False Start

BTW2 did they say you shouldn't drive?

I'm 41, and no, they didn't say I can't drive.

There's a bias here toward in-home sleep studies. But IMHO, they are accurate enough to diagnose OSA and home titration is in many ways more effective because it's determining the optimal pressure for you in your actual sleeping conditions, instead of the artifice of a sleep lab. Medicare covers home tests and home titrations because there is sufficient validation. And the major complaints about in home scoring is that they tend to UNDER-score and miss some treatable cases of apnea. With 70 AHI, you have very severe apnea that really needs treatment, and it might be even worse if that is underscored. Plus, the sooner you get to treatment the better. And some people, (ME!) would never get tested and treated if the only option is an in-lab test.

What I'm hearing is that the doctor and/or sleep lab used the home study as a screening test, and then they will use an in lab titration to be certain that your sleep apnea is being adequately treated by the machine prescribed. This makes perfect sense to me. Sounds like they know what they are doing.

In addition, the prescription was a DOCTOR'S ORDER. The DME is like a pharmacist--you have a prescription, he fills the order. If he had concerns about the order based on his professional training and experience, he should have confirmed it with the DOCTOR (or the PA your doctor supervises) who wrote the prescription, not dissuaded you from getting a machine until your in-lab sleep test without a discussion with your doctor. Perhaps they suspect that you have a more complex apnea that won't be adequately treated by an APAP--and in that case, they will have that data already to show the insurer when they do the in-lab test that you need a BIPAP or other more sophisticated machine. Or maybe, seeing how severe your apnea is on your home test, your doctor doesn't want you to wait to start treatment.

Whether the DME ever heard of doing it this way or not, the proper thing to have done is get your doctor on the phone to confirm that this is the plan.

And, perhaps the DME had an ulterior motive. If they issue you a brand new machine for rental and it turns out you really need a BIPAP, for example, now they have a used machine when they take the one you were issued back.

Mad Scientist wrote: ↑

Mon Mar 20, 2023 3:19 pm

I'm 41...

Some researchers found the odds ratios decreasing as one ages, but the data is inconsistent, and Lavie noted it started at 50, so NM.

Get the O2 saturation numbers and the APAP fired up.

BTW3 what kind of machine are you getting? ResMed's the way to go, and D/L Oscar and get familiar with it.

Janknitz wrote: ↑

Mon Mar 20, 2023 4:35 pm

...What I'm hearing is that the doctor and/or sleep lab used the home study as a screening test, and then they will use an in lab titration to be certain that your sleep apnea is being adequately treated by the machine prescribed. This makes perfect sense to me. Sounds like they know what they are doing.

In addition, the prescription was a DOCTOR'S ORDER. The DME is like a pharmacist--you have a prescription, he fills the order. If he had concerns about the order based on his professional training and experience, he should have confirmed it with the DOCTOR (or the PA your doctor supervises) who wrote the prescription, not dissuaded you from getting a machine until your in-lab sleep test without a discussion with your doctor. Perhaps they suspect that you have a more complex apnea that won't be adequately treated by an APAP--and in that case, they will have that data already to show the insurer when they do the in-lab test that you need a BIPAP or other more sophisticated machine. Or maybe, seeing how severe your apnea is on your home test, your doctor doesn't want you to wait to start treatment.

Whether the DME ever heard of doing it this way or not, the proper thing to have done is get your doctor on the phone to confirm that this is the plan.

And, perhaps the DME had an ulterior motive. If they issue you a brand new machine for rental and it turns out you really need a BIPAP, for example, now they have a used machine when they take the one you were issued back.

I mean, that's what I thought about getting the machine and then doing in-lab titration.

And the plan IS to get confirmation from the doc first - but my appointment at the DME was at the end of the day on Friday, and when he called the sleep lab the staff was already gone for the day, and they're not open on weekends.

