Kbh209's CPAP questions and updates

I very much understand being naturally passive, it is an inherited or else a habitual ingrained or trained personality trait and it helps you get along with everyone. But it is sometimes fortunate for me (healthwise) that I was born a more demanding person so I don't have to 'go outside my comfort zone' to push for what I want. I am introverted and shy and I don't enjoy conflict and I lie awake dreading the conversation sometimes, but my stubbornness and impatience, desire to get my way, or anger at them for being inflexible outweighs my shyness and dislike of conflict. Since I'm not great at being diplomatic, I ask my very polite diplomatic husband for the nicest and least annoying words to use when asking for something (I'm lucky to have him on hand). Do you have a more assertive spouse who could advocate for you with your doctor?

I'm a strong advocate for my elderly dad and go to all his doctor appointments (e.g. I recently insisted on a 'minimally invasive back surgery technique' for my dad when they wanted to do open back surgery, and it is a lot easier when you are being an advocate for a loved one rather than yourself. I was the one that insisted on getting a sleep study for myself when initially my doc resisted because I was female and skinny with a thin neck (I didn't at all fit the STOP-BANG triage criteria).

Another example of me not being passive is that today I read this article about Alzheimer's https://journals.sagepub.com/doi/full/1 ... 0520925930, and now I'm advocating for my father-in-law to try this because he is quickly fading and unable to do things like dial a phone. But other family members say passive things like 'Well if it is a good idea his doctor would have told us'. They think of doctors as always the best experts and up-to-date on all the new treatments, and I don't. Sigh.

But you will probably be stuck with whatever CPAP machine you get for FIVE YEARS. That is a very long time if in a couple months you end up wishing you got an auto machine. Maybe keep that in mind when writing the portal comments, it could help with the motivation.

lrob123 wrote: ↑

Thu Jul 02, 2020 4:39 am

But you will probably be stuck with whatever CPAP machine you get for FIVE YEARS. That is a very long time if in a couple months you end up wishing you got an auto machine. Maybe keep that in mind when writing the portal comments, it could help with the motivation.

All well and good but besides the idiot doctor...we have state medicaid involved here. People don't get a choice when medicaid is involved and you get the bare bones necessity and lucky to get a full data machine in most cases.
People who qualify for state medicaid don't normally have the funds available to go just go buy what they want. Cold hard fact of life.

It's okay...as long as he can get the Pro model and not the other no data at all model....we can live with it.
The Pro has some limited auto capabilities if we need it and I know how to make more if needed but I doubt we will need it.
We can make do with the Pro model. It's still a 1000% better than what he has now.

It's funny how when I first started out with Adventist Health Lodi Memorial, I was blessed with a ResMed Auto through LinCare at the time...so Medicare + Medicaid does cover the more expensive machine here in California. If it hadn't lost its will to stop pumping air (and the spare not falling on the floor), I'd still have my Cadillac machine. Oh well, for now the brick is doing the job in keeping me alive at night, that's all that is important until I message the doctor the day before November.

@Irob123: I don't have an aggressive spouse, nor any spouse for that matter. My confidence is a bit more higher behind a computer screen than on camera or in person. So I'll use that to my advantage (emailing the doc).

kbh209 wrote: ↑

Sun Jul 05, 2020 4:38 pm

It's funny how when I first started out with Adventist Health Lodi Memorial, I was blessed with a ResMed Auto through LinCare at the time...so Medicare + Medicaid does cover the more expensive machine here in California.

It's the billing code that they pay by...anyone...Medicare, Medicaid, private insurance...they all use the same billing code.
For the machine model you use the billing code is E0601
This billing code is used for the most basic brick no data machines as well as the fixed cpap full data machines and the auto adjusting apap model machines.
The amount of money a supplier gets paid by anyone is based on the reimbursement rate for that E0601 code. Doesn't matter brand or model or data or not. They get X amount of dollars for that billed out code.

