CPAPtalk.com

My doctor was happy to order an APAP. He first ordered a study to support it (the DME provides a wide open APAP for several nights and reads the data). It probably surprises no one here that the study shows that a set pressure would be more than I needed most of the time and occassionally less than I needed. This is true for everyone, of course, but once you get it documented it makes justification much easier. I also have occasional sinus trouble and tend to yoyo in about a 15 pound range over the course of the year. These are not things that make me very unique at all. Fixed pressure CPAP is an outdated technology, IMO.

I think with a few simple justifications like mine, you could make a case that you were prescribed the wrong thing. I would take the angle that the APAP isn't a new "same" machine, but a new and different machine prescribed by another doctor. Then it should be paid for.

Well, Janelle was the only one who saw my true question, which was if anyone knew of a good sleep doc in Austin. And she responded. To which I am extremely grateful.

The whole issue of where I can get a prescription and whether or not I can get my old one was not the problem. I want a doctor who is going to help me treat and manage my OSA. I don't need a lot of "well, just do this" or "just do that". As some of our more prolific and experienced posters have said very few of us (if any) are actual doctors. I want to make sure that my health is in no way compromised. There are other health issues I need to deal with (RLS and high blood pressure).

I know we've talked about going off-topic at times, but if I had been a first time poster and read some of the responses I got, I'd have thought that none of you were going through any of the same things I was. Thank goodness people posting when I was first diagnosed were a bit gentler with their responses.

Jeanne

Is that Austin Texas or Austin Minnesota ?
For a good doc in San Marcos just a short drive from Austin , TX there is Rod Elliott-Mullens, 1305 Wonder world Drive, San Marcos, Tx (512) 754 -0375
He is very nice and does spend time with you. Spent an hour with me. Ask lots of questions.

He does prescribe Auto titrating cpaps .

Cheers,

Chris

Austin, Texas, silly Chris. And San Marcos is not exactly a short drive from Austin. Depends what part you live in!

Nenetx2004 wrote: only one who saw my true question, which was if anyone knew of a good sleep doc in Austin.
Jeanne

Well, actually that was the second question you asked. The first was why a doctor would refuse to prescribe APAP. Both questions were preceded by a paragraph and a half of explanation of frustration and they were followed by the statement that you were now willing to pay out of pocket because of your frustrations. Some people adressed your frustrations, some tried to answer the first question and finally a couple answered the second question. I tried to point out that you might want to think about trying to get your insurer to pay if you get a different prescription. I think everyone was just trying to help.

Reinforcing the previous comment, in seeking a second opinion see a Pulmonary medicine specialist, who is often also a sleep medicine specialist. ENT has a role in sleep apnea but only after the sleep doctors/pulmonary doctors recommend the ENT doctor as last resort.
Good luck. If your insurance doesn't cover it see the pulmonologist anyway as it will probably only cost a few hundred dollars and may save you a world of grief.

Janelle and Chris,

I live in Manor (east down 290) and work in Round Rock. So I think Janelle's doc is the one I'm going to go with. Thanks!

Jeanne

Let's see, I have:

Crohn's disease
Diabetes
Eosiniphilia (rampant immune system response to most stimuli)
and now diagnosed with OSA.

I am currently on 13 different prescription meds, worn glasses since age 6, bifocals since age 12. And, I *hope* to live past age 50 (I'm 44 now and not so sure). Let's beat the dead horse on Texas laws on prescriptions and prescription transfer so the rest of the world doesn't think Texas is too stupid -- Wait, we did produce "dubya", and we do try to execute people (and minors) for parking violations; maybe we are stupid...

Anyway, once a single-fill prescription is in the hands of a provider (optician, DME, pharmacy), it is illegal for that prescription to be transferred anywhere else, period. "Refillable" prescriptions can be transferred from one provider to another, but YOU cannot act as the middle man; the two providers (pharmacies usually) must exchange the information including the last fill date so that you can't roam around and load up on drugs. Controlled substance prescription transfers (narcotics, addictive agents, etc) have more restrictions on transfer.

Now, if the single-fill prescription is for something like glasses or a CPAP machine, you *can* purchase multiple pairs of glasses, multiple CPAP machines, wheelchairs, etc. However, you must purchase them all from the same DME that has the prescription. If you want to go to another DME to have it filled, you must obtain a new prescription from a doctor. No exceptions.