The DME put the decision in my hands, but I decided to wait because of the cost. I understand it a doctor's order, and the DME just fills it like a pharmacist. But just like you can't return medication or trade it for something different, he very clearly explained that any money paid towards this initial machine does NOT carry over to a machine if the doc says I need something different. I can't afford to spend $300+ on a machine that MAY or MAY NOT be what I need after doing the in-lab study. That's the bottom line for me, and what the DME was confused about. I fully trust he has me best interest in mind, like I said, he left the ultimate decision up to me. But he was looking out for my financial situation. My insurance isn't covering this 100%, so it's not like I have the luxury of swapping out machines at no cost.

Mad Scientist wrote: ↑

Mon Mar 20, 2023 5:53 pm

I fully trust he has me best interest in mind,

Get that thought out of your head. DME's are in business to make money, period.
btw who is this DME? and who is your insurance?

I would call your insurance directly and ask them for a list of other DME's you can use should the need arise.

Also explain to your insurance what the DME told you about should your script change. Many are contracted and will have to change out the cpap with no additional charges to you.

Also you simply have to ask at the docs office for a copy of the sleep study.

I mean, I get that. But at the same time if this guy was just out to pocket some easy cash I feel like he wouldn't have said anything and just given me the machine. Then if I had to come back to swap it out and pay again, he could just say tough luck.

I guess bottom line is I need to wait until they are able to get a hold of my doc to clear things up. I was just looking to see if this is some kind of crazy situation, which it seems like it isn't. What bothers me is that lack of concern about how I'm supposed to afford this. Maybe the sleep clinic just doesn't care, maybe the DME guy fed me a line about being out the money if I have to swap. Hopefully I'll find out soon.

Thanks for the input thus far, everyone.

I don’t think of your DME as a bad actor. But I do really think you need to find out about the breakdown of your AHI. Please do, and please let us know.

Mad Scientist wrote: ↑

Mon Mar 20, 2023 6:33 pm

Then if I had to come back to swap it out and pay again, he could just say tough luck.

Mad Scientist wrote: ↑

Mon Mar 20, 2023 6:33 pm

I was just looking to see if this is some kind of crazy situation

Mad Scientist wrote: ↑

Mon Mar 20, 2023 6:33 pm

maybe the DME guy fed me a line about being out the money if I have to swap.

Unfortunately you won't know the answer to any of that unless and until you call your insurance. Never believe what the DME tells you how your insurance works bc each policy is different even with the same Co.

The in-lab titration not only can find things the at-home can't but it can also save time and get you closer to your needed pressure. You will still fine tune it at home in your natural environment but you will get there faster with the results of an in lab study which gives you more details.

Bottom line is insurance has many quirks and you need to learn the boundaries you have with yours.

For me, I had to wait over a month for my cpap to come in the mail. The wait was for insurance to approve it for the DME to issue it. Mine was an in lab study with AHI slightly less than yours but still in the severe range.

I was issued a cpap set at 17cm no exhale relief etc. It took me over a month before I could sleep thru the nite with the mask on. Try exhaling against 17cm. Some months later I was re-issued an APAP and was told they didn't want the cpap back and that was many years before covid was heard of.

It took prob close to 1yr in before I searched the net for info on cpaps and found this wonderful place to ask questions and learn.

Then some later date I was issued a bipap after yet another in lab study and was told I could keep the apap.
After reading and learning here I managed to get my hands on a bipap and brought a printout to my doc at a visit. The doc ordered this sleep study. afaik they were all in lab back then.

I'm pretty sure the DME didn't loose out on any of the exchanges but it was part of an agreement they had where they prob got less than the outrageous price they norm charge customers. So they're not loosing money but make more with the first issue and far less hand holding labor hours involved.

Thanks for clarifying the situation.

Mad Scientist wrote: ↑

Mon Mar 20, 2023 6:33 pm

I mean, I get that. But at the same time if this guy was just out to pocket some easy cash I feel like he wouldn't have said anything and just given me the machine. Then if I had to come back to swap it out and pay again, he could just say tough luck.