Some suppliers just dispense a full data machine as a matter of course but when they can get by with it and the order from the doctor is filled with a plain brick cpap machine...that's what they dispense because they make more money dispensing a cheaper model machine.
Remember they are getting X amount of dollars no matter what they dispense. Some DMEs just care more about their profit margin than they do their patients.

Medicare pays the same for a full data apap machine as they do for the base model no brick machine. Medicaid when combined with Medicare simply picks up whatever Medicare doesn't pay. If you were on Medicaid and didn't have Medicare then Medicaid might be in a position to dictate machine model but it normally only does that when Medicaid is the sole payer.

DMEs could supply the apap model machine and just set it to cpap mode if they would just do it.
Here's the deal...and these are just examples of prices and reimbursements because I have no way to what they pay for a machine or how much Medicare will pay for an E0601 billed out machine (it varies a lot depending on where someone lives).
But lets use these numbers for example.

E0601 machine gets reimbursed at say $800 total by the time the humidifier and accessories are added in.

The basic plain model no data machine costs the DME maybe $300.....the fixed pressure cpap with data costs maybe 400 and the apap costs maybe 500. The DME is going to get 800 and that's it....they supply the cheapest machine they can so they make more money and then they blame your insurance for their greed with the "this is all your insurance will pay for" big fat lie.

All numbers are just numbers a guess but the premise is the same....EVERYONE pays by the E0601 number to start with.
Brand, model and data capable or not is never part of the billing procedure or reimbursement procedure.
The only time it might be...when state Medicaid is the only person paying for anything....some states to dictate and low ball.

okay now to my current machine, which specs are in the signature: Why is my auto off function not working? There's been (embarrassingly ) a few nights where I'm getting ready for bed and seen that the machine had been running all day. Can this damage the humidifier?

Is auto off actually set to on?
It's weird but auto off has to be set to "on" for it to turn itself off when you aren't attached and it takes about a minute for it to turn itself off.

You don't have a cat that likes to walk across your machine and turn it on do you?

And no...it won't hurt things for it to run all day.

Pugsy wrote: ↑

Thu Jul 30, 2020 7:39 am

Is auto off actually set to on?
It's weird but auto off has to be set to "on" for it to turn itself off when you aren't attached and it takes about a minute for it to turn itself off.

You don't have a cat that likes to walk across your machine and turn it on do you?

And no...it won't hurt things for it to run all day.

auto off set to on, but never works. I have to manually shut it off. No naughty kitties in my apartment. Also I keep the bedroom door closed so the dog has no access.

What's the general consensus on snoring with CPAP machine running? A friend of mine and I recently had to go to Los Angeles on a business trip and while at the hotel he said that he could hear me snoring from the hallway before opening the door. Should I be raising my pressure? Should I stay at my pressure? Time for another sleep study? Just curious.


[Note: I'll be happy once I upgrade from my brick in November then I can start posting Oscar data to the forum]

Maybe? It could be leakage causing insufficient treatment, and raising pressure won't help.
How do you feel? Sleepy? Awake?

khauser, both ...just depends on the day.

As of yesterday, my sleep specialist had me raise my CPAP machine from 9.0 to 10.0. It'll take a few days to see if there's a difference or not.

I think I'm noticing a change in my sleep? I'm unsure. I wish Medicare and Medicaid weren't so picky about the exact date that the new machine can be submitted for authorization. I'd love to read some Oscar data to figure out where I'm at in this craziness.

Well, I found out that on Monday, November 30th, I'll be able to pick up my new CPAP machine. The DME provider will be calling me Monday morning to tell me when to come in that day to pick it up.

I’m glad it will be arriving soon. Do you know yet for sure what model?

Miss Emerita wrote: ↑

Tue Nov 24, 2020 8:27 pm

I’m glad it will be arriving soon. Do you know yet for sure what model?

It sounds like based off the data my sleep specialist wants, the "Pro" version of the Dream Station. He had named the Dream Station specifically.

Still mystified why he isn’t prescribing a machine that can vary its pressure during the night. But at least this will take an SD card, which is good. Keep us posted.