Now, obviously, if you just fax the prescription to the DME and keep the original, you *can* take same to another DME -- but you are technically breaking the law. Now, since you are not giving out copies of songs you ripped from a CD, there is no Recording Industry Association of America (RIAA) out there to come sue you for doing this, and to date, the only prescriptions that the Texas government follows up on are for controlled substances, you should never have an issue. However, the original poster had already given the original to the DME and, in Texas, has no hope for them to give even a copy back. It's back to the doctor for a new one. That said, if the interval between now and when the prescription was originally written is short enough (e.g. 6 months for glasses, no idea on CPAP's), the doctor should be willing and able to issue a new one without additional charges for a visit or medical review.

I've dealt with so many different doctors and insurance carriers the past few years, I'm on a first-name basis with the VP of benefits in my company --and-- the customer serviice VP at my current insurance company. BTW, if you work for a large company, the reimbursement rules are set by your employer rather than the insurance company. Oftentimes, the corporation is self-insured; they just pay Aetna, Cigna, Blue Cross, etc. to administrate for them based on rules they set. Makes arguing even more complex because you can't use anyone else's experience to help.

My OSA is "mild", and I have not decided to jump straight into a CPAP or first see if I am a candidate for a dental device like the TAP; but I sure do find the posts and sense of humor in this forum both useful and refreshing. Don't know if you want me as a permanent member, I get overwhelmed with my own situation quite often and can suck all the avaliable light out of a room on entry.

-lifesucks (a.k.a. Bullwinkle) - Yes, my meds DO include anti-depressents, what makes you ask?

Lifesucks,
Yes, it does, for all of us at times. If this board keeps it a little less sucky from time to time, I hope you check in often.
Debbie

Okay, now wait a minute. you take a prescription from your optometrist/opthamologist to say, Walmart, to get a pair of glasses. They make a copy, fill the prescription and give you back the original prescription. You can use this again if you need another pair of glasses and are out of town. How is this different from a script for a CPAP? Why can't you use the original prescription when they give it to you freely from the DME to order whatever you want in the future?

I think the point is that in TX, this is not legal. It may be DONE, but reuse of the prescription is apparently illegal there, whether you can do it or not.

At least, that's my take on it.

Considering some of the other laws on the books throughout this country of ours, this is actually one of the SANER stupid laws, in so far as I can kind of see what they might have been trying to accomplish with the law.

Liam, not a Texan.

Liam,

I wouldn't be so quick to state that as a fact (or even as "your take on it"). I have heard so much miss-information given out by the medical community regarding what requires a prescription and what doesn't. I think it stems from over-simplification. The Doc can right you a prescription for dog poop if he what's to. That doesn't mean you need one to get the poop. The DMEs often tell people they need prescription for an item only because they know that without proper documentation the insurance company won't pay. They have taken to misrepresent the requirement for the doc to give you a letter of medical necessity. It is easier to just say prescription.Finally, a durable medical equipment prescription is different than a pharmiceutal prescription. I would even hazzard a guess that, like with glasses, the prescription is just for how the lenses are to be ground. In the case of the cpap, the prescription may only be for the pressure the machine is to be set to. As long as the machine delivers the prescribed pressure, it satisfies the requirement of the prescription.

Wader, actually medical equipment and prescription drugs share the same reason for requiring a prescription...

It is labeled as such (called Legend Labelling)

The labeling reads "Caution: Federal law restricts this device to sale by or on the order of a (licensed healthcare practitioner)."

This is decided by the FDA. Not the doctor. A doctor can write a prescription for anything, but the only things that require a prescription are determined by the FDA...

For example, according to the FDA, blood pressure sphygmomanometers require a legend, but because they couldn't find how someone could hurt themselves with one they don't do anything about it

Link Here

Mikesus,

Just trying to push a few limits here! It's not exactly as you say. You cnnot fill a prescrition for the same meds twice, you can for cpaps, eyeglasses and granny walkers.

Do you need a prescription to get a new hose? how about cpap filters? a different mask? how about just a replacement cushion for a mask you already have? Software?

I've heard DME's say yes to every one of these items. This is just plain hooey.

I am in New York state, and have had the following experiences:

My insurance company says that I do not need a prescription for anything other than the machine. (They say it is State Law) They will give a one-year blanket authorization to a specific DME for me to use for all of my supplies. After some gentle persuasion, I got them to admit that they will approve one new mask per year.

My DME says that "Yes" they have the authorization from the insurance company, but that only means that they will pay for it. I need a prescription for anything I request, even a hose or filter. If submitted on a prescription, they happily ship me anything reasonable.

My doctor says "!@#$@&! them, I'll give you a prescription for anything you want."

This has been going on for 6 years. Usually my obsessive nature would cause me to investigate this to the most minute detail, but for some strange reason I just surrendered on this one.

And by the way, I am not a doctor or posess any medical expertise.