He has your credit card number for monthly charges - of what? "Supplies"? Most of us need and use far far less supplies than DME's charge for. But, your number is alread registered with him, and apparently he can already charge your credit card -- without even having supplied you a machine - i.e. without even registering the payment toward any machine. Am I understanding the situation correctly?

I guess bottom line is I need to wait until they are able to get a hold of my doc to clear things up.

Nope.

It is you who should contact your doctor's office not the DME. You need to get the results from them (in writing), you need to see your diagnosis and prescription. And it is you who should contact your insurance and have the exact info from them in writing.

I was just looking to see if this is some kind of crazy situation, which it seems like it isn't.

Not crazy from the medical aspect.
It's the DME situation that sounds a little crazy, not the sleep lab situation... As rubicon said: the sleep clinic (doctor) is aware of the severity of your situation - both the number of events per hour, per hour and your oxygen desaturations - and want to be sure they try to stop that ASAP.

What bothers me is that lack of concern about how I'm supposed to afford this. Maybe the sleep clinic just doesn't care, maybe the DME guy fed me a line about being out the money if I have to swap. Hopefully I'll find out soon.

It is you who should contact your insurance to find out how they work, and to get a copy of your policy insurance policy.

ozij wrote: ↑

Mon Mar 20, 2023 10:04 pm

He has your credit card number for monthly charges - of what? "Supplies"? Most of us need and use far far less supplies than DME's charge for. But, your number is alread registered with him, and apparently he can already charge your credit card -- without even having supplied you a machine - i.e. without even registering the payment toward any machine. Am I understanding the situation correctly?

No, that is not entirely correct. Yes, the DME company has my card on file, but no, I have not authorized any payments nor has he charged me any. I got a call from their home office, and they are the ones who said I would need a card on file before setting up my appointment at the location near me

Nothing seemed unreasonable at the time because I figured this whole process would play out as I was told it would - Get my machine, try it out, do my lab test, and have things adjusted. I thought the DME was trying to look out for me financially, but now it seems like it's just causing confusion.

This whole situation is making me feel like I'm being taken advantage of. I didn't think I'd be having to second-guess everything I've been told. I've got all these hoops to jump through, and for what? To still be at the mercy of the sleep lab, the DME, and my insurance?? I don't really see any other options. I can't just give up on the whole thing, how else am I supposed to get treatment??

Looks like I've got some calls to make, hopefully I can make sense of all this sooner than later.

Mad Scientist wrote: ↑

Mon Mar 20, 2023 10:49 pm

ozij wrote: ↑

Mon Mar 20, 2023 10:04 pm

He has your credit card number for monthly charges - of what? "Supplies"? Most of us need and use far far less supplies than DME's charge for. But, your number is alread registered with him, and apparently he can already charge your credit card -- without even having supplied you a machine - i.e. without even registering the payment toward any machine. Am I understanding the situation correctly?

No, that is not entirely correct. Yes, the DME company has my card on file, but no, I have not authorized any payments nor has he charged me any. I got a call from their home office, and they are the ones who said I would need a card on file before setting up my appointment at the location near me

Glad I was not entirely correct and that you haven't authorized charges.

This whole situation is making me feel like I'm being taken advantage of. I didn't think I'd be having to second-guess everything I've been told. I've got all these hoops to jump through, and for what? To still be at the mercy of the sleep lab, the DME, and my insurance?? I don't really see any other options. I can't just give up on the whole thing, how else am I supposed to get treatment??

Looks like I've got some calls to make, hopefully I can make sense of all this sooner than later.

Hang in there - many on this forum have had similar experiences and ended up with excellent therapy, and reasonable payments, thanks to information from more experienced forum members. Make your calls, share your info, and treat this as a small bump on the way.

Right on. I do appreciate the advice.