsurance.com to see if they will deal with your insurance.

2. Or, deal with your doctor/DME.

3. Or, you can find another DME or buy online yourself.

You seem to take offense to some suggestions if they differ slightly from what you want to hear. ... We are on your side, Man. Just relax a little, it will all work out for the best in the end. Hang in there.

A physician can make a suggestion on which DME to use, but they must also provide you with a list of all providers in the area. Around here, all the Dr's offices and sleep labs have lists that they hand out. They cannot legally steer a patient one way or another. (Not to say it isn't done, just that it is not appropriate) You are leagally entitled to a copy of your sleep study and an order for a CPAP. If you do call around to other DME companies, let them know that your DR/Sleep Lab/Dr's DME is not giving patients a choice. I guarentee that they will deal with the issue. Most of the companies that have operations like that are not allowed to provide CPAP to medicare patients because medicare has wised up to the system. ( Suprising that they can figure that one out and not many other things. )
It is your right to choose. So many health care providers view their customers as patients not consumers with choices.

[quote="Linda3032"]Rabid, I didn't suggest you go to a different clinic. I suggested getting titrated, getting your results, get your prescription, and then:

1. Check with billmyinsurance.com to see if they will deal with your insurance.

2. Or, deal with your doctor/DME.

3. Or, you can find another DME or buy online yourself.

You seem to take offense to some suggestions if they differ slightly from what you want to hear. ... We are on your side, Man. Just relax a little, it will all work out for the best in the end. Hang in there.

No problem. I know things get blown out of proportion when one is sleep deprived.

BTW, I'm an ex-Oregonian. Born in Seaside, grew up in St. Helens, Portland, Florence, and Salem. Still have a nephew who lives in Bend. Beautiful state. But these old bones like the warmer South now.

So where are you getting your sleep study done? Salem or Portland? Surely you will have a local DME in Bend from whom you can get your equipment.

Good Luck.

snoregirl wrote:Another option if the sleep doc won't prescribe what you want is to have your records forwarded to your regular doc and have him/her write what you want.

This is where it gets a little tricky for me. My doctor's 8 year old son is being treated for OSA by none other than my sleep doc. DANG!!!

[quote="Linda3032"]No problem. I know things get blown out of proportion when one is sleep deprived.

BTW, I'm an ex-Oregonian. Born in Seaside, grew up in St. Helens, Portland, Florence, and Salem. Still have a nephew who lives in Bend. Beautiful state. But these old bones like the warmer South now.

So where are you getting your sleep study done? Salem or Portland? Surely you will have a local DME in Bend from whom you can get your equipment.

Good Luck.

Snoredog,

Our situations sound very similar. My first night was supposed to be a split session, but, low and behold, they said they didn't have enough data to proceed with the titration study. I guess an AHI of 53.5 isn't enough data?

That statement about furnishing the rooms in early poverty was CLASSIC, and, in this case, true! They even furnished it with a VCR! Who has any VHS tapes they'd like to loan me?

Thanks for your response.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, AHI

[quote="Rabid1"]
.............................. During my conversation with the receptionist I learned the sleep center is also a DME!!! Now it all makes sense to ol' Rick why this doc is so adamant about prescribing a cheapo machine for me. More profit for him!............................................

Rooster Wrote:

BTW, I would caution against heavy note taking during any discussion with your doctor or anyone you are dealing with. When people think everything they are saying is being written down they tend to clam up. Keep a pen and paper handy and when something comes up that you really need to remember like a phone number, a name, the model number of a device, etc., then tell the doctor you want to write it down.

Me-thinks that this is where some diplomacy comes in... ALL of us, healthcare practitioners included, LOVE a rapt audience. I take advantage of this quirk of nature by always starting a conversation with a service provider by stating that I want to make sure that I fully understand their instructions and follow those instructions exactly. I tell the service provider that I am taking notes because I want to get their directives/instructions/advice right.

If you have a service-provider who, as Rooster puts it "clams up," do you REALLY want this person providing you service? What are they hiding? Do they really know their stuff? Are they giving you all of the information and answering your questions accurately? Are they willing to be held accountable for the service they provide or would they prefer to be able to say, after the fact, "no, you (the patient) got it wrong... you did not follow my instructions.."?

I would never want to give a service provider any indication that I'm not paying full attention to them AND I would never tolerate a service provider not paying full attention to me. Having written questions ready BEFORE you go into the conversation, asking those questions and recording the answers is the easiest, clearest and, most respectful way of being an ACTIVE part in your therapy and, of demonstrating that you expect competence from the service provider.

Note-taking need not be confrontational if you are clear about why you are doing it and keep a civil tongue in your mouth and, in your attitude. Service provider clams up because he/she is nervous about a patient taking notes? I'd get a new service provider.

Just as an aside, do any of you think that your service-provider or Dr. does NOT keep notes of the conversation that you have with them? You can bet that they do keep notes, written from their perspective... "patient asked no questions..." "patient seemed to fully understand the equipment and how to use it..." "Patient seemed satisfied with the care given..."

I suspect that American service-providers are the same as here in Canada. All Canadian service providers have to be registered with the appropriate College which regulates their practice. For example, I am registered with Ontario's College of Social Work. I MUST follow the College guidelines regarding patient care which includes note-taking AND ensuring that I have fully-informed my patients of what I am doing with them during any interaction.

I would bet that American service providers have the same expectations made of them but, some of the dodgy service providers (if it is possible that there are any dodgy ones) rely on patients not asking questions, not taking notes and not holding the service provider accountable. "Caution against heavy note-taking?" I don't think so.

Rabid1 wrote:I'm actually getting my study done at the sleep clinic in Bend.

If you DO want to head over the mountains, I had a VERY positive experience with my sleep clinic here in Portland (just not my DME). You can crash on our futon in the basement too.

blarg wrote:

Rabid1 wrote:I'm actually getting my study done at the sleep clinic in Bend.

If you DO want to head over the mountains, I had a VERY positive experience with my sleep clinic here in Portland (just not my DME). You can crash on our futon in the basement too.